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HOPE WINNER

Change. BELIEVES STONE AGE

STRATEGIES CAN

Your Life,
REMEDY MODERN

DEPRESSION

Change Your Mind


S
teve Ilardi had grown restless after college. Although he
had worked as a computer consultant for the Peace Corps
and the Centers for Disease Control, he yearned for a new
direction. So he took a friend’s advice and began volun-
teering at the Georgia Mental Health Institute in Atlanta.

There he worked in a unit that housed—or “warehoused,” as he puts it—patients


with schizophrenia. Many had been abandoned by their families and faced the
prospect of spending their lives in mental health institutions. It struck him: “These
were people just like me in nearly every way, except for the fact that they were suffer-
ing from this tragic disease,” Ilardi recalls. “They could get lonely just like anyone
else; they could suffer. They could connect, but they didn’t have that option.”
Their isolation haunted Ilardi. He started hanging out with patients for hours each
week, playing cards, talking politics, befriending them. The interaction fulfilled his
need to reach out, but it also piqued his curiosity. “I got hooked from a scientific
angle,” he explains. “I kept wondering, ‘What the hell is going on with these patients?
What’s happening at a biological level?’”
Soon Ilardi enrolled in night school. Then, at 27, with only three psychology
classes on his college transcript, he applied to clinical psychology graduate programs.
Ilardi landed at Duke, where he was drawn to depression-treatment research. After a
postdoctoral position at the University of Colorado, Ilardi joined the KU faculty in
1997, ready to defend the world from depression.

B Y K AT I E G R E E N E

ISSUE 2, 2005 | 23
•omega-3 fatty acid supplements
Depression can grow so severe •enhanced social interaction
•increased activity to prevent
that a sufferer might actually perceive the world rumination (repetitive negative
thoughts)
in muted hues, with subdued As Ilardi explains it, this simple,
behavioral approach makes sense
physical sensations. when we consider depression’s effect
on the brain. Magnetic resonance
imaging (MRI) scans reveal that the

N
ow an associate professor them to enjoy a sunny day just don’t brain of a depressed person functions
of psychology, Ilardi remains work any longer. differently from that of a depression-
wide-eyed and passionate Even more alarming than the epi- free person. But, contrary to popular
about his research, and his demic is the fact that we’re not very belief, the existence of a chemical
zeal translates into his compelling class- good at treating it, Ilardi says. imbalance in the brain does not imply
room presence. Last fall, KU seniors Psychiatrists and psychologists typically that an individual needs mediation
bestowed their traditional Honor for an treat depression with drugs or talk ther- to get well.
Outstanding Progressive Educator—the apy, but many patients avoid therapy Although chemicals from an antide-
HOPE Award—on Ilardi, whose large and take only antidepressants. These pressant medication do in fact alter the
classes in personality and abnormal psy- drugs are prescribed most often by gen- brain’s activity and ultimately a person’s
chology are mainstays for students in eral practitioners, often without an brainscape, Ilardi argues that brain
several disciplines. assessment, consultation or sufficient changes result from everything we do,
The enthusiasm that binds the education about the treatment. Then everything we think and experience. For
teacher and students belies the bleak most patients quit taking the pills after a example, neuro-cognitive research has
epidemic that dominates their discus- while. “And as soon as they stop taking shown that merely reading this article
sions. Ilardi rattles off grim statistics: the medication,” Ilardi says, “they have will forever change some of the neural
One in five Americans will suffer from about a 50-50 chance of having the pathways in your brain, altering how
depression, and the disease can be fatal— depression return in under a year.” they work and look, albeit on a very
roughly 30,000 Americans take their If depression strikes once, there is a small scale.
lives every year, largely because of the ill- lifetime recurrence rate of 70 percent. A This point forms the crux of Ilardi’s
ness. Rates of depression continue to person who has suffered three bouts theory; it is the reason he aims to fight
grow: Each successive generation for the with the illness must cope with the 90 the illness without prescription drugs
past 80 years has been afflicted in percent likelihood that it will return. whenever possible. If altering a person’s
greater numbers. As a clinical psychologist, Ilardi tests behavior will produce the same benefi-
Most of us have a sense of what it new treatments for depression. cial brain changes that can come from
means to be depressed—if not from first- Currently, he proposes an innovative medication—without the risks and side
hand experience or the trials of someone method that abandons medication, effects—then the advantages are obvious.
close, then from commercials advertising emphasizing instead a change in envi- Pills can work, Ilardi says, but re-
the arsenal of antidepressant drugs on ronment. His method reintroduces cently published research suggests that
the market. Depression occurs when lifestyle changes that act as natural anti- many people who experience relief when
someone’s mood, or background emo- depressants, and he believes these habits they take a drug like Prozac or Zoloft do
tional state, remains perpetually low. But can change a patient’s brain and behav- so because of a placebo effect. While
Ilardi stresses that depression isn’t just ior and ultimately conquer depression. improvement for any reason may be wel-
about negative thoughts and feelings. This semester, he has begun to gather come, the drawbacks of medication are
The disease also manifests itself in data in an initial trial with eight KU par- numerous. Recent studies have shown
real, often debilitating, physical impair- ticipants recruited through fliers, the that some medications could increase
ments. Severely depressed people can University Daily Kansan and introduc-
suffer insomnia, loss of energy and an tory psychology classes. He calls his
■ Ilardi is a compelling presence in the class-
inability to concentrate. What’s more, treatment Therapeutic Lifestyle Change,
depression can grow so severe that a suf- or TLC. room, where he’s known for his passionate
ferer might actually perceive the world in TLC’s six essentials are: lectures and inventive methods for connecting
muted hues, with subdued physical sen- •aerobic exercise with students. In 2004 he won the HOPE
sations. In other words, the crucial brain •adequate sleep Award, the only KU honor for teaching excel-
processes that normally would allow •natural sunlight exposure lence given exclusively by students.

24 | KANSAS ALUMNI
PH OTO ILLU STR ATIO N S BY E AR L RICHA RDS ON

the risk of suicidal behavior in some ity beyond a “new-age,” feel-good hunch, time to adjust to the change. It was as if
patients. Other less deadly but still oner- the real roots of TLC are in evolutionary the rapidly changing environment was a
ous troubles include impulsive, violent psychology. This emerging branch of race car taking off at full speed, leaving
behavior, sexual side effects, and even psychology follows the same premise the genome motionless at the start line.
emotional numbing. And then there is that biologists use with Darwin’s theory “We are designed largely for a Stone
that high chance of a depression relapse, of natural selection. Age environment, and the technological
especially when a person stops taking The idea is that ancient humans evolution that has occurred in the in-
the medication. whose genes equipped them mentally terim has happened much faster than
and physically to succeed tended to sur- our physiological evolution,” Ilardi says.
◆ ◆ ◆ vive longer and reproduce more, thereby “Natural selection usually operates on a
passing on the “winning” genes to the time scale of thousands of generations,

T
he idea for the TLC treatment next generation. and there just haven’t been that many
grew from Ilardi’s interest in two Currently, our genetic makeup looks generations since the advent of agricul-
related areas: cognitive neuro- much like our ancestors’ during the ture, 13,000 years ago.”
science and evolutionary psy- Pleistocene, an era that dates from about In other words, depression now
chology. These subsets of his discipline 2 million to roughly 10,000 years ago. runs rampant because our bodies are
tether psychology to the sciences of biol- Over these years, humans lived in out of sync with today’s environment.
ogy, chemistry and physics. From cogni- groups and hunted and gathered their Ilardi advocates restoring some of the
tive neuroscience (the field that uses food, with plenty of time to gain profi- Stone Age elements to our modern lives,
MRIs and other techniques to snatch ciency at these activities. without sacrificing cars or cell phones.
glimpses of brain activity), researchers But the world morphed at the end of He’s betting this back-to-basics treat-
can see how the brain of a depressed the Pleistocene, when agriculture was ment will work.
person alters when he or she exercises, introduced. People started to domesti- For instance, it appears that ancient
for example. Certain behaviors have cate animals and create cities, a novel humans exercised incessantly, whether
been shown to benefit a person’s brain, form of settlement. Survival techniques they were hunting and gathering for sus-
and those are the cornerstones of TLC. honed over the previous 2 million years tenance or merely traveling to new loca-
While cognitive neuroscience gives suddenly were not in demand. At the tions. Now, finding time for aerobic
Ilardi’s proposed treatment some tenabil- same time, human genes didn’t have activity—or the money for a gym mem-

ISSUE 2, 2005 | 25
bership—is a challenge. Reintroduce reg-
ular physical activity, and the contempo- We are designed largely for a Stone Age
rary human is one step less out of sync
with his or her environment. environment, and the technological evolution
Two other missing elements involve
indoor lighting. First, the light bulb has that has occurred has happened much
allowed us to stay awake longer, extend-
ing our days far beyond sunset. This
leads to an unhealthy dearth of sleep for
faster than our physiological evolution.
most adults. Second, artificial lights, the
kind most of us experience during the ment are connected. We are social crea- longed sadness is naturally selected by
day, are bright enough to trick our tures—in the Pleistocene, humans lived human evolution. That is, humans have
brains into staying awake, but not bright in close-knit groups of 50 to 150 people evolved so that depression can be worth-
enough to reset our circadian clock, the and were rarely alone—and we still crave while, because when people become
mechanism that governs sleep regula- interaction with others. Contemporary depressed, the community of friends or
tion. In fact, fluorescent lights are 20 to living structures, however, can foster family rallies around them, giving them
50 times dimmer than natural sunlight. loneliness. And when a person prone to emotional support to redirect their lives.
Only rays of sun (or a specialized light depression is alone, negative thoughts In this scenario, depression is seen as a
box, used in Ilardi’s study) are intense can creep in and relentlessly spin, caus- helpful signal for a transition or as a
enough to effectively reset the brain cir- ing a vicious downward spiral in mood. community-building tool.
cuits that govern sleep. Dwelling on negative ideas could rarely This doesn’t make much sense to
A fourth element of TLC deals with have occurred when there was dinner to Ilardi, who calls scientists ascribing to
diet. Even though the brain is actually hunt or a clan of people with which to this theory “hyper-adaptationists.” He
60 percent fat by dry weight, the most interact, Ilardi argues. says it is incorrect to presume that
crucial fatty building blocks of the Each of the six elements, when because a trait occurs, it must be an
brain—omega 3 fatty acids—have been applied separately, has been shown in adaptation. His ideas are indeed out of
disappearing from American diets for the research to reduce symptoms of depres- step with the mainstream, but he has
past century. Omega-3s are synthesized sion. But Ilardi is the only current confidence—tempered by a large dose of
by plants and algae, and they used to be researcher to unite them in a dramati- humility—that he’s on to something big.
abundant in the human diet before the cally different treatment framework. Regarding the intuitiveness and simplic-
practice of grain-feeding livestock and ity of his experimental treatment, Ilardi
fish became widespread. Omega-3 sup- ◆ ◆ ◆ says, “I think sometimes the ideas that
plements have been shown to relieve have the most staying power in science

I
postpartum depression because they lardi isn’t the first psychologist to are those that, when people see them,
clear the buildup of harmful dietary fats use the evolutionary model to they think, ‘Oh, of course,’ but yet it’s
in cell membranes, allowing circuits in approach depression. Traditional only obvious in hindsight.”
the brain to function better. evolutionary thinking about the Edward Craighead, Ilardi’s mentor at
The last two aspects of Ilardi’s treat- cause of depression claims that pro- Duke and now the chair of the psychol-

Pharmaceutical chemicals can work, ■ Adequate sleep


Six essentials of TLC but could lead to serious side effects; Chronic sleep deprivation is a risk factor

T herapeutic Lifestyle Change, or TLC,


is an innovative treatment for depres-
sion based on the idea that our modern
there is also a high chance of relapse when
medications are stopped.
There are six essential aspects to TLC:
for depression. Sleep 7 to 8 hours nightly.

■ Natural sunlight
brains are still wired for Stone Age The brain needs 2,500 lux for 30 to 60
lifestyles. ■ Aerobic exercise minutes per day. Spend 30 minutes out-
The method abandons medication Exercise is a potent doors on a sunny day or in front of a
and emphasizes lasting changes in envi- antidepressant. Elevate 10,000 lux light box on overcast days.
ronment and lifestyle. Brain change results your pulse between
not only from pharmaceutical chemicals, 120 to 160 beats per ■ Omega-3 fatty acids
but also from everything we do, think minute for 35 minutes Omega-3 intake (particularly the
and experience. three times a week. molecular form known as EPA) has

26 | KANSAS ALUMNI
ogy department at the University of
Colorado, says, “He’s going beyond the
current programs and there’s a huge
amount of data showing it could work.”
Although the two scientists did not col-
laborate on depression treatments based
in evolution, Craighead is eager to see
whether the treatment works. “He’s talk-
ing about a lifestyle change that could
treat acute attacks,” he says.
While still technically experimental,
TLC methods in private clinical settings
have produced encouraging results. But
before the world will know whether
Ilardi has found a better way, many more
trials must be held so statistical analysis
can quantify the results.
Meanwhile, Ilardi strives to keep
those missing evolutionary elements in
his life—to reach out to others just as he
did so many years ago, when he first
encountered people struggling with
mental illness. “I think it makes sense to
live in a way that integrates the best of
our genetic and our cultural evolutionary
heritage,” he says.
“What this means for me is I want
to have my iPod, I want to drive to and
from work, but I also want to invest in
relationships, because that’s what we’ve
been selected for … to spend our time
and energy on those connections with
others.”
Greene, g’04, is a free-lance
science and technology writer living
in Lawrence. She earned her master’s
degree in physics.

■ Ilardi builds rapport with students


been shown to relieve ■ Reduce negative thoughts in class and via a Web site where they
depression. Research rec- Loneliness can lead to a tendency to can post questions and comments.
ommends a daily dose of dwell on repetitive, negative thoughts. One student made a special request.
1,000 milligrams of EPA, Interact socially and learn to redirect
“She said I talk so fast it’s sometimes
typically in the form of attention to more engaging activities
hard to get everything down in the
highly concentrated fish oil. when alone.
notes and still track the lecture,”
■ Social interaction For more information or to participate Ilardi says. “She pleaded with me to
A social support net- in the study, contact Leslie Karwoski, substitute my typical caffeine-laced
work helps prevent depres- project coordinator, at 785-218-6336. beverages with water.”
sion when we suffer major losses in life.
Separation from friends and family is a
common trigger for depression.

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