IRA FLATOW, HOST:
About one in 10 Americans over the age of 12 takes an antidepressant drug, according to a report from the CDC, and the number of Americans taking antidepressants has gone up over 400 percent since 1988. Why the rise? Are we more depressed than we used to be, simply more medicated or both?
That's one of the questions my next guest, Dr. Andrew Weil, addresses in his new book "Spontaneous Happiness," and instead of taking medications to treat mild or moderate depression, Dr. Weil recommends a few alternatives, like meditation, daily exercise and what he calls anti-inflammatory diet.
What is the evidence that these treatments can actually be - put you in a brighter mood? That's what we'll be talking about. Dr. Weil is going to be joining us. Our number is 1-800-989-8255, 1-800-989-TALK. You can tweet us @scifri, @-S-C-I-F-R-I, or join us on Facebook.
Dr. Weil is here, author of "Spontaneous Happiness." Welcome back to the program.
DR. ANDREW WEIL: Thank you, Ira.
FLATOW: It's been a while. And are you spontaneously happy?
WEIL: I became happier as a result of writing the book, and I hope people will as a result of reading it.
FLATOW: And what does that mean, spontaneous happiness?
WEIL: You know, I think happiness is something that you can open yourself to. You can arrange circumstances so you're more likely to experience it spontaneously, and in using that word, I'm suggesting that it's something really that comes from inside.
Most people, in my experience, seem to think that they'll be happy if they get something they now don't have. And the root meaning of happiness, this is interesting, it comes from an old Norse root that means luck or fortune. So I think many people imagine that positive moods depend on external circumstances, and that's not a good place to have it linked to.
FLATOW: You write in your book that the notion that a human being should be constantly happy is a uniquely modern, uniquely American, uniquely destructive idea.
WEIL: And nowhere is this more evident than as the holiday season approaches. You know, my sense is that in the Northern Hemisphere, the time of the winter solstice is a time of danger. Light and warmth are at their lowest. The period of bad weather is yet to come. I think the natural tendency is to huddle together, feast, tell stories, wait it out.
It's certainly not to be happy all the time, and the disconnect between that cultural expectation and our individual experiences nowhere more apparent. But I think this extends throughout the year.
Many parents think that it's their job to make kids happy all the time. We're not supposed to be happy all the time. Our moods are supposed to vary. They're not supposed to vary so extremely that they disable us, but I think it is perfectly normal to have lows, as well as highs, and there may be even some value in those experiences.
FLATOW: All right, we'll be back to talking more with Dr. Andrew Weil, author of "Spontaneous Happiness." You can join in the discussion, make yourself happy, 1-800-989-8255. Also tweet us @scifri, @-S-C-I-F-R-I. So stay with us. We'll be right back after this break.
(SOUNDBITE OF MUSIC)
FLATOW: You're listening to SCIENCE FRIDAY. I'm Ira Flatow. We're talking about spontaneous happiness with the author of a book by that name, Dr. Weil is here with us. Andrew Weil is also director of the Arizona Center for Integrative Medicine, professor of medicine and public health at the University of Arizona in Tucson. And he's actually at our member station there, KUAZ in Tucson.
Our number, 1-800-989-8255. And when we broke for the break, Dr. Weil, you were talking about the notion that people think they have to be happy all the time, and that's not a good notion.
WEIL: No, I think a much better goal to strive for is to be content. Contentment is something that comes from within and is relatively independent of external circumstances. One of the research findings that's - I think, find very interesting is that the more people have, the less content they seem to be.
There is a clear correlation of depression with affluence, and we're seeing an unprecedented epidemic of depression, in our country especially but in the developed world generally. Some of this is manufactured by the medical pharmaceutical complex. The pharmaceutical companies have been very effective at convincing people that ordinary states of sadness are now matters of imbalanced brain chemistry which needs to be treated.
I think that's spurious, and I don't know how much that is. Maybe it's a quarter of it; maybe it's a third of it. If you remove that, we're still left with a great deal of depression to explain.
FLATOW: And what does it have to do with the state of our society these days? I know you've written in this book and in other books that if you want to really achieve some kind of peace and some sort of feeling of well-being, you have to shut off your TV, stop reading magazines, newspapers, things like that. We...
WEIL: Well, you know, another - yeah.
FLATOW: I'm just saying we're bombarded more now than when you wrote your last books about this stuff.
WEIL: True, and I think it has everything to do with modern life. I think in essence the depression epidemic represents a mismatch between our genes - the kind of life our genes have prepared us for and the kind of life most of us actually live. One clue is that major depression is virtually unknown in hunter-gatherer societies. You can't find a case of it in Papua New Guinea.
So what's different there? Well, everything. You know, people in those cultures are living close to nature. They enjoy strong tribal and community support. They're eating natural diets, not industrial food. They're getting plenty of physical activity.
So everything has changed, and I think that if you want to attend to emotional well-being, you really have to look at all of the influences on physical health and emotional health, both in the physical realm, mental realm and spiritual realm.
FLATOW: Could not Facebook and Twitter, though, could you not argue that it's creating more of a sense of community?
WEIL: I think it's a false sense, frankly. You know, the research is so strong, showing that interpersonal connection is protective against depression and protective of emotional wellness. And I think that more and more of us substitute virtual interaction for real interaction.
Also, a great deal of what we see as the advancements of technology in modern life make it easier for us to live in isolated cocoons. We think that we live very comfortably, but in fact I think this is at the expense of a kind of social support that people in other cultures and people earlier in this culture enjoyed.
FLATOW: 1-800-989-8255 is our number, talking with Dr. Andrew Weil, author of the new book "Spontaneous Happiness." Tell us how we might overcome - you give us some recommendations. What would be the top few recommendations?
WEIL: First of all, we have - on the physical level, the strongest evidence we have is for exercise and for supplemental fish oil. Both of these interventions work as well as antidepressant medication for mild to moderate depression. I think they're even very helpful as adjunctive measures for severe depression.
So I think this the first thing, very important...
FLATOW: What is in the fish oil?
WEIL: These long-chain omega-3 fatty acids have a great influence on brain function. One of them, DHA, is the major constituent of cell membranes, of neuronal membranes. And if that's deficient in the diet, as it is generally in the North American diet, brain health suffers.
So we have very strong evidence here for the - not only the antidepressant effects but I'd say generally the brain protective effects of supplementing the diet with omega-3s. I recommend that everybody take two to four grams of supplemental fish oil a day, whether or not you eat fish. There's really no upper limit: The more you take, the better.
FLATOW: But aren't fish farms now feeding their fish stuff that doesn't have the omega-3s in it?
WEIL: The - most of the high-quality fish oil products are molecularly distilled, and they're therefore free of contaminants like mercury and PCBs and other things we have to worry about.
FLATOW: You say in your book that, well - what you just said, that people would be beneficial from taking fish oil. And a lot of these are in cold-water fish. And I keep wondering where in our evolutionary process we were around all these cold-water fish. We weren't, you know.
WEIL: No, but there were several things going for us. The first is that the animals that we ate until recently grazed on grass. And grasses have low levels of omega-3s in them. Animals eat great, tremendous quantities of them. So they concentrate omega-3s in their fat.
Now the animals we eat are fattened on grains, which are sources of omega-6 fatty acids that have opposite effects. Now, it's not that omega-6s are bad, we need both of these classes of essential fats in the right proportion, but we're getting a tremendous overload of omega-6s today, mostly from refined vegetable oils.
And this is heavily present in industrial food. The more omega-6s you consume, the more omega-3s you need to consume in order to get tissue levels up to where they need to be. So I think the main things are that our omega-3 sources have been reduced, and our omega-6 intake has greatly increased, and this puts us at a great disadvantage biochemically.
FLATOW: 1-800-989-8255. Cathy(ph) in San Antonio, Texas. Hi, welcome.
CATHY: Hi there.
FLATOW: Hi there.
CATHY: What a wonderful, wonderful conversation. Happiness, I think if we all were just happy all the time, what a great world we would live in. And it is available to us, as I know Dr. Andrew Weil knows, all the time. But he made a comment earlier about that he didn't think that we should be happy all the time.
And I don't want to disagree with that, but I'm a yoga instructor, and I, you know, practice yoga every day, and I just know that I tell my students happiness is a choice. In every situation that you're in, you know, there's options. And you can either choose to be happy, or you can choose, especially if the situation is tough to deal with, you can choose to let that drag you down.
And one of the things that I tell my students all the time, because they're always asking me how do I change this, how do I change this, and all of us deal with traffic, for example, and this is my best analogy. I tell them if you're in a traffic jam, in general, people start fussing and fussing and being irrational - not irrational but impatient.
And I say it's the easiest thing to change in the world. Flip that switch and be grateful you have a car.
WEIL: I couldn't agree more in principle, and in fact, that principle is the essence of positive psychology. That field, which I strongly support, actually derives from ancient philosophy. It goes back to the Stoics in Greece and Epictetus, who taught in Rome. And the basic message there is that we can't change what happens to us, but we can change our reaction to it.
And I think you're quite right that this is a choice, but it's not necessarily so easy. It takes practice to do that. I have a friend who - a colleague of mine who's an integrative oncologist, who describes his mother as someone who not only sees the glass as half-empty but thinks that at any moment, it could tip over, spill and break on the floor.
(SOUNDBITE OF LAUGHTER)
WEIL: So I think we do have this kind of choice, but I think it takes some practice to retrain the mind that way, and that's, you know, one of the other measures I recommend.
FLATOW: Thank you, Cathy. 1-800-989-8255. What other suggestions, Dr. Weil?
WEIL: Well, you know, first of all let me say something about medication. There is a disturbing and growing body of evidence that the major class of antidepressant drugs, the SSRIs, the selective serotonin reuptake inhibitors, don't work so great, in fact that they barely can be distinguished from placebo even in severe depression now, and it may only be in very severe depression that they show an advantage.
There is also, I think, great concern about a new problem just coming to light. It's called tardive dysphoria. That means lingering depression caused by the drugs. You know, we were always taught that depression, however severe it is, is self-limited, that it resolves itself.
Well, it doesn't anymore, and one reason why it may not is because the drugs produce the very problem they're meant to treat, and this is so logical. It's similar to what you discussed earlier about antibiotics and germ resistance, and when you push on the body with an outside force, it pushes back. This is called homeostatis, a basic truth of physiology.
If you increase serotonin at neural junctions with a drug, the body responds over time by producing less serotonin and dropping serotonin receptors. And therefore, it gets you into a worse situation. It's just like trying to treat acid reflux with drugs that suppress acid: You take it away, and you have a worse problem than you did to begin with.
So the drugs may create their own need. I'm not going to tell people to get off them or not use them, and I certainly would never tell anyone with bipolar disorder to stop taking medication or people with major depression, but I think if you've been on these drugs for a year, it's worth finding a practitioner who can help give you a schedule to wean yourself off while using the other measures that I recommend.
And if you have mild to moderate depression, I would really urge you to find out about the other things you can do first before you try medication, and that not only includes the things we've discussed. It may include getting your vitamin D levels checked because there's a clear correlation with low vitamin D and poor emotional health. I think it means working in retraining the mind, and that may be going to practitioners of cognitive behavioral therapy, which can help you learn to make those choices that the caller referred to.
And I think there are things you can do - I have called it secular spirituality in the book, meaning it has no reference to the supernatural or to a deity. I was very surprised in writing this to discover how much scientific evidence we have for the power of gratitude to improve mood. There's two aspects to this. It's feeling grateful and expressing it. And the good thing here, there's nothing in the way of doing it. All you have to do is remember to do it. You know, forgiveness also has great power, but that's tricky. There's a whole lot in the way of being forgiving.
But there's nothing in the way of expressing gratitude. There's a simple exercise from positive psychology called keeping a gratitude journal. You get a little notebook, keep it by your bed; during the day, make mental notes of things you have to be grateful for, jot them down when you go to bed. Doing that for one week can cause improvement of mood for up to six months. And that's pretty dramatic.
FLATOW: Is there really research on that?
WEIL: There is really research on that.
FLATOW: Simple stuff.
WEIL: So simple.
(SOUNDBITE OF LAUGHTER)
FLATOW: 1-800-989-8255 is our number. Let's go to the phones and get some more tips. Edith in Fort Wayne, Indiana. Hi, Edith.
FLATOW: Hi there.
EDITH: My question is this. I have several people in my life who are suffering from mild to moderate depression, and I wondered if Dr. Weil has any strategies for how I can help them without getting - without putting myself at risk, without getting myself caught up in the cycle of depression and (unintelligible)?
WEIL: Well, without being...
(SOUNDBITE OF LAUGHTER)
WEIL: Without being too self-promotional, I would suggest you give them this book because it has a program in it, a step-by-step, week-by-week program for doing just that. And, you know, people can follow this at their own rate. All these suggestions that I give are backed by very good scientific evidence, and I think people will find this very helpful.
FLATOW: All right. Good...
FLATOW: Good luck to you, Edith. 1-800-989-8255 is our number. Let's go to Caroline(ph) in Greenwich, Connecticut. Hi there.
CAROLINE: Oh, hi. This is a wonderful topic. I didn't tell the screener that my niece, who is a freshman in college, was given antidepressants and committed suicide shortly thereafter.
FLATOW: Sorry to hear that.
WEIL: Oh, I'm sorry.
CAROLINE: It had the reverse effect. But I was just telling him that there is an off-label use for antidepressants which may explain a lot of the uptick in sales because it really does affect and help with hot flashes, which, you know, us baby boomers...
(SOUNDBITE OF LAUGHTER)
CAROLINE: ...are now getting them, and it cuts down the time and the temperature by, oh, a good 90 percent.
CAROLINE: It's amazing.
FLATOW: Do you know people taking them?
CAROLINE: Yeah. I did. I did for 10 years. I have lots of friends who do it.
WEIL: Well, I'm a little concerned about that because these drugs also...
CAROLINE: It's a (unintelligible).
WEIL: ...are not benign.
WEIL: They're not benign. No, there are some significant adverse effects of antidepressant drugs. They may increase cardiovascular risk. They may increase cancer risk. A latest finding - although this doesn't apply to hot flashes - is that pregnant women who take them, there are higher rates of autism in their offspring. You know, so these are not benign agents. And in general, I would recommend looking for safer ways of managing hot flashes.
FLATOW: 1-800-989-8255. We're talking with Dr. Andrew Weil on SCIENCE FRIDAY from NPR. I'm Ira Flatow. What other messages are in your book? What other kinds of techniques can you use - breathing, meditation?
WEIL: You know, yes. I think that there is a tremendous amount of research that's been done, and this derives from Eastern psychology, that learning to focus the mind, to concentrate attention in the present moment is very beneficial, that the more the mind wanders into the past and future, the more attention is fragmented, the more vulnerable we are to poor emotional health. This is, by the way, I think one of the problems of information overload today and all the new media. They encourage multitasking, and there's very clear research that the brain really can't do more than one thing at a time.
All it can do is rapidly switch back and forth. You can get good at that, but I think this leaves you very vulnerable. So learning to, you know, whether it's simply sitting down and focusing on breathing, trying to bring full attention to every act that you're doing - the eating, so forth. This is a very useful practice.
FLATOW: Would you say that this is - that you've written about so many of these things over the years, did you have something new, an epiphany, or you're just basically summarizing what you've learned over the years?
WEIL: Well, I think there's a lot of new information here about, first of all, the limitations of the biomedical model in the mental health field, how much all these other options have been ignored. One of the things that was new for me in researching the book is the connection between inflammation and depression. And if I can tell this story, I found it very interesting. Farmers have long known that when domestic animals become sick usually with infectious illnesses, they show a characteristic pattern of behavioral changes, and these are called sickness behavior.
They include immobility, loss of appetite, loss of interest in socializing with others of their kind, loss of interest in sex, changes that are strikingly similar to the changes that human beings show who have major depression. It was - farmers assumed that this was due to fatigue caused by illness. But in the 1950s, it was found that sickness behavior is mediated by a blood-borne factor. You can take blood from an animal with this behavior, inject it into a healthy animal, and that animal shows the same behavior. Nobody knew what it was. It was called factor X for 20 years.
And then in the 1970s, it was identified as cytokines, a group of regulatory proteins used by the immune system to regulate inflammation. In - some of these cytokines later become - became purified and available for medical use, like interferon for the treatment of chronic hepatitis and interleukin-2. When these are administered to people for medical treatments, the most severe side effect is extreme depression and suicide. And this is on the label warnings of the package.
So this has led to the cytokine hypothesis of depression, which I find very compelling. And it is that there is a link between up-regulated inflammation and cytokines and depression. In animals who are sick, this is an adaptive response that the cytokines affect the brain, cause behavioral changes that probably favor healing. It makes more energy available to the immune system. But I think this is a really interesting connection, opens new avenues for both preventing and treating depression by following an anti-inflammatory lifestyle.
FLATOW: All right. We'll come back, take a break. We'll talk more with Dr. Andrew Weil, author of "Spontaneous Happiness." Our number, 1-800-989-8255. You can tweet us, @scifri. Stay with us. We'll be right back.
(SOUNDBITE OF MUSIC)
FLATOW: I'm Ira Flatow. This is SCIENCE FRIDAY from NPR.
This is SCIENCE FRIDAY. I'm Ira Flatow, talking with Dr. Andrew Weil, author of "Spontaneous Happiness." Our number is 1-800-989-8255. There a lot of folks - when we posted this on our Facebook page, a lot of folks who said that what you do - integrative medicine, alternative treatments - they're not science. There's no scientific basis in any of this. How do you respond to that?
WEIL: Well, I think they're uninformed. And, you know, the Arizona Center for Integrative Medicine has trained now almost 1,000 physicians from all specialties very intensively in an evidence-based curriculum in integrative medicine. Many of these people are out there practicing, teaching others, working at academic health centers. A group called the Consortium of Academic Health Centers for Integrative Medicine now includes, I think, more than a third of the nation's medical schools. This is involvement at the level of deans and chancellors.
Oxford University Press is publishing a series of volumes for clinicians in integrative medicine. I'm the general editor of that series. We've had volumes come out so far in integrative oncology, cardiology, pediatrics, psychiatry, women's health. This is a very robust field. We're currently working to establish a board certification as a specialty in integrative medicine. I think this is the future. It's not only medicine that makes economic sense. It's what people want.
And the focus on alternative therapies is really, I think, a distraction. You know, there's a lot more important aspects to integrative medicine, such as really emphasizing the body's own innate capacities for healing and for maintaining health. And I would just say that, you know, everything that we teach and everything that we practice is backed by scientific evidence, and we also encourage research to gather more evidence. And with - specifically as regards the recommendations in "Spontaneous Happiness," the book is very well-referenced, and you'll find, you know, scientific backing for all of the things that I suggest that people try.
FLATOW: Well, are we going to see someday our in-network doctor be an integrative medicine doctor?
(SOUNDBITE OF LAUGHTER)
WEIL: You know, I - yes, absolutely. I think in fact, one day, we'll drop the word integrative, and this will just be good medicine. It's what medicine has been in the past when it's worked well; I think it's what it can be in the future.
FLATOW: Let me go back - we only have a couple of minutes, but you touched on a very interesting topic that we've been talking about for years from a traditional medicine side, and you're now bringing it from another side. And that is the role of inflammation in disease.
WEIL: Now, for years, I've been recommending an anti-inflammatory diet as the best strategy for optimizing health, extending longevity, reducing overall risks of disease, and I have devised an anti-inflammatory diet. You can find this in the book or in my website, DrWeil.com. It's a version of the Mediterranean diet, for which we have great evidence of general health benefits. I've tweaked it to make it even more effective. But the theory here is that all of the major chronic diseases - cardiovascular disease, cancer, neurodegenerative disease - begin as inflammatory processes.
And I think most people in our culture go through life in pro-inflammatory states. Many reasons for that - genetics, stress, exposure to environmental toxins. Diet plays a huge role. The mainstream diet, which is heavy in industrialized food-like stuff, is strongly pro-inflammatory. It gives us all the wrong things, the wrong fats, the wrong kinds of carbohydrate and it's deficient in all that can protect us from the damage from inflammation. And now, there is this new connection that our emotional health may also be tied here. So that following an anti-inflammatory diet and lifestyle may offer great protection as well as a new treatment strategy for managing depression.
FLATOW: And you say in your book that you lay out a diet and an exercise regimen and an integrative approach.
WEIL: I do. And, Ira, the simplest step, the first step of an anti-inflammatory diet is simply to avoid eating refined, processed and manufactured food because that's...
FLATOW: You sound like Michael Pollan now.
(SOUNDBITE OF LAUGHTER)
WEIL: Well, we're good friends, and we're pretty much on the same wavelength.
FLATOW: All right. The book is called "Spontaneous Happiness." There used to be "Spontaneous Healing." All kinds of great books...
(SOUNDBITE OF LAUGHTER)
FLATOW: Andrew Weil has put together "Spontaneous Happiness." Thank you very much, Dr. Weil, for coming on the program and talking with us today.
WEIL: I enjoy talking with you.
FLATOW: Good luck to you.
WEIL: Thanks. Transcript provided by NPR, Copyright NPR.