• According to the World Health Organization, more than 264 million people suffer from depression. It is the leading cause of disability and, at its worst, can lead to suicide. Unfortunately, depression is often misunderstood or ignored until it is too late.
• Psychologist Daniel Goleman, comedian Pete Holmes, neuroscientist Emeran Mayer, psychiatrist Drew Ramsey, and more outline several of the social, chemical, and neurological factors that may contribute to the complex disorder and explain why there is not a singular solution or universal “cure” that can alleviate the symptoms.
• From gaining insight into how the brain-gut connection works and adopting a more Mediterranean diet, to seeking help from medical or spiritual practitioners, depression is a personal battle that requires a personalized strategy to keep it at bay, as well as more research and understanding.
• Check Drew Ramsey’s book “Eat to Beat Depression and Anxiety: Nourish Your Way to Better Mental Health in Six Weeks” at https://amzn.to/3b1jtuU

JOHANN HARI: When I feel depressed, like loads of people, I say I feel down, right? And as I was learning about the causes of depression and anxiety for my book, "Lost Connections," I started to realize, I don't think that's a metaphor. There is this amazing Professor at Stanford called Robert Sapolsky who in his early '20s went to live with a troop baboons in Kenya. And it was his job to figure out when are baboons most stressed out. So his job was to hit them with little tranquilizer darts and then take a blood test and measure something called cortisol, which is a hormone that baboons and us release when we're stressed. And baboons live in this hierarchy, so the females don't interestingly but the men live in a very strict hierarchy. So if there's 30 men, number one knows he's above number two, number two knows he's above number three, number 12 knows he's above number 13. And that really determines a lot. It determines who you get to have sex with, it determines what you get to eat, it determines whether you get to sit in the shade or you're pushed out into the heat. Yeah, it's a really, really significant where you are in the hierarchy.

And what Professor Sapolsky found is baboons are most stressed in two situations. One is when their status is insecure. So if you're the top guy and someone's circling which comes for you, you will be massively stressed. And the other situation is when you feel you're at the bottom of a hierarchy, you've been kind of humiliated. And what Professor Sapolsky found is when you feel you've been pushed to the bottom, what you do is you show something called submission gesture. Baboon will put its body down physically or put its head down, it will put its bottom in the air and it will cover its head. So it clearly seems to be communicating, "Just leave me alone, you've beaten me. Okay, you've beaten me." And what lots of scientists, people like Professor Paul Gilbert in Britain and Professor Kate Pickett and Professor Richard Wilkinson also in Britain have really developed is this idea that actually what human depression is in part, not entirely, but in part, is a form of a submission gesture. It's a way of saying, I can't cope with this anymore, right? Particularly people who feel they've been pushed to the bottom of hierarchies or who feel remember the other stressful situations when you feel your status is insecure it's a way of just going, "Okay, can I retreat?" "I don't want this fight anymore." "You've beaten me." It's a kind of very strong evolutionary impulse where you feel you're under attack to just submit in the hope that the stress and anxiety will then go away. The sources of the stress and anxiety will then go away.

And one thing that is so important, Kate Pickett and Richard Wilkinson really developed this, is they've shown so as inequality grows, depression and anxiety grow. They've shown, this is very robust effect, right? This helps us to explain it. One in five Americans will take a psychiatric drug, one in four middle-aged women in the United States is taking a chemical antidepressant in any given year. And I began to think, could it really be that just so many people are just mysteriously lacking a specific chemical in their brain? Why does it seem to be rising so much if that's the cause? If you live in Norway, your status is relatively secure, right? No one's that high, no one's that low, movement between where you are is not so extreme. If you live in the United States, especially today which is we're now at the greatest levels of inequality since the 1920s, there's a few people at the very top, there's a kind of precarious middle, and there's a huge and swelling bottom, right? So you can see why in the United States, you've got more people who'd be showing a submission gesture. Who'd be like, "Oh, Jesus, I've been beaten," than there would be in Norway. World Health Organization has been trying to tell us for years, depression is a response to things going wrong deep in our lives and our environments, our pain makes sense. As the World Health Organization put it, mental health is produced socially. It's a social indicator, it requires social as well as individual solutions. It requires social change, right? Now that is a very different way of thinking about depression and anxiety, but it happens to fit with the best scientific evidence. And it really required me to reassess how I'd felt about my own pain and how I tried to deal with it, unsuccessfully, and open up a whole different way of responding to my depression and anxiety that worked for me. And I think as the World Health Organization says, and the UN says, if we talk less about chemical imbalances and more about power imbalances we will get more at the heart of depression and anxiety and we'll find better solutions.

JULIE HOLLAND: So there's quite a few things you can do that aren't prescription medicine. The first thing is to really look at how you're living your life. How much sleep are you getting? What is your diet like? Are you moving your body? Are you getting sunshine? Sort of the basic things that we as social primates should be doing. Which also includes being social, being interactive and not being isolated and withdrawn. My patients who have sort of gotten off their meds and left me for the most part, are people who have adopted regular cardio practice, where they're exercising regularly. I think that's really important.

EMERAN MAYER: There're some very intriguing observations, both clinically but also now more recently scientifically that make it highly plausible, that there's an intuit connection between serotonin in the gut, serotonin in our food, to depression and gut function. So on a clinical level, there's a connection because many patients with depression also complained of constipation, so a distinct dysfunction of the gut. And often the medications that people with depression take particularly serotonin re-uptake inhibitors, such as Prozac and all the other drugs in this category. They often cause transient gastrointestinal dysfunction, so that's on the clinical level. However, what makes it particularly interesting and still an open question really, more than 95% of all our serotonin we have in our organism is really produced and stored in the gut in specialized cells, so-called Enterochromaffin cells. So our major by far the largest store of that molecule that plays such a big role in modulating our mood and our wellbeing—also appetite, pain sensitivity—is stored in the gut. And a lot of very interesting discoveries have been made more recently that makes this even more intriguing, so this serotonin is synthesized in the gut from precursors that come from our food that we ingest and the microbes that live in the gut are actually able through chemicals that they produce to stimulate the production of serotonin.

DREW RAMSEY: When you eat poorly, your risk of depression and illnesses like depression, just go up 70, 80%. And when you eat a more traditional diet, like a Mediterranean diet or Japanese diet, your risk of an illness like depression can go down by as much as 50%. So that's now led to the first clinical trial that is just being reported, showing that a Mediterranean diet augmented with some red meat actually can treat clinical depression, major depressive disorder. And it's a very exciting moment for nutritional psychiatry, it's a time when we have more science that tells us food should really be part of the conversation when it comes to our mental health. The most science is about the Mediterranean diet. Mediterranean diet is a plant-based diet, you're gonna see lots and lots of nuts and seeds whole grains, gonna see seafood. You're gonna see meat and dairy treated differently. I mean, it's interesting that all Mediterranean diets you know, Greek yogurt, for example, right? They have some dairy and fermented dairy products and meat, but they're used more as flavorings. You don't see what we see in a Western diet of, a giant steak and a baked potato. You see a lot more spices in the Mediterranean diet, and fresh herbs.

These are very, very powerful medicines that have always been used to treat human illness. And so one of my favorite interventions is helping people do like even a little herb pot on their fire escape or in their front yard. Cause you can just walk out in the morning grab some chives, grab some basil, chop it up, have it with your scrambled eggs. You've just increased the nutrient density of that meal. And you've made it a little bit more like the Mediterranean diet. So what you're gonna see is in the Mediterranean diets mainly monounsaturated and polyunsaturated fats. You're going to see, again, a lot of crunchy vegetables, a lot of rainbows on those plates, and lots and lots of seafood that again we know have these molecules that are so important for brain health. And that's really one of the main differences, if you look at a Spanish diet, right? All those Tapas with little anchovies and a little bit of squid, and a little bit of octopus.

We are facing an incredible mental health epidemic. I've been in New York as a psychiatrist now for 16 years and the amount of distress and the amount of mortality that we're seeing is just like levels we've never seen before. And we need as many tools in our toolbox and food is very much there, both from just common sense, right? We all know that to feel right we need to eat right. But then also backed up by now an incredible amount of science showing a course that our nutrients actually have very clear data that can help in the prevention and the treatment of illnesses, again, like depression and dementia. So we wanna encourage people to eat those foods that have the most of these nutrients and then help them do that, is really part of a mental health care plan. We think about a lot of illnesses when we eat heart disease, cancer, diabetes, and it's always struck me that really the illness you should be worried about or the organ you should be worried about when you're eating is your brain. Because that is by far your biggest asset. It consumes more of your energy in your food than any other organ you have. And so focusing on the nutrients your brain needs guides you to a slightly different set of foods than if you focus on just things like calories, or saturated fat, or preventing something like cancer. And so it's an exciting moment as the data begins to catch up with common sense.

PETE HOLMES: I wanna be careful here when we're talking about depression because I had a friend who was very depressed. And I remember talking to him, out of love trying to explain some of these ideas, some of these ways that we can think and interpret our suffering. And sometimes when someone is suffering, the last thing they want is for you to go, "Hey, there's another way to look at this." Maybe that's later. None of this is to be imposed on anybody and I don't wanna belittle or just say like, "You know, your brain is, that's really it's your attachment to your desire to not be depressed, that's causing you..." No, none of that. That is not what I'm saying at all. We can give space to someone's depression, we can love them, we can honor them, we can just eat some noodles, we can watch some movies, whatever it is we can just sit and not talk. That's that's real stuff. It's a real, I don't know if you'd call it a disorder or disease, but it's happening and we don't need to coach people through with ideologies, right?

That being said, if you're in a place to talk about this, usually when you're not depressed, I found it helpful to step inside what I call the witness. And other traditions call that your soul. I believe science might just call it, the phenomenon of your base consciousness. If you think about when you were born, I have a baby girl now, she's not thinking in ideas yet. She doesn't know she's American, she doesn't know she lives in California. Just like a ladybug doesn't know it's Italian, know what I mean? It's just awareness. So she's just there. And, but slowly over time, we build up what Young and others called the false self, right? So we have the story of who we are, and I'm a man, and I'm a comedian, and I'm a tall man, and I have big teeth and all these things. And I like the first two Batman movies and I don't drink coffee, or whatever it is. So you build up this identity. And oftentimes in that identity is where things like suffering are occurring, sometimes. I can't speak for everybody, but I will say that for me, when I've been depressed and I get depressed, I have irrational bouts of anxiety, I have random like FedEx deliveries of despondency just like, "I didn't order this." Oh, well, keep the PJ's on, cancel everything you're doing today, it's time to take a sad shower, like that happens to me, right?

So I'm speaking for me with full respect to other people's processes and their experience. When I'm depressed, if I can get into that quiet space, it's the space that's noticing the thoughts. So if you think "I'm hungry," we always just think that I'm hungry is the thought in the animal and then we eat and then it goes, "Thank you." Who's talking to who, really? I would say that the thought is talking to your awareness, your base awareness, your witness. So that's what's watching your thoughts. And if you can get into that, you see how impartial and unswayed by your life circumstance this witness really is. It's just there, it's neutral. It's just is-ness, it's just this, and it's just watching. It's compassionate, it's involved, it's invested, but it's not really as connected and tied to the events of your life story as you are, as your false self is. So, when those depressions happen, I found it helpful—and this is something Ram Dass taught me—is instead of identifying with the depression and saying, "I am depressed," although that is how I might say it to somebody. What I'm thinking is there is depression. I am noticing—it's gonna make me cry—I'm seeing depression. And you can almost, it's not denial, it's real and it's valid, but you're a little bit less in the quicksand and you go, "Wow." This is Ram Dass, he's like "I don't know if people get out of depressions like this one. Look at this one. This is too much." But who is noticing it? And Ram Dass asks, "Is the part of you that's noticing the depression, depressed?" Now I asked my friend that who was depressed and he said, "Yes." So not everybody is there, not everybody can get there. Later he did by the way, we talked about it later. In my experience I've had success in getting into the place that goes, "There is an impartial part of me, that's witnessing whatever the feeling is and I can rest in that." Ram Dass talks about it being like a candle that's inside that isn't swayed or flickered by the wind. It's in a quiet place, and when you go in there, you don't resist the depression, you give it space. You observe it, you don't identify with it, you honor it. Sometimes you medicate it, sometimes you go to therapy. I'm not saying we need to sit in a cave and heal ourselves. But I am saying that there is some relief to be had in not identifying as "I'm this, I'm sad." I do it all the time, there is sadness. I'm anxious. There is anxiety. Look at Pete, he's anxious. And this is every great spiritual mystic through all time, they've all been doing this. St. Francis called his body his corpse. He was like, "I drag my corpse around. My corpse wants to eat." You know what I mean, I don't like it because it kind of puts it down. But I just go like, I say to Valerie all the time I go, "Pete's frustrated." You know what I mean? Not "I'm frustrated, this is real. My parents should, they should listen more. My dad still wants me to be a baseball player." Oh, look at Pete go. Oh, and then you're there and you're just like you're not being flickered by the wind because that's always gonna be there. And with practice, with meditation, with mindfulness and with contemplation and study, literally like reading about it, talking about it like this, when we're in it in real time not necessarily later. At the beginning it goes like this, you're depressed and then later you look back and go, "Oh, I think I was still this watching me." And then with practice when it's happening you can go, I can witness this in real time. I can go, that's happening, it's a phenomenon, it's real, it's to be honored, I understand, but it's not who I really am.

DANIEL GOLEMAN: It turns out that meditation generally makes people feel more positively, it helps diminish anxiety. But it becomes particularly powerful when it's combined with a psychotherapy. The way this is usually done is with mindfulness on the one hand, and what's called cognitive therapy on the other. Mindfulness allows us to shift our relationship to our experience. Instead of getting sucked into our emotions, our thoughts which is what happens when we're depressed or anxious. We see them as those thoughts again or those feelings again, and that disempowers them. There's actually research at UCLA that shows when you can name that feeling, "Oh, I'm feeling depressed again." You have shifted the activity levels neurologically in the part of the brain which is depressed to the part of the brain which notices, which is aware, the prefrontal cortex and that diminishes the depression and enhances your ability to be able to understand it or to see it as just a feeling. So if you combine that ability with cognitive therapy, cognitive therapy helps you talk back to your thoughts. The basic realization in cognitive therapy is "I don't have to believe my thoughts." This is extremely important in people with chronic anxiety or chronic depression, because it's our thoughts that trigger the anxiety, that trigger the depression. You know, the depressive thoughts are classic. I'm no good, my life is worthless, whatever it is. Those thoughts actually make us depressed. So if you use mindfulness based cognitive therapy on the one hand you can see, "Oh, there's that thought again!" On the other hand, cognitive therapy lets you talk back to that thought, "Oh, I'm not so worthless, "I've done some pretty good things in my life." "There are people who love me." Whatever it may be, you can develop a habit of not letting those thoughts take you over but countering them with actual evidence from your life that says, "Oh, they're not true. I don't have to believe them." The impact is palpable and it turns out that mindfulness and other meditations particularly combined with cognitive therapy worked just as well for anxiety or depression as the medications do, but they don't have those side effects.

RUBY WAX: I had a depression, it doesn't define my life. Seven years ago, I had a really bad one. I ended up on a kind of a chair for a few months. Let me just say, people think, I'm just going sideways, that depression is about having a bad hair day or your cat left out. It isn't sad, nothing to do with sadness. It's like your old personality slowly leaves town and you're left with a block of cement, which is you. I mean, it's like being in hibernation, but you can't wake up. And so I ended up on a chair, to take a shower was unimaginable. I didn't tell anybody, I didn't tell my friends. Because you know what comes with this disease is a real sense of shame, because everybody thinks, "We'll look at you, you have everything. You're not in a township, you're not being carpet bombed." So I always say you get these abusive voices. But not one voice—but a hundred thousand voices. Like if the devil had Tourette's, that's what it would sound like. So I was sick, I never told anybody. I got a few phone calls from a few friends saying, "Perk up." Yeah, perk up because I never thought of that. So then I was really interested in how the brain works because I thought well, every other organ in your body can get sick and you get sympathy except your brain, so I thought let's learn about the brain. So I gave up my career, kissed that one bye-bye and decided I would do research as to how this baby works because we know so much about technology but we know nothing about the mind. You know, it's running us, we're not running it. So I decided okay let's do research and find out how I can maybe control my chemicals. You know how I could cool the engine. So I researched it in mindfulness based cognitive therapy had the best results. Otherwise I would have gone in a workshop for how to hug your inner elf. You know, I'm not into the fluffy stuff. So because of the empirical evidence, I studied. So I found the founder, one of the founders, he was a professor at Oxford. So I have the drive of a Rottweiler, so I drove to Oxford. It was at the time I was sick. I think I smashed into some trees on the way. When I got to him, I was crazy. And I said to him, "Just tell me in a nutshell what happens in the brain when you do this mindfulness? 'Because I don't want to waive crystals." He said, "You'd have to get into Oxford and get your masters if you want to know about the brain." So I did. And I graduated in September and I got the bat wings and the Hogwarts hat. And so it made my life so much easier because of this thing called neuroplasticity, which I don't understand why it's not shouted from rooftops. That you can change the wiring in your brain by changing how you think. Basically, we used to think we were at the mercy of our genes, but you know, like how you come into the world is how you go out. Look, the length of your leg and the color of your eyes, those you inherit, there's no question. Because I'll never forgive my parents for giving me the legs of a dachshund. Because I wanted to go down that catwalk, and now I've come to terms it ain't gonna happen. But the genes that develop your brain they keep changing because they're dependent on experience. So it's like they hand you a blueprint and a deck of cards, but how you play them is up to you. So you can look in a brain with a brain scanner and see those neurons wire and unwire and that corresponds to how you think. And every time they wire together you're laying down memory. But the good news is you can unwire them and create new habits and give yourself a more flexible or happier life, whatever that means. I mean, you're the architect of your own brain. It's known as neuroplasticity, which was so hopeful to me. So I always say Gloria Gaynor was wrong when she sang that song, "I Am What I Am", you're not, you have many possibilities.