DEPRESSION AS A DISEASE OF MODERN-DAY LIVING

In the last several thousand years, humans developed better-structured civilizations that gave rise to vast improvements in building, agriculture, and convenience. With the exception of a few tribal cultures, societies began to change the environments in which they lived, giving rise to the metropolitan environments that we now occupy.

Research is beginning to piece together the effects that the modern environment has on our biology^[1]. Some of these effects may serve to perpetuate states of disease in susceptible individuals. Depression may be considered a prime candidate.

As it’s not always easy to tell what affects our health and well-being, remaining informed of environmental factors can be useful. Depression and it’s incidence in the context of modern day living is discussed below.

A Brief Look at Depression

Depression may present with chronic sadness and/or irritability, but is ultimately associated with a deficit of feeling, a loss of interest, and physical symptoms such as fatigue and sleep disturbance.^[2]

The cognitive and neurological changes observed in depressive disorders impact the daily functioning of affected individuals. Depression may also increase the risk of disease due to its relationship with immune function.^[3]

Other symptoms of depression can include^[4]:

• Loss of pleasure
• Feelings of guilt
• Lack of self-worth
• Changes in appetite and weight
• Suicidal ideation

Pathology

The pathology of depression has yet to be fully established. Common neurobiological factors include disruptions in serotonin signaling of the central nervous system and sometimes of other tissues, such as blood platelets. This is observed for all types of depression and is one of the reasons that serotonin reuptake inhibitors are often prescribed.

Norepinephrine and dopamine levels may be altered in states of severe depression, affecting attention, energy levels, motivation and perceived reward. Unbalanced glutamate, GABA and brain-derived neurotropic factor levels are also implicated in moderating cognitive ability in depressed people.

Damage to areas of the brain that regulate emotion can contribute towards chronic depression and anxiety as well. Thus neurological diseases, vascular lesions, brain ischemia and traumatic brain injury are known to substantially increase the risk for depression.

Sickness syndrome is another major risk factor in which serotonin alterations occur in the context of chronic infection. This can eventually give rise to faulty serotonin signaling in the nervous system and induce depression. This is particularly prominent in neurological infections.

Prevalence

In the 90s, depression rates nearly doubled, moving from 3.6% to just over 7%, where it currently remains. However, due to misconceptions (largely perpetuated by societal attitudes discussed below) the prevalence of depression is actually thought to be much higher in the population. It is estimated that as many as 60% of cases are unreported and left untreated.

Women are at a 1.5-3-fold higher risk for depression than men. Furthermore, the incidence of depression is three times higher in those aged 18 to 29 years, than in those aged 60 and older. 

The elderly are known to have better emotional well-being than they did in their youth. Yet the incidence of depression is likely also commonly misdiagnosed in elderly individuals. Symptoms are experienced differently due to lifelong stress exposure and lived experience.^[5]

When Depression Was First Documented Historically: A Big Clue

The first cases of depression were documented in early settlements in which humans began to participate in agriculture. It’s not that agriculture is a cause of depression, but it is that with agriculture, many lifestyle factors changed simultaneously. As humans were originally hunter-gatherers that lived while roaming a variety of terrains, the change induced by staying in one place to tend vegetables and livestock is substantial.

Another aspect of this change would be an ever-growing focus on wealth accumulation. Systems of commerce provide a platform for inequality as well as for both inadequate and excessive consumption. Alcohol, tobacco and other addictive substances that detract from health were likely to have only emerged after the invention of agriculture. When taken to the extreme, all of these factors may predispose individuals to depression.

Social Isolation as a Main Feature of Modern-Day Depression

Social isolation and depression tend to go hand-in-hand and enhance one another. Depressing thoughts can easily arise from alienation, and feeling depressed is strongly linked to retraction from social settings.

Modern-day societal perceptions, consumerism, technological advancements and media have contributed towards a reduced degree of social connection, which can increase the risk of social isolation.

The Negative Impact of Social Isolation on Health

Social isolation has a pronounced effect on mental health^[6]. The main symptoms induced by social isolation include^[7]:

• Anxiety
• Depression
• Poor sleep quality
• Physical inactivity

If prolonged, symptoms of social isolation can increase the risk of chronic fatigue, poor immune function, and mental health disorders, the most common of which are anxiety disorders. Chronic social isolation may induce social anxiety disorder in susceptible people and can serve to perpetuate the disorder in those already affected.^[8]

Over and above mental health conditions, social isolation is conducive to the development of various diseases and places individuals at an increased risk of all-cause mortality^[9]. Depending on the individual, chronic anxiety and stress can facilitate metabolic disturbances, low-grade inflammation and cardiac tension; increasing the risk of diabetes, heart disease, muscle wasting and/or weight gain.

A healthy social life is known to improve and maintain upon many faucets of health, including behavioral, psychological and physical health^[10]. Positive socializing has been shown to promote (and sometimes enforce) healthy behavioral patterns, including consuming a balanced diet and exercising. A lack of social interaction is able to detract from these important behaviors, which can also add to the risk of acquiring a chronic illness. Scientific literature also links social support to improved stress resilience^[11], which is greatly reduced in socially isolated individuals.

Social Isolation at an Early Age Affects Neural Development

Children and adolescents are particularly susceptible to the effects of social isolation, which may increase with stressful life events, social exclusion^[12], bullying at school and a lack of social support from family, friends or caregivers.

Childhood social isolation is also linked to an increased risk of developing a substance abuse disorder later on in life, in tandem with chronic anxiety. Healthy socializing helps to regulate neurotransmitters that influence behavior, such as dopamine. Faulty noradrenergic signaling is linked to childhood isolation, persistent anxiety, and alcoholism^[13].

Following on from this trend in children, rats undergoing social isolation proved that it affects brain areas that regulate fear, anxiety and aggression. Neuropeptides get released during social isolation that help to regulate these areas of the brain. Chronic isolation may result in unbalanced levels of these peptides, leading to persistent fear and heightened aggression^[14].

It is natural for children to learn from stressful situations through fear-based conditioning, however the fear generally abates as the child becomes an adult. This is referred to as fear inhibition. Childhood isolation has been shown to increase a lack of fear inhibition, which may lead to chronic anxiety later on in life.

Is There a Difference between Social Isolation and Perceived Loneliness?

Some studies emphasize how the detrimental effects of social isolation are increased in people who subjectively perceive themselves as being lonely or isolated^{[15] [16]}. This is true whether the people were objectively isolated or not. In other words, people that think they are alone will suffer the effects of social isolation even when in company and those that do not think they are alone may not suffer any effects from actual isolation.

This raises the question: is social isolation a purely subjective phenomenon? The realistic answer is no. Objective social isolation has been proven to negatively affect health and increase mortality risk^[17]. Subjective isolation can increase or induce the negative effects of objective isolation. The tendency for perceived isolation is heightened in depressed, stressed or anxious individuals and those with mental health conditions. One’s approach to socializing, to others and to themselves, all appears to influence the impact of social isolation in a way unique to the individual.

Lockdown Measures May Increase Social Isolation Risk

COVID-19-induced social isolation proved to increase depression scores by 12.8% and anxiety by 12.3% over a period of 6 weeks in 7127 UK citizens above the age of 50^[18]. The increased incidence rates seen for women were double that of men. Women were more susceptible to depression, while men were more susceptible to anxiety. Oddly, a small percentage of participants reported an improvement of symptoms in response to the lockdown, most of which were for anxiety (4.9%) and not depression (1.5%).

The social isolation brought about by the covid pandemic may promote perceived loneliness; leading to loneliness and social inactivity. Rates of loneliness increased during the pandemic from 2-20%, in spite of having the option to communicate remotely with friends and family.

In men, digital social activity appears to promote more anxiety related to social isolation instead of providing relief. This suggests that digital social interactions are not equivalent to physical social interactions and that physical contact is important for avoiding depressive symptoms induced by social isolation.

The fraction of those that experienced symptom relief highlights how perception plays a large role in moderating the negative effects of social isolation. Perceived social connectedness and connection are invaluable for well-being, and should still be emphasized under stringent lockdown conditions^[19].

The Benefits of Socializing May Be Quality and Dose-Dependent

There is a limited body of evidence that suggests that a person with less social roles participates in less social activity and is at a higher risk of disease. This proved to be true of cardiovascular disease, with disease risk in relation to social activity being more pertinent to men. ^[20]

It also suggests that social contact has dose-dependent health effects, with too little increasing the risk of disease and social isolation. Too much social contact may have a negative impact on some individuals in terms of increasing perceived isolation; however, it is generally not associated with adverse health effects.  This does not apply to unhealthy relationships which are not conducive to well-being.

The quality of social relationships is as important as the degree of social contact. Abusive or highly strung relationships are associated with similar effects of social isolation, increasing disease risk^[21]. This is well-documented in long-lasting marriages that have taken chronic strain due to unresolved, underlying tensions, constant arguments and stress.^[22]

Relationship strain of this kind is linked with increased body inflammation, prolonged infection, and delayed wound healing. ^[23] If left unresolved, it can get worse over time, increasing the risk of disease and subsequent mortality.

Peaceful conflict resolution is generally seen as a sign of a healthy relationship as it serves to diminish perpetual emotional stress. Conflict resolution is not equitable to conflict avoidance which often facilitates relationship strain and may promote unhealthy coping mechanisms, such as alcoholism.

Mental Health Platforms for Social Well-Being

Nobody should ever be completely alone. While digital socializing is not an actual replacement for in-person contact, it does help to alleviate many of the negative effects of total social isolation. Those that find themselves in total isolation can make use of online social platforms to reach out and get at least some form of contact.

Mental health platforms are available that offer social support with an emphasis on promoting optimal social integration in those prone to chronic isolation. Some of these platforms allow for the person to record their mood and other mental health symptoms in order to track progress, as well as including a medication schedule where applicable.^[24] Those with pre-existing health conditions are at a higher risk of being socially isolated and may benefit immensely from the support offered by such platforms.

Telehealth therapists are another option for those that require psychological input in order to expand and improve the quality of their social life. Mya Care can get you in touch with some of the world’s top telehealth therapists.

7 Other Modern Lifestyle and Environmental Factors Associated with Depression

Already depressed and/or anxious individuals are susceptible to being socially isolated, as they may promote worry in others or push others away through their interpersonal social style.

Other factors pertinent to living a modern lifestyle have been associated with promoting depression and anxiety, contributing to the prevalence of social isolation and symptom exacerbation. The main ones are discussed below.

1. Excessive Consumerism May Promote Social Isolation

Western consumerism has promoted a societal trend towards venerating the individual over the whole. In contrast to the age-old wisdom that wealth can’t buy happiness, people have been subliminally informed of the opposite message in today’s world.

Media outlets, including social media, influence the way in which people think and behave by promoting ideals pertaining to one’s self concept.

Social culture plays a large role in what is considered popular, which is further perpetuated by advertising. Advertising often relies on selling a product or idea as an important component of an identity, whether individual or corporate, in order to make it desirable to a specific target market. These concepts have been intimately linked since humans began to trade, however the digital era has substantially increased the degree of advertising exposure.

Social media platforms tend to be littered with advertising that subliminally informs users of what is desirable. Many have subsequently linked successful living to wealth accumulation and possessions. People aspire to the likes of celebrities and other icons of wealth. This is a massive shift from the way the human psyche originally operated. Our ancestry was far more religious, spiritual and social, with less emphasis on the material aspects of living. Eastern cultures and some religious circles are less focused on individualistic consumerism.

Experts have been gauging the effects of this exposure on the mental attitudes of adolescents. Adverts may negatively impact self-esteem^[25] and body image, as well as perpetuate perceived inequality. In susceptible individuals, these may impact mental well-being and increase depressive tendencies. Individualism has also been linked with a reduced propensity to relate properly to others^[26] and selfish thinking^[27], potentially contributing towards the risk of social isolation, loneliness and depression.

Public awareness can improve upon the negative effects of excessive advertising exposure, especially for children and adolescents.^{[28] [29]}

2. Digital Social Activity, Family Connection and Relationship Quality

In the modern paradigm, social norms pertaining to family are changing. Families have gotten smaller, both parents spend more time working on average, and family (group) values are less emphasized than they used to be.  Less connection time between parents and children can negatively impact on the social development of children; as can less real social interaction amongst peers.

Digital socializing can become addictive^[30] and may also increase social isolation in some individuals. The majority of people are spending more time on social media compared to previous generations, which has added to a less social dynamic in many households. When carried out in a balanced, healthy context, digital socializing has shown benefits for social well-being in some^[31]; provided it does not impact important relationships or social skills.

Smaller families are a general trend nowadays and it has its advantages, however this also means more responsibilities and getting carried away in the commotion of life. And even though we have come a long way, unfortunately in many parts of the world, it is still considered as a woman's responsibility to manage the house and care for elderly. A large family in contrast and a good social network can help in minimizing the stress that accompanies these responsibilities, alongside promoting less household tension and better well-being of the whole family.

3. Physical Inactivity

Since agriculture became prominent amongst civilizations, humans have been far less physically active than their more tribal ancestors. Modernization has taken an even bigger leap in this direction, with the free time of many being far less physical than seen in previous centuries. Television and other recreational electronics have caused a rise in “couch potato syndrome.” The development of computers and the integration of the internet into everyday life has led to a rise in sedentary working habits.

Some people spend virtually no time being physically active and the consequences weigh heavily on physical and mental health. Sitting for 10hours per day increases mortality by up to 34% and may interfere with glycemic control, resulting in blood sugar spikes and reduced insulin sensitivity^[32]. A lack of exercise coupled with lots of mental activity due to electronic devices may increase anxiety, tension, boredom, low sleep quality, weight gain^[33] and excessive food consumption.^[34]

The energy requirements of those watching television or using a computer tend to increase due to elevated neuro-excitability. This can drain energy quickly and promote over-feeding. While increased physical activity does increase energy intake, this increase is in line with increased energy production which helps regulate weight.

All of these factors contribute to the risk of disease, particularly for respiratory^[35], cardiovascular, neurologic and metabolic conditions. Children are at an increased risk as they require physical activity for proper development.

Low physical activity levels are very connected to depression and social isolation^[36], being both a symptom and prime risk factor of each. Little to no stimulation from physical inactivity is a large contributing factor in this regard. Physical activity, irrespective of physical fitness, has been shown to lower scores of depression, anxiety and stress.^[37] Exercise is advised for patients suffering from depressive disorders^[38].

4. Over-feeding and Undernutrition

Statistics highlight how much of the world suffers from various nutritional deficiencies. This is in part due to starvation, however it is also related to the over-consumption of non-nutritious foods. Mass produced foods are typically high in calories, low in essential nutrients, satisfying (sometimes addictive) and above all, extremely convenient.

Over-feeding and undernutrition often conspire to produce obesity and/or states of chronic low energy imbalance. This is particularly true of sedentary individuals who are inclined to opt for convenience foods more often than not. The risk of disease is enhanced under these conditions, to which depression is a common comorbidity. Malnutrition can increase depression risk in all populations.^[39]

Those following a clean, more traditional diet, high in nutritious wholefoods, are at a 25-35% reduced risk of developing depression.^[40]

5. Antibiotic Use, Chemicals and the Gut-Brain Axis

The gut microbiome is a currently underappreciated aspect of well-being. The trillions of bacteria residing in the gut contribute towards digestion and nutrient uptake. They also produce a wealth of essential nutrients and enzymes that would otherwise be lacking in a sterile digestive tract. Many of the nutrients produced by the microbiome play very important roles in maintaining the health of the brain and nervous system at large.^{[41] [42]}

In the context of depression, the gut microbiome is a valuable source of serotonin, which helps to reduce anxiety, enhance digestion and optimize nerve function. Depressed individuals and those with chronic illnesses are noted to have altered microbiome profiles^[43] as compared to healthy individuals. Depressed behavior and stress are known to have a bi-directional relationship with the health of the gut microbiome^[44].

The use of antibiotics, disinfectants, pesticides and other chemical solutions has increased in the modern era, while the use of probiotics has declined. Compared to our forefathers, these factors and other considerations have contributed towards reducing bacterial numbers in the gut^[45]; increasing the risk of undernutrition, unbalanced metabolism, depression, anxiety and illness. Western diets are associated with a decreased diversity compared with non-Western diets and more traditional diets.^[46]

6. Chronic Lifestyle Diseases

While many advances have been made in disease prevention, the incidence of chronic lifestyle diseases has been steadily increasing over recent decades as a result of the modern lifestyle. Obesity, cardiovascular disease, diabetes, metabolic syndrome, hypertension and many more related conditions are becoming more prevalent. Chronic disease is a known cause of depression^[47] and depression predisposes one to disease^[48].

7. Artificial Light, Night Shift Work and Modern Circadian Changes

A whole wing of our metabolism depends upon the day-night cycle that sets the body’s circadian rhythm. Several hormones released in response to either light or dark ques are known as circadian hormones. These ensure that other cellular processes occur “on time.”

Natural sunlight exposure during the day is a requirement for healthy circadian signaling, as is darkness exposure at night. In seasonal affective disorder, altered serotonin status is linked with circadian changes that occur as a result of less sunlight which promotes depression in the colder, darker seasons.

The sleep-wake cycle is one example of a vital body function that is dependent on circadian signaling. If circadian signaling is disrupted; the quality of sleep declines, sleep may be disrupted and some people may battle to fall asleep. Depression, mood disruption and anxiety may promote sleep disruption or be a symptom of it, which connects the two to circadian signaling.^[49]

Civilization began to interfere with circadian signaling the moment man-made sources of light came into being. Electricity allowed for people to have much brighter environments at night than was previously possible. The effects of bright light exposure at night are highlighted in night shift workers, who are a well-known population to suffer the effects of circadian and sleep disruption.

Over and above room lighting, many electronic devices emit light. Digital screens, cellphones, televisions and other devices such as alarm clocks all emit lights of varying spectrums. The light emitted from these artificial sources is not the same as that from natural sources. Light intensity and the spectrum of light emitted are suggested as having varying effects on health and circadian signaling. Some spectrums are used in light therapy and can be of benefit to those who suffer from mood disorders, particularly seasonal affective disorder.

Conclusion

It’s quite clear that our biology is better adjusted to a natural setting and that as generations move forward, human biology is changing in response to modern living conditions. In light of this, it is important to remain informed of the effects one’s living environment has on the body and to what degree modern lifestyle factors may affect one.

A lot of factors that are commonly overlooked are able to contribute towards depression and detract from general well-being. Social isolation and loneliness are critical risk factors in this regard and are often under-acknowledged in today’s youth. Diets low in adequate nutrition, sedentary living, excessive screen time, chemical exposures and reduced quality of social interactions also have a role to play in promoting depression and may also increase the risk of social isolation.

For those battling with similar symptoms, particularly during the current pandemic, promoting mental health through improving diet quality, natural light exposure, and exercise may be beneficial. Making an effort to connect with peers, working at enhancing the quality of one’s relationships and getting adequate social support is most important. If one is completely isolated, it is critical to reach out for social help, which may be achieved through the use of telehealth therapists and online mental health services. Psychotherapy may be beneficial for those that battle to maintain healthy relationships and may help to address underlying causes of anxiety and depression in lonely individuals.

To search for Psychologists in India, Thailand, London, Malaysia and more, use the Mya Care Search Engine.

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