Lost Connections: Why You’re Depressed and How to Find Hope (2018) is a work of journalistic nonfiction by Johann Hari. In some editions, it has the subtitle Uncovering the Real Causes of Depression instead of Why You’re Depressed and How to Find Hope. The work argues for looking at the social and economic causes of depression, rather than viewing depression as mainly a chemical imbalance.

Hari is a Scottish-Swiss journalist who was diagnosed with clinical depression as a teenager. His book taps into personal experiences and includes interviews with doctors, psychologists, and social scientists, and it makes a case for why attitudes about depression and its treatment need to be reconsidered. This guide is based on the 2018 paperback edition published by Bloomsbury Publishing.

Content Warning: The source material features references to assault, drug addiction, suicide, and mental illness. Additionally, the source material may use outdated or offensive terminology that is reproduced in this guide only in direct quotes.

Summary

Lost Connections is split into three parts. In the first, Hari relates how he was diagnosed with clinical depression before he started college. His doctor prescribed him Paxil, an SSRI, or selective serotonin reuptake inhibitor, which is believed to treat depression by increasing the level of the chemical serotonin in the brain. As a student in college, Hari promoted the use of SSRIs to friends experiencing depression: “I explained to anyone who asked that depression is a disease, and SSRIs are the cure” (9).

Later, Hari became aware of arguments by doctors like Dr. Irving Kirsch that antidepressants only help a small minority of people with depression and have harsh side effects like heavy sweating, weight gain, and sexual dysfunction. At first, Kirsch’s arguments against antidepressants made Hari feel threatened: “[Kirsch] seemed to be kicking away the pillars on which I had built a story about my own depression” (23). Kirsch’s research suggested that drug companies played up the effectiveness of antidepressants by using cherry-picked test results. Eventually, Hari went off antidepressants and considered potential non-biological causes of depression and anxiety.

Part 2 details the results of Hari’s interviews with medical professionals, social scientists, and people who experienced depression. From this research, Hari lays out nine catalysts that may cause depression: lack of meaningful work, lack of relationships, lack of meaningful values, childhood trauma, lack of status and respect, disconnection from the natural word, disbelief in a hopeful or secure future, gene changes, and brain changes. While Hari admits that genes and the brain may play a role, he claims that biological changes causing anxiety and depression are often triggered by a person’s environment or traumas. What the causes have in common, Hari argues, is that these are “all ways in which we have been caught off from something we innately need but seem to have lost along the way” (71).

Hari begins the third and final part by describing Kotti, an impoverished, working-class neighborhood in the German capital of Berlin. The neighborhood’s diverse residents, including older leftist activists, socially-conservative Muslim migrants, and a gay community, organized protests against evictions and higher rents. Theirs became a city-wide movement that won important housing reforms. Hari says that the residents of Kotti supported each other in smaller and personal but important ways, exemplifying how community and reconnection can combat depression: “They had stopped being solely private,” Hari says. “They had stopped sitting alone” (215).

From there, Hari describes seven ways of reconnection that could combat depression: reconnection to other people, social prescribing, meaningful work, meaningful values, sympathetic joy and overcoming addiction to self, acknowledging and overcoming childhood trauma, and restoring the future.