An old friend who held a senior position at Disney told me that every Christmas, theme park staff have the unenviable task of locating and then concealing the bodies of suicides before reporting them to the police and escorting them off the premises. I imagine the deceased being carried out in brightly colored Disney-themed body bags, decked out with your choice of mouse ears or wizard hat.
Christmas is the happiest time of the year and Disneyland is the happiest place on earth, so if you can’t be happy in Disneyland at Christmas you might as well give up. Game over, man. (‘Game Over, Man’ is an appallingly unfunny American 2018 ‘comedy’.)
The truth is that Christmas can be the unhappiest time of the year, and a dangerous time for the vulnerable.
Financial problems, the tensions of socializing with long-avoided family members, seasonal increases in alcohol consumption, and winter darkness (in the Northern hemisphere, where Christmas is primarily celebrated) possibly triggering Seasonal Affective Disorder, if that indeed exists (1, 2) – the list of trigger factors is a long one, and it seems that we are becoming more easily triggered. Epidemiological work throughout the world indicates increasing rates of depression and earlier ages of onset in succeeding birth cohorts (3 – 5).
An estimated 350 million suffer from depression worldwide, ie roughly 1 in 22 of the global population. 1 European in 15 experiences an episode of major depressive illness every year, as do 1 in every 12 North Americans (3). In the USA, one large study (3) found that depression increased significantly from 2005 to 2015, from 6.6 percent to 7.3 percent. The rise was most rapid among those ages 12 to 17, increasing from 8.7 percent in 2005 to 12.7 percent in 2015. Age of onset fell remarkably. In 1988 the average age of first onset of depression was 30, but by 2018 this had fallen to 14!
The increasing numbers of fat folk have lead to the creation of self-affirmation groups such as the Fat Acceptance Movement, and the same phenomenon has emerged in depressive circles. (The two groups overlap to a considerable extent (6, 7) with each condition increasing the risk of the other, and both being independently negative health predicators). Teens and the omnipresent social media have taken to calling depression ‘beautiful suffering’, but the truth is that depression is not beautiful at all. It is tedious, painful and – well, depressing.
Our increasing consumption of ultra-processed foods has made a major contribution to both obesity and to depression, via neuro-inflammation. Neuro-inflammatory stress in the hippocampus is profoundly linked to depression (8), but we cannot disregard social factors.
The marginalization of youth, the imposition of social correctness and the related abdication of parental responsibility, the loss of traditional role models, the excessive marketing pressures, the echo chambers of social media, the loss of hope in a better future, all matter#.
And then there are the hikikimori, first described in Japan in 1998 (9).
Hikikomori comes from the verb hiki, which means to move back, and komoru, which means to come into. It is a disorder or syndrome that mainly affects adolescents or young adults who live cut off from the world, locked in their bedrooms for days, months, or even years on end. They do not engage in face-to-face interactions, refuse to communicate even with their family and only venture out to deal with their most imperative bodily needs.Many hikikomori however interact on the internet and sometimes spend more than 12 hours every day in front of the computer, to which many of them are addicted.
There are over a half million Hikikimori in Japan, but it is no longer solely Japanese. The phenomenon has spread to Oman, Spain, Italy, South Korea, Hong Kong, India, France, the USA, Canada, Australia, Bangladesh, Iran, Taiwan, Thailand – in short, it is found today in all countries, and particularly in urban areas (10 – 12).
Labels matter. Hikikomori and something called ‘modern type depression’ overlap considerably and are probably the same thing, emerging through different cultural filters. Modern depression has been characterized as a shift in values from collectivism to individualism; distress and reluctance to accept prevailing social norms; a vague sense of omnipotence; and avoidance of effort and strenuous work.
Hikikomori and/or ‘modern depression’ are not exactly classic depression. Young people with these conditions tend to feel depressed only when they are at work, or in public. But they are typically content in the virtual world of the internet, video games and (in Japan) pachinko. They do however have difficulties in adapting to work or school and participating in the labour market, and live lives that older generations would think of as being socially isolated.
If Hikikomori and ‘modern depressives’ really are socially isolated, then they are indeed at risk. Already suffering from low levels of physical activity and diets containing excessive amounts of ultra-processed foods, they tend to be overweight, chronically inflamed and depressed, at least part of the time. All of these factors are unhealthy, but social isolation is also and independently bad for you; in fact, social isolation is as deadly as excessive alcohol consumption and smoking (13, 14).
Given all these health-negative factors, it is not surprising that recent research has uncovered evidence that the Hikikomori may be experiencing an acceleration of the ageing process (15, 16).
Should society do something about these trends, and if so, what should be done?
Interesting research has focused on a set of genes that predispose to happiness, depression and neuroticism (17), but it is not easy to see how these findings can be translated into praxis. There appear to be multiple genes involved, and in any case their effects are mediated by environmental factors including social interactions (!), nutritional status and others. And even if the genomics, proteomics and metabolomics of depression could be untangled, would we want a brave new world where Soma was available on prescription, or on mandate?
It would be easier to change our diets. A new New Zealand study (18) showed that increasing fruit and vegetable consumption by as little as 2 servings more per day, can improve psychological well-being within 2 weeks.
It was a small-scale trial but well designed, and I believe it because there are compounds in plant foods, specifically polyphenols and carotenoids, which damp down the inflammation in the brain that creates depression.
The spice saffron has the best data base, with 24 clinical trials (19) showing that it is as effective as any anti-depressant drug in treating all kinds of depression, backed up by several good meta-analyses and a host of excellent mechanistic studies.
The actives in saffron are a couple of atypical carotenoids, and (probably) a polyphenol. Zeaxanthin and lutein, two carotenoids that accumulate in the macula densa, appear to have similar effects (20, 21); with some evidence for various polyphenols also (22).
My preference at this time is for the standardised saffron extract used in Viva, which I have found extremely effective in treating both depression and low mood states. It is at least as effective as any pharmaceutical product, and has an unblemished safety record. Unlike the drugs, it is effective within an hour or so of taking the first pill; because unlike the drugs it targets the main cause of depression, ie neuro-inflammation in the hippocampus.
This is a revolutionary product, and I recommend it whole-heartedly to hikikomori everywhere.
- LoBello SG, Mehta S. No evidence of seasonal variation in mild forms of depression. J Behav Ther Exp Psychiatry. 2019 Mar;62:72-79.
- Hansen V, Skre I, Lund E. What is this thing called “SAD”? A critique of the concept of Seasonal Affective Disorder. Epidemiol Psichiatr Soc. 2008;17(2):120-7.
- Weinberger AH, Gbedemah M, Martinez AM, Nash D, Galea S, Goodwin RD. Trends in depression prevalence in the USA from 2005 to 2015: widening disparities in vulnerable groups. Psychol Med. 2018 Jun;48(8):1308-1315.
- Wittchen HU, Uhmann S. The timing of depression; an epidemiological perspective. Medicographia 2010:32:115-125
- Mannan M, Mamun A, Doi S, Clavarino A. Prospective Associations between Depression and Obesity for Adolescent Males and Females- A Systematic Review and Meta-Analysis of Longitudinal Studies. PLoS One. 2016 Jun 10;11(6):e0157240.
- Pratt LA, Brody DJ. Depression and Obesity in the U.S. Adult Household Population, 2005–2010. NCHS Data Brief No. 167, October 2014
- Vasic V, Schmidt MHH. Resilience and Vulnerability to Pain and Inflammation in the Hippocampus. Int J Mol Sci. 2017 Mar 31;18(4).
- Saito T. Shakaiteki hikikomori: Owaranai shishunki [Social withdrawal: A neverending adolescence] PHP Shinsho; Tokyo: 1998.
- Kato TA, Tateno M, Shinfuku N, Fujisawa D, Teo AR, Sartorius N, Akiyama T, Ishida T, Choi TY, Balhara YP, Matsumoto R, Umene-Nakano W, Fujimura Y, Wand A, Chang JP, Chang RY, Shadloo B, Ahmed HU, Lerthattasilp T, Kanba S. Does the ‘hikikomori’ syndrome of social withdrawal exist outside Japan? A preliminary international investigation. Soc Psychiatry Psychiatr Epidemiol. 2012 Jul;47(7):1061-75.
- Kato TA, Shinfuku N, Fujisawa D, Tateno M, Ishida T, Akiyama T, Sartorius N, Teo AR, Choi TY, Wand AP, Balhara YP, Chang JP, Chang RY, Shadloo B, Ahmed HU, Lerthattasilp T, Umene-Nakano W, Horikawa H, Matsumoto R, Kuga H, Tanaka M, Kanba S. Introducing the concept of modern depression in Japan; an international case vignette survey. Affect Disord. 2011 Dec;135(1-3):66-76.
- Kato TA, Shinfuku N, Sartorius N, Kanba S. Are Japan’s hikikomori and depression in young people spreading abroad? Lancet. 2011 Sep 17;378(9796):1070.
- Holt-Lunstad J, Smith TB, Layton JB. Social relationships and mortality risk: A meta-analytic review. PLoS Medicine. 2010;7:e1000316.
- van Beljouw IM, Verhaak PF, Cuijpers P, van Marwijk HW, Penninx BW. The course of untreated anxiety and depression, and determinants of poor one-year outcome: A one-year cohort study. BMC Psychiatry. 2010;10:86.
- Yuen JWM, Yan YKY, Wong VCW, Tam WWS, So KW, Chien WT. A Physical Health Profile of Youths Living with a “Hikikomori” Lifestyle. Int J Environ Res Public Health. 2018 Feb 11;15(2).
- Hayakawa K, Kato TA, Watabe M, Teo AR, Horikawa H, Kuwano N, Shimokawa N, Sato-Kasai M, Kubo H, Ohgidani M, Sagata N, Toda H, Tateno M, Shinfuku N, Kishimoto J, Kanba S. Blood biomarkers of Hikikomori, a severe social withdrawal syndrome. Sci Rep. 2018 Feb 13;8(1):2884.
- Okbay et al. Genetic variants associated with subjective well-being, depressive symptoms, and neuroticism identified through genome-wide analyses. Nat Genet. 2016 Jun;48(6):624-33.
- Conner TS, Brookie KL, Carr AC, Mainvil LA, Vissers MC. Let them eat fruit! The effect of fruit and vegetable consumption on psychological well-being in young adults: A randomized controlled trial. PLoS One. 2017 Feb 3;12(2):e0171206.
- Zhou X, Gan T, Fang G, Wang S, Mao Y, Ying C. Zeaxanthin improved diabetes-induced anxiety and depression through inhibiting inflammation in hippocampus. Metab Brain Dis. 2018 Jun;33(3):705-711.
- Stringham NT, Holmes PV, Stringham JM. Supplementation with macular carotenoids reduces psychological stress, serum cortisol, and sub-optimal symptoms of physical and emotional health in young adults. Nutr Neurosci. 2018 May;21(4):286-296.
- Kanchanatawan B, Tangwongchai S, Sughondhabhirom A, Suppapitiporn S, Hemrunrojn S, Carvalho AF, Maes M. Add-on Treatment with Curcumin Has Antidepressive Effects in Thai Patients with Major Depression: Results of a Randomized Double-Blind Placebo-Controlled Study. Neurotox Res. 2018 Apr;33(3):621-633.