Without
Meds
Five lifestyle decisions correct your Th
wa e n
chemical imbalance so you recover pr y t w,
e
from depression naturally, even e o be
ou ss
t io end tte
when antidepressants have dr th n, de r
si ug e w -
failed. By a former depressive de co hig ith
s
ef ts h -
who made a full recovery It fe
ct nda
without drugs yo wi
l s
ur l .
li ch
fe an
Mark Myers . ge
Up
without
Meds
5 lifestyle decisions correct your chemical imbalance
so you recover from depression naturally,
even when antidepressants have failed.
Mark My ers
Hug o Pr e ss
Taos, NM
For Fu rt her Help
For additional information on ending depression by mak-
ing lifestyle changes, and to see how you can get live, per-
sonal guidance and support, go to:
5decisions.com
e1.0
To my darling wife Judy, the golden thread
in the fabric of my life. She walked into my
office one day by pure grace, but once fate
made its contribution, I earned her love. That
is, she said she liked the look of my forearms.
Contents
5. Psychotherapy:
Why You Can’t Talk Your Way Out of Depression 65
Men and women need equal sleep but women get less 89
Aches and pains and the royal pain lying next to you 94
8. Renouncing
Nutritional Recklessness 97
Sugar is a loan shark, and the payments can kill you 101
Cholesterol: bad for your heart, worse for your brain 104
You won’t get far carrying two suitcases and a poodle 152
Setting aside the time you need to get well fast 165
Index 185
O N E
Y
our depression isn’t about what you think. It’s about
how you live.
Your low mood isn’t caused by how you feel, but by
the negative conditioning of debilitating habits.
You don’t get depressed because something depressing
happens. Unfortunate things do happen, and when they do,
you get depressed because of choices you made a long time
before misfortune knocked on your door.
Your episodes aren’t a normal response to stress. Stress
is the bale of straw that breaks the camel’s back, but what
makes the camel’s back breakable is the way you live.
Depression isn’t a brain-chemical imbalance. A chemical
imbalance is most assuredly involved in depression, but how
did it come about? Genes have something to do with it. So
does childhood history. But above all, unbalanced chemistry
is your body’s response to an unbalanced life.
Does it surprise you to hear someone say that your de-
pression is caused by something that’s entirely within your
control? It may be a new idea to you, and, indeed, is a new
one to many people. You won’t find a lot of experts or drug
ads saying it, though hundreds of studies confirm it1, and
many doctors, in their heart of hearts, know it...2
Up without Meds
In this book I’m going to ask you to jump several years ahead
of the experts, and make up your own mind about what’s
really causing your depression. It’s important to rely on your
own judgment here, because if you allow the weight of current
expert opinion to make up your mind for you, you’ll come to
the wrong conclusion. And the wrong conclusion will almost
surely keep you depressed, just as it keeps many of the ex-
perts depressed.3
So in the first part of this book I’ll lay out the evidence
that implicates your lifestyle as the deciding factor. If I make
my case, and you become convinced, you’ll have the key to
ending your depression.
Explaining an epidemic
In Chapter 3 I cite statistics showing that depression in the
U.S. has been doubling in every generation since the Second
World War, and I ask why this has been happening. I argue
that the usual suspects blamed for depression—genes, child-
hood trauma, stress, and brain chemistry—don’t provide an
adequate explanation for the epidemic. But these facts do:
days, and shelves stocked with products that harm people but
keep being produced anyway because they generate profits.
Since time is money, a “right-thinking” American maxi-
mizes wealth by avoiding exertion that doesn’t pay, by sleep-
ing parsimoniously, by minimizing time spent preparing and
eating food, and by largely avoiding contact with anyone out-
side the family who isn’t part of the organization where he
earns money.
Wealth. Never before in human history has the average
citizen had the wherewithal to hire others to do most of his
physical work for him, to purchase diversions that keep him
up late, to delegate the production of his meals to food-prep-
aration mercenaries, to isolate himself in a cocoon of elec-
tronic devices, or to buy an unending supply of experience-
enhancing substances from every continent. In this country,
everyone, including teenagers, has the wealth to purchase
health-wrecking chemicals that, until just a few decades ago,
couldn’t even be bought by emperors.
Not all of these developments are bad, by any means.
But they’re new, so new that both human culture and hu-
man physiology haven’t had time to adapt to them. What is
bad, though, are some of the effects of all the newness. These
include escalating rates of obesity, diabetes, heart disease,
cancer, Parkinson’s disease, Alzheimer’s disease, and frail-
ty. Last and certainly not least, they include the astonishing
boom in depression rates since the Second World War. Most
of us would agree that we are the lucky beneficiaries, in so
many ways, of modern progress. But it’s also clear that when
you get depressed, you are its victim as well.
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5decisions.com
If you’re suicidal
If suicide is a possibility for you, you shouldn’t be reading
this book, or any book. Put it down now and call 911 or get in
touch with a physician. The person who answers the emer-
gency call or the doctor can get you into a hospital, where
you’ll be in the hands of professionals who are trained in sui-
cide prevention.
» It costs nothing.
14 Up without Meds
S
even years ago I lost my business, my income, my
house, most of my savings, my health insurance, and
my SUV. This is what led to the end of my depression.
I don’t recommend this particular way of going about it,
but if I tell you the story, I think you’ll begin to see the pos-
sibility of ending your own depression, but without the tur-
moil that preceded my recovery.
I suffered my first episode of major depression when I
was 16, the year I gave up high school sports. Subsequent ep-
isodes came on a fairly regular basis, and in my sophomore
year at Harvard I became so depressed that I had to drop
out. Later, I went back and finished. I got married, started
a family, and began a career in advertising. My life looked
fairly normal, except for one thing: Four times a year on av-
erage, I came down with depression so severe, I had to call
in sick and stay in bed. This pattern lasted for a total of forty-
five years in spite of three courses of psychotherapy and a
fling with Prozac.
By the time I reached middle age, I had abandoned any
hope of ever recovering. After struggling with depression for
so many years and never making any headway against it, I
came to see myself as someone born with an inoperable de-
fect. But I was wrong.
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upwithoutmeds.com
Blindsided by success
Several things are noteworthy, I think, about my story. The
first is that as I made changes to my lifestyle, I wasn’t think-
ing about ending my depression. I didn’t even know this was
possible, until it happened more or less spontaneously. I just
knew, as a matter of general knowledge, that the changes I
was making were considered to be salutary, and, especially
at my age, it made sense to start taking better care of myself
by incorporating better habits into my life.
Everyone knows it’s good to exercise. No one denies you
should get out and about. Every mother tells you to eat your
vegetables. No one recommends alcoholism as a way of life.
We’re talking here about well-worn, perfectly conventional
ideas memorialized in countless bromides. What I didn’t re-
alize until I had adopted them was that regular exercise and
the rest aren’t just filler content for free pamphlets put out
by government agencies. They were—or rather, my disregard
of them was—the very cause of my depression. But I didn’t
know that until I made the changes.
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Notice that antidepressants, psychotherapy, supplements,
affirmations, and other common methods for reengineering
someone’s mood don’t play a part in my story. Since I had
tried each of these unsuccessfully, I never considered them
during this period. However, I’m certain that if I had been
using any of them, my depression would have ended just as
surely, provided I wasn’t relying on them as a substitute for
lifestyle changes. Without these changes, no matter what
else I was doing, I would never have recovered completely,
because it was my lifestyle that was the deciding factor in my
depression.
How My Depression Ended 25
Misinformation Incorporated
One more reason you haven’t read much about the lifestyle
approach is that the evidence for it, though publicly accessi-
ble, is usually drowned out by the billions of dollars in drug-
company advertising that promotes a persistent chemical
imbalance as the root cause of depression.7 Some of this ad-
vertising is directed at consumers, but the target for most of
it is physicians, and the money is well spent. Your doctor’s
most valuable asset is his time, and he’s receptive to any
theory that makes it acceptable for him to dispose of a case
quickly by speed-writing a prescription and moving on to the
next patient. Once he buys into the drug companies’ slant
on things, it’s all downhill from there. The doctor’s quasi-
religious authority means that, just on his say-so, dozens of
his patients become believers. Multiply all those patients by
almost a million doctors in the U.S., and you’ve got one of
the strongest misinformation networks known to history.
No wonder it’s virtually impossible for me to have a conver-
sation about depression without the person across from me
saying, usually within the first two minutes, that they believe
depression is caused by a chemical imbalance.
torial matter and the ads. He doesn’t have the time and may
not even have the analytical skills to look at the raw data re-
ported by the studies and draw sound conclusions. Even if
he’s the rare doc who looks more deeply into things to form
his own ideas, there’s always a drug-company rep, usually
an attractive woman known in the trade as a “pharma babe,”
at the doctor’s door every day offering him and his staff free
lunch if he’ll agree to listen to her pitch.8 More often than
not, he accepts the offer.
The media are also complicit. For their editorial content,
medical journals depend on depression studies sponsored
by the drug companies and on “independent” studies that
are usually led by researchers in the pay of and barely an
arm’s length away from those same drug companies.9
The consumer media push Big Pharma’s message as
well, and not just because drug companies are important
consumer advertisers. A news outlet sells its product by tell-
ing compelling stories, and the people who make editorial
decisions are astute judges of what does and does not grab
people. They know no one is interested in reading the same
dull advice you’d get in a government publication—exercise,
get plenty of rest, eat right, and blah blah blah. But a tech-
nological advance, a magic bullet, a little pill that promises
to eliminate one of the scourges of modern life? Now that’s a
story—even if it doesn’t contain much truth.
Believe it or not
The lifestyle approach doesn’t ask for a great deal of trust
from the people who try it. In contrast to the faith required
when you try antidepressants or psychotherapy, it isn’t nec-
essary to wait six, eight, ten, twelve weeks, or more before
finding out whether it’s working.11 You’ll feel your morale
lifting and your buoyancy increasing with every small step
you take. You’ll know you’re getting better as surely as you
know, when you eat, that you’re getting fuller.
But will you be able to make the changes and stick to
them? Absolutely you will—as long as you go at the right pace
and don’t get ahead of yourself. Take small steps, following
the guidance in Chapter 11.
For additional help, you’ll find options for live, personal
guidance and support at my website, 5decisions.com.
Let your confidence build. Give yourself time to let new
habits form, and to start feeling better as your body beco-
mes happier. As you gain strength with each step, it’ll make
the next step that much easier. One good thing will lead to
another naturally, without your having to force it. Then,
instead of being trapped in the vicious circle of depression,
you’ll have the positive momentum of a virtuous circle, as
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in: “the rich get richer.” Only in your case, it’ll be the healthy
get healthier and the lighthearted become more and more
depression-free.
T H R E E
Th e Th r e e Un d e r l y i n g
Causes of Depr ession:
Nat u r e, Nu rt u r e,
and Furniture
The deciding factor in your
depression is reversible.
I
t took more than one bad break to turn you into a depres-
sion victim. To begin with, you had to get unlucky geneti-
cally. Then, you had to be scarred in particular ways dur-
ing childhood. But even though you were dealt both of these
setbacks, they weren’t, by themselves, enough cause clinical
depression. Something else had to happen to you.
I call it the Furniture Factor.
Before discussing it, let me ask: What do you think de-
presses you?
Some people tell me that what gets them down is “the way
the world is today.” Others say it’s some negative situation
closer to home, like job or family problems. These answers
aren’t entirely off the mark, because depression often strikes
when someone is having a bad day or a bad year.1 But it isn’t
plausible that external circumstances are the deciding factor
in your depression, and here’s why: We all live in the same
world with the same outrages taking place, and we all have
job and family problems, yet most of the individuals who face
these problems never become clinically depressed, as you do
and I did.
You may have a sense that it’s not what’s going on out-
side that’s the main problem. Perhaps you suspect that the
32 Up without Meds
negative thoughts you have about the world when you’re de-
pressed aren’t necessarily an accurate description of reality,
much less the cause of your depression, but more often an
effect of it. If so, you’re getting closer to the truth.
ter what kind of trouble the ship ran into, it would be able
to recover its normal state. The ship was unsinkable, they
thought, because its homeostasis was unassailable. The prin-
cipal homeostatic feature was a series of sixteen water-tight
compartments that were designed to maintain the ship’s
buoyancy come hell or high water (or iceberg).
stasis. It’s what I call the Furniture Factor, and here is the
furniture that’s involved:
What all these studies don’t tell you is that if you combine
all the individual changes that have proven to be effective,
depression doesn’t just recede. It ends altogether.
As I discussed in Chapter 1, the scientific method requires
scientists to focus on only one issue at a time. This means
that each research study can provide only a “one-tree” view
of reality. The investigator who demonstrates that exercise
reduces depression symptoms has little professional interest
in learning that better sleep habits have a comparable effect,
and the scientist who proves that a good night’s sleep im-
proves buoyancy may have only the most casual awareness
that a change in diet also helps. It’s up to you and me, who as
nonscientists aren’t limited to a narrow view, to understand
Nature, Nurture and Furniture 39
that when you replace all the burned-out bulbs, and not just
this one or that one, the dark night of depression is over.
But even scientists have to be impressed by another type
of evidence, provided by groups of people who suffer low
rates of depression.
More exercise
To begin with, they were more active than we are. Most of
them didn’t earn their living in sedentary ways, as we do.
The majority of them, whether they were employed outside
the home or were housewives, did a lot of physical work.24
And when they weren’t working, they were often still moving.
They walked more miles than they drove.25 They played more
sports than they watched.26 They pushed manual lawnmow-
ers, churned ice cream using muscle power, and hauled fur-
nace ashes in buckets. For most people, just getting through
the day provided a workout.
More sleep
This generation had better sleep habits than we do, too. It was
before late-night television, the Internet, and the DVD player
began tempting people away from their beds, and before a
large number of Americans started encountering sleep prob-
lems because of shift work. The members of the War Genera-
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More togetherness
Sixty years ago in the U.S. there was more social connection
at every level of society. People of the War Generation got out
more and were more involved with other people than we are
today. They went to club meetings and church functions more
often, entertained in their homes more often, visited neigh-
bors more often, went out with the girls or the guys more
often, helped out other people more often, and ate with their
families more often.32 If something went wrong in their lives,
they weren’t so much on their own, because a friend or neigh-
bor was usually there to help.
Less addiction
For the War Generation, the rate of alcoholism was about the
same as it is now,33 and people smoked more then,34 but the
plethora of other addictions that snare people today were far
less prevalent, when they existed at all. These include recre-
Nature, Nurture and Furniture 41
N o P i ll C u r e s S t a r v a t i o n
At best, antidepressants
turn black moods into gray ones.
I
magine how outraged everyone would be if the World
Health Organization proposed to give diet pills to starv-
ing people in developing countries, arguing that it would
dull their hunger. Yet no one bats an eye when pills are pre-
scribed for depressives who are starved for things that are
almost as basic to human wellbeing as food.
Since antidepressants don’t address the underlying causes
of depression any more than diet pills address starvation,
they often don’t work, and when they do, it usually isn’t for
the reasons given by the drug companies. Many people who
try antidepressants see no improvement at all,1 and among
those who do improve, the change is often slight.2 And it’s
often temporary.3 Drugs don’t promise, and can’t promise, to
end depression for anyone.
Indisputably, drugs have provided a welcome modicum of
help to many people and have even saved lives by sometimes
easing depression enough to head off severe health problems
that are associated with depression like heart disease, and
even prevent suicide in some cases. Yet there is another side
to the story, told in the personal histories of people you and
I know and in every independent research study ever pub-
lished. It’s the story of the little pill that couldn’t.
But if you are one of the exceptions—if drugs are work-
ing well for you and you’re willing to put up with the side
effects—I suggest that you stick with them, because any help
you can come by is worth having. If you’re on antidepres-
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Side effects
About 70 percent of people who take the most-prescribed
class of antidepressants, SSRIs, lose some sexual desire or
function.33 About a third quit because of this, or because of
nausea, drowsiness, weight gain, ringing in the ears, or other
side effects.34
Eli Lilly, the maker of Prozac, says that, in addition to
sexual dysfunction, the drug causes nausea in 23 percent of
patients, insomnia in 20 percent, drowsiness in 13 percent,
diarrhea in 12 percent, tremors in 10 percent, and rashes or
hives in 7 percent.35 Many patients suffer from two or more
of these.
In 2004 the U.S. Food and Drug Administration issued
an advisory warning that the top-ten-selling antidepres-
sants, including Prozac, Zoloft, and Paxil, can cause “anxi-
ety, agitation, panic attacks, insomnia, irritability, hostility,
impulsivity, akathisia (severe restlessness), hypomania, and
mania.”36
Unpredictability
Finding out whether drugs will work for a given individual,
and which drugs, and how well, and with what side effects,
is purely a matter of trial and error.37 When a drug doesn’t
work, all the patient can do is ask her doctor to try changing
the prescription, wait up to six weeks or more to see if the
new drug helps, and hope the side effects that accompany the
next adventure in pharmacology aren’t worse than those of
the drug that failed her.
No P i l l C u r e s S ta rvat ion 59
Wearout
Among those who keep trying until they find a drug that helps
them, it eventually stops working 20 percent of the time.38
Then it’s back to the doctor’s office.
Slow results
Dr. Andrew Leuchter of UCLA, who in 2005 helped manage
a 35-million-dollar study of long-term antidepressant treat-
ment sponsored by the National Institutes of Health, told the
New England Journal of Medicine, “The side effects are im-
mediate. The therapeutic benefits take a long time.” In fact,
the study showed that, among the patients who got some re-
lief, half of them didn’t notice any change for the first eight to
ten weeks of the study.39
Cost
Taking an antidepressant, plus going to a doctor for monitor-
ing, can cost you, every month, the equivalent of a monthly
payment on a midsize car.40 Insurers prefer to pay for health-
care only from the neck down, and rarely cover more than
half the cost of antidepressant treatment. Paying thousands
of dollars out of your own pocket is especially galling, of
course, when the treatment doesn’t work.
Proven dangers
In one study, 15 percent of the respondents said that antide-
pressants deepened their depression.41 Some studies suggest
that antidepressants may increase the risk of suicide, espe-
cially for younger people.42 The FDA now requires packaging
for the most-prescribed type of antidepressants, SSRIs, to in-
clude a warning that SSRIs double the risk of suicide.43
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that more than 1.5 million Americans are injured every year
by drug errors made by caregivers.49
Unk unks
With drugs of any kind, and especially newer antidepres-
sants for which there isn’t a lot of real-world data, you always
have to worry about the unknown unknowns, the unk unks,
as technical people call them. How many times have we been
shocked by an announcement that a familiar drug long con-
sidered safe is now believed to harm some people? We surely
know by now that any drug, no matter how benign they said
it was when it came on the market, can suddenly make head-
lines as a potential killer.
In fact, there is no study so large, and no reporting jour-
nal so prestigious, that you can ever fully trust the safety as-
surances that you read. In 2005 the drug company Merck re-
ported on a study of its now-infamous arthritis medication,
Vioxx, which has been shown to increase heart attack risk.
The study involved twenty-six hundred patients, and the re-
sults were reviewed by and then reported in the New England
Journal of Medicine.50 According to Merck, the study showed
that Vioxx increased heart problems only after a patient took
it for eighteen months. A drug that waits a year and a half
to start harming people is frightening enough, but the study
did undoubtedly reassure those patients who had discontin-
ued it early. However, a year later, Merck “discovered” that
the eighteen-month safety period doesn’t really exist. The
company’s claim, they said, had been based on a “statistical
error.” Vioxx, the “reinterpretation of data” showed, begins
killing people quite quickly.51
One example that would be funny if it weren’t so scary:
In 1989, Canadian researchers discovered that chemicals
naturally occurring in grapefruit juice, known as furanocou-
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Addiction
The phrase that doctors are now using to describe what hap-
pens to some people when they stop taking antidepressants,
discontinuation syndrome, is a euphemism for addiction
withdrawal. Up to a third of those in treatment experience
unpleasant effects, including nausea, flu-like symptoms,
anxiety and sweating, when they go off antidepressants.55
Labels for SSRIs now note that “intolerable symptoms”
are possible when the drugs are discontinued. In Europe it
is illegal to use the phrase “non-habit forming” in SSRI ad-
vertising.56 The World Health Organization makes no bones
about it. They say SSRIs are addictive.57
Some medical professionals believe that drugs are more
effective when they’re combined with psychotherapy. The
poster child for this approach is a study reported in the May
18, 2000 issue of the New England Journal of Medicine. In
this study, severely depressed patients, averaging 27 on the
Hamilton Depression Scale, improved to the point where
they were only mildly depressed, hitting 10 on the scale after
twelve weeks of cognitive-behavioral therapy combined with
the antidepressant Serzone.58
Reducing a patient’s depression by 17 points is an impres-
sive performance, especially compared with the usual results
No P i l l C u r e s S ta rvat ion 63
reported in drug trials. But the glow fades when you read the
report’s fine print.
To begin with, the research subjects were the cream of the
depressed crop. So many people were kept out of the study,
including those with suicidal tendencies, drug problems,
severe phobias, acute anxiety, and eating disorders, it’s sur-
prising there were any depressives left as research subjects.
And, as usual, dropouts—in this case almost 40 percent of
the people who were there at the beginning—weren’t counted
in the final result.59
P s y c h o t h e r ap y :
W h y Y o u C a n ’ t T al k Y o u r
Wa y O u t o f D e p r e s s i o n
It ’s l i k e f i g ht i n g a f o r e s t f i r e
by attacking the smoke.
A
s a group, psychotherapists are more depressed than
the rest of us.1 Does this tell you something?
Psychotherapy can be helpful in dealing with
many personal problems, but the record shows that talking
to a therapist almost never ends depression.
The most ambitious study ever done on depression treat-
ments, by the National Institute of Mental Health (NIMH) in
1989, found that for most people, two forms of psychothera-
py widely favored for depression, interpersonal therapy and
cognitive behavioral therapy, were no more effective than a
placebo plus a few visits to a primary care doctor.2 As we saw
in the last chapter, primary care docs are not particularly ef-
fective in treating depression, so matching their results is no
recommendation.
One measure of psychotherapy’s ineffectiveness is the
disconcertingly large number of psychotherapists, starting
with Freud,3 who have failed to overcome their own depres-
sion. Richard O’Connor, a psychotherapist who’s among the
most highly respected experts on depression, says most of
the psychotherapists he knows are on antidepressants.4 He
acknowledges that he himself continues to undergo both
drug and talk therapy for depression, in spite of which he still
suffers episodes from time to time.5
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Analyzing Freud
Would Freud have taken this advice? I doubt it. Like a lot of
intellectuals, he believed that the mind is where the fullness
of life happens, and that the four-fifths of a person located
below the neck is, to borrow Sir Ken Robinson’s quip about
university faculty, just there to get the head from one place
to another. This distorted point of view had a lot to do with
keeping Freud depressed, because it prevented him from see-
ing that many of his problems, though they found their way
into his mind, originated in his heedless lifestyle.
One famous intellectual who succeeded in overcoming
his depression to a significant degree was Robert Burton, a
seventeenth-century Oxford scholar and cleric. Burton was
known for his cheerfulness and love of a good time, but he
sometimes fell into deep depressions. A man of exquisite
self-awareness, he understood that his recurrent low moods
were a kind of illness, and he took a great interest in his own
symptoms, their causes, and the possibility of a cure. He pub-
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U s e It ( Yo u r B o d y)
O r L o s e It ( Yo u r M i n d)
As surely as a shark that stops
swimming suffocates, a depressive
who stops moving gets depressed.
D
epression is common among elite athletes who are
sidelined with an injury or have to retire, and we ex-
plain this by saying it’s because they can no longer
do what they love to do, or because fame, glory, and product
endorsement deals are now out of their reach. And we’re not
altogether wrong. These losses often do trigger depression.
But a setback that sinks someone’s mood is never what holds
them under. (Remember, the iceberg made the Titanic go
down, but it doesn’t play any role in keeping the ship on the
bottom.) The things that most likely traps a sidelined athlete
in depression? It isn’t a career disappointment. The problem
is that he’s stopped exercising.
In 2007 a research team at the University of Michigan
studying depression among retired National Football League
players found that the biggest difference between those who
were depressed and those who weren’t was that the depressed
players had given up exercise.1 Kevin Guskiewicz, director of
the Center for the Study of Retired Athletes at the University
of North Carolina, found a similar connection when he sur-
veyed twenty-seven hundred retired football players. He told
the New York Times, “What happens is that the retired ath-
lete can’t exercise because of the injuries he’s sustained and
pain he is in, and that leads to higher weight, depression, bad
eating habits, high blood pressure, and so on.2
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Sit-down work
Just a few decades ago, most jobs, including the job of grow-
ing up, involved heavy or moderate exercise. Now, chances
are, you earn your livelihood without lifting a finger, or per-
haps, like me, by moving just ten fingers and sometimes your
mouth. And if you have a typical American job, you’re at your
desk longer, and sitting in you car longer on the way to that
desk, than people ever have been, or the average worker any-
where else in the world is even now.5
When you get home, you may be on your feet only brief-
ly, before you sit down to dinner, and then afterwards settle
down in front of a flickering screen. If you’re a typical Ameri-
can, you watch, each day, an average of three hours of TV6 and
spend almost an hour and a half online.7 In all, over half of
your waking hours, if you’re typical, are occupied with some
form of media, when you’re sitting or lying down.8
Use It Or Lose It 73
Structure it
Don’t try to be spontaneous about exercise. Put yourself on a
schedule. The easiest way to do this is to join a class or pro-
gram, or become a member of a team.
If you decide to exercise on your own rather than joining
a formal program or team, structure it as if it were a formal
program. Schedule your exercise at the same time and on the
same days each week. Put the schedule in writing. Have a
Plan B ready if you need to miss a session. For example: “If I
have to go to lunch with a client and can’t take my usual walk
at noon, I’ll walk after I get home from work.”
Go public with it
One of the most powerful human motivators—it’s so potent
that army generals count on it to induce soldiers to put their
lives on the line68—is social pressure, or the avoidance of
shame. Smart people use it as a way to motivate themselves
to keep their commitments.
So don’t be private about your exercise program. Tell peo-
ple about it. Put yourself on the hook by giving them details.
Be specific. Don’t tell them, “I plan to going to start running
next week.” That provides too much wiggle room. Instead,
make a real commitment. Say, for example, “I’m going to run
five miles, three times a week for the next six weeks.” That
removes the wiggle room, and puts you on the hook for a long
enough time to embed the habit.
Let your friends know they’re an important part of your
program. For example, tell them: “I’d appreciate it if, now and
then, you’d ask me how I’m doing. That’ll help me stick with
it.”
78 Up without Meds
Start slowly
At the beginning, watch out for exuberance and unrealistic
expectations, especially if it’s been some time since you ex-
ercised vigorously. It’s natural to forget you’re no longer the
sixteen-year-old who could leap tall buildings, at least until
you find yourself limping around the house. But if you over-
do it, you may sideline yourself with an injury, and then you
may not be able to exercise at all for a while. It’s best to treat
yourself like a delicate piece of porcelain until you know what
your limits are. Start out doing less than you think you’re
capable of, and build slowly. To be safe, consult a coach or
physician.
Just a few generations ago, most people who had the predis-
position for depression that you and I share made it through
life without a single episode. One reason was that they walked
everywhere. And now, in the technologically advanced
twenty-first century, it’s still hard to beat walking as an an-
tidepressive. That may be why, when the Harvard Medical
School faculty were surveyed, they said walking was their ex-
ercise of choice.
Here are some of the reasons walking is a great way to
exercise:
Use It Or Lose It 83
E s cap i n g f r o m
Sleep -debtor’s Pr ison
Most A mericans are in the dark about their sleep
problems. This probably includes you.
A
hundred forty years ago England stopped jailing
people who couldn’t pay their debts, but there’s a
prison still open for people who don’t pay the Sand
Man what’s owed him, and it’s filling up fast. This dungeon
can be almost as bad a place to be stuck in as institutions like
Marshalsea Prison, where Charles Dickens’ father John was
confined for his debts. It’s the prison of depression.
Though some people sleep more when they’re depressed,
four out of five lose sleep during an episode.1 But most people
who are depressed were sleep deprived before the depression
hit. It was the sleep deficit that helped bring on their depres-
sion.2
Of course, it isn’t just depression-prone people who aren’t
getting enough sleep. The National Sleep Foundation says
that a majority of Americans are now having problems at
night.3
For those like you and me whose genes and childhood
make us susceptible, undersleeping is a sure road to depres-
sion.4 For those who aren’t depression-prone, sleep problems
lead to a host of other physical and psychological maladies—
none of which we depressives are immune to, either.5 If you’re
not getting enough sleep, depression may be only the most
visible part of the damage you’re doing to yourself.
You may be among the sleep-deprived majority and not
even know it. Most of America’s sleepy heads are in denial
86 Up without Meds
A gender difference
One of the many reasons women suffer more depression
than men is that more women are sleep deprived. When the
National Sleep Foundation identified the segment of the U.S.
population with the worst sleep problems, they found that
three-fourths of this poorly-rested group were women.38
About twice as many suffer from insomnia as men.39 More
than half say they get, at best, no more than a few good nights
of sleep each week.40
Depression is much more prevalent in young people than
it was just a few years ago,41 and one reason is that almost
half of today’s children and teenagers have sleep problems.42
According to a Sleep Foundation survey, 60 percent of chil-
dren ages 4 to 17 complain of feeling tired during the day.43
On average, American teenagers get an hour and a half less
sleep than they need.44
According to conventional wisdom, sleep needs diminish
in old age, but studies show that an 80-year-old needs just
90 Up without Meds
as much sleep as she did when she was 40.45 The misunder-
standing about this may stem from the fact that many older
people do need less sleep at night, but this is only because
they nap during the day,46 not because their overall need for
sleep is different from anyone else’s.
People caring for a dying spouse or parent suffer a greater
rate of depression than almost any other group.47 A Univer-
sity of Texas study found that the chief factor isn’t, as you
might think, overwork, sadness, or anxiety about losing their
loved one. It’s sleep deprivation.48
The culprits
Sleep deprivation has a variety of causes. Let’s see what
might underlie the problem in your case, and talk about how
you can make adjustments so you’ll get the sleep you need for
good buoyancy.
Insomnia
About one in eight Americans suffers from insomnia,56 and
many of these troubled sleepers are depressed.57 If you’re an
insomniac, you can try changing your habits and see if that
solves the problem. If not, professional help is available.
Here are ten tips from the National Sleep Foundation that
have proved effective:
Sleep apnea
This condition, which affects eighteen million American
adults,58 and possibly an even larger percentage of children,59
repeatedly stops your breathing for a few seconds at a time
while you’re sleeping. It seriously compromises the quality of
rest, resulting in sleep deprivation even when you’re sleeping
an adequate number of hours.
Sleep apnea has been linked to heart problems60 and, be-
cause it leaves people sleep deprived, is also a factor in de-
pression.61
The cause may be any of a number of slight physiological
abnormalities, including a small upper airway or large uvula.
Common symptoms are heavy snoring, drowsiness during
the day even after eight or nine hours of sleep, and, as I men-
tioned, depression.
Out of Sl e e p -D e b t or’s P r i s on 93
Like those who are sleep deprived for other reasons, most
people who suffer from sleep apnea aren’t aware of the prob-
lem.62 If you suspect you might have it, see a doctor, and have
her arrange an overnight stay for you in a sleep center, where
they’ll monitor your sleep for a full night and give you a diag-
nosis. For a list of sleep centers in your state accredited by the
American Academy of Sleep Medicine, go to:
www.sleepcenters.org
www.sleepfoundation.org
Physical discomfort
Pain and discomfort caused by infirmities, ailments, and the
medications prescribed for them can keep people awake and
reduce the quality of their sleep. In the National Sleep Foun-
dation’s 2003 national poll, two-thirds of older Americans
reported having sleep problems at least a few times a week,
and these problems were often tied to the physical symptoms
of arthritis, heartburn, asthma, heart disease, and other
problems that often accompany old age.66 It’s one reason old-
er people are the most depressed of all age groups.
If physical problems are keeping you from getting a full
night’s sleep, there are three things you can do about it:
First, look for ways your behavior may be aggravating
your sleep problems. The American Sleep Foundation’s tips
listed under “Insomnia” above are a good place to start.
Second, if there are things you could do to reduce your
physical symptoms, consider doing them. Most diseases re-
spond, at least to some degree, to lifestyle changes—including
regular exercise and the other good habits that I recommend
for ending depression. Once you understand that your physi-
cal symptoms are contributing to your depression by depriv-
ing you of sleep, it may be all the motivation you need to make
the changes you know you should be making anyway.
Third, have a conversation with your doctor about any
prescription medications that might be causing sleep prob-
lems for you. If you and your doctor conclude that your sleep
might improve with different medications or alternatives to
medications like diet changes, they may be worth trying.
Out of Sl e e p -D e b t or’s P r i s on 95
www.rls.org
Depression itself
Among the most vicious of circles in depression is the feed-
back loop in which sleep deprivation leads to depression,
which in turn leads to even more sleep problems. Depression
frequently encourages insomnia, restless sleep, and prema-
ture waking.69 And when you’re depressed, you get less of the
deep sleep that provides rest and rehabilitation, and spend
up to twice as much time dreaming, which means that some
96 Up without Meds
Renouncing
N u t r i t i o n al R e c k l e s s n e s s
For a depressive, t he most dangerous
place in town may be the supermarket.
W
ith depression doubling every twenty years in the
U.S., you’d think they were putting something in
the water.
They are. It’s called high-fructose corn syrup.
Nutritional usery
High-fructose corn syrup and other varieties of extracted,
concentrated sugar are loan sharks. When you’ve missed
payments on exercise and sleep, and you’re suffering an en-
ergy and morale deficit, the Sugar Mafioso arrives on the
scene with a fistful of empty calories to give you a boost. But
what is given is soon taken back, and with a punishing rate
of interest. Just as hard-up debtors only dig the hole deeper
when they accept help from pitiless lenders, people who get
trapped in the cycle of borrowing from Sugar Daddy wind up
falling farther and farther behind.
Any food product with a high white-flour content has a
similar effect. White bread isn’t sugar when it goes into your
mouth, but quickly converts to sugar during digestion.18 Food
products with a high sugar or white-flour content carry what
nutritionists call a high glycemic load, or GL, meaning that
they spike your blood glucose level to give you a rush. Most
of us think we just like the taste of high-GL foods, but we’ve
102 Up without Meds
» Pizza
» Baked potatoes
» French fries
» White rice
These happen to be the foods most of us think of giving up
first whenever we think about going on a diet. But it’s impor-
tant to keep them off your plate most of the time even when
you aren’t dieting. Whether you’re fat or thin, high-GL foods
reduce your emotional buoyancy by putting you on a sugar
roller-coaster that always ends up at the bottom. Plus, eat-
ing a lot of high-GL foods eventually raises your blood sugar
level permanently, not just after you’ve eaten, and can lead to
diabetes.20
Death by sugar
In 2006 Britain’s leading medical journal, the Lancet, re-
ported that eating too much sugar and white flour kills three
million people around the world every year.21 A dispropor-
tionate number of those three million are Americans.22 And,
as many Americans as there are filling hospital beds thanks
to high-GL foods, there are even more under the covers in
their own beds at home, the victims of depression brought on
in part by the effects of food. The foods that ultimately stop
hearts are the same ones that start mood spirals, making life
feel like death, before high glucose levels actually do you in.
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Keeping score
Many nutritionists recommend you keep your daily GL
score below 50. If you’d like to start counting GL points,
you’ll find a chart showing GL values for popular foods at
5decisions.com.
The website also links to diet books that can help you
minimize GL.
Counting has never been my thing, so instead of totting
up GL points, I rely on this rule of thumb:
The rule tells me to eat brown rice, baked goods and pasta
made with brown flours, oatmeal and other brown grains,
All-Bran™ cereal, and no highly processed sugars.
Eating defensively
What can you do to stop being hurt by your food?
I follow the advice of Michael Pollan, the writer I men-
tioned in Chapter 2. A few years ago, Pollan became interest-
ed in what he calls “our national eating disorder,” and wrote a
book about it, The Omnivore’s Dilemma. He followed it with
a New York Times Magazine piece, “Unhappy Meals.”37 The
article begins by summarizing, in seven words, his conclu-
sions:
The first two words, “eat food,” sound silly, until Pollan ex-
plains that he means “food” as distinct from “food prod-
ucts.” A food product is anything made in a factory, sealed
in a package, and often labeled with a list of ingredients that
bring high-school chemistry lab to mind. In the supermar-
ket, what we might call food proper—produce, eggs, meats,
seafood—is typically displayed against the outer walls. What
occupies the inner aisles is mostly food products. In the su-
permarket, if you just steered your shopping cart around the
race track without ever driving it into the infield, your diet
would improve markedly.
Here’s another Pollan rule of thumb I like:
110 Up without Meds
Re-joining the H u m a n R ac e
Social isolation is hazardous to your health,
a s d a n g e r o u s a s s m o k i n g t w o p a c k s a d a y.
W
hen Tom Hanks is stranded alone on an island in
the movie Cast Away, he teaches himself to spear
fish, improvises his own dental treatment, and
predicts the weather with a calendar that he fashions himself.
But his self-sufficiency goes only so far. The most important
item in his improvised survival kit, it turns out, is a friend.
Hanks paints a face on a volleyball, christens it “Wilson,” and
begins a one-way dialog with this pretend companion, a con-
versation that continues for four years. When Wilson later
floats away on the ocean current, Hanks’ anguish reminds us
that perfect self-sufficiency, for a human being, is not achiev-
able.
The movie suggests that without the companionship of
Wilson, Hanks would be in danger of losing his mind. But
you don’t have to be shipwrecked to be so lonely that it affects
your mental and emotional wellbeing. There are millions of
people in the U.S. today who have marooned themselves on
an island of their own making, and most of them are suffer-
ing.
Every ten years USA Today asks people how often they’re
seeing each other socially. In 1990 the average was six times
a month. Just ten years later it was a third of that.1 It’s a trend
of increasing isolation that began about sixty years ago, a
pattern that parallels the doubling of depression in every
generation since the Second World War and has helped feed
the depression epidemic.
118 Up without Meds
A world of soloists
The family farm has all but disappeared, together with the
lifestyle that went with it. Where my grandparents’ farm was,
there is now a suburb. Few people living in the tract houses
that have sprung up there in the last few decades were born
anywhere near the acre or so where they currently make their
home. Most will not be there ten years hence.
Many aren’t there even now. They’re at work in the city, or
by themselves in a car somewhere on one of the area’s high-
ways, or walking amid strangers at the mall. And among those
who happen to be present in the suburb at any given hour of
the day, there is no sign of them. They’re behind locked doors
in their homes.
Suburbs give the appearance of a community, but in fact
there isn’t much more real communal life in most of them
than there is in a scale-model village displayed on an elec-
tric train layout. As the urban architects Andres Duany and
Elizabeth Plater-Zyberk said, the suburbs are “the last word
in privatization,” a social arrangement that minimizes inter-
action, and that “spells the end of authentic civic life.”10
longer hours, and with more people working past what used
to be considered “retirement age,” work has become the new
forum for social interaction. But in trading the neighborhood
community for a community centered on productivity, we’ve
traded down. Our freedom to socialize at work is constrained
by the fact that our time is owned by our employers; social in-
teraction has to take second place. And the emphasis that has
to be placed on results at work means that the culture of the
office is a low-context culture, where people are more often
seen as a means to an end, rather than as fellow human be-
ings with whom we can experience and celebrate our mutual
humanity.
Most people say they have no close friends at work, which
helps explain the increasing mobility of the American work-
force. With connections so shallow, it isn’t hard to leave peo-
ple you know at Company A for a better opportunity offered
by the strangers at Company B.
Of course, we now have cellphones, email, instant mes-
saging, online forums, blogging, social websites, and many
other new technological wonders that connect us with other
people everywhere. Research suggests that these connections
are worthwhile, but their impact on our wellbeing is limited
by the fact that they tend to be emotionally limited.
Friendless
In spite of new opportunities for social interaction provided
by work and by the new forms of connectivity, more people
than ever report feeling isolated. According to the journal
American Sociological Review, the number of close friends
people have has declined steeply in recent decades, with 25
percent of us now saying we have no close friends at all.19
Today four out of five say the only people they have to con-
fide in, if they have anybody, are their relatives.20 Stephanie
124 Up without Meds
D
epression and addiction are like a pair of drinking
buddies. Often found together, they feed off each
other’s darkness. If you’re a depressive, any addic-
tion that snares you will hold you hostage by threatening to
depress you if you quit. But you face a Catch 22 here, because
your addiction also depresses you when you don’t quit. This
damned-if-you-do-and-damned-if-you-don’t dynamic is why
ending depression usually requires giving up what you’re
hooked on for good.
Tobacco
As with alcohol, the link between nicotine and depression
is bidirectional. People who are prone to depression take up
smoking to mitigate depression’s symptoms. Smoking in turn
triggers more episodes of depression. Its effects are so de-
pressive that a University of Helsinki study found that smok-
ers can cut their risk for depression in half just by giving up
cigarettes.12
Marijuana
In the U.S. during the past few decades, there’s been a grow-
ing movement to legalize marijuana. The pro-pot argument,
when it isn’t advanced along libertarian lines, is often based
on the claim that marijuana is nonaddictive and harmless.
But whether it is considered nonaddictive by certain tech-
nical criteria that may or may not be relevant, and putting
aside the question of whether it should be legalized, pot is not
harmless, at least in frequently repeated doses, and especial-
ly for depressives.13 An Australian study found that teen-aged
girls who smoked pot every day wound up with five times as
138 Up without Meds
Deifying addictions
Though addictions can be tenacious, their power to enslave
has been overstated. As I mentioned in Chapter 2, I found it
relatively easy to end a thirty-year alcohol dependency, and
I know many others who’ve walked away from all kinds of
things—cigarettes, caffeine, alcohol, drugs, food addictions,
gambling, shopping mania, Internet compulsion—without
a struggle. It happens more often than you’d guess, but be-
140 Up without Meds
Addicted to distraction
In addition to the substances and activities that snare us,
there’s another group of dependencies that also encourage
depression, but not the same way alcohol and the other loan
sharks do. I call them occupiers, because they relieve the men-
tal unease of normal living by occupying your mind. They’re
G e t t i n g O ff E a s y 141
occupiers in another sense, too: They can take over your life
like an occupying army takes over a country. This category
includes television, the Internet, reading, video games, and
work. (The Internet can fall into the neurotransmitter-boost-
ing category of addiction as well, because it’s a gateway to
addictive gambling, shopping, and pornography. But here I’m
talking about the compulsive need to keep surfing, no matter
what the particular content.)
Occupiers don’t always turn into addictive habits, but
most Americans have become dependent on at least one of
them, developing noticeable withdrawal symptoms when TV,
or whatever they’ve become dependent on, is taken away for
any length of time.
What hooks you, though, is not a pleasurable rush, but a
welcome vacation from your own thinking—relief from the
usual tiresome jumble of obsessions, worries, plans, and
memories that parade through any human’s mind when she’s
not concentrating on anything in particular. Occupiers allow
you to lose yourself and your concerns temporarily.
Research shows that some of the diversions we use to oc-
cupy the mind, like TV and reading, actually have a mildly
depressing effect.19 They frequently leave people feeling a lit-
tle depleted when the set is turned off or the book is closed.
However, these little crashes aren’t usually enough to trig-
ger an episode of major depression or severely deepen one
that’s already underway. Like the other occupiers, their main
contribution to depression is to prepare the ground for a big
crash by diverting you from doing the things that maintain
your body’s mood-recovery system. When you become com-
pulsive about them, they monopolize your free time, crowd-
ing out the exercise, sleep, wholesome cooking, and social
contact that every depressive needs to maintain buoyancy
and keep depression at bay.
142 Up without Meds
one else will have quit by then, and most of these recoveries
will have been achieved without a program of any kind. 31
The 1992 National Longitudinal Alcohol Epidemiologic
Survey found that three-fourths of all alcoholics who quit do
it without the benefit of a formal program, and these do-it-
yourselfers stay on the wagon more successfully than rehab
clients and 12-steppers.32
Nicotine is one of the most addictive substances, yet most
cigarette smokers eventually kick the habit, and all but a
small minority do it without treatment, therapy, hypnotism,
patches, or self-help groups.33 An even larger percentage of
heroin and cocaine addicts quit on their own.34
This doesn’t necessarily mean you should stay away from
treatment or self-help groups. Millions of people, including
at least two dozen I know, have overcome addictions with the
help of structured programs, and these folks are usually eager
to tell you how important the support was to their recovery.
At the same time, you should be clear that no program can
ever do more than provide you with a supportive framework
for doing what you’ve already decided to do. No program can
quit for you.
And just as no one but you can quit your addiction, no
one can tell you the best way for you to quit. You’re the ex-
pert here, the only person qualified to chart your route to
freedom. In the University of Rochester study I mentioned
a moment ago, smokers who designed their own recovery
plan were more successful at quitting than those who were
assigned to a program by somebody else.35
If you know you’re the kind of person who performs best
in a well-defined structure, you may lean toward treatment.
If you’re comfortable with introspection or respond well
to coaching, psychotherapy could be a way to go. If you’re
a loyalist who’s comfortable embracing a system of beliefs
146 Up without Meds
To r t o i s e s R e c o v e r
Fa s t e r Th a n H a r e s
A nd it doesn’t mat ter what your
first step is, as long as you take one.
I
f you make the changes this book recommends, it could
be the most life-enhancing endeavor you’ve ever under-
taken. But the changes it’s going to require in order for
you to be successful—at least two or three of them, depend-
ing on how well you’re already tending to your needs—may
seem like just too much to take on. And they are too much,
if you were to try to accomplish all of them at once. But that
isn’t necessary, or even desirable. All you ever need to do is
take a single step.
A research team at the University of Missouri found this
out in 2007, when they were looking for the best approach
for recovery from Type II diabetes. They found that, even
though diet modification is theoretically the best route, and
exercise the second-best, patients who were encouraged just
to exercise did twice as well as those who were assigned both
exercise and diet modification. One step at a time was better
than two.
But what is the first step to ending your depression?
That’s for you to decide. You can begin anywhere, as long
as you begin somewhere. Pick any of the five lifestyle prob-
lems that underlie depression—exercise deprivation, sleep
deprivation, nutritional recklessness, social deprivation, or
addiction. You’ll find that when you take a single step toward
correcting any one of them, it’s a step toward correcting all
of them. Because each lifestyle problem feeds all the others—
152 Up without Meds
your own life, I think you’ll see that the real limitation isn’t
time, but carrying capacity.
help you come up with a strategy. You can also find a way
out of the dilemma by signing up for one of the live, personal
guidance and support options at 5decisions.com.
Once you’ve lightened your burden, it’s important to avoid
overtaxing the extra capacity that you’ve freed, which you’ll
do if you attempt too much change at once. Many depressives
are conscientious to a fault, so you might be inclined to over-
do it. But I would encourage you to make a modest first effort
that will give you a small but reliable foundation to build on.
If you’re starting to exercise after avoiding it for a period
of time, begin with just three sessions a week, and see how
it goes. If you decide to cut back on nighttime TV so you can
get more sleep, don’t toss the set in the trash; try an hour
less every night. If diet is your initial focus, make just a few
adjustments; becoming a vegan may be overreaching at this
point. If coming out of social isolation is your first step, find
one good club to join, and take it from there.
Form a team
Everyone has his own definition of friendship, but this is one
definition I like:
I’ll bet you have some friends like this; if so, they can be enor-
mously helpful in keeping you on track as you make changes
in your life. Share your commitments with them, and ask
them to mention it to you if they ever see you backsliding.
This increases the stakes for you.
But be careful whom you put on your team. Many of us
have friends who neglect their own wellbeing and are full of
understanding and forgiveness when we neglect ours. They
may be wonderful friends, but overly permissive people don’t
make good team members.
In fact, just having friends who are unhealthy can be haz-
ardous to your own health. A 2007 study at Harvard Medi-
cal School found that when an individual becomes obese, it
triples the chances that her closest friend will also become
obese. On the other side of the coin, when one member of
To r t o i s e s R e c o v e r Fa s t e r 159
the pair loses weight, it increases the chances that her friend
will, too. This is not to say that social considerations are the
most important factor in weight gain or loss—it’s more com-
plicated than that—but does underline the fact that peer in-
fluence has a lot to do with how we conduct our lives.
If you don’t have friends whom you feel you can count on
for support, consider getting yourself a life coach or behavior
therapist. Joining a support group can be a great way to make
sure you stick to your plans, too. Or sign up for live, personal
guidance and support at 5decisions.com.
After you’ve anchored a change into your life as a new
habit, it will start to seem fairly automatic, and won’t feel so
much like forcing yourself to do it every time. At that point,
it’ll be time to think about the next change you want to make.
You’ll know when that time comes, and you’ll also have a
sense about what the next change should be. If you’re pa-
tient and don’t go too fast, you’ll find that as you take on each
new challenge, you’ll proceed with confidence and strength,
thanks to all the changes you’ve already made.
If you have an addiction, keep checking in with yourself,
as you make step-by-step changes, to see if the time has come
to quit. Because every positive lifestyle change you make
strengthens your neurotransmitter system, each one helps
pave the way for recovery from any form of addiction. It’s
been proven that correcting deficiencies in exercise, sleep,
good nutrition, and social contact even helps people give up
compulsive gambling and shopping. But only you can know
when the moment has come. If you’re not ready, don’t worry
about it. Keep making the changes that weaken addiction’s
hold on you, and your addiction will drop away as soon as it’s
no longer of any use to you.
Getting back to the present, my wish is that when you
close this book now or a few minutes from now, you’ll get to
160 Up without Meds
work on your recovery right away. I’d like you to think about
it, sleep on it, and then tomorrow, decide which first step
you’re going to take. Before you go ahead and take it, I hope
you’ll increase your chances of success by shedding some ev-
eryday responsibilities that would weigh you down and hurt
your chances of sticking with it. And then, when you’ve freed
up enough carrying capacity, you’ll be all set to take that first
step. I’m confident you can get this done before another week
goes by, and if you do, you’ll later look back on these few days
as among the most important ones ever on your road to hap-
piness and wellbeing.
T W E L V E
I
f you go to my website, upwithoutmeds.com, you’ll find a
blackboard that shows how long it’s been since I was last
depressed. Check it out, and you’ll see that it’s been years
since my last episode. Look again ten years from now, and
it’ll show ten more years of depression-free days. The num-
ber on the blackboard will keep going up for as long as I live,
because depression is out of my life for good.
How can I be so sure? Well, for one thing, I know I’ll keep
taking my own advice and continue to maintain my buoyancy
through regular exercise, sufficient sleep, and the other good
habits that protect me against depression. Since I’ll be giving
my body the daily care it requires, my biology will have no
need to lodge a complaint in the form of depression or some-
thing even worse, like heart disease. Oh, I may come down
with something or other by the time you’re reading this book.
I may even be dead. After all, I’m 65 as I write this, and may
be much further along in years by the time you get around to
reading it. But if I do become ill, it won’t be because of self-
neglect. And whatever I fall prey to, it won’t be depression.
My daily routine gives me even more immunity than the
33 percent of the population who carry two anti-depression
genes. But even this protection could be breached by an un-
accustomed load of stress. If that happens, I’ll still be un-
sinkable, because I have a self-rescue technique that keeps
me from going under, no matter what happens.
162 Up without Meds
Don’t be spontaneous
When you’re dealing with depression, it’s always important
to have a structure rather than relying on yourself to do the
smart thing spontaneously, because when you’re depressed,
what you do spontaneously is nothing. So you need to pre-
pare ahead, before it becomes necessary to rescue yourself
from an episode, by taking these three steps:
Sick-day arrangements
When you’re recovering from an appendectomy, your body is
unlikely to respond to a part-time effort. For example, sup-
pose after surgery you stay in your hospital bed for a couple
of hours, then get up and get dressed to go out to a business
meeting. After the meeting, you come back and put on your
hospital gown for a little while, then jump out of bed again for
another appointment. No doctor would allow this, because it
would, at best, delay the recovery. Chances are, your condi-
tion would just get worse.
Your body demands no less devotion when you’re fighting
off an episode of depression. A part-time effort simply won’t
do it. Your recovery may not take long—as little as an hour
or two—but until you’ve got your buoyancy back, you can’t
afford to divide your efforts. You’ve got to be single-minded,
just as you would be when you’re recovering from surgery.
This means clearing your schedule of all your normal obli-
166 Up without Meds
Now let’s talk about what you’re going to be doing with all
the free time you’ve created.
The script
Your script is a detailed schedule of mood-elevating activities
that, except for necessary food breaks and hygiene needs,
will occupy you until the depression lifts for good. By writing
a script before you get depressed, you’ll know exactly what to
do if depression starts to come on. When the time comes, you
won’t have to make any decisions. You’ll just get out the sheet
and follow the directions.
When you create your script, combine your antidepres-
sant activities any way you want, but stick to the tasks that
provide quick depression relief: exercise and meaningful so-
cial contact (and, if you have the skills, meditation or prayer).
Here are some tips about writing the script:
My Script
Time Activity Alternative Plan
6:00 a.m. Shower and shave (same as always)
6:30 a.m. Email my hiking buddies, inviting any
who are available to go out on the trail
with me this morning
6:45 a.m. Meditation group (same as always)
8:00 a.m. Breakfast with Judy (same as always)
8:45 a.m. Phone calls to arrange lunch with one of
several close friends who lift my spirits
9:00 a.m. Hike my favorite trail, either by myself Rain gear in case of a storm.
or, if I’ve had any takers from my email, Snow shoes in winter.
with one or more hiking buddies
Noon Lunch with whoever accepted my invita- If no one is available for
tion during the 9 a.m. calls lunch, call close friends on
the East Coast, where it is
two hours earlier. Grab a
sandwich.
1:30 p.m. Visit nursing home
3:00 p.m. Workout with exercise DVD
4:30 p.m. Meditate at home
6:00 p.m. Dinner with Judy
7:00 p.m. Write emails to friends with the purpose
of making them feel loved and appreci-
ated
9:00 p.m. Bed
Support
When you fall into depression, it’s normal to experience a
strong aversion to doing the very things that will pull you out
of the depression. When your mood starts to plummet, your
Becoming Unsink able 173
instincts are the same as when you come down with the flu.
Everything in you tells you to crawl into a cocoon and do as
little as possible. This is the right thing to do when you have
the flu, but the wrong thing to do when you’re depressed. But
you’ll want to do it anyway.
Unless you’re exceptionally strong-willed, you may not be
able to count on yourself to resist depression’s seductive ar-
guments for staying on the couch or under the covers. That’s
where family and friends can make all the difference. If you
tell them about your sick-day plans in advance, and ask them
to support you if and when the day comes, they’ll be there to
encourage you when you’re having a hard time persuading
yourself to get moving.
When you prove to yourself that you can rescue yourself from
depression, it will do wonders for your self-confidence. You’ll
find that you’re like a protagonist in the movies who’s always
been mocked and humiliated by powerful people, but then
turns the tables on everyone and winds up on top. This role-
reversal, in which you turn the tables on the mood disorder
that has always dominated you, will do so much for your mo-
rale, it’ll have a healing placebo affect on you. Together with
regular exercise, sufficient sleep, and the other habits that
maintain normal buoyancy, discovering that you’re in control
176 Up without Meds
Yo u We r e B o r n
To B e B u o y a n t .
Depression c a n’t ta ke root in a well-tended life.
D
epressives are famous for feeling hopeless, and may-
be one reason is that for five thousand years, the ex-
perts on depression have been giving us hopelessly
incompetent advice.
Ancient depressives were told by the experts that devils
had entered them. Since there were actually no devils in-
volved, exorcism was no cure, and the situation remained
hopeless.
Depressives of Hippocrates’ time were told by the experts
that they had black bile in their blood. Since black bile was
nonexistent, drawing blood didn’t cure anything, and the
situation remained hopeless.
Depressives of the Middle Ages were told by the experts
that their disease was punishment for their sins. Since sin
has nothing to do with depression, virtue was no cure, and
the situation remained hopeless.
Depressives of more recent times have been told that their
disorder is caused by genes, childhood conditioning, distort-
ed thinking, stress, and now, above all, an inherent chemical
imbalance. Since all of these factors play only a supporting
role in depression and are not decisive, our weak attempts to
correct or compensate for them are no cure, and the situation
remains hopeless.
In fact, the situation is far from hopeless, but only when
reality isn’t being defined by the experts and their off-the-
mark theories.
178 Up without Meds
F u r t h e r H e lp
My webside of fers a wealth of resources
for ending your depression
or helping someone else end theirs.
Ongoing support
» A free buddy program that matches you with a
compatible “tele-pal,” who’ll support you in mak-
ing changes in return for your support
» A telephone support group that meets weekly
to put group dynamics to work for you while pro-
tecting your privacy
» A local support group in your area
A corporate program
» Ways to integrate the lifestyle approach to recov-
ery into your company’s wellness program
Genes 1, 4, 5, 10, 13, 34-6, 85, 149, 161, modern technology’s role in 8
177, 179 tips for reducing 156
Geneva Conventions, American lifetyle J
defined as torture under 6 Jacobs, Jane 121
Glucose 98, 100, 106 Jewish Hospital in Cincinnati 105
Glycemic index 102 K
Glycemic load 101-3, 106 Kentucky, University of 153
Gottleib, Elaine 138 KFC 108
Guskiewicz, Kevin 71 Kirsch, Irving 53, 56
H L
Haig, Scott 50 Leno, Jay 87
Hall, Edward T. 119 Leuchter, Andrew 59
Hamilton Depression Scale 44-5, 56, 62 Lifestyle
Hanks, Tom 117 decisions 11, 25, 182
Harvard 15, 25, 38, 48, 73, 108, 114 habits 66, 162
Harvard Medical School 82, 88, 158 mistakes 2, 3, 179
Harvard School of Public Health 108, 113 sedentary 73
Health trends 4, 46
clubs 182 Lilly, Eli 58
foods, warning about 114 Loan sharks, chemical 101, 133, 140
Heart disease M
cholesterol and triglycerides as causes Marijuana 133, 135, 137-8
of 105 Marriage 66-7, 124, 146
depression’s relationship to 2, 105, 166 Marx, Karl 130
and sleep Maslow, Abraham 119
apnea 92 Mayo Clinic 25, 73
deprivation 89, 94 McDonald’s 99, 112
and trans fats 108 McGill University 60
and the Western diet 110 McLean Hospital 74, 138
Henry Ford Sleep Disorders Center 86 Media, role of in depression 27
High-fructose corn syrup 97 Mediterranean diet 110
Highway Traffic Safety Administration Merck 61
88 Mexico 67
Hippocrates 177 Miami, University of 142
Homeostasis 7, 32-4 Michigan, University of 38, 71
Hydrogenated oil 106-7 Michigan State University 55
I Mirapex 95
Illinois, University of 125 Missouri, University of 151
Inert, definition of 53 Moffitt, Terrie 35
Insomnia Moncrieff, J. 48
antidepressants’ link to 58 Mood regulation as homeostatic system 8
depression’s link to 95 Mood-recovery system 141, 175
exercise as a treatment for 75 Moral character as a poor explanation for
statistics and tips 91 addiction 146
Institute of Medicine 52, 60 Mothers 14, 23, 44, 60, 152
Insulin, high-GL foods’ effect on 106 nursing 113
Internet 10, 39, 41, 91, 122, 139, 141-2, 175 Mumford, Lewis 120-1
Isolation, social Myers, Judy 16, 80
depression’s relationship to 25, 118, 179 N
help in overcoming 132 National Academies of Science 60
186 Up without Meds
upwithoutmeds.com
190
You can help Mark Myers spread the word more effectively
about the lifestyle approach to ending depression by sharing
your thoughts with him about this book. Let him know what
you like about the book, and offer suggestions about how he
can make it more useful. If the book has made a difference in
your life or the life of someone you love, let him know about
that, too!
Here’s the link:
upwithoutmeds.com/feedback_for_the_author.htm
191
A r e Yo u
A n Author a nd Speaker
Wh o Tr a n s f o r m s L i v e s ?
hugopress.com
192
Order an A dd i t i o n al
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Lyndie Doerr
T his could be the year you free yourself from depression and throw
away the pills. In this groundbreaking book, a Harvard-trained
scholar and former depressive presents a new nonmedical approach
to recovery that is safe, natural, and stunningly effective. You achieve
a full recovery, no matter how bad your genes, your childhood, or
your brain chemistry. Inside you’ll discover how to:
• Find out what’s really been getting you down all your life
• Overcome heriditary and childhood negatives to become even
more buoyant than those born with two antidepression genes
• Control your mood, no matter what’s happening in your life
• Optionally continue with meds or psychotherapy if you like
• Pull yourself out of the spiral when you start to get depressed
• Permanently improve your brain chemistry and outlook
• Stay depression-free every day for the rest of your life
$
16