Dopamine fasts: Could taking a break from pleasure help treat depression?

Paula Andropolous explores psychiatrist Anna Lembke's novel way of tackling addiction and anxiety

03 October 2021 - 00:00 By Paula Andropoulos
At times, dopamine fasts can be prescribed instead of medication.
At times, dopamine fasts can be prescribed instead of medication.
Image: 123RF/Aleutie

It might seem like the acme of perversity to suggest that, as a species, human beings might benefit from a cultural diet consisting of a bit less pleasure ... and a bit more pain. But according to Stanford-based psychiatrist Anna Lembke, social media and smart technology in particular have made dopamine fiends of us all, and the consequences are rather harrowing.

In her new book, Dopamine Nation, Lembke — a long-standing expert in the field of addiction studies — explores the connection between the relative ease of modern life and rising rates of depression and anxiety, as well as the fundamentally give-and-take relationship between pleasure and pain.

Lembke — who featured in the disturbing 2020 Netflix documentary The Social Dilemma — contends that many of our existential and psychic maladies can be attributed to our unhealthy relationship with dopamine, the reward chemical that makes us feel heavenly when we bite into, say, a bar of chocolate, and that generates cravings, substance notwithstanding.

'Dopamine Nation' by Dr Anna Lembke is published by Dutton.
'Dopamine Nation' by Dr Anna Lembke is published by Dutton.
Image: Supplied

Indeed, Lembke herself has had a (rather unique) run-in with addiction — Dopamine Nation begins with a recollection of how she gradually got hooked on paranormal romance novels (?!) after devouring Stephanie Meyer's Twilight franchise.

The Yale-educated academic tore through ever-worsening tawdry romantic melodramas on her Kindle, before realising that she had virtually lost all interest in doing anything else, including spending time with loved ones and immersing herself in her work with her usual aplomb.

She has worked with a variety of addicts, including people who are addicted to food, sex, weed ... and their phones.

Social media in particular is designed to keep us hooked. Nothing about the design of your newsfeed is incidental — everything, from font to sound effects, operates to stimulate dopamine production in our brains. But pain and pleasure exist on a spectrum, and the excessive dopamine production engendered by compulsively scrolling through reels on Instagram, for example, triggers a compensatory, self-regulating effect in the brain as it tries to restore homeostasis.

The more pleasure we're inundated with, the less dopamine registers with our neurotransmitters — this is the comedown — and, over time, we require more and more of
whatever we're hooked on to get off (as it were.)

Instead of prescribing psychiatric medication in every instance, Lembke is taking a novel approach to treating her clients' depression and advising them to go on dopamine fasts — to do away with whatever it is they're compulsively attached to, be it a television series or a vibrator — for a predetermined period of time.

Nothing about the design of your newsfeed is incidental — everything, from font to sound effects, operates to stimulate dopamine production in our brains

Going cold turkey in this fashion precipitates feelings of anxiety, restlessness, discomfort, paranoia and irritability: in other words, when you're weaning yourself off a crutch of this variety, things get worse before they get better.

So, in a physiological as well as a rather philosophical turn of events, it turns out that sometimes the path back to pleasure is paved with some pain, and it might be time for us to make peace with this duality, this trade-off, instead of constantly and determinedly trying to keep pain at bay.

Of course, discretion is required in any medical undertaking, and not all addictions can be reversed or remedied simply through sheer force of will — addiction exists on a spectrum too and where people are chemically addicted to alcohol or opiates, it can be extremely dangerous to go on the equivalent of a self-imposed “dopamine fast” without consulting a doctor and working in conjunction with professionals to wean yourself off.

But if you find you're spending more and more time reading through the comments section on Facebook groups after bed, or expending hours riffling through memes, then perhaps you should consider that what began as a harmless pastime has devolved into a really inane dependency. Especially after the advent of this pandemic, it might really be time for us to evaluate how we have been coping and, more importantly, what we have been using to cope.

On some commonsensical level, we know this already even without the scientific vocabulary to back it up. Most of us grew up hearing some variation on the maxim “too much of a good thing is never a good thing”; although, between you and me, I also think there's something to Mark Twain's take on the issue: “Too much of anything is bad, but too much good whiskey is barely enough.”