Speaker 1: Would you like to hear your voice on an episode
Speaker 1: of The One You Feed? We sure would. Our five
Speaker 1: hundredth episode is coming up in May, and to celebrate,
Speaker 1: we'd like to feature listeners of the show during the episode.
Speaker 1: If The One You Feed has meant something to you,
Speaker 1: we'd love to hear from you. You can go to
Speaker 1: one you Feed dot net slash message and leave a
Speaker 1: voicemail tell us how the podcast has impacted you, or
Speaker 1: tell us how the Wolf parable applies to your life.
Speaker 1: Go to one you Feed dot net slash message by
Speaker 1: May one and leave us a voicemail. We're excited to
Speaker 1: celebrate this milestone with you, our dear listeners. These drugs,
Speaker 1: you know, they're not going to cure anything. They're going
Speaker 1: to be able to support you as you try new things,
Speaker 1: as you battle the depression. With all these different avenues
Speaker 1: that we have and finding the one that fits, because
Speaker 1: everyone's journey is going to be really, really different. Welcome
Speaker 1: to the One You Feed. Throughout time, great thinkers have
Speaker 1: recognized the importance of the thoughts we have. Quotes like
Speaker 1: garbage in, Garbage out, or you are what you think
Speaker 1: ring true, and yet for many of us, our thoughts
Speaker 1: don't strengthen or empower us. We tend toward negativity, self pity,
Speaker 1: jealousy or fear. We see what we don't have instead
Speaker 1: of what we do. We think things that hold us
Speaker 1: back and dampen our spirit. But it's not just about thinking.
Speaker 1: Our actions matter. It takes conscious, consistent and creative effort
Speaker 1: to make a life worth living. This podcast is about
Speaker 1: how other people keep themselves moving in the right direction,
Speaker 1: how they feed their good wolf. Thanks for joining us.
Speaker 1: Our guest on this episode is Alex Riley, an award
Speaker 1: winning science writer. In two thousand nineteen, he received a
Speaker 1: Best Feature Award from the Association of British Science Writers
Speaker 1: for his reporting on the Friendship Bench, a project that
Speaker 1: began in some bobwe in two thousand six. Alex's articles
Speaker 1: have been published by New Scientist, Mosaic, Nova, Text, Nautilus Magazine,
Speaker 1: the BBC and many others, and his new book is
Speaker 1: A Cure for Darkness, The Story of Depression and How
Speaker 1: We Treat It. Hi, Alex, Welcome to the show. Hi,
Speaker 1: thanks for having me. We are going to be discussing
Speaker 1: your book, A Cure for Darkness, The Story of Depression
Speaker 1: and How We treat it, which listeners will know, is
Speaker 1: right up my alley, the kind of thing I love
Speaker 1: to read, and it's a wonderful book. But before we
Speaker 1: do that, will start, like we always do, with the Parable.
Speaker 1: In the Parable, there is a grandparent talking with their
Speaker 1: grandchild and they say, in life, there are two wolves
Speaker 1: inside of us that are always at battle. One is
Speaker 1: a good wolf, which represents things like kindness and bravery
Speaker 1: and love, and the other is a bad wolf, which
Speaker 1: represents things like greed and hatred and fear. And the
Speaker 1: grandchild style ups and thinks about it for a second,
Speaker 1: looks up at their grandparents, says, well, which one wins,
Speaker 1: and the grandparents says, the one you feed. So I'd
Speaker 1: like to start off by asking you what that parable
Speaker 1: means to you in your life and in the work
Speaker 1: that you do. I think the parable it really speaks,
Speaker 1: you know, quite intimately with depression. Some of the words
Speaker 1: that you just said there, I mean hatred, greed. Depression
Speaker 1: is often related to a hatred of yourself, and in
Speaker 1: my personal experience, that seems quite apt. It came from
Speaker 1: a Freudian background, but it seems to be relevant to
Speaker 1: a lot of people. People don't have that love for themselves.
Speaker 1: So I think the two wolves in terms of depression
Speaker 1: is do you love yourself or do you hate yourself?
Speaker 1: And which one are you going to allowed to win
Speaker 1: that battle? And sometimes you can't really control which one
Speaker 1: you seem to be, you know, helpless and hopeless when
Speaker 1: you are faced with a precative episode, and unfortunately the
Speaker 1: self hatred wins. And so the Parable really does connect
Speaker 1: quite deeply with some of the basic underlying symptoms and
Speaker 1: experiences of depression. And it's very difficult to love yourself
Speaker 1: when you've experienced a depression or you're going through a depression.
Speaker 1: But for me that's been one of the main elements
Speaker 1: of recovery is through therapy and using pharmacological tools, is
Speaker 1: to enable yourself to open you to love yourself. There
Speaker 1: are other things that this parable readers speak in terms
Speaker 1: of you know, which one do you feed with depression?
Speaker 1: And as I write in the book, a large part
Speaker 1: of depression they come from what you actually eat. So literally,
Speaker 1: which wolf for you feeding? Are you feeding this this depression?
Speaker 1: Are you feeding this healthier side of yourself? What do
Speaker 1: you eat eating a healthy, balanced diet or eating very
Speaker 1: high saturated fat content and you know, feeding this beast
Speaker 1: that will only lead you down the path of depression.
Speaker 1: I love that. I love the idea of the wolf,
Speaker 1: of hating yourself versus loving yourself. And it's funny. One
Speaker 1: of the ways that I can tell I'm having a
Speaker 1: bit of a depressive episode is I actually will hear
Speaker 1: my brain say I hate myself. I'll actually hear those words,
Speaker 1: and for me, it's an immediate like hang on a second.
Speaker 1: It's like a harbinger for me of old scripts starting
Speaker 1: to run and of something being off, because it's so
Speaker 1: out of character for broadly speaking, how I relate to
Speaker 1: myself most of the time now, because I agree with you,
Speaker 1: I think learning to love myself, to care about myself,
Speaker 1: to take care of myself, has been a huge part
Speaker 1: of what all this healing has been about for me.
Speaker 1: So when I hear something that's stark, it kind of
Speaker 1: sets me off. So I love the way you said
Speaker 1: that because it kind of made that come to mind
Speaker 1: for me. And that's amazing that you can do that.
Speaker 1: I mean, that takes a lot of time, I'm sure,
Speaker 1: And you know, it's very easy to believe what your
Speaker 1: brain is telling you in that moment you know, there's
Speaker 1: a real disparity between what's real and what isn't when
Speaker 1: you're going through a depressional that first instance of where
Speaker 1: depressive episode might be star thing that voice is just
Speaker 1: as real as a voice that saying no, I don't
Speaker 1: hate myself, that I'm actually proud of myself for doing
Speaker 1: this thing that I've done, or I feel, you know,
Speaker 1: great affection for myself. Because I've been through these quite
Speaker 1: portress experiences, I'm still probably not at that level I think.
Speaker 1: I mean, I I let that voice overtake me. I mean,
Speaker 1: I've just come out of quite a severe three months.
Speaker 1: Often my depressions are quite associated with seasons. It's quite seasonal,
Speaker 1: so often during the inter worse. Yes, I'm coming out
Speaker 1: of that depression over the last month or so, and
Speaker 1: it's still very difficult for me to to stop that
Speaker 1: voice like you just mentioned. Yeah, And it's interesting. I
Speaker 1: don't know that I would say that I can always
Speaker 1: stop it, but I recognize it, and it may just
Speaker 1: be that maybe I have a benefit of having a
Speaker 1: very dramatic inner voice sometimes, like when it says something
Speaker 1: like that, like it's just that stark, I'm like, whoa
Speaker 1: you know, or I wish I was dead. I'm like,
Speaker 1: all right, hold on, Like I almost laugh at it
Speaker 1: a little bit because I'm like, it is so it
Speaker 1: is so dramatic, and I am not, by nature or
Speaker 1: a very dramatic person, so when it does that, it
Speaker 1: just sort of catches me. I don't necessarily say that
Speaker 1: I can always turn it off. But what I have
Speaker 1: gotten better at, and I've talked about this on the
Speaker 1: show a lot over the years, is like, you know,
Speaker 1: is my depression better than it used to be? And
Speaker 1: we're going to talk about this in a little while.
Speaker 1: Is it depression? What do you even call it? All
Speaker 1: this different stuff, But one of the things I unequivocally
Speaker 1: know is that I respond to it in a much
Speaker 1: wiser and more sane way than I used to. And
Speaker 1: I can sort of recognize it a little bit as
Speaker 1: sort of that bad wolf of me, like, Okay, I
Speaker 1: can't turn you off, but I'm gonna try not to
Speaker 1: give you a ton of attention either, you know, I'm
Speaker 1: gonna try and just go are there it is again?
Speaker 1: You know? There it is again. I know from previous
Speaker 1: experience it's not true. It feels very real, but depending
Speaker 1: on how severe it is, obviously has to do with
Speaker 1: how we're able to do that. So you just kind
Speaker 1: of came out of difficult period. Do you have any
Speaker 1: sense of what caused you to either go into it
Speaker 1: or come out of it? You mentioned the seasons being
Speaker 1: part of it. Was there anything else and what do
Speaker 1: you think lad to the emergence or is it just
Speaker 1: sort of it followed its cycle and now it's done.
Speaker 1: So I think my depression is quite recurrent. It seems
Speaker 1: to come and go maybe every few months or you know,
Speaker 1: I think once it was eighteen months, and you know,
Speaker 1: it lasts for anywhere between, you know, a few weeks
Speaker 1: to a few months. But actually with antidepressants, I can
Speaker 1: really reduce that amount of time. I think that's what
Speaker 1: antidepressants have done for me, is they don't remove the depression,
Speaker 1: they allow it to have a short course. You know,
Speaker 1: people think of depression as being you know, you're constantly disabled.
Speaker 1: You can't do anything for that amount of time where
Speaker 1: it's still fluctuates within that episode. For me, where some
Speaker 1: days I'm incredibly disabled from it, and then other days
Speaker 1: I might feel like a bit of lucidity. I might
Speaker 1: feel like it's over, and then it slams me back
Speaker 1: into it. So people are often surprised that, you know,
Speaker 1: I turn up to either events and stuff and I
Speaker 1: can seem to be able to switch it off, but
Speaker 1: actually it's just sort of obviously this sort of sound
Speaker 1: wave that's going through this episode. Yeah, I'm still trying
Speaker 1: to understand the triggers. I mean, they're obviously our triggers.
Speaker 1: I think even publishing this book has been really difficult
Speaker 1: given the topic. Given you know that it took me
Speaker 1: four years and now it's been released into the world,
Speaker 1: and you know, it's been really well reviewed. But during
Speaker 1: a pandemic, books just aren't selling. We talked about hating
Speaker 1: yourself and then this this voice comes in your head
Speaker 1: where you're saying you're a failure. Yeah, this isn't being successful,
Speaker 1: So you know, it's kind of trying to rationalize that
Speaker 1: and just almost wait until you're in a more stable
Speaker 1: position to kind of climb out of this hole that
Speaker 1: depression has thrown you into. And like you said, I
Speaker 1: think as you become older something dealing with this for
Speaker 1: for many years now, you become experienced in your own
Speaker 1: sort of depression and you can kind of hear the
Speaker 1: tell tale signs. It's incredibly stressful, but at the same
Speaker 1: time you almost have this thought in your head where saying,
Speaker 1: I know this isn't forever, and that's a really hard
Speaker 1: thing to think about. Yeah, you know it's going to end,
Speaker 1: and I know that on the other side, I'll be sociable,
Speaker 1: I'll be hopefully interesting, and my relationship won't be failure,
Speaker 1: like my partner still loves me and everything like that
Speaker 1: along with the book. I think we had our first
Speaker 1: child just before the book was published, so it's been
Speaker 1: a bit of accessful years. I think these things do,
Speaker 1: even subconsciously add to the triggers. I'm just happy that
Speaker 1: it's not as severe and as permanent as a lot
Speaker 1: of depressions are, that it responds to certain types of
Speaker 1: therapy and antidepressants. That's what I'm really really thankful for. Yeah,
Speaker 1: so let's talk about antidepressants. You know, in the book,
Speaker 1: you talk about sort of going on them, coming off
Speaker 1: of them, and going back on them, you know, and
Speaker 1: and the debate that a lot of people have, myself
Speaker 1: included because I have done that day. It's the on again,
Speaker 1: off again dance, and at the time of the book
Speaker 1: being published, the answer for you was back on antidepressants
Speaker 1: and you felt like that's kind of where you were,
Speaker 1: but you mentioned to me in our conversation beforehand that
Speaker 1: that's not kind of where you are now. So let's
Speaker 1: kind of talk about that back and forth a little bit,
Speaker 1: and you know, sort of what causes you to think
Speaker 1: sometimes that you should be on you should be off,
Speaker 1: and maybe we could just swap experiences on that. Yeah, sure,
Speaker 1: So it's a balance. Really, the drugs aren't, you know,
Speaker 1: without side effect or you know, impact on your life.
Speaker 1: Compared to some of the older drugs. They are almost
Speaker 1: without side effect, but some of the older drugs are
Speaker 1: more effective and really severe depressions. So it's different for
Speaker 1: every person. And the side effects that I really struggle
Speaker 1: with and try to this is the reason I keep
Speaker 1: coming off them or trying to come off them, is
Speaker 1: it's almost like it puts up a force field between
Speaker 1: you and the world, so I don't really experience the world.
Speaker 1: I don't feel connected to it, and that has problems
Speaker 1: with my relationship. I was on a very very high
Speaker 1: dose just after my daughter was born, and I realized
Speaker 1: that I was not really connected to her like I
Speaker 1: should be, like I thought I would feel more when
Speaker 1: I said my daughter, and you know that just wasn't
Speaker 1: happening if it did feel sort of being surrounded by
Speaker 1: some force field, and then that emotion couldn't come in.
Speaker 1: So I came off them in order to try and
Speaker 1: experience the world a bit more. But in doing that,
Speaker 1: you become more delicate, and that's when the depression might
Speaker 1: come back in is through these the stressful events and
Speaker 1: these triggers, and you're not bubble wrapped anymore, so you
Speaker 1: know it's easier for it to do some damage. Right now,
Speaker 1: I'm off them again, And that was actually because I
Speaker 1: recently had a dose, as I explained the Book of
Speaker 1: silo Cybin, so that the key ingredient of magic mushrooms,
Speaker 1: and they're almost the opposite of s RI, is the
Speaker 1: drugs I take the antidepressant in that in my experience,
Speaker 1: they don't shield you from anything. They open you up
Speaker 1: and it feels like this overwhelming sense of love for
Speaker 1: yourself and for other people around you. It allows you
Speaker 1: to have a different perspective um and for me that's
Speaker 1: really powerful that even though it's about six hours long,
Speaker 1: it can have lasting effects of you can relate back
Speaker 1: to that moment you feel, yeah, this overwhelming sense of
Speaker 1: love that other drugs seem to take away from me.
Speaker 1: And so I'm still going back and forth between therapy,
Speaker 1: between different types of pharmacological options. Some of them are legal,
Speaker 1: some of them legal, and it is a dance, and
Speaker 1: often it's not a very good dance for dance. So yeah,
Speaker 1: right now I'm kind of hopefully riding away out out
Speaker 1: of a depression and that hopefully we'll we'll see me
Speaker 1: on for a few more months. And it's something that
Speaker 1: everyone has to kind of, you know, decide for themselves
Speaker 1: the cost benefit of being on these drugs that are
Speaker 1: effective for of people, and they're certainly affective for me,
Speaker 1: but then they're also with these side effects that sometimes
Speaker 1: you know, you wonder whether it's all worth it. So yeah,
Speaker 1: that's that's kind of my story right now. Yeah, that
Speaker 1: sort of mirrors mine in a lot of ways. Certainly,
Speaker 1: the thought being, hey, are these medicines shrinking my overall
Speaker 1: emotional range is the thought. And certainly what what certain
Speaker 1: people say is what they do. My experience of coming
Speaker 1: off of them, and when I've come off of them,
Speaker 1: I've done it in the past in really not wise ways.
Speaker 1: At not good times and had you know, it went poorly.
Speaker 1: And I've come off of them in more recent years,
Speaker 1: in a very very long taper periods, with a great
Speaker 1: deal of support, a lot of clarity on the things
Speaker 1: that I know treat my depression in addition to medicine,
Speaker 1: you know. So for me, my approach to it is,
Speaker 1: I say, I throw the kitchen sink at it. Right,
Speaker 1: I check every box I can think of to check
Speaker 1: that you know, we know helps and I know help me.
Speaker 1: And so I've come off of them. And where I
Speaker 1: am right now is I am the on phase a
Speaker 1: much smaller dose than I used to be on, much
Speaker 1: much smaller. But what I have found is that when
Speaker 1: I come off of them, it's not that my emotional
Speaker 1: range expands across the board. It's just that the bottom
Speaker 1: falls out of it. Right. It's not that it's like, oh,
Speaker 1: I'm feeling more of everything, the good and the bad, wonderful, Okay,
Speaker 1: I'll take a little more down for a little more up.
Speaker 1: It's just the sort of bottom falls out. The better
Speaker 1: way I can describe it is a I just become
Speaker 1: extraordinarily irritable with everything and then be every activity I
Speaker 1: feel like I'm carrying like a hundred pound bag of
Speaker 1: rocks around with me, and so, like you described, I
Speaker 1: can function with a hundred pounds of rocks in a backpack,
Speaker 1: you know, like I'm functioning, but it sure feels like
Speaker 1: a lot of work. You know. I've gone through this
Speaker 1: a couple times of the last decade and done it
Speaker 1: in a really smart and intelligent way, and then I've
Speaker 1: gone back on and I've almost immediately been like, oh,
Speaker 1: I feel like myself again. So you know, the question
Speaker 1: I never know is I've been on him a long time, right,
Speaker 1: So what I don't know is have I just habituated
Speaker 1: my body to needing them? And that's just kind of
Speaker 1: what I've done. But for me, the side effects are
Speaker 1: really pretty minimal and the benefit seems fairly obvious. So
Speaker 1: I am right now in the on camp. But my
Speaker 1: experience is any indication sometime in the next few years,
Speaker 1: my brain will go, well, I wonder, and you know,
Speaker 1: maybe we'll do the dance again. I don't know. Yeah,
Speaker 1: I mean they are amazing that, you know, you can
Speaker 1: stay on these drugs for so long and the side
Speaker 1: effects I I describe are so minor compared to you
Speaker 1: very severe depression, right and right. You mentioned that I
Speaker 1: went back on them just before my book was published,
Speaker 1: and as I'm describing the book, it was those signs
Speaker 1: of suicide that I realized that I was becoming dangerous
Speaker 1: to myself self. These fantasies and these thoughts of killing
Speaker 1: myself were almost taking up all of my waking time.
Speaker 1: You know, I discussing with my partner because I like
Speaker 1: to be open about these things, and previously that's maybe
Speaker 1: saved my life because she knew what I was planning.
Speaker 1: You're almost trying to state up ahead of your depression,
Speaker 1: so when it does become more severe, she knows. And
Speaker 1: maybe there have been some signs in what I've been
Speaker 1: saying that she can, you know, take action. And you know,
Speaker 1: I feel so much guilt for the load that I
Speaker 1: put on her, but it's unfortunately part of a relationship
Speaker 1: with someone who has, you know, severe mental illness. Yeah,
Speaker 1: she's just thrilled that I do have these moments where
Speaker 1: I almost come back, and you know, whether that's with drugs,
Speaker 1: often it is with the antidepressants. And someone asked me recently,
Speaker 1: you know which of these I talked about? So many
Speaker 1: different treatments in the book ones that I've taken and
Speaker 1: also historical examples. And someone asked me which one's worked
Speaker 1: best for you, And I couldn't really say which one
Speaker 1: had worked best as like a percentage thing, but I
Speaker 1: know for a fact which one I probably wouldn't be
Speaker 1: able to do without. And that's an antidepressant. And sometimes
Speaker 1: that's quite hard to get your head around that almost
Speaker 1: dependent on this drug existing, and so that that can
Speaker 1: almost add to your you know, self hatred. You are
Speaker 1: depending on something that is a prescription, but you know
Speaker 1: this is a disease. You know, I have a family
Speaker 1: history of depressions and alcohol abuse and schizophrenia and environmental
Speaker 1: sort of triggers from my childhood, you know, probably going
Speaker 1: to exacerbate these genetic sort of vulnerabilities. So they just
Speaker 1: got to remind yourself of these drugs don't show that
Speaker 1: you're in any way weak or malfunctioning or anything like that.
Speaker 1: It's just something that my body sometimes needs a bit
Speaker 1: of help, because that's just what's happened in our family. Yeah,
Speaker 1: and we'll get to this in a minute. What are
Speaker 1: we even talking about with depression because we don't really
Speaker 1: even know what we're resting sailing with right, we don't
Speaker 1: even really know why these drugs work, but I often
Speaker 1: think of it as you know, there are just different people.
Speaker 1: You know, some people have family histories and they need
Speaker 1: a certain type of medication to keep their cholesterol down,
Speaker 1: even if they live a healthy lifestyle. You know, there
Speaker 1: are people who need insulin even if they live a
Speaker 1: healthy lifestyle. So for me, I feel like antidepressants get
Speaker 1: me almost just to the starting line. It's still up
Speaker 1: to me from there to craft a life that has
Speaker 1: meaning and has purpose and has value and has enjoyments
Speaker 1: and love, and I mean, all that still has to happen.
Speaker 1: It's not like I just take the pill and it's
Speaker 1: like boom, it's all there, right. I mean I tried
Speaker 1: that with heroin for a long time and and uh,
Speaker 1: it didn't really it didn't work. So you know, it's
Speaker 1: more than like a pill fixes everything, at least in
Speaker 1: my case. It's like a pill almost in a lot
Speaker 1: of cases. And you reference this in your book at
Speaker 1: one point in talking about we know exercise and nutrition
Speaker 1: are really powerful tools for dealing with the pre However,
Speaker 1: if you are really in the depths of it. For
Speaker 1: a lot of people, the depression is so severe they
Speaker 1: can't even get to the point they do those things.
Speaker 1: But you give them a little bit of medicine, and
Speaker 1: all of a sudden, now they're at a point where
Speaker 1: they can say, all right, now, let me incorporate exercise,
Speaker 1: let me incorporate good nutrition, let me incorporate meaningful connections.
Speaker 1: That's kind of how I think about it really, as
Speaker 1: as just sort of like getting me to a starting
Speaker 1: line at which then I can make the decisions about
Speaker 1: the other aspects of life that make it meaningful. It's
Speaker 1: the same for psychotherapy as well. I mean since the
Speaker 1: nineties seventies, as I mentioned the book We've Got the
Speaker 1: Rise of CBT and personal psychotherapy, and the whole thing
Speaker 1: about using antidepressants then was to for psychologist at least,
Speaker 1: was to get them into a state where they were
Speaker 1: able to discuss the problem. It's kind of kind of
Speaker 1: a yeah, psycho analytical theme to it, but yeah, you're right.
Speaker 1: These drugs, you know, they're not going to cure anything.
Speaker 1: They're going to be able to support you as you
Speaker 1: try new things, as you battle the depression with all
Speaker 1: these different avenues that we have and finding the one
Speaker 1: that fits. Because everyone's journey is going to be really,
Speaker 1: really different. Yeah, in the mental health world, the medicine
Speaker 1: debate can be a very fierce one, right, I certainly
Speaker 1: understand the argument in a lot of cases around over medication.
Speaker 1: What I feel more concerned about is just the walk
Speaker 1: into your primary care physician and you're given a pill
Speaker 1: after answering a seven question survey, and that's all that's
Speaker 1: done to treat what might be a condition that has
Speaker 1: a lot of other aspects to it. I think it's
Speaker 1: good that we've gotten to the point where you can
Speaker 1: talk with your primary care physician about this stuff. I mean,
Speaker 1: it's a nuanced area. I would always hope for people
Speaker 1: that like medicine is step one in a series of
Speaker 1: other interventions that lead to a better quality of life stuff.
Speaker 1: One suggests that you would give the antidepressant as the
Speaker 1: sort of the starting point for every person, whereas I
Speaker 1: would maybe say that if someone isn't in a dangerous position,
Speaker 1: if someone's in a critical condition and they need something
Speaker 1: that's going to work within a month, then yes, I
Speaker 1: would agree. But if someone walks into their family practitioner
Speaker 1: and they are showing some signs of almost like a
Speaker 1: sub threshold depression. Then I would argue that maybe you know,
Speaker 1: exercise and diet, these things that don't have the same
Speaker 1: side effects or problems with coming off with draw the
Speaker 1: impacts of these drugs, try those first. But again it's
Speaker 1: difficult when you're working with a vulnerable patient and you
Speaker 1: don't know how it's very difficult to gauge in what
Speaker 1: state they're in, so it's a very complex decision to make.
Speaker 1: I just think if everyone is given the medication first,
Speaker 1: it's quite hard to come off them, and if they
Speaker 1: don't work, that can then make people switch off from
Speaker 1: reaching out again. Whereas these other sort of alternative approaches
Speaker 1: of exercise and diet and social connection of course, to
Speaker 1: really boost someone's someone's own sort of more natural reserves,
Speaker 1: I think would be a really positive way that both
Speaker 1: psychiatry and just general practitioners could go down. I think
Speaker 1: that's always been my approach is like on meds, when
Speaker 1: I'm doing everything else that I know treats depression and
Speaker 1: it's still there, then I go Okay, I'm comfortable, and
Speaker 1: like a lot of things in life, there we often overcorrect,
Speaker 1: and so I think we went from a point where
Speaker 1: it was like so haboo for people to take medicine.
Speaker 1: There was a positive swing in which we went, Okay,
Speaker 1: you know, that's not a bad thing, and you know,
Speaker 1: talk to your doctor about it, and that's all good, right,
Speaker 1: But I think we've overcorrected and now we're at the
Speaker 1: point where, unfortunately, for a lot of people, medicine is
Speaker 1: the very first thing they're given. It's just again, you
Speaker 1: answer this eight question survey in your primary care physician office,
Speaker 1: at least here in America, in a lot of practices,
Speaker 1: and you're going to walk out with a script for
Speaker 1: you know, an antidepressant, and that is not ideal. All right, Anyway,
Speaker 1: Let's change direction because I want to talk a little
Speaker 1: bit about what is depression? Right, you say in the book,
Speaker 1: a single diagnosis doesn't capture the reality of depression. It's
Speaker 1: a syndrome, a collection of different but overlapping mental states.
Speaker 1: So let's just talk a little bit about what do
Speaker 1: we know today about what we're calling depression, what it is.
Speaker 1: You know, we can get into its relationship with other conditions.
Speaker 1: We can talk about the P factor that you also
Speaker 1: right about, which is fascinating, But let's just kind of
Speaker 1: wade into we've been tossing this word around, like it's
Speaker 1: this clearly defined thing or I have depression, and like
Speaker 1: it can be measured and diagnosed in a simple way,
Speaker 1: and that is very far from reality. Yeah, it's incredibly diverse,
Speaker 1: and I wouldn't say that any diagnosis is very accurate
Speaker 1: when it comes to depression. I think we go to
Speaker 1: things like the DSM. So the American sort of Bible
Speaker 1: tries to, you know, put labels on different symptom clusters,
Speaker 1: and you look at the one which is major depression,
Speaker 1: and there isn't a mention of anxiety in there, and
Speaker 1: that just struck me as either trying to put another
Speaker 1: diagnosis on anxiety disorder. But for me and everyone I've
Speaker 1: spoken to and looking through history, even back to Hippocrates
Speaker 1: and ancient Greece, depression and anxiety are almost one and
Speaker 1: the same. You're very rare to see a pure depression.
Speaker 1: It's very rare to see anxiety that might not slip
Speaker 1: into a sort of state of helplessness and incredibly low mood.
Speaker 1: So here in the West, we kind of focus on
Speaker 1: this symptom of low mood. You know, depression means something
Speaker 1: that's been decreased, so the mood has lowered. Historically it
Speaker 1: came from depression in pulse or heart rate, blood pressure,
Speaker 1: and that's what stuck here. But in the book, I
Speaker 1: kind of try and find alternatives. You know, depression almost
Speaker 1: it fuses with one's cultural sphere and the language that
Speaker 1: people use almost shapes it into slightly different forms of
Speaker 1: the same disease. So I traveled a Zimbabwe to meet
Speaker 1: some amazing psychiatrists and scientists and the local grandmothers that
Speaker 1: they work with and they are providing problem solving therapy
Speaker 1: for people in really low income neighborhoods. And the psychiatrists
Speaker 1: tried to do a survey, as you would do for
Speaker 1: any study of how prevalent is depression in the area
Speaker 1: in Hararia, the capital city of Zimbabwe, and the wasn't
Speaker 1: a word for it. So they had to talk with
Speaker 1: the grandmothers who were community health workers since the nineteen
Speaker 1: eighties but haven't worked on mental illnesses, mainly sanitation and
Speaker 1: things like that, and they had to kind of come
Speaker 1: up with, okay, what people describing here that might allow
Speaker 1: us to see if they're suffering from something that is depression.
Speaker 1: And they found the phrase thinking too much, which you know,
Speaker 1: it has a huge amount of like the rumination, the
Speaker 1: anxiety that makes you fall into a depression. It's it's
Speaker 1: a really common and amazing phrase and it's kafungi see
Speaker 1: so in the local in the Zimbabwean language of Shauna.
Speaker 1: So it kind of shows that depression is not a
Speaker 1: thing that you can just simply label and just say, okay,
Speaker 1: this is it, like like it would be a cancer
Speaker 1: that's got a specific cells, even a specific gene that
Speaker 1: has mutated to allow this cell to divide and continue
Speaker 1: to divide. But depression is part of everything that surrounds
Speaker 1: us as well as our biology. So we're thinking too much.
Speaker 1: This actually is really common in South America and across Africa.
Speaker 1: There's also some political influence in how we sort of
Speaker 1: defined oppression. So when Mao was in power in China
Speaker 1: and communist state there, it was almost illegal to be depressed,
Speaker 1: and so you couldn't really have this mental disease because
Speaker 1: that would be seen as an insult to this great leader.
Speaker 1: And so there was more of a physical term near
Speaker 1: a senior which means a weakness of the nerves, So
Speaker 1: you weren't mentally ill, you were physically ill, even though
Speaker 1: the symptoms were very much similar to what we would
Speaker 1: see and diagnosed as depression, and this sort of global
Speaker 1: view just maybe realize that it's very diverse and you
Speaker 1: can call it a lot of things, but there's still
Speaker 1: the same core, whether it's the low mood, thinking too much,
Speaker 1: anxiety and rumination, the effect on sleep. Historically that used
Speaker 1: to be you don't sleep, but there are people who
Speaker 1: sleep too much, and so you can have almost the
Speaker 1: opposite of each other. When you're sort of treating two
Speaker 1: people with depression, one might sleep too much, the other
Speaker 1: might be suffering with insomnia. Another person might be not eating,
Speaker 1: and the other person might be overeating and be overweight.
Speaker 1: So depression is yeah, it's just a very diverse illness,
Speaker 1: and it makes it almost more remarkable that we have
Speaker 1: treatments that work for for this really really unique disorder.
Speaker 1: What I try to learn from, not only from around
Speaker 1: the world but historically is how we have become so
Speaker 1: fixated on this one word of depression, and there are
Speaker 1: other ways of describing it, so there are terms that
Speaker 1: have almost been forgotten. We have, like endogenous depressions that
Speaker 1: are more biological in nature, so there don't seem to
Speaker 1: be many social triggers for why this person is feeling
Speaker 1: this way and is in a very dangerous position, whether
Speaker 1: they're suicidal or not eating or not sleeping. And then
Speaker 1: you have more reactive depressions, more in tune with someone's
Speaker 1: social sphere, So there are obvious triggers in their environment
Speaker 1: are causing them to feel this way, and each of
Speaker 1: these has has had its own sort of treatment in
Speaker 1: the past. To then just fast forward to the nineteen
Speaker 1: eighties where we came up with this term major depression
Speaker 1: and everyone just started bulling it. Depression really just obliterates
Speaker 1: this really rich history that we've had of understanding all
Speaker 1: these types of depression that can be then understood, treated
Speaker 1: and almost communicated better. So you know, you can not
Speaker 1: only just say that I struggle with depression, but I
Speaker 1: struggled with a certain form of depression or melancholic depression,
Speaker 1: which comes from ancient Greek the idea that your more
Speaker 1: psychotic is a type of depression that has really been lost.
Speaker 1: It responds really well to electroc convulsive therapy, which is
Speaker 1: the treatment that when I first started writing this book,
Speaker 1: I was hesitant to mention it. But after meeting the
Speaker 1: practitioners of today and seeing how this treatment has been
Speaker 1: reshaped and remolded. It's really a remarkable treatment for this
Speaker 1: specific type of depression. A lot of people my age
Speaker 1: would have seen or read the book by Ken Kesi
Speaker 1: when he flew Over the Cuckoo's Nest, and you see E. C.
Speaker 1: T used as this really awful way to control this person,
Speaker 1: and so it, Yeah, it has these awful connotations, but
Speaker 1: I know a couple of people personally who have benefited
Speaker 1: greatly from it as a treatment. I think what you're
Speaker 1: saying is really interesting, and I want to ask a
Speaker 1: question there, because on one hand, you're sort of saying, hey,
Speaker 1: depression is too broad. There's actually these sort of maybe
Speaker 1: more narrow lanes that we might look at. We recently
Speaker 1: interviewed somebody you may be familiar with. Her book. It's
Speaker 1: called Pathological The True Story of Six Misdiagnosis is Sarah Fay.
Speaker 1: I don't know if that rings about not having to
Speaker 1: come across that I'll make Yeah, it's right up your alley.
Speaker 1: She's covering the same ground. Her point is basically, over
Speaker 1: her course of her life, she was diagnosed six different ways,
Speaker 1: and so she started digging into the d s M
Speaker 1: and you know, sort of coming up with what happens
Speaker 1: if you dig far into the history of the d
Speaker 1: s M and you're like, oh, none of these things
Speaker 1: are a real diagnosis in the sense that like cancer
Speaker 1: is that you could get a scan, and talking about
Speaker 1: how one of the criticisms of the d s M
Speaker 1: is that it's splintered into I don't remember how many,
Speaker 1: but you know, seven hundred diagnosis is or five hundred
Speaker 1: and it sounds crazy and that a lot of people
Speaker 1: believe maybe it's less diagnosis, and I know you sort
Speaker 1: of talk about that too, And maybe what we're calling
Speaker 1: depression and in another case we're calling anxiety are all
Speaker 1: manifestations of a similar thing. So I kind of hear
Speaker 1: you on one hand saying, hey, maybe we need more
Speaker 1: nuance and how we talk about it, And then I've
Speaker 1: also seen you write about, hey, maybe there's more similarity
Speaker 1: between these different things than we think. Say a little
Speaker 1: bit about that. Yea. So this came from my own
Speaker 1: family where you know, my cousin has schizophrenia or a
Speaker 1: mood disorders. So these have historically been opposite sides of psychiatry. Yeah, um,
Speaker 1: you have mood disorders and you have psychotic disorders. We
Speaker 1: kind of have more nuance and how we describe our depression.
Speaker 1: I just don't think it needs to be a clinical
Speaker 1: like how we describe it in terms of a diagnosis.
Speaker 1: I just think if we appreciate that we can take
Speaker 1: all of these different parts from all of these so
Speaker 1: called diagnoses. So I have some parallels with autism, hyper
Speaker 1: sensitivity to sound, other things that really kind of, you know,
Speaker 1: make me wonder well, maybe I'm kind of a little
Speaker 1: bit of autistic. And maybe one of the reasons I
Speaker 1: could research a book like this for you know, four
Speaker 1: years and you know, absolutely love my time just completely
Speaker 1: embedded in a library. I don't know, but it's these
Speaker 1: sort of taking these pieces from what we've kind of
Speaker 1: historically thought of as diagnoses. So you can have, you know,
Speaker 1: some sort of recurrence such as in bipolar you have
Speaker 1: anxiety disorders, and they really do seem to kind of
Speaker 1: almost tie together. And so the way I kind of
Speaker 1: appreciate my own depression is it can have any of
Speaker 1: these sort of facets that come from a wide range
Speaker 1: of the spectrum of mental illness in general, So it
Speaker 1: doesn't have to be just depression and it's in the
Speaker 1: d s M. I don't think that's very helpful for
Speaker 1: the for someone who's trying to kind of understand what
Speaker 1: they're feeling right now. Like I said, it doesn't even
Speaker 1: include anxiety. It's really for psychiatrists to understand with a
Speaker 1: very short amount of time, what's the most likely situation here,
Speaker 1: and lots of the most likely treatment that's going to work,
Speaker 1: which I think has been quite a successful thing for
Speaker 1: a lot of people. But as you just mentioned in
Speaker 1: that book, you can be misdiagnosed several times and often
Speaker 1: be put on the wrong treatment because we do see
Speaker 1: it as a sort of tunnel vision that we need
Speaker 1: to pick one of these options. And so when you
Speaker 1: get to a stage where your mental illness is sort
Speaker 1: of almost matured, I think that you do become more
Speaker 1: better into either depression or schizophrenia. Like me and my cousin,
Speaker 1: are you very different in how we express our mental disorders.
Speaker 1: But look further back in times like where did that
Speaker 1: actually come from? And I think the unity in mental
Speaker 1: illness comes from maybe a childhood, a shared vulnerability to
Speaker 1: going down certain paths, and it can be shaped by
Speaker 1: your own life and what you experience. So I think
Speaker 1: right now thirty one year old. I think, you know,
Speaker 1: I have a pretty good idea of this is quite
Speaker 1: a stable part of my mental illness, and it could
Speaker 1: go into more of an anxiety state, to more of
Speaker 1: a depression state, or it could go into alcohol use.
Speaker 1: Because these are things that really they clustered together in adulthood.
Speaker 1: If you go back into childhood, we're probably showing quite
Speaker 1: similar symptoms, and you know, we still haven't kind of
Speaker 1: been funneled down. Then can become more close to a
Speaker 1: strict diagnostic system. Something I'm really interested in is trying
Speaker 1: to understand how people almost become put onto a certain
Speaker 1: track in their own life and how that changes over
Speaker 1: adulthood as well. It is quite fascinating. I love the
Speaker 1: way you say this that you know it's a syndrome
Speaker 1: of collection of different but overlapping mental states, and then
Speaker 1: you go on to say, you know, it can be
Speaker 1: a product of upbringing, trauma, financial uncertainty, loneliness, social bonds,
Speaker 1: diet behavior, sedentary lifestyles, neurotransmitters, and genetics. Right, it's all
Speaker 1: these different things, you know, so many different contributing factors.
Speaker 1: I have alcoholism and addiction, you know, and you look
Speaker 1: at that and you go, all right, well, what's the
Speaker 1: genetic component of that? Appears there are genetic components to
Speaker 1: these things, but genetics are certainly not destiny. So to
Speaker 1: your point, the phrase I've always heard is sort of
Speaker 1: like genetics loads the gun, environment pulls the trigger right,
Speaker 1: something to that effect. So I do think there's a
Speaker 1: lot to this. Say a little bit more about this idea, though,
Speaker 1: that there's an emerging argument it all mental illnesses are interconnected,
Speaker 1: like the branches of a tree growing from the same trunk.
Speaker 1: Is that what you're saying that we believe there are
Speaker 1: some underlying vulnerabilities and then depending on what happens sort
Speaker 1: of determines a little bit about like which branch you
Speaker 1: go down. Yeah, it's quite recently in terms of giving
Speaker 1: a name, but it's it's got roots in psychoanalysis and
Speaker 1: another sort of non diagnostic approaches to psychotherapy, and so
Speaker 1: it became known as the P factor, so the psychopathology factor.
Speaker 1: And I think that's a terrible name in terms of,
Speaker 1: you know, trying to make something understandable. Don't call it psychopathology. Yes,
Speaker 1: received a lot of attention, and some people really hate
Speaker 1: the term. People who really have been dependent on using
Speaker 1: a diagnostic system, but there's no doubt that it's it's
Speaker 1: changing how we study because thomasin's All, who used to
Speaker 1: lead one of the major sort of scientific institutions in
Speaker 1: the US, he left and said, we need to change
Speaker 1: how we approach the scientific research towards mental illness that
Speaker 1: you know, this hasn't been working over decades. We're still
Speaker 1: no closer to wondering where they come from. We still
Speaker 1: can't find the genetic basis of any of these diagnoses,
Speaker 1: and treatments haven't improved since the nineteen fifty And what
Speaker 1: his approaches is to change the fundamental way we study
Speaker 1: them so we don't use symptoms, is his ar Can
Speaker 1: we use different dimensions of how we experience mental illness
Speaker 1: so they can be more linked to your personality, linked
Speaker 1: to sort of just patterns of sleep or behavior. And
Speaker 1: it really kind of breaks the mold of thinking of
Speaker 1: mental illness as like like you say this checklist of
Speaker 1: seven symptoms that you get given, it becomes a bit
Speaker 1: more nebulous and it's quite hard to understand. But hopefully
Speaker 1: once we dig into these elements of personality and genetic vulnerabilities,
Speaker 1: the genetic patterns that don't just lead to say schizophrenia
Speaker 1: or studying depression, stud all of them at the same time.
Speaker 1: Were the tools we have available now and seeing if
Speaker 1: the genetics are actually more understandable as we see them
Speaker 1: as a whole. So if we've been studying them separately
Speaker 1: over time, of course we haven't seen a genetic risk
Speaker 1: factor for schizophrenia because it might not exist. It might
Speaker 1: be a risk factor for bipolar. It might be a
Speaker 1: risk factor for autism as well. And there are some
Speaker 1: really interesting studies into you know, this idea that we
Speaker 1: have schizophrenia and bipolar very closely related and there are
Speaker 1: some strong genetic risk factors involved in those two. One
Speaker 1: of the mood disorder and is historically a psychotic disorder,
Speaker 1: So that breaks down that old sort of division there.
Speaker 1: And then if you study the more sort of the
Speaker 1: commernalizing disorders, so depression and anxiety, and see whether we
Speaker 1: can find the genetic risk factors for that collective group.
Speaker 1: Rather than just saying can we find day specific risk
Speaker 1: factor for depression, because that might not exist, it might
Speaker 1: be more can we find this sort of part of
Speaker 1: the genome that, together with environmental triggers send someone down
Speaker 1: this path towards you know, thinking about there themselves constantly
Speaker 1: of rumination of self hatred that then can become depression
Speaker 1: or anxiety. And so yeah, this this idea of the
Speaker 1: P factor, I think it really changes our conception. It
Speaker 1: gives me a lot of comfort actually in my own
Speaker 1: experience of mental illness. It allows me not to just
Speaker 1: think of me myself as a depressed person, but more
Speaker 1: of a human because it's it's it's it's broader, richer
Speaker 1: palette from which from which we experience the world. There's
Speaker 1: a lot of negativity, of course to it, but it
Speaker 1: makes me feel more connected to people who have mental illnesses,
Speaker 1: and especially with my cousin, who you know, has been
Speaker 1: institutionalized and given really horrendous sort of treatment as soon
Speaker 1: as he started hallucinating and having delusions and stuff. Yeah,
Speaker 1: it kind of makes me think, well, hopefully this idea
Speaker 1: of a shared P factor will allow people to reduce
Speaker 1: the stigma not only for me, but for people who
Speaker 1: have psychotic disorders like my cousin, and to think of
Speaker 1: him as not this sort of fringe sort of person
Speaker 1: who can just be institutionalized, but actually as someone who's
Speaker 1: got this shared predisposition that has been you know, funneled
Speaker 1: down a path that has led him to you know,
Speaker 1: have these vivid hallucinations, this vivid imagination, and rather than
Speaker 1: locking him away, can we find some common treatment that
Speaker 1: can work across that p factor. I think that might
Speaker 1: be heading towards, especially in children, is trying to find
Speaker 1: if there is such a thing, when does it happen,
Speaker 1: what does it look like, and how can we prevent
Speaker 1: someone from becoming fully psychotic or fully depressed. It's fascinating
Speaker 1: to think about where this field has come from and
Speaker 1: where it might go and the treatments that might be coming.
Speaker 1: Let's sort of spend the last part of this conversation
Speaker 1: talking about treatments that are available, treatments that you have tried,
Speaker 1: or treatments you've heard of. Like, let's try and sort
Speaker 1: of stay in the lane of depression right now. What's
Speaker 1: the menu look like for people who are dealing with depression?
Speaker 1: You know, we've covered the obvious ss R eyes, We've
Speaker 1: talked a little bit about diet and exercise. Like you,
Speaker 1: if I had to pick one tool for my depression,
Speaker 1: it would be a toss up between perhaps medicine and exercise.
Speaker 1: That's how critical and fundamental exercise is to my overall
Speaker 1: well being. We could talk about diet and exercise for
Speaker 1: two hours and not even cover how important it is.
Speaker 1: But but we've already sort of hit it. What else
Speaker 1: is out there? What are other things that people can do?
Speaker 1: What are other things that you've done? You know, let's
Speaker 1: let's explore a few others. So, yeah, I think exercise,
Speaker 1: though you say that to the really fundamental to my
Speaker 1: own stability. Depressents. We mentioned that there are SSR ees,
Speaker 1: but often it's kind of forgotten that there's this rich
Speaker 1: history of antidepressants. If people don't respond to these rise
Speaker 1: then there are other options that have maybe in some
Speaker 1: ways a more severe list of side effects. So we
Speaker 1: have mipromine, which is a tricyclic nddepressant, so that family,
Speaker 1: and then we have another group that it was the
Speaker 1: first depressant to discover that it's an m I and
Speaker 1: they do come with, you know, more physical side effects,
Speaker 1: just dry mouth and constipation and things like that. But
Speaker 1: I've talked to people who you know, esse didn't work
Speaker 1: for them, and these drugs did for a long time.
Speaker 1: So it's not just about thinking of antidepressants equals s s.
Speaker 1: There are other options that other people really do respond
Speaker 1: well to. Some of them don't come with the emotional
Speaker 1: blunting that arise are often associated with. I think one
Speaker 1: of the researchers I spoke to, he actually mentioned he
Speaker 1: was on the mipromede for ten years and you know,
Speaker 1: he'd take constipation all day, if you know, because it worked.
Speaker 1: It was the first drug that really were it for him.
Speaker 1: They are also blunting of the libido, in which a
Speaker 1: lot of people struggle with. And if you're already in
Speaker 1: a depression and you're struggling to connect with someone, then
Speaker 1: that can be one of the reasons that is probably
Speaker 1: not the drug that's best for your situation. Thankfully, I
Speaker 1: haven't had as severe stable in that domain, but that
Speaker 1: can be a real issue for a lot of people.
Speaker 1: And away from pharmacology, I think mindfulness, which is becoming
Speaker 1: part of cognitent behavioral therapy kind of meditation, is something
Speaker 1: that I tried to practice quite regularly. So it's just
Speaker 1: sort of like almost this Eastern approach of you kind
Speaker 1: of take time out. And I won't describe my methods
Speaker 1: and stuff, but everyone's probably familiar with using meditation and
Speaker 1: it seems to have effects to looks in some ways,
Speaker 1: so psychedelic substances from other mushrooms or in Brazil, the
Speaker 1: people I speak to there from types of plants that
Speaker 1: mashed up into a t called ayahaska. And this meditation
Speaker 1: kind of silence is this default mode network in the
Speaker 1: brain that is almost it's completely associated with yourself, what
Speaker 1: you're going to do next, and what you've been doing
Speaker 1: in the past. It's it's really this self obsessed network
Speaker 1: in the brain that seems to be overactive, and a
Speaker 1: lot of people with depression. Mindful meditation allows you to
Speaker 1: kind of silence it, at least for a time and
Speaker 1: really think about others. A compassionate meditation is where you
Speaker 1: think about someone, usually someone that you really kind of love,
Speaker 1: and trying to imagine them in a difficult situation, and
Speaker 1: you sort of building that affection for them, and it
Speaker 1: kind of breaks you out of this constant, interceptive sort
Speaker 1: of thought process. I think that's been really helpful for
Speaker 1: me try to do every day. It's difficult because it's
Speaker 1: not something that you can just see benefits from, like
Speaker 1: with depressants, but added together, I think that it's certainly
Speaker 1: something from my menu as you put it, that I
Speaker 1: think is critical. It might be like a starter or
Speaker 1: a dessert. It's not a main course, but it's it's
Speaker 1: it's something that you know, you really do depend on
Speaker 1: and you really like to have now and again. And
Speaker 1: for people who are really severely depressed, there are options
Speaker 1: that are really exciting, at least from my point of view,
Speaker 1: and the people have reported on and an interviewed of
Speaker 1: deep brain simulation where you can have also related to
Speaker 1: this sort of this idea of the neural circus in
Speaker 1: your brain being completely hardwired for depression and being able
Speaker 1: to in certain electrode to kind of almost switch it
Speaker 1: off and allow yourself have this moment where you can
Speaker 1: break free from what has become your default state, which
Speaker 1: is a really powerful powerful tool for a few people
Speaker 1: who haven't responded to every other trench relea. So it's
Speaker 1: not going to be, you know, something you can just
Speaker 1: pop down and get a prescription for, but it's something
Speaker 1: that I think it really gives me hope when thinking
Speaker 1: about depression, is we have all of these things from
Speaker 1: exercise and diet of mindfulness to these aggressive treatments for
Speaker 1: people who have failed all the other options. When we
Speaker 1: say treatment resistant depression. I think you think that, Okay,
Speaker 1: this person hasn't responded to anything, but there's so much
Speaker 1: more out there, and treatment resistance the actual definition on
Speaker 1: your needs two different types of antidepressant to be considered
Speaker 1: treatment resistance. It's not a full stop on their story whatsoever,
Speaker 1: and kind of linked to exercise and diet. But trying
Speaker 1: to understand depression is inflammation is quite a powerful message,
Speaker 1: and antien Planet is now being tested for certain types
Speaker 1: of depression. I think it's around the third of depressions
Speaker 1: that can be linked to high amount of pro inflanmetory
Speaker 1: molecules in the blood, and so this sort of stress
Speaker 1: response just becomes flooded with these inflammatory molecules. And I
Speaker 1: think that's an avenue that really excites me because there
Speaker 1: are some really good studies coming out showing that for
Speaker 1: a third of people, which is a huge amount, these
Speaker 1: tools can be effective. And the beautiful thing about it
Speaker 1: is if you reduce inflammation, antidepressant become more effective. One
Speaker 1: thing we know about antidepressants is they're not very good
Speaker 1: at working when someone is suffering under inflammatory storm or
Speaker 1: a cloud of inflammation in their bodies. So they can
Speaker 1: work synergistically as well. These treatments and psychedelics there they're
Speaker 1: not really a treatment that you can go out because
Speaker 1: there's still Schedule one and you know, illegal to have
Speaker 1: and to take. But this is why I focused on
Speaker 1: some of the work in Brazil because they're legal there
Speaker 1: for religious ceremonies in the Santa Diamd Church and the
Speaker 1: Brazilian scientists who are working, you know, really closely with
Speaker 1: this more cultural element of these of these drugs really
Speaker 1: sort of excites me and thinks that, you know, this
Speaker 1: does have a future because it has this really rich
Speaker 1: history from decades and centuries ago in South America and
Speaker 1: across the world, depending on which psychedelic substance we're talking about.
Speaker 1: For me, I self experimented with psilocybin with magic mushrooms,
Speaker 1: and yeah, I think I'm not as dependent on it
Speaker 1: as I would be with the necessary but I think
Speaker 1: that it can sometimes help to provide an alternate perspective
Speaker 1: on your life at the current state. And for me,
Speaker 1: that returning to the Parable, for me, it really feeds
Speaker 1: the love part of the Parable and the wolf that
Speaker 1: is full of hatred and greed. Really just it gets
Speaker 1: almost laughed away in these psychedelic trips. Yeah, there's a
Speaker 1: lot happening around psychedelics these days, in a variety of
Speaker 1: mental health treatments, and if people are interested, you know,
Speaker 1: as you said, they are illegal. There are more and
Speaker 1: more clinical trials though, that are starting to open up
Speaker 1: where that is one way that people can explore that.
Speaker 1: And of course there are plenty of people offering treatment
Speaker 1: even though it's not legal, and I think a lot
Speaker 1: of people are getting benefit out of it. You've described
Speaker 1: something called the winner's curse. Could you say a little
Speaker 1: bit about what the winner's curses? And I'm kind of
Speaker 1: curious whether you think any of that might be happening
Speaker 1: with some of what we're seeing around psychedelics. I was
Speaker 1: told this by someone in the psychedelic field, and he
Speaker 1: was describing this winner's curse of he used Prozac as
Speaker 1: an example. All so, you have this drug that has
Speaker 1: all of this hype around it. You know, people who
Speaker 1: have been working on marketing campaigns for other companies, which
Speaker 1: as like automobiles and McDonald's, and you have the same
Speaker 1: marketing strategies that have pushed this new antidepressant into the mainstream.
Speaker 1: Because it was one of the first sri is to
Speaker 1: be put into prescription. All this excitement builds into this
Speaker 1: being a winner, even if it isn't. And over the decades,
Speaker 1: since we now know that prozac is, it's no different
Speaker 1: to most of the size and in some cases it's
Speaker 1: actually not as effective. And so these drugs and these
Speaker 1: new treatments can't be steen just in terms of what
Speaker 1: comes out in in peer reviewed science, because they are
Speaker 1: part of the societies that sort of create them and
Speaker 1: put them into people's bodies. So with prozac, you know,
Speaker 1: people responding to this drug in the and they hadn't
Speaker 1: responded to anything else, and suddenly this new drug comes out.
Speaker 1: People are excited about it. It's gotten new catchphrases, and
Speaker 1: it just seems very popular, and it's suddenly they respond.
Speaker 1: And that's often not the drug, it's often the hype
Speaker 1: around it. So there's this beautiful thing of the placebo effect.
Speaker 1: You know. It's something that we were often try to
Speaker 1: take away from clinical trials, and rightly so, we need
Speaker 1: to find out whether a joke worse above a pacebo.
Speaker 1: When you're working with something like depression, which is a
Speaker 1: mental state where people are often hopeful and they can
Speaker 1: get better and someone then gives them this new thing
Speaker 1: that's really exciting, and they do get better. Then it
Speaker 1: takes time for them to understand, you know, this placebo
Speaker 1: effect starts to wane, and then we get what was
Speaker 1: once a miracle drug becomes a very average s R.
Speaker 1: I and I think that unfortunately, this might be the
Speaker 1: case for psychedelics as well, because we see it everywhere
Speaker 1: at the moment, it's become this sort of trendy thing
Speaker 1: to do, to micro dose, to take large doses every
Speaker 1: three months for depression, and some of the people that
Speaker 1: I've spoken to an interviewed for this book, they've almost
Speaker 1: become like celebrities have got like a real cult following
Speaker 1: of you know, you see him on the front of magazines,
Speaker 1: you see their work on the front of magazines. And
Speaker 1: looking at this historically, it really kind of brings up
Speaker 1: a bit of concern that we might be repeating history here.
Speaker 1: We're building up this this bubble that might suddenly burst.
Speaker 1: And there was a study published last year where psilocybin
Speaker 1: silocybin was put in a trial alongside est telegram and
Speaker 1: there wasn't a significant difference between the two in terms
Speaker 1: of people responding to it. I think this is really
Speaker 1: positive because it shows that both are effective, Like, these
Speaker 1: are two effective treatment options that we have. The psychedelic
Speaker 1: showed some sort of pattern towards being significantly better, but
Speaker 1: it wasn't statistically. And what concerns me is when pros
Speaker 1: that came out it was significantly better. It was, you know,
Speaker 1: people responding to this thing that hadn't responded to anything.
Speaker 1: And now we have these trials a style of cybin
Speaker 1: and we're struggling to find significance between the drug and
Speaker 1: regular antidepressant and we're not finding it, and that makes
Speaker 1: me worried. It's like, when this hype starts to drop,
Speaker 1: whether it's in twenty years or thirty years, what state
Speaker 1: of these new therapy is going to be in and
Speaker 1: they're going to be average or is that sort of
Speaker 1: winner's curse going to become the truth of the matter
Speaker 1: for for these drugs. And I think that's one caution
Speaker 1: I'd like to put on psychedelics is we still don't
Speaker 1: know whether they are a really long term treatment, and
Speaker 1: there are risks involved, especially for taking high doses of them,
Speaker 1: and especially if you have a history of psychosis that
Speaker 1: can be enduring psychostic episodes with these drugs. For me,
Speaker 1: the risk of my depression seemed so high that I
Speaker 1: was willing to try them. Thankfully, I've only had very
Speaker 1: safe and very meaningful experiences with them, but I don't
Speaker 1: see them as a replacement for anything that I've had before.
Speaker 1: We'll see how that the field is in the next
Speaker 1: ten years, but we've also got to remind ourselves at
Speaker 1: least have been used for potentially millennia, and to then
Speaker 1: say that they're not effective or not safe is almost
Speaker 1: an insult to indigenous populations around the world who know
Speaker 1: a lot more about these substances than science and will yeah, yeah,
Speaker 1: And I think to say that they're not effective, you know,
Speaker 1: clearly for some people they are proving to be effective.
Speaker 1: I don't think they would be getting all the noise
Speaker 1: they were getting if there was not some degree of effectiveness.
Speaker 1: And I share your concern that, you know, the coverage
Speaker 1: of it is so breathless that I'm always a little
Speaker 1: bit like I'm not sure that there's really a golden ticket,
Speaker 1: you know, or a silver bullet, or use whatever analogy
Speaker 1: you want, you know, I think likely they can be
Speaker 1: another tool that can be effective for certain people used
Speaker 1: in the right circumstances. And you know, we can use
Speaker 1: as many tools, you know, as many items on the
Speaker 1: menu as we can given that, you know, we don't
Speaker 1: know what works for which people and in what circumstances.
Speaker 1: So I think more options is better options for sure. Yeah,
Speaker 1: I think just a comment on the self experimentation, I
Speaker 1: think these aren't recreational drugs when used in this setting.
Speaker 1: I mean, it's often a horrifying experience to take these drugs.
Speaker 1: It's not like something that you can just take it
Speaker 1: for a day and then it has you know, long
Speaker 1: lasting effects. Some people describe it as a nightmare that
Speaker 1: goes on for eight hours and you can't wake up.
Speaker 1: So there's an element of and I tried to put
Speaker 1: this in the book of being really Hard Labor. It
Speaker 1: can be horrifying. And this is why it's so important
Speaker 1: that it's not just seen as a drug. It's seen
Speaker 1: as you know, you're having a therapist there with you
Speaker 1: and someone who can guide you, because if you don't
Speaker 1: have that, guys, and you don't have that knowledge of
Speaker 1: how to get through these really dark moments, you can
Speaker 1: become trapped. Yeah, it can make you feel a lot better,
Speaker 1: but it also can make you feel worse, and it's
Speaker 1: quite yeah, it's quite dangerous. I think I've shared this
Speaker 1: story on this show before. I don't remember if I
Speaker 1: I'm pretty sure I probably have. But to your point,
Speaker 1: I experimented with psychedelics a lot a long time ago,
Speaker 1: you know, my late teens, early twenties, and I was
Speaker 1: using them recreationally and my stud good brother. One night,
Speaker 1: it was the night of my grandmother's funeral, and he
Speaker 1: convinced me we should do LSD that night. And I
Speaker 1: knew it was a bad idea. I just I was
Speaker 1: like this, No. I kept saying no, and he kept
Speaker 1: being like, no, it's going to be Somehow he talked
Speaker 1: me into it. And you talk about like a dark
Speaker 1: a dark night of the soul like I mean, you
Speaker 1: talk about eight hours of like torment like it was
Speaker 1: unquestionably one of the worst, one of the worst nights
Speaker 1: of my life. I can laugh about it now, but
Speaker 1: but yeah, I could have used a therapist for sure
Speaker 1: that night, probably for for quite some time afterwards. But
Speaker 1: to your point, I think there are real ways to
Speaker 1: use these things as tools of healing, and then there
Speaker 1: are ways to use these as a drug. And I
Speaker 1: think it is so much in the intention and as
Speaker 1: they say, set and setting right, you know, the approach exactly.
Speaker 1: The history of that setting setting is part of the book,
Speaker 1: and it comes a lot from Betty Eyes and a
Speaker 1: woman he's often forgotten in psychedelic circles. It's often a
Speaker 1: very mascular and dominated field, and she was really pivotal
Speaker 1: of creating the setting of comfortable space music photographs, like
Speaker 1: trying to really kind of like harness as much as
Speaker 1: you can from someone's trip while also being in a
Speaker 1: very very safe space for people with depression in particular,
Speaker 1: you know there is going to be a dark moment there,
Speaker 1: whether it's a moment in your past or something you're
Speaker 1: growing within the present. You really need to be sure
Speaker 1: to get past that, to get through it. Yeah, Betty
Speaker 1: would clearly have come down on my side in the
Speaker 1: debate with my brother about whether LSD was a good
Speaker 1: idea that night. Betty would have been like, huh, don't
Speaker 1: do it. Don't her second taste of LSD in the fifties,
Speaker 1: I think it is in Yeah, she said it felt
Speaker 1: like the universe had collapsed upon her, So she would
Speaker 1: definitely sympathize and yeah, she didn't try it again after that.
Speaker 1: My memory is of laying on a bed feeling like
Speaker 1: literally thinking that what was happening to me was I
Speaker 1: was being crucified. All I could hear is my brother
Speaker 1: outside laughing like the devil. That's my recollection of that,
Speaker 1: of that eight hours. All right, On that note, I
Speaker 1: sure knew how to have a good time. Yep, yep,
Speaker 1: you can certainly have some moments there well. Alex, thank
Speaker 1: you so much for coming on. The book is really wonderful.
Speaker 1: You know, there's certainly a memoir aspect of it, and
Speaker 1: there's a lot of really deep and really good science
Speaker 1: writing in it. It's a wonderful combination of both those things.
Speaker 1: We'll have links in the show notes to where listeners
Speaker 1: can get access to it and how they can find you.
Speaker 1: And so, Alex, thank you so much for coming on.
Speaker 1: I've been looking forward to this one. Thanks for having me.
Speaker 1: It's been brilliant. If what you just heard was helpful
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