Rising rates of depression and anxiety in wealthy countries like the U.S. may be a result of our brains getting hooked on the neurotransmitter associated with pleasure.
One of my patients, an intelligent and thoughtful young man in his twenties, came to see me with debilitating anxiety and depression. He had dropped out of college and was living with his parents. He was vaguely thinking of suicide. He also played video games almost every day and late at night.
Twenty years ago, the first thing I would have done for a patient like this was give him an antidepressant. Today I recommended something completely different: a dopamine fast. I suggested that he refrain from all screens, including video games, for a month.
Over the course of my career as a psychiatrist, I have seen more and more patients with depression and anxiety, including otherwise healthy young people with loving families, elite education, and relative wealth. Their problem is not trauma, social dislocation or poverty. That’s too much dopamine, a chemical produced in the brain that functions as a neurotransmitter, associated with feelings of pleasure and reward.
Pleasure and pain are processed in the same parts of the brain, and the brain works to keep them in balance.
When we do something we love, like playing video games for my patient, the brain releases some dopamine and we feel great. But one of the most significant discoveries in neuroscience over the past 75 years is that pleasure and pain are processed in the same parts of the brain and the brain works to keep them in balance. Every time it swings in one direction, it strives to restore balance, what neuroscientists call homeostasis, by tipping in the other.
As soon as dopamine is released, the brain adapts to it by reducing or “down-regulating” the number of dopamine receptors stimulated. This causes the brain to stabilize by tilting to the pain side, which is why pleasure is usually followed by a hangover or sinking feeling. If we can wait long enough, this feeling goes away and neutrality is restored. But there is a natural tendency to counter it by going back to the source of the pleasure for another dose.
If we hold this pattern for hours every day, for weeks or months, the brain’s set point for pleasure changes. Now we have to keep playing games, not to feel pleasure but just to feel normal. As soon as we quit, we experience the universal symptoms of withdrawal from any addictive substance: anxiety, irritability, insomnia, dysphoria, and mental preoccupation with using, otherwise known as the urge to smoke.
Our brains have developed this refined balance over millions of years in which pleasures were rare and dangers still present. The problem today is that we no longer live in this world. Instead, we now live in a world of overwhelming abundance. The quantity, variety and potency of highly reinforcing drugs and behaviors have never been greater. In addition to addictive substances like sugar and opioids, there is also a whole new class of electronic addictions that did not exist around 20 years ago: texting, tweets, web browsing, online shopping. and gambling. These digital products are designed to be addictive, using flashing lights, celebratory sounds and “likes” to promise ever greater rewards just a click away,
Yet despite increased access to all of these wellness drugs, we are more miserable than ever. Rates of depression, anxiety, physical pain, and suicide are increasing all over the world, especially in wealthy countries. According to the World Happiness Report, which ranks 156 countries according to the level of satisfaction of their citizens, Americans reported being less happy in 2018 than in 2008. Other wealthy countries saw similar declines in self-reported happiness scores, including Belgium, Canada, Denmark, France, Japan, New Zealand and Italy. The Global Burden of Disease study found that the number of new cases of depression around the world increased by 50% between 1990 and 2017, with the highest increases recorded in the highest income regions, particularly in America. North.
It is difficult to see the cause and effect when we are chasing dopamine. It is only after taking a break from our drug of choice that we are able to see the true impact of our use on our lives. This is why I asked my patient to stop playing video games for a month, the time to allow his brain to restore its dopamine balance. It wasn’t easy, but he was motivated by the counterintuitive idea that refraining from what made him feel good in the short run might actually make him feel better in the long run.
To his surprise, he felt better than he had been in years, with less anxiety and less depression. He was even able to resume playing video games without any negative effects, strictly limiting his playing time to no more than two days a week, for two hours a day. This way, he left enough time between sessions for the brain’s dopamine balance to be restored.
He avoided overly powerful video games, the ones he couldn’t stop playing once he started. He designated one laptop for games and one for school, to physically separate games and class work. Finally, he pledged to play only with friends, never with strangers, so that the game strengthens his social bonds. The human connection itself is a powerful and adaptive source of dopamine.
Not everyone plays video games, but pretty much we all have a digital drug of choice, and that likely involves the use of a smartphone, the equivalent of the hypodermic needle for a wired generation. Cutting down on phone use is notoriously difficult, as at first the pleasure-pain balance of the brain shifts to the pain side, making us restless and cranky. But if we can maintain it long enough, the benefits of a healthier dopamine balance are well worth it. Our minds are less preoccupied with envy, we are more able to be present in the moment, and the unexpected little joys in life are rewarding again.
-Dr. Lembke is a psychiatrist and professor at Stanford University. This essay is adapted from his new book “Dopamine Nation: Finding Balance in the Age of Indulgence”, which will be published on August 24 by Dutton.