by Kristine Keller

These days, when a flame sputters and fades out, we’ve got an armful of friends ready to peel us off the floor with the margarita blender, limes and coconuts. You’ll do the proverbial dance around the blender while Jose Cuervo wafts through the air and spend the night yelling aspersions aimed at the opposite sex. Your army of comforting friends succors you with “you deserve better!” and “you do you tonight!” over the humming of the blender. You then delete said flame from your phone, take down the pictures of the two of you basking in La Esquina Park last summer and do your best to forget. But just when you think your heart can’t break into any more pieces, another memory seeps through and you grab your chest in disbelief that it’s happening again. Another perilous pang from the omnipotent organ that oxygenates us, protects us and makes us feel alive and in ruin at the same time.

For most of us, situations like this are fleeting. Most make a full recovery from those stumbles in the capricious dance of love and life, but for 5 percent of the population affected by a condition called limerence, heartbreak feels like an indefinite December night pierced by the strings of Joni Mitchell’s Blue album. Psychologists characterize this unique ailment as an involuntary and incessant state of compulsory and unrequited longing for another person. Usually both parties remain dejected for a period of time after a flame-out, but when one half of the couple moves on and the other remains in a state of constant longing and obsessive thoughts and feelings, limerence has the ability to take a serious toll on one’s already heavy heart.

During one’s initial descent into attraction, it’s healthy and quite fun to feel life’s natural euphoric high and the ascent of pleasure-activating hormones like dopamine and oxytocin. You’ll nod and smile while friends tell stories about their day, while the only thing you can think about is his mouth on yours or her bare back in your bed. You’ll shrug off the busy deadlines or running late to the subway only to find the doors shut in your face; these annoyances don’t matter when you’ve got someone waiting for you at the end of the day. Naturally, you want these honeymoon feelings to last forever, but for our productivity and sanity, we actually need these reward-seeking hormones to dissipate. And thankfully they do, after six to twenty-four months.

For those who suffer from limerence, however, these intense feelings never ebb. They say absence makes the heart grow fonder. But what these universal idioms surrounding love neglect to mention is what can happen when separation causes one’s heart to desire too much. Patients who suffer from limerence describe their thoughts and feelings as obsessive and compulsive; it shouldn’t come as much of a surprise, then, that one of the only medications to treat those suffering from limerence, Lexapro, is the same one used to treat obsessive-compulsive disorder. Lexapro, a type of antidepressant, thaws the part of the brain that is responsible for the obsessive thoughts. Patients report difficulty concentrating, constant rehearsal and replay of shared interactions, and loss of control over one’s actions.

Although research on this condition is nascent, medication and cognitive behavioral therapy are providing promising results. Leading experts on limerence suggest that patients don’t ever forget the breakup entirely, but that if taken care of properly, symptoms can decrease after a few years. But, future empirical research and brain-imaging techniques are currently under way to yield a more comprehensive understanding of this evolving condition. What we do know is that a bad breakup or unrequited love can trigger the onset and that it can happen to anyone—limerent individuals can be found in all age groups, both genders and the full range of socioeconomic classes. So, if all it takes is a chant to “put the lime in the coconut” to get you over your heartbreak hump, then you’ve found your silver lining, and it’s looking more like a bubbling gold on the rocks.

Kristine received her master’s in psychology from NYU. She currently works at Vanity Fair. E-mail her at StreetshrinkNYC@gmail.com for questions.

How Seasonal Affective Disorder could put a damper on the holiday spirit

Like the planets orbit the sun, our lives spin around the seasons. These subdivisions of the year do more than signal us when it’s time to whip out our Mackage coats and begin fireside chats with friends over which artist sings the best “Baby It’s Cold” rendition. They inform us that time is passing and events are moving forward, as is the natural order of things. As New Yorkers, we have an internal hourglass that marks the passing of time until the sand has run out, signaling our earmuffs and legwarmers that winter has arrived! Not one to be late to the party, winter arrives on cue and sashays down Sullivan Street in all her glory while dusting off her snowy skin and casting an opalescent sheen over downtown’s cobblestone streets and awnings.

The red cups brimming with spices and peppermint have returned to ye faithful Starbucks, Broadway has become the mecca for ambling tourists hiding behind maps in search of NYC tchotchkes, and Christmas-tree vendors pepper the once-subdued streets from Nolita to Soho. It’s hard to imagine a downtown without a winter, just as it would be impossible to imagine the harbor without the Statue of Liberty. But for some, winter doesn’t evoke the same jubilation, and getting through the season can feel like navigating a dark labyrinth of gloom and despair.

Those severely impacted by winter’s shorter days and long frigid nights might be at risk for Seasonal Affective Disorder (SAD). Recognized by the Diagnostic Statistical Manual of Mental Disorders 4th Edition (DSM-IV), SAD is described as a subtype of a major depressive episode. During winter’s reign, our brains produce increased levels of the sleep-inducing hormone melatonin. For those affected by SAD, one theory is that a biochemical imbalance of melatonin could lead to a shift in one’s internal hourglass, causing unhealthy behaviors that require medical intervention.

Typical symptoms of SAD include depressed mood, lethargy, lack of interest in activities, social withdrawal and a craving for sweets and carbohydrates. Those affected also spend inordinate amounts of time sleeping and have difficulty leaving their beds. As a result of weight gain and decreased interest in sex and physical contact, SAD sufferers also experience feelings of misery, shame, hopelessness and loss of self-esteem. These symptoms usually occur like clockwork beginning in November or December, peaking during January and February, and dissipating by March or April, depending on how quickly sunlight returns from hibernation. Though anyone can suffer from SAD, an overwhelming majority are young adults and women.

The key to diagnosing SAD is a recurrence of these deleterious symptoms during two successive winters followed by a routine remission in the spring. And while those who suffer from SAD may experience these symptoms at an extreme, there might be a greater number of people at risk for a milder assortment of SAD symptoms categorized as the “winter blues.” For the less-extreme blues, individuals might experience the decreased energy, increased appetite and feelings of sleepiness without feelings of depression and anxiety.

A season that should be welcomed with Bryant Park ice-skating arms thus becomes a dismal march through gray days, but there is some relief. Clinicians and those who have previously been affected by SAD now know when to expect the onset, how long it will last and how to treat it head-on. Special lamps are just one method that has proven helpful. And for downtowners in need of a quick Vitamin D pick-me-up, I suggest long runs along the glistening Hudson River or an idyllic Washington Square Park walk. Though anyone in cold northern cities can feel winter’s burn, downtown New Yorkers are lucky in that we’re surrounded by environmental therapy. Here’s to a healthy and happy winter for all.

By Lucy Barish

Until about 15 years ago, scientists believed humans were born with all the brain cells (neurons) they would ever have. However, with new methods in brain imaging, they have learned that the brain does, indeed, grow. This is called neuroplasticity, and they have discovered new ways to help brains grow into greater resilience and mental health.

We know that cavemen, who had to face the dangers of saber-toothed tigers, developed an effective way to deal with such dangers—the famous “fight or flight” response. The part of the brain in the more primitive limbic system, particularly the amygdala, the seat of emotion, would signal danger, causing cortisol, a stress hormone, to flow through their bodies, causing quick, hopefully life-saving decisions.

Although we modern humans have a prefrontal cortex that enables us to learn, reason, make decisions and execute them, we still have a primitive limbic system that can cause us to perceive dangers where there are none, causing anxiety and other emotional problems such as obsessive-compulsive disorder, agoraphobia (fear of the outside world), post-traumatic stress disorder (PTSD) and, of course, depression.

Scientists have also discovered that a child’s view of the world is formed in the first six years of life based upon how they are seen and treated and what they see, as well as caregivers’ attitudes and behaviors. This world “map” is unconscious. If parental figures are good enough, a benign view of the world develops. If not, constant fear makes the amygdala hyperalert and hypervigilant, constantly on the lookout for danger, along with inflammation of the body and consequent physical illnesses.

More and more articles are being published that show that anti-anxiety and anti-depression medications, both older and newer, are not as helpful as first thought and often come with significant side effects. Of course, there are situations in which medication is vital, but understanding the brain and its ability to change and grow as well as methods to induce growth is vital to the psychotherapist. While talk therapy and understanding the early history that has caused a client to perceive the world and feel in dysfunctional ways is vital, it is also very important to take how the brain changes into account.

In an earlier article, I discussed the importance of life coaching as a part of psychotherapy, which many therapists discount. However, they can teach clients to change their brains, helping them become more mindful of their emotional reactions and understand how to make them less reactive and more positive.

One way is to breathe and cue. When a client becomes anxious and/or depressed, deep breathing can help dispel hyperarousal and the fight or flight response when paired with positive words such as “I am safe” or other calming thoughts. When done in an effortful way and with determination, new, healthier tracks can be laid down in the brain, enabling them to become more resilient and emotionally balanced.

This is actually what we do when we learn a new habit, skill or sport, for example. Old negative tracks, or “tapes,” degrade and disappear.

Furthermore, scientists have discovered that activities such as meditation, spiritual practice, including prayer, regular exercise and healthy eating and sleeping practices, as well as massage, yoga, tai chi, etc., go a long way toward dispelling anxiety and depression with only positive side effects. Thus, psychotherapists really need to know more about these areas in order to educate clients.

Psychotherapists also need to be especially mindful about their own inner thoughts and feelings and those of their clients. Scientists have discovered what they call “mirror neurons” on each side of the brain. Put simply, these mirror neurons make it possible for us to know our own emotional and physical states and thus know those of others, leading to empathy. A high degree of empathy and attention to the facial and bodily expressions of their clients helps psychotherapists know them and mirror back to them the true selves they see beyond the emotional issues.

Other methods based upon neurological as well as integration of emotional pain and trauma, are eye movement desensitization and reprocessing, especially helpful for PTSD, and a somewhat newer one, EFT tapping, in which a statement of the issue is made and meridian (acupuncture) points are repeatedly tapped to facilitate neurological changes.

It is very good news that we can change our brains to become more positive and calm so we can live fuller, happier lives with greater inner peace and physical health.

Lucille Barish is a licensed clinical social worker. For further information, contact her at 212-362-7146.

City & State: Were you surprised when Governor Cuomo announced that he was going to push for the decriminalization of marijuana possession up to 25 grams?

Richard Stratton: Not really, because I think that any smart politician really sees that the writing on the wall is that decriminalization and legalization is inevitable. They say there were three reasons why Prohibition ended: the Depression, the Depression and the Depression. I think the three reasons why ultimately marijuana will be legalized are the Recession, the Recession, the Recession, particularly in states like California and New York, where you have a major underground market that is huge. People don’t even begin to realize how much money is being made in the illegal market of growing and distributing marijuana. For the government not to be getting a piece of that is stupid.

CS: You have dealt with a lot of marijuana. Is 25 grams a substantial amount of marijuana?

RS: No, it’s like an ounce. It’s not a lot of marijuana.

CS: Were you surprised at all when the Senate Republicans rejected Cuomo’s decriminalization effort?

RS: You know, I was surprised, because I’ve always believed that it’s a Republican issue. You’re talking about those values that Republicans supposedly hold dear, like personal liberty and less involvement of the state in our personal lives. That’s really what it’s about. The laws against marijuana do not make any sense at all. It’s so irrational and so costly to the American culture as a whole that you’d think that smart Republicans would say, “You know what? This is anti-American, and we should open it up and we should legalize it” —but they don’t.

CS: Don’t you feel the Republicans in the Senate would point to you as a case study as to why there shouldn’t be decriminalization of marijuana? That they would argue that’s it’s a slippery slope, and that if the government let you have a couple of grams, then soon enough a person could be on his way to becoming a multimillion-dollar drug smuggler like yourself?

RS: Since when are Republicans opposed to entrepreneurship? It’s American to make money. Again, I go back to Prohibition. Some of the greatest fortunes in this country and in North America came about as a result of Prohibition. The Kennedys, the Bronfmans and those other huge dynasties that were created on money that was made from illegal alcohol. So I don’t think it’s anti-American to make money, especially when it’s not something that’s particularly harmful. I was never involved in hard drugs, and I always felt that hard drugs were dangerous. I think there’s a lot to be said for the idea that it’s not “Just Say No,” N-O, it’s “Just Say Know,” K-N-O-W. People need to know about the harms of using drugs, using alcohol, using any of these things. They need to be educated about it, but to try to make it criminal to make people stop doing it, that doesn’t make sense…. There are millions and millions of people who use marijuana in this country and don’t create a problem for other people, who don’t go out and rape and murder and start shooting heroin after using it for awhile. I grew up during that whole Reefer Madness era and we would go to school and watch these movies about what marijuana was supposed to do to you, and we’d be high and laughing, thinking, “Oh, we’re going to grow huge breasts. Then, great! We won’t have to feel our girlfriends up. We can feel ourselves up.” So it’s nuts; it’s completely insane. It’s been interesting for me. Obviously a huge part of my life has revolved around this—and still does to some degree—but as an American I really feel that we always have to be vigilant about protecting our liberties as much as possible. That’s what makes us a great country and a great society, and wherever the government tries to encroach upon our personal freedoms, we have to be pushing back—always pushing back—and marijuana is a perfect issue for that. For me it’s always been a great symbol of what we need to do as Americans, how we need to engage with the government. Say: “No; no, you can’t tell me what I can and cannot do in the privacy of my own home as long as I’m not hurting other people.”

To read the full interview visit City & State by clicking here.

But unrelenting depression is not normal. If you feel this way, you should seek medical attention. Most people get better if they treat their depression.

There are many causes of depression. Some of them are the natural consequences of being older: a health crisis or death, the loss of physical or mental capacities or being a stressed-out caregiver.

Seniors usually rebound from a period of sadness. However, if you are suffering from “clinical depression” and you don’t get help, your symptoms might last months, or even years.

The following are common signs of depression. If you have several of these, and they last for more than two weeks, get treatment: anxiety, fatigue, loss of interest or pleasure, sleep problems, eating too much or too little, abnormal crying, aches that can’t be treated successfully, diminished concentration or memory, irritability, thoughts of death or suicide and feelings of despair, guilt and being worthless.

Depression is a serious illness. It can lead to suicide. Don’t waste time; find help.

Start with your family doctor. The doctor should check to see if your depression could be caused by a health problem (such as hypothyroidism or vitamin B12 deficiency) or a medicine you are taking.

After a complete exam, your doctor may suggest you talk to a social worker, mental health counselor, psychologist or psychiatrist. Doctors specially trained to treat depression in older people are called “geriatric psychiatrists.”

Support groups can provide new coping skills or social support if you are dealing with a major life change. A doctor might suggest that you go to a local senior center, volunteer service or nutrition program. Several kinds of talk therapies work well.

Antidepressant drugs can help. These medications can improve your mood, sleep, appetite and concentration.

Electroconvulsive therapy (ECT) is an option. It may be recommended when medicines can’t be tolerated or when a quick response is needed.

What can be done to lower the risk of depression? Nurture your family ties and friendships; they are your lifelines. Hobbies keep your mind and body active. Exercise is a mood-elevator. Eat a balanced diet. Get outdoors to absorb sunlight and breathe fresh air. Take naps.

Remember, with treatment, most people will find positive thoughts gradually replacing negative thoughts. And you can help this process by catching yourself when you are dwelling on the negative and shifting gears to sunnier thoughts.
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If you have a question, please write to fred@healthygeezer.com.

All Rights Reserved © 2009 by Fred Cicetti

The doctor, who specializes in treating men at his Upper East Side practice, said that much like a retailer, the holidays have become his busiest season.

“My practice booms at this time of year,” he said, estimating that he typically sees a 25 percent spike peaking in January. And that’s on top of the 50 percent increase he’s already noticed since the economic crisis began.

If the greeting cards and Christmas carols have it right, the holidays are supposed to be a time of merriment, laughter and cheer. But for many men, a darker reality hides behind the gift wrap.

While women are traditionally more prone to depression, psychologists say men can be especially vulnerable this time of year.

“Men can feel very alone, they can feel very, very isolated,” said Schwalbe, who is also the author of Sixty, Sexy and Successful: A Guide for Aging Male Baby Boomers. “It’s the sense of obligation that is part and parcel of the holidays.”

Women, he said, tend to be better at dealing with the social pressures of the holiday season. But many men are lost in the shuffle. Some find themselves forced to socialize with relatives, co-workers and friends when they’re really not up for it. Others who don’t have the same social networks are reminded again of the fact that they are left out.

There’s also the issue of money. Buying and receiving gifts has become an integral part of the holiday tradition. But that requires money, which is in especially short supply this year.

Many of the men Schwalbe treats, for instance, have lost anywhere from 25 to 55 percent of their net worth—which they often equate with self-worth—thanks to cutbacks and layoffs. Plummeting incomes and dwindling savings have put marriages and other relationships on the rocks.

“It’s very, very bad,” Schwalbe said. “It’s a matter of pride that they cannot live the lifestyle they have been living. ‘Are they still the man they used to be,’ many ask themselves,” he said.

Dr. Vatsal Thakkar is medical director of the Graduate Medical Education Wellness Team at New York University and also runs a medium-sized clinical practice. He said that he is especially worried about men who are mourning the loss of loved ones this year.

“There’s a unique confluence of events every holiday season that can sometimes magnify loss and suffering,” he said.

This is also compounded by a simple fact of nature: While Christmas lights may be shining, the sun is not.

According to Dr. Jonathan Stewart, a research psychiatrist at the New York State Psychiatric Institute and professor of clinical psychology at Columbia University’s College of Physicians and Surgeons, the real culprit behind holiday depression is the lack of sunlight caused by shorter days, which severely disrupts biorhythms. Dec. 21, the shortest day of the year, falls coincidentally just days before Christmas, he noted.

But whatever the cause, because men express depression differently than women, Thakkar said it is especially important to know which symptoms to look out for. Men are more likely to withdraw or act out aggressively. Some display self-doubt or a sense of worthlessness. Others may exhibit self-destructive behavior, from drinking and drug use to seeking extra-marital affairs.

So what can men do to try to stave off the Christmas blues?

Schwalbe thinks it is crucial to adapt.

“Just because you’ve done it this way all those many years doesn’t mean you have to do it this way,” he said.

That means being able to admit that you can’t afford an annual family ski trip to Aspen, or all those toys for the kids.

It’s also important to try to minimize other pressures. Try positive distraction, like playing ping pong or spending time outdoors with the kids.

And learn to say no. Accept that it’s okay to do less, whether it’s declining an invitation, cooking fewer dishes at a holiday meal or telling out-of-town relatives that this year, it may be best to book a hotel.

“It’s very, very important that we have the chance of saying, ‘Not this year, it’s not for me,’” Schwalbe said.

Stewart adds that getting enough sunlight is crucial. Interventions may be as simple as taking vitamin D tablets, getting a light therapy lamp or enjoying a walk in the morning.

“These other interventions can be pretty powerful when done correctly,” Thakkar said.

SAD, also known as seasonal depression or winter depression, begins affecting people in late fall and can last through early May; in accordance with the time of year when overall daylight is shortest.

The specific cause of SAD remains unknown. Early on, researchers thought that SAD was triggered by shorter days in winter and thus total daylight. Now they theorize that it is the earliest morning light exposure that is the critical factor. That’s the time of day when our internal biological clock needs to receive a light signal in order to stay synchronized to local time. When we let our bioclock slip, depression can set in explained Dr. Michael Terman, director of the Center for Light Treatment and Biological Rhythms at Columbia University Medical Center.

Changes in melatonin levels, the hormones that play a role in sleep patterns and mood that are affected by changes in the seasons, and serotonin levels, the neurotransmitters or brain chemicals that affect mood and can be reduced by lack of sunlight, are also thought to be contributing factors to SAD, according to researchers at the Mayo Clinic.

What this means for people living in urban areas, who tend to get insufficient exposure to morning light regardless of the season, is that their exposure is even less during the time of year when people are most susceptible to SAD.

Knowing the symptoms and dispelling misconceptions about seasonal depression are preemptive measures that can be taken before even the earliest signs of slumping set in. The list of SAD symptoms is similar to that of non-seasonal depression and includes: anxiety, loss of energy, social withdrawal and changes in appetite. Difficulty getting out of bed, daytime fatigue and carbohydrate food cravings are also early signs of SAD, according to Dr. Terman. The subtlety of symptoms oftentimes leaves people equating how they’re feeling to other situations such as stresses of the school year, bad family experiences over the holidays or the cold weather; all common misconception people make about SAD, according to Dr. Terman, that prevent them from seeking treatment.

Like non-seasonal depression, antidepression medication is a form of treatment for SAD, but because of its relationship to early morning light exposure, another popular form of treatment for seasonal depression is light therapy, a concept Dr. Terman has been researching for over 20 years.

Light therapy, or naturalistic-dawn therapy uses a light therapy box that exposes individuals to a bright, artificial light source mimicking natural outdoor light. The purpose is to alter people’s circadian rhythms in a way that reduces the impact of insufficient light exposure and SAD. It offers an alternative to drug-based treatment; the clearest benefit of which is lower risk of side effects. People using this form of treatment have the ability to program their machines to automatically come on while they’re sleeping so they don’t have to remember to take medications and can begin feeling the effects of their treatment quicker than with antidepressants, which Dr. Terman says, can take weeks to begin showing benefits.

In cases where SAD is not severe enough to require clinical treatment, or for individuals suffering from the less severe winter blues, simple lifestyle changes can also be beneficial. Exercising more, brightening up your environment to boost your mood and spending time outdoors—for instance, taking a walk on your lunch break—are home remedies recommended by the Mayo Clinic.

Dr. Terman emphasized that a clinician should treat severe instances of SAD. People having a hard time determining if their feelings are clinically significant can take a diagnostic test online and print out results for their doctors.

“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.”

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Julia M. Klein is a frequent contributor to AARP, The Magazine where this article first appeared.