Lost Connections: Uncovering the Real Causes of Depression - and the Unexpected Solutions

Hari notes that Tipper Gore, the wife of Al Gore, the former vice president of the United States, had told the newspaper USA Today that she had been taking antidepressants for depression caused by a lack of serotonin in the brain. From there, Hari continues examining Kirsch’s research, especially his investigation into the origins of the claims that a lack of serotonin causes depression.

In 1952, a drug for treating tuberculosis had the unintended effect of making “patients gleefully, joyfully euphoric” (34). This and other drugs seemed to have a positive, short-term benefit for people with depression, but only for a short time. By 1965, a British doctor, Alec Coppen, theorized that the effect of the drugs was on serotonin levels in the brain. Professor David Healy, an expert on the history of antidepressants, told Hari in an interview that there “was never any basis” for the idea that low serotonin causes depression (35).

Drug companies marketed the idea because it made antidepressants easy for the general public to understand and for them to sell. Hari’s further interviews with medical professionals confirmed that there is little if any scientific basis for serotonin as the cause of depression. One of Hari’s interviewees, Prof. John Loannidis, says, “it is not surprising that the drug companies could simply override the evidence and get the drugs to market anyway, because in fact it happens all the time” (38).

According to Kirsch, antidepressants do not only seem to be ineffective; they also have serious side effects. These side effects include sexual dysfunction, weight gain, and sweating. Some studies also suggest that antidepressants increase the risk of suicide, violent behavior, diabetes, stroke, miscarriage, autism in children, and birth defects. As when Dr. John Haygarth published his research on the tractors, the reaction to Irving’s work on antidepressants was significantly negative.

Hari interviews Dr. Peter Kramer, who wrote Listening to Prozac, which promoted the use of antidepressants. Kramer argued that the trials Irving examined were not long enough to accurately assess the effectiveness of antidepressants, that Irving did not distinguish between people with moderate and severe depression, and that the volunteers in the studies, because they were being paid and tended to be poor, were telling interviewers what they wanted to hear.

Hari concludes by describing a study done in the late 1990s, the Star-D trial. The researchers found 67% of patients felt better on antidepressants in the first few months, but only one in three people had long-term recovery (45). Further studies have found that “the proportion of people on antidepressants who continue to be depressed is […] between 65 and 80 percent” (45).

Hari says that it’s “possible” that antidepressants “may be a partial solution for a minority of depressed and anxious people” (46). At the same time, Hari believes the evidence overwhelmingly suggests that antidepressants do not truly help the majority of the people suffering from depression and anxiety who take them.

Hari interviews Joanne Cacciatore, a professor of social work at Arizona State University who specializes in the study of grief. Cacciatore herself experienced grief when her infant daughter died. While treating grieving patients, Cacciatore noticed that many of them were being diagnosed with clinical depression and treated with antidepressants. This is because the symptoms of depression, as laid out in the Diagnostic and Statistical Manual (DSM), resemble grief. The authors of the DSM ultimately devised the “grief exception”: People who had experienced the loss of a loved one would not be considered depressed for a year after the loss.

Hari argues that the same may be true for other difficult circumstances, such as going through a divorce or being in a job you hate. Cacciatore agrees, arguing that some psychiatrists see depression this way as well: “Instead of saying our pain is an irrational spasm to be taken away with drugs, they see that we should start to listen to it and figure out what it is telling us” (52). Hari notes that, in the latest edition of the DSM at the time of his writing, the grief exception has been eliminated.

A London woman in the immediate aftermath of World War II drowned herself in the Grand Canal. Her suicide was not widely discussed: “It was taboo to ask why people become desperately distressed in this way” (55). The suicide inspired George Brown, a neighbor who was a child at the time, to research suicide as an adult and anthropologist in 1978. He launched a project with therapist Tirril Harris where he and other researchers studied two groups of women, the first diagnosed with depression and the second not. One of the women they interviewed, Mrs. Trent, had a husband who became unemployed. It was considered taboo for her to take a job herself. Brown and Harris made two categories for the circumstances affecting the women they studied: “difficulties” or a “chronic ongoing problem,” like having to leave one’s neighborhood or being in a bad marriage, and “stabilizers,” or positive factors like close friendships (61).

The results found that 68% of the women who developed depression had a disruptive event in their lives the year before they developed depression. Only 20% of the women who experienced such an event did not develop depression. Women with depression were three times more likely to have long-time “difficulties” in their life (61-62). Brown and Harris’s research found that people living in poverty are more likely to become depressed because they are more likely to have difficulties or experience sudden traumatic events.

Research by another group of social scientists found that the traumas and difficulties that cause depression were similar in places as unrelated as Zimbabwe and rural Spain (64). The results of Brown and Harris’s studies went ignored by the scientific community, which preferred to focus on depression as a chemical process in the brain rather than an environmental process.