Here’s a story that is not about Trump or Brexit. But this could be worse, with even direr consequences. Addiction is up. Depression is up. Death is up. In America, we have seen a decline in our life expectancy for the first time since 1993. But this is not just happening in the US – death rates are up in the UK, Germany and China.
At the same time, suicide rates in teenagers have reached an all-time high and continue to climb. After their introduction in 1987, selective serotonin reuptake inhibitor (SSRI) prescriptions in the US quintupled over the ensuing 15 years and doubled over the next 10. Recently, SSRI prescriptions have declined slightly as marijuana use has increased following legalisation in many states – it’s easier to procure an over-the-counter drug than a prescription one.
But none of these data explains what’s going on in the UK. Across the pond, you don’t have legal marijuana – yet. But heroin use has skyrocketed – the UK has only 8% of Europe’s population, yet a third of all European overdoses are in the UK. And depression has climbed sharply in tandem. According to the NHS, antidepressant prescriptions have increased 108% in the last 10 years, with a 6% increase in 2016 alone.
Add to this the toll the four other global epidemics – diabetes, fatty liver disease, heart disease and dementia – all of which exact a toll on mental health – if not on ours, then on our families’. It’s estimated that chronic metabolic disease accounts for 75% of America’s $3.2 trillion health care bill, of which 75% is preventable. Indeed, our Medicare will go belly-up by 2026, and Social Security by 2029, due to diabetes. Same for the NHS. But diabetes, depression, and dementia go hand in hand. Does diabetes cause depression? Or could there be some other primary factor, which is responsible for addiction, depression, diabetes, AND dementia?
Three recent UK studies lend some perspective. First, the Million Women studyshows that unhappiness itself doesn’t kill. But the aberrant behaviours that unhappy people perform to “get happy” (tobacco, alcohol, sugar) do. Second, the Whitehall II study demonstrated that those in the highest third of sugar consumers exhibited a 23% increase in risk for common mental disorders such as dysphoria. Lastly, research from the University of Bath found that sugar consumption drives a reaction called glycation in the brain, which appears to be a primary risk factor for dementia.
These three studies are by no means proof, but together they suggest that sugar consumption could be a predisposing factor. And the empirical data is supportive. But there are other exposures as well. For instance, tobacco and alcohol predispose to addiction, depression and dementia (if you live long enough). Mobile phone use and sleep deprivation have also been implicated in addiction and depression in teenagers and young adults, even leading to death.
What’s the connection? Elementary, my dear Watson. Too much dopamine and not enough serotonin, the neurotransmitters of the brain’s “pleasure” and “happiness” pathways, respectively. Despite what the telly and social media say, pleasure and happiness are not the same thing. Dopamine is the “reward” neurotransmitter that tells our brains: “This feels good, I want more.” Yet too much dopamine leads to addiction. Serotonin is the “contentment” neurotransmitter that tells our brains: “This feels good. I have enough. I don’t want or need any more.” Yet too little serotonin leads to depression. Ideally, both should be in optimal supply. But dopamine drives down serotonin. And chronic stress drives down both.
Too many of our “simple pleasures” have morphed into something else – a 6.5-oz soda became a 30z Big Gulp drink; an afternoon with friends gave way to 1,000 friendings on Facebook. Each of these momentary pleasures is just that – momentary. But chronic dopamine from your favourite “fix” reduces serotonin and happiness.
Furthermore, government legislation and subsidies have tolerated ever-available temptation (sugar, tobacco, alcohol, drugs, social media, porn) combined with constant stress (work, money, home, school, cyberbullying, internet), with the end result of an unprecedented epidemic of addiction, anxiety, depression and chronic disease. Thus, the more pleasure you seek, the more unhappy you get and the more likelihood you will slide into addiction or depression.
Our ability to perceive happiness has been sabotaged by our modern incessant quest for pleasure, which our consumer culture has made all too easy to satisfy. Those who abdicate happiness for pleasure will end up with neither. Go ahead, pick your drug or device. Pick your poison. Your brain can’t tell the difference. But please be advised – it will kill you sooner or later, one way or another.
Robert H Lustig is the author of The Hacking of the American Mind. He is Emeritus rofessor of Pediatrics and the Institute for Health Policy Studies, University of California, San Francisco