The Role of Poverty and the Corporatization of Food
I have always found it quite ego-deflating that as a psychiatrist I can only help about half the patients who come to me for depression. However as a social activist, I am also increasingly aware of the role social factors play in depressive disorders. I would rank nutritional deficiencies stemming both from poverty and our dysfunctional system of food production, marketing and supply as number one on the list of social factors leading to depression. The link between omega 3 deficiency (as opposed to so-called serotonin deficiency) and depression has been clearly established. Numerous studies show that cultures which consume a minimum three to five servings of fish per week experience miniscule rates of depression. There are also demonstrated links between depression and vitamin B, folic acid and various phytonutient (newly discovered plant based "vitamins") deficiencies, as well as increasing evidence for the role of Vitamin D and specific mineral deficiencies (mainly calcium and magnesium) in mood regulation. Except for Vitamin D (derived from sunlight and Vitamin D enriched dairy products) and Vitamin B12 (derived mainly from meat), the best source of these other nutrients is fresh broccoli and leafy green vegetables.
Owing to recent skyrocketing food costs, I feel a little silly advising low income depressives to eat more oily fish and fresh vegetables it's simply not an option. I also find it hard to suppress feelings of disgust for our government's corporate driven health policy whereby Medicaid and insurance companies are happy to pay for a prescription for Prozac (to help out their friends at Big Pharma) but not to subsidize fresh, organically grown food for low income patients with obvious nutritional deficiencies.
The Demise of Civic Engagement: Possible Links to Depression
Unfortunately less than one quarter of the depression I encounter in clinical practice is nutritionally based and responsive to improved diet. In fact over the past decade, I find myself looking more and more to the breakdown of extended family and community as a possible cause of depression. "Civic engagement" is a subject that both Robert Putnam (Bowling Alone 2000) and Ralph Nader have written about extensively. Their work has mostly focused on the negative effect declining civic engagement has had on overall quality of life in American communities. Whereas I myself see increasing evidence of links between our withdrawal from community life and the growing epidemic of clinical depression.
Decades of anthropological and ethnological research have established unequivocally that human, like other primates, such as apes, monkeys and gorillas, are fundamentally social beings. Behavioral experiments consistently find that the vast majority of people function very poorly when deprived of contact with their fellow creatures. It is well established that subjecting prisoners to solitary confinement is one of the most severe and most poorly tolerated punishments that can be inflicted rating far higher than beatings by guards and other inmates and some forms of deliberate torture.
Owing to my medical training, I have a particular interest on the effect social activity (or its absence) has on human beings' biological functioning specifically on brain function. Recent advances in neurophysiology been quite spectacular to the extent that we can identify electrochemical events in the human brain associated with specific psychological functions, such as trust, bonding, empathy and altruism.
Oxytocin
Oxytocin is the best known chemical influencing social activity, most likely because a nasal spray containing oxytocin, called Liquid Trust, is being heavily marketed by the manufacturer. At present it's being promoted as a potential treatment to parents of children with Autism and Asperger's Disorder. The hormone itself is associated with phenomena such as collaboration, altruism, empathy, compassion, parent-child bonding, monogamy, trust and forgiveness. Some researchers believe that oxytocin, rather than testosterone as previously believed, regulates female sex drive (contrary to popular belief female hormones such as estrogen and progesterone, which regulate ovulation and pregnancy, tend to suppress women's sex drive).
Oxytocin was first synthesized by Vincent du Vigneaud in 1953, for which he received the Nobel Prize for Chemistry in 1955. It's secreted by the posterior lobe of the pituitary gland and can be made synthetically. Physiologically, it promotes the secretion of breast milk and stimulates the contraction of the uterus during labor. Its structure is very closely related (differing by two amino acids) to a second pituitary hormone called vasopressin, which regulates fluid balance. However both hormones are produced and result in emotional and behavioral effects in both sexes.
Oxytocin has been dubbed the "bonding" hormone, primarily as a result of animal experiments, in which males become super attentive to their young following treatment with oxytocin. Oxytocin effects seem to work both ways: high oxytocin (or vasopressin) levels in human beings seem to stimulate bonding and group affiliation whereas various group activities clearly increase oxytocin levels. And because high oxytocin/vasopressin levels are associated with subjectively pleasurable feelings people who engage in these activities (gang banging for example) experience a distinct neurophysiological reward for doing so. And are motivated to seek out activities likely to replicate the experience.
Endorphins
Research shows that endorphins, which are opiate-like substances produced by the human brain (as opposed to synthetic opiates like morphine, codeine and heroin), are also increased by social and group activity (as well as by sex, vigorous exercise and creative activities). Whether increasing brain endorphins also stimulates social interaction is less well studied. Although endorphins (which are complex polypeptides) can be synthesized in the laboratory, they are extremely expensive and not as readily available. Research showing the benefits of exercise in the treatment of depression suggest thatvigorous physical activity increases endorphins, which in turn elevate mood.
Neurotransmitters
Neurotransmitters, such as dopamine, norepinephrine and serotonin (the same biochemicals affected by antidepressants) also appear to increase with social activity though these effects have received even less study.
Mirror Neurons
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