The Noonday Demon (25 page)

I
f many remedies are prescribed for an illness,” Anton Chekhov once wrote, “you may be certain that the illness has no cure.” Many remedies are prescribed for depression—in addition to the standard measures, a stupefying number of alternatives. Some of these are wonderful and may be extremely helpful, most of them selectively. Others are perfectly ludicrous: the emperor has a whole new wardrobe in this business. Anecdotal marvels are everywhere, and people relate them with the ecstasy of the newly converted. Few of these alternative treatments are acutely harmful, except perhaps to the pocketbook; the only real danger comes when fairy-tale remedies are used in place of effective ones. The sheer quantity of alternative therapies reflects a persistent optimism in the face of the intractable problem of emotional pain.

In the wake of prior publications on depression, I have received hundreds of letters from people in nine different countries and most of the fifty states who, touchingly, have wanted to let me know about alternative treatments. One woman from Michigan wrote that after years of trying every medication, she had finally found the true solution, which was “doing things with yarn.” When I wrote back to ask her what she did with yarn, she sent me a remarkable photograph of some eighty identical little bears she had made in rainbow colors and a self-published book about really, really easy weaving. A woman in Montana complained, “You might want to know that all the effects you describe come from chronic poisoning. Look around you. Did you have your house insecticided, your lawn herbicided? Are you living with particleboard subflooring? Until writers such as William Styron and yourself examine their surroundings for such exposures, and remove them, I have no patience with you and your depression narratives.” I would not presume to speak on behalf of William Styron, whose floors may well be leaching Agent Orange, but I can say quite safely that my house, whose innards have
been revealed to me during a decade of plumbing and wiring disasters, has only wood floors on a wood frame. Another of my readers thought I had mercury poisoning from the fillings in my teeth (but I don’t have any fillings in my teeth). Someone wrote me an anonymous letter from Albuquerque saying that I had low blood sugar. Someone else volunteered to help me find a teacher if I wanted to try tap-dancing lessons. Someone in Massachusetts wanted to tell me all about biofeedback. A man in Munich asked whether I would like him to replace my RNA, an offer that I politely declined. My favorite came from a woman in Tucson who wrote simply, “Did you ever consider leaving Manhattan?”

My own (and William Styron’s) situation notwithstanding, the effects of formaldehyde poisoning can in fact be similar to the symptoms of depressive illness. So too can the neurotoxicity of mercury poisoning from amalgam fillings in teeth. Low blood sugar is linked to depressed mood. I cannot testify to the therapeutic potential of tap-dancing lessons, but physical activity of any disciplined kind can be a mood elevator. Even the repeated soothing manual occupation of making things from yarn can probably serve a useful purpose under the right circumstances. Leaving Manhattan would most assuredly lower my stress level. My experience is that no one, no matter how lunatic he may seem at first glance, is completely off base. Many people achieve astonishingly good results with batty-sounding projects. Seth Roberts, in the psychology department at the University of California at Berkeley, has a theory that some depression is tied to waking up alone, and that the experience of having a talking head to look at for an hour as you begin the day may help. His patients have videotapes of the kind of talk shows that use a single camera so that the head on the screen stays about life-size. They watch these for the first hour of their day, and a convincing number of them feel miraculously much better. “I never knew that the TV could be my best friend,” one of his patients said to me. The mitigation of loneliness, even in this hokey form, can have a most uplifting effect.

I had a blessed series of encounters with a man I took to calling “the incompetent mystic.” The incompetent mystic wrote me about the energy therapies he practices, and after some considerable correspondence, I invited him to my house to demonstrate his work. He was extremely pleasant and clearly full of good intentions, and after a few minutes of discussion we set to work. He had me hold together the thumb and middle finger of my left hand to make an
O
and then make a similar
O
with my right hand. Then he had me link the two
O
s together. He then asked me to recite a number of sentences, claiming that when I spoke the truth, my fingers would hold firm against his attempts to pull them apart, but that when I lied, my fingers would grow weak. My gentle readers
may perhaps imagine the self-consciousness I felt sitting in my own living room saying “I hate myself” while an earnest man in a light blue suit pulled at my hands. To describe the procedures that followed on this set of exercises would take pages and pages, but the high point came when he began a chant over me and forgot halfway through what it was he was supposed to be chanting. “Hold it for just a second,” he said, and searched through his briefcase until he found, “You want to be happy. You will be happy.” I decided that anyone who could not remember those two sentences was a big booby, and with some effort I got the incompetent mystic back out of my house. I have since been told by patients of their better experiences with energy therapy, and I must accept that some do reverse their “body polarity” and arrive at blissful self-love through the inspired practice of such methodologies. I, however, remain very much a skeptic—though I cannot doubt that some quacks are more gifted in their presentation than was mine.

Since depression is a cyclical illness that will go into temporary remission without any treatment, one might credit any sustained useless or useful activity with its eventual amelioration. It is my absolute belief that in the field of depression, there is no such thing as a placebo. If you have cancer and try an exotic treatment and then you think you are better, you may well be wrong. If you have depression and try an exotic treatment and think you are better, then you are better. Depression is a disease of thought processes and emotions, and if something changes your thought processes and emotions in the correct direction, that qualifies as a recovery. Frankly, I think that the best treatment for depression is belief, which is in itself far more essential than what you believe in. If you really truly believe that you can relieve your depression by standing on your head and spitting nickels for an hour every afternoon, it is likely that this incommodious activity will do you tremendous good.

Exercise and diet play an important role in the progress of affective illness, and I believe that some considerable control can be achieved through good regimes of fitness and nutrition. Among the more serious alternative treatments I count repeated transcranial magnetic stimulation (rTMS); the use of light boxes for people with seasonal affective disorder (SAD); eye movement desensitization and reprocessing (EMDR) therapy; massage treatments; survival courses; hypnosis; sleep deprivation therapy; the plant Saint-John’s-wort; S-adenosylmethionine or SAMe; homeopathy; Chinese herbal medicine; group therapies; support groups; and psychosurgery. Only an infinite book could discuss every treatment that has ever given a reasonable result.

“Exercise is the first step for all my patients,” Richard A. Friedman of
Payne-Whitney says. “It boosts everyone.” I hate exercise, but as soon as I can drag myself out of bed, I do some calisthenics; or if I can manage it, I go to a gym. When I was emerging from depression, it didn’t really matter what I did; StairMasters and treadmills were the easiest. It felt as though the exercise helped to clear the depression out of my blood, as though it helped me to get cleaner. “It’s a very clear matter,” says James Watson, president of Cold Spring Harbor Laboratory and one of the discoverers of DNA. “Exercise produces endorphins. Endorphins are endogenous morphine, and they make you feel great if you’re feeling normal. They make you feel better if you’re feeling awful. You have to get those endorphins up and running—after all, they’re upstream of the neurotransmitters too, and so exercise is going to work to raise your neurotransmitter levels.” Further, depression makes your body heavy and sluggish; and being heavy and sluggish exacerbates depression. If you keep making your body function, as much as you can, your mind will follow suit. A really serious workout is just about the most disgusting idea I can imagine when I’m depressed, and it’s no fun doing it, but afterward I always feel a thousand times better. Exercise allays anxiety too: nervous energy gets used up by sit-ups, and this helps to contain irrational fear.

You are what you eat; you feel what you are. You cannot cause a depression to remit simply by choosing the right foods; but you can certainly bring on a depression by failing to eat the right foods, and you can to some extent protect against recurrence through careful monitoring of diet. Sugar and carbohydrates appear to raise the absorption of tryptophan in the brain, which in turn raises serotonin levels. Vitamin B
₆
, which is found in whole grains and shellfish, is important to serotonin synthesis; low levels of B
₆
may precipitate a depression. Low cholesterol has been linked to depressive symptoms. The studies aren’t in, but a good diet of lobster and chocolate mousse may do much toward improving one’s state of mind. “The twentieth century’s emphasis on a physically healthy diet,” says Watson, “has probably given us a psychologically unhealthy one.” Dopamine synthesis also relies on B vitamins, especially B
₁₂
(found in fish and dairy products) and folic acid (found in calf’s liver and broccoli), and also on magnesium (found in cod, mackerel, and wheat germ). Depressed people often have low levels of zinc (which occurs in oysters, endive, asparagus, turkey, and radishes), vitamin B
₃
(found in eggs, brewer’s yeast, and poultry), and chromium; and these three have been used to treat depression. Low levels of zinc have been especially strongly associated with postpartum depression, since all reserves of zinc pass from the expectant mother to the baby at the very end of pregnancy. Increasing intake of zinc can elevate mood. One theory in circulation is that people in the Mediterranean have less depression
because of the amount of fish oil—rich in B vitamins—they consume, which raises their level of omega-3 fatty acids. The evidence for beneficial mood effect from omega-3 fatty acids is the strongest of all.

While these foodstuffs may be effective in preventing depression, other foodstuffs may cause depression. “Many Europeans have wheat allergies, and many Americans have corn allergies,” Vicki Edgson, author of
The Food Doctor,
explains. Food allergies can also trigger depression. “These common substances become brain toxins which precipitate all kinds of mental distress.” Many people develop depressive symptoms as part of a syndrome of adrenal exhaustion, a consequence of excessive indulgence in sugars and carbohydrates. “If you’ve got a constantly fluctuating blood sugar level, with highs and lows throughout the day, quick fixes from sweets and junk food, this will cause sleep problems. It will limit not only the ability to cope throughout the day, but also patience and tolerance with other people. People with this syndrome are tired all the time; they lose their sex drive; they ache all over. The stress on their systems is ruinous.” Some people develop celiac disease, which causes a general failure to thrive. “People who are depressed fool themselves into thinking that coffee is the one thing that provides energy,” Edgson says, “but in fact it leaches energy and stimulates anxiety responses.” Alcohol also, of course, takes a substantial toll on the body. “Sometimes,” Edgson says, “the depression is your body’s way of telling you to stop abusing it; it’s evidence of how things are falling apart.”

Robert Post at the NIMH has been working on repeated transcranial magnetic stimulation (rTMS), which uses magnetism to create metabolic stimulation much like that caused in ECT, but at lower levels. Modern technology allows magnetism to be focused and concentrated to provide intense stimulus to specific areas of the brain. While electric current has to be turned up quite high to get through the skull and scalp to the brain, magnetic fluxes travel through easily. So ECT causes a brain seizure, and rTMS doesn’t. Post proposes that with the advance of neuro-imaging, it may ultimately be possible to pinpoint the areas of the brain that are depressed and to aim magnetic stimulations at those areas, customizing treatment to correspond to the specific form of illness. Also, rTMS offers the possibility of enormous specificity; the magnetic stimulation can be focused with precision. “Sometime,” says Post, “we may use technology to put a hood, like an old-fashioned hairdryer, over your head. It would scan your brain and pick up the areas of depressed metabolism, and it would then focus stimulation on those areas. Half an hour later, you would leave with your brain rebalanced.”

Norman Rosenthal discovered seasonal affective disorder (SAD) when he moved from South Africa to the United States and began getting rounds of the winter blues. Many people have seasonal changes of mood and develop recurrent winter depression; the changes of season—what one patient called “the crossfire between summer and winter”—are a difficult time for everyone. SAD is different from just not liking cold days. Rosenthal argues that human beings were made to respond to seasonal variation, which artificial light and the artificial constraints of modern life do not allow. When the days get shorter, many people go into withdrawal, and “asking them to perform in the face of their own biological shutdown is a formula for depression. How would a hibernating bear feel if you wanted it to enter the circus and stand up on its hind legs and dance all winter long?” Experiments have shown that SAD is affected by light, which influences the secretion of melatonin and so affects neurotransmitter systems. Light stimulates the hypothalamus, where many of the systems—sleeping, eating, temperature, sex drive—that depression deregulates are based. Light also influences serotonin synthesis in the retina. A sunny day offers about three hundred times as much light as the average household interior. The therapy generally prescribed for SAD sufferers is the use of a light box, which casts terrifyingly bright light at you. I find that light boxes make me a bit dizzy, and I feel as though they challenge my eyes, but I know people who love them. Some actually wear light visors, or head-mounted light boxes. A bright box, which is very much brighter than regular indoor lighting, has been shown to raise brain serotonin levels. “You see the SAD people beginning to go in the autumn,” says Rosenthal. “It’s like watching the leaves fall off the trees. And then we started treating them with intense light exposure, and it’s like seeing the tulips come up.”