Simply Happy

maybe we've been wrong about depression. maybe it's not simply a biochemical malfunction best corrected by a prozac prescription or a psychological malady requiring soul-baring confessions to a therapist. maybe, says stephen s. ilardi, associate professor of clinical psychology at the university of kansas, what's darkening our lives is the way we actually live.

"there's increasing evidence that we were never designed for our sedentary, socially isolated, indoor, sleep-deprived, poorly nourished lifestyle," says the bearded, wiry ilardi. "if throughout the course of human evolution people were as vulnerable to depressive illness as 21st-century americans, we would long since have gone extinct as a species."

since world war ii, as the united states has modernized and grown more urban, depression rates have risen tenfold. nearly a quarter of today's adult population will have experienced the disorder by age 75. to address this phenomenon, ilardi wants us to look back to our paleolithic past-to our cave-dwelling, hunter-gatherer ancestors, who he suggests were protected against depression by their highly social, active, outdoorsy lifestyle. "i'm not advocating a return to the stone age. i want to keep my ipod," ilardi says. "i just want us to have the best of both worlds-to not be ignorant of how our technology can sometimes be our own worst enemy." ilardi believes his new regimen, called therapeutic lifestyle change for depression (tlc), could revolutionize the treatment of mood disorders. his book, the depression cure: the 6-step program to beat depression without drugs (da capo lifelong books), published in june, argues that this behavior-oriented approach does more than just cure depression-it can also guard against it.

what makes this lifestyle regiment distinctive is both its live-like-a-caveman rationale and its packaging. the 14-week program pairs group therapy with a battery of already proven depression-fighting remedies: increased sleep, aerobic exercise, ingesting omega-3 fatty acids, bright-light exposure, social interaction and replacing rumination (dwelling on negative thoughts) with activity. the book gives specific instructions on how to implement these six measures, including optimal omega-3 and light dosages.

"don't think. do," is one of the program's mantras. ilardi's patients aren't just told to exercise at least three times a week; they receive an exercise consultant (an "ex con," ilardi jokes) and a free gym membership. social interaction is encouraged, and not just through group therapy: patients are encouraged to call friends and family members and arrange lunches or other get-togethers.

the early results are impressive, outpacing both conventional psychotherapy and antidepressant medication. eighty-two patients have completed the program, ilardi says, and 75.3 percent had a favorable response (at least a 50 percent reduction in initial depressive symptoms), compared with 22.7 percent in the control group, which received medication and/or traditional psychotherapy. lifestyle regimen patients frequently haven't been helped by other treatments, and ilardi cites studies showing that only about half of depressed patients typically respond to an antidepressant drug (slightly more than respond to a placebo). that makes his success rate all the more noteworthy.

one appreciative patient is zona olson. now in her late 50s, the aspiring entrepreneur from lawrence, kansas, laughs easily on the phone but says she was depressed on and off for years. the antidepressant medication she had been taking had unpleasant side effects, including a flattening of her mood that sheared off the highs as well as the lows. then the pills stopped working altogether.

olson began the lifestyle regiment in 2005. "it took me seven or eight sessions to really start responding," she says. patients react differently to the various steps, ilardi says, with exercise being "an especially potent curative because of its immediate effects on brain chemistry." for olson, however, avoiding rumination was the charm. she used to dwell on negative thoughts, which amplified her depression. now she short-circuits those thoughts with lifestyle regimen techniques. "i socialize," she says, "and i stop ruminating."

ilardi's passion for curing depression has personal roots: two family members suffered from the disease. and yet, as painful as that was to observe, he acknowledges that, "there's something about the pain of depression that you can only know from the inside.

"my students say, 'dr. ilardi-it's like you're on this crusade.' and i say, 'this is a lethal disorder. not only does it rob people of their ability to experience joy, rob them of their energy and sleep and concentration, their ability to love and work and play; it robs them of their lives-at least 20,000 americans a year.' and that's probably an underestimate-a lot of suicides go misreported."

ilardi was an economics and math major in college, but his life changed after he volunteered at the georgia mental health institute in atlanta, where he spent time with chronic schizophrenics. "it was this huge eye opener: 'oh my god, there's this whole world of individuals that i've always thought were beyond the realm of understanding, crazy, so other.' and i discovered that these are people like me, except they're tormented. and that sparked intense curiosity. what's causing this? what are the treatments, and how come they don't work well?"

important backing for this theory came from anthropologist edward schieffelin, who found that the kaluli people of papua new guinea-contemporary hunter-gatherers-were virtually depression-free. other studies suggested that less industrialized communities, such as the amish, also have much lower depression rates. "we've been engineering the activity out of our lives," ilardi says. "the levels of bright-light exposure-time spent outdoors-have been declining. the average adult gets just over six and a half hours of sleep a night. it used to be about nine hours a night. there's increasing isolation, fragmentation, the erosion of community."

the result? "we feel perpetually stressed. and the more we learn about depression neurologically, the more we learn that it represents the brain's runaway stress response."

though ilardi's results look promising, psychiatrist peter d. kramer, the best-selling author of listening to prozac (viking, 1993) and against depression (viking, 2005), warns that initial therapy studies often register good outcomes because of the enthusiasm of their creators. when neutral researchers study the same therapy, "the advantage disappears." and many lifestyle remedies, kramer says, are already part of the therapeutic arsenal: "many therapists working in the northern latitudes, for example, will say, 'add bright lights in winter, fish oil in your diet, exercise? let's see if we can get you in more supportive relationships.'"

ilardi agrees that independent verification of his results is critical. but he says therapists aren't routinely prescribing the lifestyle regimen's behavioral fixes. he also disputes the commonly held notion that depression is higher among older americans. "it just doesn't turn out to be true," ilardi says. "you find much higher rates of depression among people who are younger." according to one 2003 study, 25 percent of young adults had experienced depression by age 29. but for those age 60, the lifetime incidence of depression was less than 10 percent.

as for the lifestyle regimen, ilardi has ambitious plans to fine-tune his approach, including, offering individual therapy to selected patients and possibly adapting his approach to other clinical problems, such as bipolar disorder. interest in the program is growing, he says. numerous clinicians in the kansas city area and elsewhere have contacted him about integrating the regiment into their practice.

"what we're doing now is primitive compared with what i hope we'll be doing in five years," he says. "i'm not going to be satisfied till we get to a 100 percent response rate."

-- julia m. klein is a frequent contributor to aarp, the magazine where this article first appeared.