What can recent research tell us about how to treat depression?

In 2010 the Journal of the American Medical Association (JAMA)  made head-line news when it published research which concluded that whilst anti-depressants were effective in helping those with severe depression, they were no better than a placebo in treating mild to moderate depression.

Anti-depressants such as SSRIs (Serotonin Re-uptake Inhibitors) are widely used to raise the level of serotonin in the brain and this, in turn, is thought to alleviate the symptoms of depression. However, only about half the patients who take SSRIs appear to be helped by them, and then it takes at least three weeks for any effects to be felt.

So the following questions were asked* - if increasing the amount of serotonin in the brain was the answer to depression, why didn't these SSRIs help everyone who took them?  And if a lack of serotonin in the brain was the reason we get depressed, why wouldn't the pills work immediately?

One possible answer was thought to be that, in cases of mild to moderate depression, it was the placebo effect that was really helping patients not the SSRIs.

But that can’t be the whole story, as anyone who has suffered from depression - however mild - will tell you. It also doesn’t explain why the pills take three weeks to become effective in the case of severe depression.

The neurogenic hypothesis of depression suggests that the reason SSRIs work for severe depression is that in these cases the drugs promote the growth of new neurons - and it takes three weeks, because that's how long it takes for the brain to start making new neurons and creating new neural pathways.

This neurogenic hypothesis challenges the old neurotransmitter (serotonin is a neurotransmitter) explanation. In the new explanation, it is the creation of new neural pathways which ultimately frees people from the grips of depression and also explains why depression is so intractable for those who have it and can't seem to shake it off. Old patterns of behavior (i.e., pre-existing neural pathways) get reinforced in depressed people in the same way that new patterns of behaviour get formed: with repetition. Whilst old behaviours go over old ground - again and again and again - new behaviours, on the other hand, create new neural pathways and it is these that can help forge a path out of depression. Cells that fire together wire together.

We are what we repeatedly do; happiness, then, is not an act but a habit.

with apologies to Aristotle

The ability of the brain to forge new neural pathways is what is known as neuroplasticity . To illustrate plasticity, imagine making an impression of a coin in a lump of clay. In order for the impression of the coin to appear in the clay, changes must occur in the clay -  the shape of the clay changes as the coin is pressed into the clay. Similarly, the neural circuitry in the brain must reorganize in response to new experience or sensory stimulation - it’s a physical process - grey matter can actually shrink or thicken; neural connections can be forged and refined or weakened and severed .  

Brains are designed to change. It's what allows us to cope with the ever-changing world around us. So anything that restricts our brains ability to change would be a major hindrance to personal growth and our own survival. And it turns out that one of the things that inhibits the growth of new neurons in the brain is stress. In effect, chronic stress limits neuroplasticity in the brain. And as a result, unrelenting stress can have a major impact on our mental health and influence a whole host of psychological disorders including depression. But in order to benefit from our brain's ability to change, the depressed person must force him or herself to do new things and participate in new activities every day.

Charles Darwin (1809-1882) knew this a long time ago when he wrote:

"My mind has changed during the last twenty or thirty years... Now for many years I cannot endure to read a line of poetry… I have also almost lost any taste for pictures or music… My mind seems to have become a kind of machine for grinding general laws out of large collections of facts...

If I had to live my life again I would have made a rule to read some poetry and listen to some music at least once every week… The loss of these tastes is a loss of happiness, and may possibly be injurious to the intellect, and more probably to the moral character, by enfeebling the emotional part of our nature."

We seem only now to have caught up with him.

So what can we do to help ourselves?

Just as we create flexibility in our bodies by stretching physically, so too we can create flexibility in our minds by stretching mentally. Every day we have the opportunity to exercise our flexibility. We can do this in small ways such as taking a different route home from work or changing the ways we do routine tasks – just doing things differently. On a larger scale, we can learn a new language or learn to play an instrument. Doing unique, random, different, and sometimes ridiculous things is a good way to exercise the mind and promote new ways of thinking about the world around us as well as alleviating any symptoms of depression by markedly refusing to reinforce negative experiences by forging alternative pathways. 

“A mind that is stretched by a new experience can never go back to its old dimensions.”

Oliver Wendell Holmes (1841-1935)

As those of you who took part know, we have recently undertaken a Happiness Habits Experiment to see whether repeating between one and six simple activities that are correlated with well-being, daily, for three weeks, raised people’s happiness levels and became embedded as habits. We’ve had very positive results and will be bringing you the full report in a few days time. Watch this space.

* see Jim Porters blog for more

**I am not in any way suggesting that people who are on anti-depressants should come off them except under the guidance of their doctor - what I am suggesting is that there are alternatives which can compliment drug treatment and that should certainly be considered as a first option in cases of mild and moderate depression before resorting to drug treatment. 


Posted by Annabel

Mothers' Day and the Thank You Letter

For all that Mothers' Day, or Mothering Sunday, has become commercialised, it offers most of us a great opportunity to reflect gratefully on the contribution our mothers have made to our lives and happiness, and to thank them for it.

Sizzla (above) turned his thanks into a song, but a card, gift or gesture will carry the same weight for those of us less artistically gifted - both for the recipient of our thanks and, indeed, for ourselves.

“I would maintain that thanks are the highest form of thought; and that gratitude is happiness doubled by wonder.”

G.K. Chesterton, writer (1874-1936)

Counting your blessings, or consciously feeling appreciation, thankfulness or wonder, has been shown to raise levels of happiness in a wide range of psychological research projects.

"The Thank You Letter" is a Happiness Habit taken from research in Positive Psychology, like “Three Good Things” which is part of our Happiness Habits Experiment. "The Thank You Letter"  is another of Professor Martin Seligman’s “ happiness interventions” that demonstrably raised happiness levels in volunteers who took part in the project and produced the highest levels of subsequent positive emotion for a month afterwards. (If you do this once every month, you can look forward to seriously improved levels of joy and contentment.)
 

“Appreciation is a wonderful thing. It makes what is excellent in others belong to us as well.”

Voltaire (1694-1778)

Mother's Day is a great incentive to try this one out. The task is to write a letter to someone you know - in this case your mum - thanking them for their contribution to making your life happier.

That’s it. Simple? But effective!

You might decide you want to tell or show the person some or all of the things you have written about them, but that is not part of this Habit as we present it in Step 12 of The Real Secret. It may not be possible to give a Thank You Letter to someone who is no longer part of your life, or has passed away. In general, though, we suggest that before you do so, you think carefully about the timing and context in order not to embarrass or overwhelm the recipient, or even appear too gushing or insincere yourself.

On Mothers' Day, though, timing and context works perfectly if it is possible to give or send your Thank You Letter to your mum. It should bring happiness to her and, in a virtuous circle, her happiness will return still more pleasure to you. In fact by doing this you will also be carrying out our Happiness Habit No 4, Spreading Happiness.

Two Happiness Habits for the price of one. Happy Mothers' Day!

posted by Lucy

Why doesn’t money make you happier?

We’ve all been told a million times that having a lot of money won’t make you happy - or no happier, that is, than having just enough money. After enough (to keep the wolves from the door, the rent paid, and some honey in the cupboard), money seems not to make much difference to levels of happiness at all. Moreover, research has shown that, in many cases, rich people seem to be less happy.

"Although gold dust is precious, when it gets in your eyes it obscure your vision.!

His-Tang Chih Tsang, Zen Master (735-814)

So why doesn't having more money make us happier? New research by Jordi Quoidbach and colleagues* suggests that the answer lies, at least in part, in how rich people lose touch with their ability to truly appreciate or savour life's pleasures.

Savouring is a way of increasing and prolonging our positive experiences: taking time to experience the wonderful taste of a fresh apple, for example, or the beauty of the sky at night, or the way a good joke can make you crack up so your whole body ripples. Being aware of the effect of these good things and taking the time to appreciate them, however minor they might be, is what will turn an ordinary day into a day in which a number of wonderful things happened to you. Being aware of, and appreciating, the small delights of life is what makes people happier, not money. And is also why the habit of recalling Three Good Things (Happiness Habit No. 6) in our Habits of Happiness Experiment works.

So why, then, don't rich people savour these things, if it feels so good?
It's obviously not for a lack of delightful things because rich people probably have easier access to the finer things in life, as well as more time to savour them (I’m obviously thinking of gourmet restaurants and African sunsets here). The basic idea is that when you have the money to eat at fancy restaurants every night and buy designer clothes whenever you want, those experiences diminish the enjoyment you get out of the simpler, more everyday pleasures, like the smell of a sausage in the pan cooked by a friend or the bargain you got on Ebay.

"He who is richest is content with least, for content is the wealth of nature."

Socrates (469 - 399 BC)

When you have more than enough money to buy whatever it is you think you want, that want has lost all its flavour - it’s just another thing you can have. Wanting something implies the possibility of not getting it, surely. But if you know you can have whatever you want, then the desire, as well as the pleasure of getting it, has been diminished.  

So that’s why having more than ‘enough’ money won't make you happier, and can also be bad for you.

One way rich people can offset this disadvantage is using their money for the good of others. Philanthropy has its rewards - as you can find out from reading about Happiness Habit No 4, Spreading Happiness.


Quoidbach, J., et al.,(2010) Money giveth, money taketh away: The dual effect of wealth on happiness. Psychological Science, 21, 759-763

Posted by Annabel

Spreading Happiness - Happiness Habit No. 4

What single thing will bring you the most happiness today?

It could be a much needed cheque arriving in the post. It might be successfully completing a challenging project. Or it may be the simple pleasure of a walk in the park with your dog. But the likelihood is that it will be some kind of communication with another person: appreciation from your boss, a phone call from a friend, being able to cheer up your child, or sharing a moment with your partner.

“One of the best ways to make yourself happy is to make other people happy. One of the best ways to make other people happy  is to be happy yourself.”

Gretchen Rubin, writer

Every recent study of happiness shows that good relationships are fundamental to being happy and that happy people have better relationships.

Positive emotions are generated by good interactions with other people. During these interactions our brain responds with chemical responses such as the production of “feel good” hormones like dopamine and oxytocin. In an upward spiral, positive emotions then make us feel better disposed towards others, more empathic, helpful, open and loving.

Positive Psychology research has found that altruism is strongly correlated with happiness. Professor Martin Seligman commented on a study that linked happiness with altruism; he was surprised, because he thought that unhappy people would identify with the suffering of others and be more altruistic. But "findings on mood and helping others without exception revealed that happy people were more likely to demonstrate that trait [altruism]" (Seligman, 2002, p. 43). And likewise, altruism helps people to be happy. Seligman cites a range of evidence to show that there is a causal link between altruism and becoming happier in his book, Authentic Happiness (e.g. pp. 8-9). Jane Piliavin has also analysed studies which have looked at the effects of helping others, and concludes that, "on many levels - psychologically, socially, and even physically - one indeed does 'do well by doing good'" (Piliavin, 2003, p. 243). 

Richard Layard tells us that neuroscientific research shows that when we do kind things for other people the same areas of our brain light up as when we eat chocolate. What a bargain - and it's not even fattening!

"Happiness comes from giving, not getting. If we try hard to bring

happiness to others, we cannot stop it from coming to us also.

To get joy, we must give it, and to keep joy, we must scatter it."

John Templeton, philanthropist (1912 - 2008)

Habit No. 4 of the Happiness Habits Experiment is "Spreading Happiness" and we ask participants to undertake some act of kindness, above and beyond their normal, kind activities, daily for three weeks. Amongst our first tranche of participants, this Habit is only the fourth most popular: coming after "Simply Smile", "Three Good Things" "And Breathe..." - but ahead of "Yes I Can!" and "Fun To-Do Lists". We very much look forward to finding out how effective those who signed up for it, found it.

Whether you have signed up or not to the Happiness Habits Experiment, think of some generous actions which you could realistically carry out each day over the next three weeks. They can be gifts of your time, energy, or effort, and don’t have to cost money; they could be small and impulsive, or they could involve serious input and planning on your part. They can be directed to people you know and love or to someone you find hard to get on with; to contacts or colleagues; to strangers in need or to charitable organisations. They should be actions different to or beyond those kindnesses you already do on a regular basis.

You can do something extra for someone you see every day, or you can reactivate a lapsed friendship by an act of unexpected giving. You can enjoy watching the surprise and pleasure of those you offer your gift to, or you could savour in your imagination the amazement and gratitude of someone you help anonymously.

If you want some ideas for Spreading Happiness, have a look on the Random Acts of Kindness website for inspiration. And there are more Happiness Habits in The Real Secret programme.

Post by Lucy

Piliavin, J. A. (2003). Doing Well by Doing Good: Benefits for the Benefactor. In C. L. M. Keyes and J. Haidt (Eds.), Flourishing: Positive Psychology and the Life Well-Lived (pp. 227-247). Washington, DC: American Psychological Association.

Seligman, M. E. P. (2002). Authentic Happiness: Using the New Positive Psychology to Realize Your Potential for Lasting Fulfillment. New York: Free Press.

Words of Love

From the Greek* we have four different forms of love; eros, philia, agape and storge.

Eros - this is passionate love which is characterised by sexual desire, longing, jealousy and a heightened awareness. Eros is exciting - it gives spikes of happiness rather than a constant feeling of well-being. It’s the love we feel at the very beginning of a love affair. It’s the ‘falling in love’ stage and the inspiration for artists. Eros doesn’t last long - about two years - on its own; to last any longer Eros needs to be supported by the following forms of love.

Philia - this love is serene and more akin to friendship. You love each other for the care and support you experience in the relationship. It’s the kind of love that can last a very long time and the longer it lasts the more precious it becomes. Whilst philia has no need of eros, eros cannot survive for long without philia.

We talk about the neurological basis of Eros (lust and romantic love) and Philia (long term attachment) in this blog post.

Agape - this is a selfless love that only wants the best for the other person. It can apply to universal themes such as the love for mankind as taught by Buddha, but is also the love you feel for your partner, even when they no longer love you back. Agape brings happiness to those who give it and doesn’t ask for anything in return. In this way Agape can love all on its own - it needs no-other.

Storge love means "affection". It is the kind of affection felt by parents for their children, or between members of a close knit community. This is not a romantic form of love but a necessary understanding for other forms to develop.

There is more information about how we find, attract and are attracted to new friends, lovers and partners in this post. Or check to see whether your relationship or marriage is likely to be long lasting and happy by clicking here.

*http://en.wikipedia.org/wiki/Greek_words_for_love

posted by Annabel

Happy Pills - take two or three without water whenever you feel unhappy

 

If you ever go to Barcelona then you really must try very, very hard to visit The Happy Pills Shop. It's just wonderful - have a look at their website here . That sound, by the way, is the sound of pills popping! If you click on the English sentence on the home page it'll talk to you in English. I like the Spanish best. And don't leave the site until you've looked at the cure for love sickness by clicking on the printer.

Tested by Annabel

How to be happy - tips from recent research

It appears that people suffering with mild to moderate depression focus too much on the bad and the sad*, and that socially anxious people tend to remember negative rather than positive experiences*. When trained to shift their attention, both groups experienced a major improvement.

In the case of the research on depression, sad faces seemed particularly attractive to people with mild to moderate depression, whereas non-depressed people found neutral or happy faces more attractive. The question is whether the increased attention paid by depressed people to unhappy or sad themes is simply a byproduct of depression or might it be a cause?

Researchers looked at the question of whether biased attention towards sadness plays a maintaining role in depression and, more specifically, they looked at the question of  whether modifying the attention for sadness, by training participants to shift their attention toward neutral stimuli, could reduce depressive symptoms.

The study provided evidence for the first time that training attention away from unhappy or sad stimuli to neutral stimuli reduces depressive symptoms. In addition, these effects lasted beyond the duration of training. Perhaps most notably, these results provide additional evidence that, rather than being by-products or symptoms of depression, attentional biases towards sad themes play a causal role in the maintenance of depressive symptoms.

These findings worked with people with mild to moderate cases of depression, and those are also the people for whom anti-depressants often don’t work. Since we are all prone to episodes of mild depression, it may well be worth remembering to keep a tab on the amount of attention you pay to sad or unhappy events - and try to stop yourself.

In the study that looked at people who suffer from social anxiety, results showed that socially anxious individuals more easily forget socially positive words and experiences than do non-anxious individuals. It’s not that socially anxious individuals have fewer positive experiences than non-anxious individuals, it’s just that they appear not to recall them as readily.

Martin Seligman’s research is worth noting here. He found that the habit of writing down Three Good Things that went well each day increased happiness and decreased depressive symptoms for six months after the single week of testing.

So if you can get into the habit of writing Three Good Things that went well, and reasons - preferably to do with you - why they went well, even if you only manage it twice a week, you’ll have clocked up over Three Hundred Good Things that have happened to you in a year.

The first and last Steps of The Real Secret "Choose to be Happy" and "Smell the Roses" give you Habits that promote focusing on the positive and have been shown to raise happiness levels. Get your copy from Amazon.com or Amazon.co.uk in paperback or Kindle



* Tony T. Wells and Christopher G. Beevers (2010) Biased Attention and Dysphoria : Manipulating selective attention reduces subsequent depressive symptoms Cognition and Emotion, Vol. 24 (4)
* Chi-wen Liang et al., (2011) Absence of a positive bias in social anxiety: The application of a directed forgetting paradigm" Journal of Behavior Therapy and Experimental Psychiatry, Vol. 42 (2)

Post by Annabel

Talking About Happiness

I was interviewed today by Helen McDermott at BBC Radio Norfolk about happiness, the new campaigning charity, Action for Happiness and the BBC's Happiness Challenge - and, of course, The Real Secret.

Helen claimed she was a glass-half-empty kind of person, and revealed that she had in fact experienced depression, which just goes to show that you often have to look beneath the surface as she comes across as positive and full of energy - even if coping with her new presenting role and the technical demands of the job meant she called me Lynn several times. I can't blame anyone for failing to pronounce "McCarraher" correctly, though - it sounds like "M'Carra", not the "MacCarragher" it reads as.

Anyway, if you want to hear the interview, and the quick tips for boosting your Happiness Set Point on a daily basis, you can listen here (interview starts at 4.45 minutes in):  http://bbc.in/h5Fm4B

Lucy