“The Depression Cure: The 6-Step Program to Beat Depression without Drugs” by Ilardi (2009) is a self-help book for people who suffer from depression that helps them make lifestyle changes associated with improvements in depression scores. The book is divided into three sections, which include understanding depression, therapeutic lifestyle change, and making the change. In understanding depression, the author begins with describing a case study of a patient he had personally treated for depression. Of course, it is noted that names throughout the books were changed to protect the patient-therapist privacy while allowing the author to build trust and expertise by writing from personal experience.
The introductory story is something which an audience can relate to because it describes a man whose work, social life, family relations were suffering. The depression was strong to the extent that the patient had lost the will to live after losing confidence, energy, memory, and the ability to concentrate. The arguments continue supporting the author’s premise about the etiology of depression.
Despite the increased usage of antidepressants, depression rates in industrialized nations are on the rise while only developing countries and hunter-gatherer tribes today show a low prevalence of mental disorders. That leads the author to the conclusion that the post-industrial lifestyle is the key determinant of depression, and the book offers a brief overview of the lifestyle elements responsible for depression, which include the lack of omega-3 fatty acids, lack of sleep, contemplating on negative thoughts, lack of sunlight exposure, inadequate social support, and the sedentary lifestyle.
The rest of this section presents the diagnostic criteria for major depression disorder (MDD) to distinguish it with the term “depression” that is sometimes used synonymously with sadness, the physiological mechanisms of depression, risk factors for developing depression, and points out the weaknesses in mainstream approaches to treating depression. These limitations are supported by evidence, but their main purpose appears to be framing the reader to differentiate them from the Therapeutic Lifestyle Change (TLC), which is then presented as an alternative solution.
The second section describes the six steps of TLC in practice. The interventions presented include increasing omega-3 fatty acid intake, increasing awareness and engaging in activity to avoid rumination, aerobic physical exercise, light exposure, encouraging social interactions, and enhancing sleep. Each intervention is thoroughly described and supported with relevant research.
The third section is dedicated to creating a plan of action that considers the impossibility of making several lifestyle changes simultaneously. The complete lifestyle transformation is spread out across 12 weeks, and after each week, the readers can test their depression scores with the Center for Epidemiological Studies Depression Scale (CES-D) in Appendix A to monitor their progress.
Reflection
The book places significant emphasis on the physiological background and physical interventions for managing depression. The advice presented in the book is consistent with contemporary research on the influence of biological and social factors on depression. Most recommendations presented in the book are proven strategies for reducing depression. However, the book could benefit from more focus on cognitive coping strategies and better dietary advice.
Compliments
Patient education is an important aspect of healthcare because it helps patients understand their position better and allows them to build realistic expectations. The depression diagnostic guidelines presented in the book are detailed and unambiguously instruct the client how the symptoms need to be assessed in order to reach a clinical diagnosis. The first section describes depression thoroughly, so the readers get to know their disorder better, which is the first step in taking a proactive stance towards psychological health.
Ilardi’s approach to examining the etiology of depression in the first section of the book is definitely a positive aspect because all important elements are covered and common misconceptions are eliminated. For example, the gene-environment interactions are emphasized as a critical element in determining depression, which means genetics alone does not determine who develops depression, and by manipulating their environment, the readers can control their quality of life.
The six steps of the TLC program are usually thorough and complete. For example, in addition to improving social interactions by connecting with others, the author also suggests eliminating toxic relationships which hinder progress and induce depression. In most cases, they are also easy to implement. Including fish oil in a daily diet to increase the intake of omega-3 fatty acids is an inexpensive intervention that takes one minute per day to implement.
New Perspectives
I was familiar with most arguments presented to support the importance of lifestyle in managing depression, but the book provides several interesting arguments that gave me a new perspective on the human body and psychological health altogether. For example, I did not know that the human brain is comprised of approximately 60 percent fat, which explains why dietary fats are critical components in our diet to maintain our cognitive abilities and improve mental well-being.
Other interesting findings were the recommendations for improving sleep. Because heat is often associated with a relaxing environment, the recommendation for turning down the room temperature to enhance sleep came as a surprise. The importance of reducing light exposure from household appliances to improve sleep is also often overlooked in the modern lifestyle dependent on technology.
Criticism and Possible Improvements
The nutritional information presented in the book could use improvement because it relies too much on supplements without giving adequate guidelines for safety. For example, vitamin D supplementation is presented as a good solution to the lack of sunlight in winter months. However, the only warning to the readers is the potential interference with the calcium balance.
In reality, a chronic overdose with vitamin D takes several months to cure and causes a variety of health issues. Furthermore, the calcium balance mentioned is not a trivial issue because it can damage the heart, kidneys, and blood vessels. Most importantly, determining the upper limits for vitamin D intake depends on the amount of vitamin A in an individual’s diet, age, gender, and pre-existing deficiencies, which makes it difficult to determine how much vitamin D somebody should take.
Overall, the brain food chapter could benefit from improvement by actually discussing foods rather than supplements. Supplements are never suitable for replacing a diverse diet, and beneficial foods are introduced only at the end of the third section. A more logical progression would be to introduce the foods that comprise a healthy diet first and the supplements as beneficial additions to the diet second.
I do not agree with the author’s viewpoint on the importance of engaging activity to prevent “rumination,” a term which he uses to describe dwelling and building upon negative thoughts. Even though engaging activity can prove useful in these situations, it is nothing more than a distraction, and cannot be considered a long-term solution without cognitive interventions. The author does present psychotherapy as a better alternative to antidepressant medication, but there is no further discussion on the benefits of cognitive interventions on depression in the book.
Most importantly, the writing style often indicates a possibility of bias. That is expected because the book was designed to help the readers take action, but the book analyzes several treatments, such as behavioral interventions, comments how they do not work in 50 percent of depression cases and presented TLC as an alternative solution. However, few limitations concerning TLC are discussed at the beginning of the book. The transparency is introduced only at the end of the third section when the author described comorbid physical and psychological disorders that may render TLC ineffective. The advice to see a physician before attempting TLC because of possible interferences with clinical interventions is also explicitly stated only at the beginning of the third section. Setting realistic expectations for readers at the beginning of the book might have been a better option for building trust.
Conclusion
Overall, the book occasionally feels like reading a very long sales letter, especially in the first section. Even though I am already reading it, the author has the need to continue persuading me that TLC is better option than other treatments because it has higher success rates. Given the fact that the book is written for the public and not the academic community, it would be nice to see less theory and more practical advice. Also, elaborating on cognitive approaches to resolving depression in the book would be excellent because subconscious cognitive processes may affect human behavior.
References
Iliardi, S. S. (2009). The depression cure: The 6-step program to beat depression without drugs. Philadelphia, PA: Da Capo Press.
