One thing I have learned in my weekly men's group is how fragile we are. Lawyer, felon, editor-in-chief, our lives go up and down. We are healthy and not, wealthy and not. Yet we share an understanding that we are often wise together when each of us alone is not. We go around the circle sharing our stories, working through our stuff, and invariably, each man's work is also someone else's, or everyone's. We come to unburden ourselves, I suppose. But in the end, we're seeking something unusual, even magical. We go into a space beyond the stories, where the energy gets thick and feels like pure joy. I no longer believe that this joy can be accurately located with a brain scan. It's not just in my head. It also exists where I feel it -- in my heart.
This joy in my heart is not a romantic notion. Established science tells us that my heart is packed with as many neurons as one of the major subcortical regions of my brain. If my heart were transplanted into someone else, some of my memories, the basic stuff of me, would go with it. My heart started beating before my brain developed and still has its own drummer. My heart thinks, flooding my body with powerful hormones, for reasons unknown to my brain. My heart puts out an electromagnetic field detectable across the room. I suspect that in my men's group, when the energy gets thick, part of the joy I feel is a shift into coherence of five or six powerful heart fields. This shared joy, I believe, is profoundly healing.
Of course, not all my joy is in my heart. I can meditate myself into joy -- and if I were more dedicated I could probably, over time, reshape my brain to be more consistently joyful. But I can also eat my way to joy because my gut, too, has large clusters of neurons, a hormone-secreting mind of its own. Certain foods cause my gut brain to flood me with hormones that fill me with joy. Meanwhile, in certain situations, that same brain fills me with gas, imploring me to cut and run -- no matter what my conscious brain thinks it wants.
Making love is another source of joy linked to another large cluster of hormone-secreting neurons, another brain. It is not literally true that when this brain is fully engaged, my blood supply is insufficient to supply my other brains, but at times it might as well have been.
We can expand on this notion of body brains and recognize that each of our three-trillion-odd cells actually has its own brain and field. One path to joy may be a coherence in those fields created by the practice of stillness. For my kids, on the other hand, the greatest joy is eating Popsicles while bouncing on a trampoline to activate all three trillion cells simultaneously. I love that childlike simultaneous activation, so my whole-body happiness is rowing flat-out in the middle of an eight-oar shell. Rowing with my three trillion cells linked with all those others, I mainline pure joy.
Here's What Makes Me Sad
When we Americans become desperately joyless we tend to ignore our body brains, these fields of joy, and look only inside our heads. We have been taught to accept that the root of our unhappiness has been pinpointed: an imbalance of a brain chemical called serotonin in our synapses. We are told that we can correct this imbalance with pills called selective serotonin reuptake inhibitors such as Paxil. Balance our serotonin, and we'll be back on the path to happiness.
But this is nonsense. As veteran science writer Sharon Begley carefully documented in the Wall Street Journal (Nov. 18, 2005), "Not a single peer-reviewed article . . . support[s] claims of serotonin deficiency in any mental disorder," noting, "There is no such thing as a scientifically correct 'balance' of serotonin." As one researcher from a pharmaceutical firm told Begley, "I worked on central nervous system drugs for eight years, and I can confidently state that we know just slightly more than jack about how antidepressants work."
At this point in the story I imagine the flood of emails from readers whose lives have been saved by SSRIs. (One from our own copy editor is on page 8.) The drugs clearly do save lives. Nearly 123 million prescriptions for the drugs were written last year, so they obviously help lots of people. But they can backfire and make depression worse. They also cause "emotional blunting." In a 2002 study from the Journal of Neuropsychopharmacology, 80 percent of patients reported less ability to cry, worry, become angry, or care about others' feelings. The sexual side effects of SSRIs, such as erectile dysfunction, are well known. Less well known is the fact that the drugs can hamper a patient's ability to form or sustain romantic attachments. Neuroscientists suspect that the cause of this emotional blunting is dopamine hijacking, a complex problem they do not yet understand. As a journalist and storyteller, I suspect that the real problem is more basic: the neuroscientists are so focused on the big brain that they inadvertently create problems in the brains of the heart, belly, and testes.
All this points to my real issue with antidepressants and the story of serotonin balance. If you view happiness and depression as a matter of brain chemicals that are in or out of balance, it makes sense to take pills to adjust that balance. And it is reasonable to expect that the perfect pill will solve the problem. But if you step out of your head for a moment, this may begin to seem like a remarkably bad idea.
To put this in perspective, consider what happens when a sedentary, overweight, stressed-out smoker goes to a doctor complaining of chest pains. Even in a seven-minute visit to America's busiest HMO, the doctor would warn our patient to stop smoking, change his diet, start walking, make love more often, meditate, and reduce stress. Whether or not he follows the doctor's advice, he now recognizes that a heart problem is at least a whole-body problem if not a community problem. But if this patient's ailment is depression, the doctor may send him off with nothing more than a prescription for an SSRI to rebalance his serotonin. What more does he need if depression is all in his head?
How Depression Is in the Body
After 20 years of monitoring thousands of people's moods day in and day out, Robert Thayer, Ph.D., professor of psychology at California State University, Long Beach, and author of Calm Energy: How People Regulate Mood with Food and Exercise (Oxford University Press), probably knows as much as anybody about our moods and how to change them. He is the first to admit that our moods are too complex for current science to explain. Like many drugs, SSRIs were developed by accident, he says, and theories for how they work came later. His reading of the data also suggests that SSRIs don't work as well as many people believe. Placebos help about 40 percent of the time and the best SSRIs help about 65 percent. So the net benefit of the SSRIs is about 25 percent. He also points out that compared to exercise and cognitive therapy, SSRIs tend to be more effective in the short run. But after about 10 months, the benefits of SSRIs fall behind those of either exercise or therapy. (The obvious message is that SSRIs should always be combined with exercise and therapy.)
What make Thayer's own research so important is his simple yet radical way of envisioning what happiness actually feels like. To Thayer, levels of happiness correlate with four states of energy and tension. Calm energy, the feeling of high energy and low tension that we get when we take a walk, produces the highest level of happiness. Indeed, he has found in study after study that walking is the most reliable way to improve mood. The more people walk, the happier they are.
A distant second level of happiness is tense energy, the caffeine rush we feel from an enormous Starbucks when we're working against a deadline. Calm tired is what we feel before a good night's sleep. The worst mood is tense tired -- not the same as depression, but the state that underlies depression.
Thayer says that over the last 20 years, the acceleration of life has sent us on a chronic search for more energy. We binge-eat and drink larger and ever stronger coffees. Meanwhile, we exercise less because we have less time and mistakenly believe that exercise saps our energy. Thayer says that, as a nation, we are forgetting the feeling of calm energy as we become more tense tired, fat, and depressed.
Our moods reflect the energy and tension of the entire body, says Thayer. So let's look again at our patient -- that overweight, sedentary smoker addicted to fast food, who is now being rescued from depression by an SSRI. Despite lifestyle choices that make his body tense tired, that have his heart clogged, his stomach upset, and his penis only functioning with Viagra, our patient may become less depressed, at least for a time. Even if we don't know how they work, we can theorize that these drugs must be powerful to override those angry brains in his body. In The Chemistry of Joy, psychiatrist Henry Emmons, M.D., gives us a sense of how powerful they are:
"Warning: Antidepressants are very powerful medications that affect your brain chemistry, mood, and emotions in profound and long-lasting ways. You must never attempt to stop taking them without the support of your doctor or psychiatrist, and you must never stop taking them suddenly or try to reduce your dosage on your own. Agitation, disorientation, severe depression, and suicidal feelings are only some of the symptoms that might result from an improper cessation of antidepressants."
Ouch! A friend of mine who suffered from mild depression was briefly a proselytizer for antidepressants until he decided the side effects were no longer worth the relief the drugs provided. So he stopped taking them. He then began to have blackouts, and realized that this sudden cessation could have been fatal if he'd been driving a car.
Why We Believe in Serotonin Balance
At the recent annual Natural Supplements Conference at the Scripps Center for Integrative Medicine in La Jolla, California, psychiatrist Scott Shannon, M.D., of the Northern Colorado Center for Holistic Medicine, noted that over the last 20 years, most of the funding for drug studies has shifted from the government to the pharmaceutical industry. In other words, over the same period that the industry began advertising directly to consumers, they have taken over the majority of the research behind the ads. Shannon also pointed out that when a company funds the research, it gets to decide whether the results are sent to journals to be published. In the current Vioxx debacle, where the pain medication has been linked to heart failure, there is evidence that the company did not report some data on heart attacks. This is not a level field.
At the previous Scripps conference in January 2005, David Eisenberg, M.D., director of the Center for Alternative Medicine Research and Education at Beth Israel Deaconess Hospital in Boston, reported that America's harried doctors now get most of their drug information from pharmaceutical sales representatives rather than peer-reviewed journals, which may explain how the serotonin story got so much traction in the first place. The doctors got the story from the sales reps and we got the story from them.
Such stories are powerful. In the sixties, stomach ulcers became a badge of honor for high-powered executives. When the explanation of the ulcer changed from stress to stomach bugs, executives stopped getting so many ulcers. The ulcers of the sixties were real and painful. My point is that the ulcer epidemic can be linked to a story that was wrong. Likewise, our epidemic of depression may turn out to be linked not just to changing lifestyles but to an inaccurate story about the nature of happiness.
Shannon told me that you can think of serotonin balance as "either one of many competing theories or as a marketing strategy." He prefers to treat depression with nutritional supplements, but he bases his therapy on the patient's beliefs. He told the Scripps conference, "If your patients really believe they are going to be cured by an SSRI, go with the SSRI." He also noted that the patients who come to him for SSRIs tend to become dependent on him and the drugs. The patients he treats nutritionally tend to take the treatment, get better, and move on.
Do Herbs Help with Depression?
A large, highly publicized study by the National Institutes of Health published a couple of years ago comparing the herb St.-John's-wort to Zoloft found that neither worked significantly better than a placebo in the treatment of severe depression. Yet somehow the headlines about the study mentioned only that St.-John's-wort had failed.
Now the NIH story has gotten really strange. As Mary Hardy, M.D., of UCLA's Integrative Oncology Program, told the doctors gathered at Scripps, a more recent look at the blood samples from that NIH study found that 17 percent of the placebo group had traces of St.-John's-wort (hyperforin) in the bloodstream. Meanwhile, 17 percent of those who were supposed to be taking St.-John's-wort had no traces of the herb in their blood. In other words, the strong result of the placebo group may have had to do with the fact that many of the patients were taking St.-John's-wort. And the weak result of the St.-John's-wort group may be the result of patients not getting the herb. (Blood tests showed that all of the SSRI group took the drug that they were supposed to take.)
Dr. Hardy went on to say the most recent studies of St.- John's-wort suggest that the herb is as effective for mild and moderate depression as the best available SSRIs, with fewer side effects. My point here is not to suggest any particular supplement, but to point out that there are proven alternatives to SSRIs.
How SSRIs Point the Way
In the Wall Street Journal, Sharon Begley offered an explanation on why SSRIs ease depression:
"A clue to how SSRIs do work comes from how long they take to have an effect. They rarely make a dent in depression before three weeks, and sometimes take eight weeks to kick in, but they affect serotonin levels right away. If depression doesn't lift despite that serotonin lift, the drugs must be doing something else; it's the something else that eases depression. The best evidence so far is that the something else is neurogenesis -- the birth of new neurons . . . As best as scientists can tell, SSRIs first activate the serotonin system, which is necessary for neurogenesis. That is what takes weeks."
Some other ways we know of to generate new neurons is to take up a new sport, learn a new instrument, or join a new group. So SSRIs may be the chemical equivalent of doing something new. That burst of neurons from the SSRI may be exactly what a person needs to get out of bed and actually try something new.
So why do herbs help people beat depression, with fewer side effects than SSRIs? Medicinal herbs contain hundreds of phytochemicals, so the typical answer is that the organic mix has natural buffers that make them safer than a single-agent pharmaceutical. But here is another explanation.
My skeptical friends tell me that medicinal herbs have been identified by healers through what is an extended version of the same scientific method used by pharmaceutical companies. Over thousands of years, these healers have munched their way through the forests of the world, noting what makes them sick and what makes them better, passing the knowledge along. It's just trial and error.
The indigenous healers, however, tell a different story. As herbalist Stephen Buhner detailed in "The Heart as an Organ of Perception" (S&H, April 2006), indigenous healers not only feel the sort of heart connection I feel in my men's group, they use their hearts to see. Using their heart fields as energetic eyes, they find plants with fields that harmonize with the fields of the sick person. This isn't necessarily a conscious process. Nor is it trial and error. Instead, information is exchanged in the convergence of heart and plant fields, and the healing plant often appears to the healer in a dream. Diagnosing with the heart makes it less likely to wind up with a cure for depression that blocks our ability to make love, fall in love, or see with our hearts.
Buhner says we can all learn to see with our hearts: It is what we naturally do. With our hearts, we can know immediately whether a doctor has a healing connection to us, whether we need to take a walk, whether the food we eat will help our moods, and whether we really want to do the things that make us so tense and tired.
And the Real Secret to Happiness is . . .
Norwegians are happier than Americans, and a young Norwegian M.D. told me why: "The disc jockeys speak so much more slowly."
Schizophrenics fare better and suffer fewer relapses in India than in America, and the World Health Organization explains that social connections are more healing than the most advanced pharmaceuticals.Obviously, the key to happiness and health is to slow down and connect. Those of us who refuse to slow down should keep it in our heads that both happiness and high productivity come from what Dr. Thayer calls calm energy. As he has proven with countless subjects, the most reliable source of calm energy is a 10-minute walk. Really feeling down? Add music to your walk. Better still, add a friend to your walk. In other words, slow down and connect...