Home » Depression is a Disease of Civilization by Stephen Ilardi (Transcript)

Depression is a Disease of Civilization by Stephen Ilardi (Transcript)

Stephen Ilardi

Full text of Dr. Stephen Ilardi, on: Depression is a Disease of Civilization at TEDxEmory conference.

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I believe depression is one of the most tragically misunderstood words in the entire English language and here’s the problem. Depression has two radically different meanings depending on the context. So in everyday conversation when people say they’re depressed, they use the word depression as a synonym for sadness. It’s the normal human reaction to the slings and arrows of outrageous fortune. In that sense, all of us know the pain of depression.

And yet in a clinical context, depression is shorthand for a devastating illness we refer to it technically as major depressive disorder. This is an illness which robs people of their restorative sleep, robs them of their energy, robs them of their focus, their concentration, their memory, their sex drive, their ability to experience the pleasures of life. For most individuals, it robs them of their ability to love and work and play. It may even rob them of their will to live. And I’ll tell you why.

Because we now know depression lights up the pain circuitry of the brain, to such an extent that most clinically depressed individuals, if you talk to them and they let their guard down, they will tell you as they’ve told me hundreds of times. It’s torment, it’s agony, it’s torture, and many begin to look to death as a welcome means of escape.

Depression is the main driver behind suicide which now claims over one million lives every year worldwide. Now I know what you’re probably thinking at this point. Man, this talk is going to be really depressing. So I am going to give you a friendly little spoiler alert. It’s not. It’s truly not.

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Depression – yes, it is a treacherous foe. But what I found in my 20 years of clinical research and clinical work is this is a foe that can be defeated. That’s the good news, and that’s the news that I am going to focus on for most of the talk tonight.

First, a little more bad news. Depression is now a global epidemic. In fact, if we look in the U.S. we now find that nearly one in four Americans will experience that agonizing debilitating pain of depressive illness by the time they reach age 75. And it gets worse. The rate of depression seems to be increasing generation after generation. So every successive birth cohort is having higher rates of depression than the one that preceded it.

Now I want you to look at these lines. We’ve got four different generations on this graph. The green line on the right, that’s the oldest Americans and by the time they’ve made it out into their 60s and 70s they have a lifetime rate of depression of 10%. That’s horrible but it’s much lower than every succeeding generation.

Now take a look at the line that really upsets me the most is the one on the far left: that’s our youngest American adults. Do you see what’s happened? By the time they are in their mid-20s they already have a rate of depression up 25%. Remember, we’re talking about a potentially lethal debilitating illness. Left unchecked, it’s an illness that can cause brain damage. And if we extrapolate that line, by the time they reach middle-age, their lifetime rate of depression will already be over 50%.

So what in the world is going on? What’s driving the epidemic? What can we do about it? What causes depression?

Well, on one level when we ask this question, we’re going to face the answer – it’s really complicated. There have been literally thousands upon thousands of published studies that have identified a dizzying array of factors that are implicated in the onset of depression: biological, psychological, cultural, social, behavioural but if we wade through this complexity what we begin to find is there’s a common underlying pathway, a primary driver, a primary trigger, I call it, the brain’s runaway stress response.

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Now we all know the stress response. We think of it probably as the fight-or-flight response in its most extreme form. I want you to think about that response and especially how it was evolved and adapted to serve us.

The fight-or-flight response was designed primarily to aid our ancestors when they faced predators, other physical dangers, that required what? Intense physical activity that would go on for a few seconds, for a few minutes, maybe in extreme cases for a few hours. It’s a very costly response but fine if it shut off when it’s supposed to.

Here is the problem. For many Americans, Europeans and people throughout the Western world, the stress response goes on for weeks and months and even years at a time and when it does that, it’s incredibly toxic to the body and to the brain. It’s disruptive to neural circuits in the brain that use neurochemicals you’ve heard of, like dopamine and serotonin, acetylcholine, glutamate and this destruction can lead directly to depressive illness.

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