Episode 55
Modern Day Depression Causes & Remedies

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Description

In this exciting episode, we are joined by acclaimed Dr. Ilardi, to discuss his knowledge on how modern-day depression is caused and remedies to help.

Talking Points

1. Going over how modern brains are different from brains of the past
   
2. The toxicity of rumination
   
3. Remedies to help with modern depression
   

Quotes

“Depression is following a pattern, that we see with other diseases, called diseases of civilization. Where these diseases are really really endemic and highly prevalent in the west and not very prevalent at all among aboriginal groups. … Our ancestors didn’t get depressed very often. Why? Because presumably, they had protective measures woven into their day-to-day lives.”

-Dr. Stephen Ilardi, Ph.D. Professor, Clinical Neuroscientist 

Episode Resources:

‘The Depression Cure’ by Stephen S. Ilardi, PhD

Therapeutic Lifestyle Change (TLC)

Episode Transcripts

Episode 55 Transcripts

empathy is knowing your own darkness

don’t have power without that connection

you don’t have any what’s the opposite

of addiction just freedom

all right

team

fans of finding peaks welcome back to

another special episode

uh with a special guest today

part two of this journey as you’ll

notice i’m wearing the same clothes

because i was asked by the production

crew to keep it simple keep it straight

come back look the same so it doesn’t

look like you did this on the same day

which we would never do here at finding

peaks ever uh in that regard time is of

the essence brandon burns chief

executive officer for peaks recovery

centers joined today apparently we’re

co-hosting jason freeze exciting lpclac

chief clinical officer we are also

joined by chief operating officer clint

nicholson lpclic

chief of all things as we learned in the

last episode

and again our special guest dr stephen

elardy clinical psychologist researcher

professor university of kansas also

author of the depression cure join us

again here to do

another deep dive into the book and

welcome back uh you know what i’m so

excited except for the part that i’m

just now realizing i’m wearing the same

exact clothes and now everybody’s gonna

be like oh that dude has like one outfit

yeah um it it is actually the same yeah

yeah it’s understandable or traveling

yeah

yeah yeah it’s it’s it’s the humble

midwesterner in you it is a

good refrain yeah

i i’m i’m delighted to be here

yeah always a pleasure um haven’t seen

you in four years the viewers might not

know this but that was our initial time

together in uh washington where we where

we originally met but without going down

that rabbit hole

of how we became good friends

in the process

i feel like there should be some special

music for this little monster to be a

little montage clayton and i can leave

yeah like we can step out yeah

we’ll ignite the candle yeah that’s what

i’m talking about right yeah ritualistic

important aspect

of the depression cure

i think anyways on the last step is so

we didn’t get an opportunity to explore

we’re calling it the schtick the the

thing that’s important the the narrative

for why the tlc model makes sense the

thing that we can

um gravitate towards and appreciate

about why we’re exploring these things

in the first place and so

um

without giving the whole introduction of

your book away because we want the

readers out there amazon.com uh order

the book local library all those things

find it read it it’s excellent but

without giving it all away what is this

for the setup well so there really is a

story behind it so

i i’ve been a clinical researcher for 32

years now

and

about 15 years ago

i was getting so frustrated

with the fact that

yeah we know a lot about clinical

depression but we’ve barely moved the

needle in terms of patient outcomes this

is 15 years ago i was like okay you know

we’ve got

a whole armamentarium of medications and

psychotherapies and evidence-based

practice and all the things

more things actually now than we had

then but

um

we weren’t getting great outcomes and

particularly what was vexing for me

is the societal burden of depressive

illness was growing so depressive

illness went from 30 years ago it was

like the seventh cause of work-related

disability in the u.s

now it’s number one it is the single

leading cause of work-related disability

it’s a major cause of death

through depression-related suicide it’s

a major cause of

relationship dissolving

unemployment it’s i mean it’s it’s

exacting this huge toll

and i stumbled on the work of an

anthropologist somebody in a completely

different field this anthropologist

named edward schieffelin

who was studying aboriginal groups and

he spent 10 years with a group in

the highlands of papua new guinea

they’re called the kaluli people

and one of his questions was

okay well

how like when the kaluli gets sick what

does that look like and how does it

compare to when we get sick and then he

was like

what about mental illness so we got

himself a dsm for viewers who may not

know that’s like our diagnostic

psychiatric bible our bible of diagnosis

takes a dsm

people and he’s like okay well like what

kinds of mental illness did they get

and one of his findings when i saw it it

smacked me in the face it was like

somebody like splash cold water on me

and it was like oh out of 2000 members

of the columbia people he’s found one

case of marginal depression

i’m like

wait that’s like

one percent of what we have

and their lives are arguably harder than

ours they don’t have any modern medicine

they don’t have any of our technology

they have a high rate of infant

mortality they have a high rate of

parasitic infection like all kinds of

really tough things and yet they don’t

get clinically depressed

what the hell’s going on

and then i started thinking wait a

minute

depression is following a pattern that

we see with other diseases called

diseases of civilization

where these diseases are really really

endemic and highly prevalent in the west

not very prevalent among aboriginal

groups like what like atherosclerosis

heart disease like many forms of cancer

like oh here’s one hemorrhoids did you

know aboriginal groups do not get

hemorrhoids why because they don’t spend

their day sitting down

they’re active they’re up they’re moving

tooth decay i mean they have it but not

the way we do why because they’re eating

not processed foods right they’re eating

whole foods

it’s like oh depression fits that

pattern wait a minute that sparks

another

association

the human species lived primarily we our

ancestors until 10 000 years ago

everybody lived as hunter-gatherers so

all of our ancestors spent their entire

lives in this group of 30 50 people

on a lifelong camping trip with their

closest friends and relatives

and that’s the way the kaluli are living

today so

oh okay so our ancestors

didn’t get depressed very often probably

just like the kaluli don’t why because

presumably they had all kinds of

protective things woven into the fabric

of their day-to-day lives

likewise

they probably did not have to fend with

lots of the things in our lives that are

toxic

so even though we love in many i think

we do love lots of the things that we

um take advantage of in 21st century

american life i mean i love my laptop i

love mocha lattes i love i mean there

are all kinds of things that like i am

not

i’m not a luddite i don’t want to get

rid of technology i love technology

but many of the things like social media

which we’ll talk about later many of the

things

that we experience day-to-day traffic

and you know fast food and i mean i

could go on

are psychologically toxic so

here’s the sound i’m finally now at a

moment of sound bite here we go

everybody brace yourselves

our ancestors were protected

by several things that were woven into

the fabric of their day-to-day lives and

we can reclaim them

bring them into the present

and

have the best of both possible worlds

have the best of modernity

jettison the toxic things that are

present to modernity and embrace or

reconnect with the healing habits of the

past

it may sound like a tall order

but

i don’t think we have any choice because

the societal burden of depressive

illness now

it’s one out of three americans are

going to be cut down by this massively

disabling painful illness at some point

and

that rate of depression is going up with

every generation so gen z

kids that are college age or below

they’re already at like 20 25

their lifetime burden if we don’t do

something to turn this around it’s

probably going to be 50

and um

so that was the genesis of this idea of

oh

what are the things that the kaluli are

doing that are protecting them what are

the things that our ancestors benefited

from by the way quick side point of the

shtick you ready for this

here’s the shtick

if our hunter-gatherer ancestors were as

depression prone as we are if they were

as vulnerable as we are given how much

harder their life objectively harder

their lives we

we would have been obliterated as a

species yeah

tens of thousands of years ago we never

would have made it we never would have

lasted this long so we know

given how debilitating depressive

illnesses we know that our ancestors had

to be way less vulnerable than we are

why why do we not have

genetic protection there should have

been massive selection pressure

to give us antidepressant circuitry

to mimic the antidepressant effect of

all of our best meds and other best

practices

why don’t we have it we didn’t need it

why because the antidepressant was woven

into the fabric of our lifestyle

just like by the way interesting maybe

maybe interesting side note

did you know

that

primates that subsist on fruit

you’re injured going this is really

random steve i hope you’ve got a pointer

there are primates

relatives of ours who only live on fruit

they’re called frugivores

the genetic machinery

that they would normally use to make

vitamin c did you know that most

primates

have genetic machinery that their bodies

can make their own vitamin c awesome

but when they became frugivores

now they were getting so much vitamin c

in their lifestyle

that there was genetic drift and all the

the genetic machinery to make vitamin c

was allowed to basically drift and turn

off there are all these mutations that

accrued and it doesn’t work anymore but

it’s still there

it’s a genetic fossil

it’s in our dna right now every one of

us sitting around the circle have

basically vestigial vitamin c machinery

in our dna

doesn’t work anymore

even though our ancestors long since

went away from being frugivores

they don’t have the genetic machinery

anymore so now we have to get the

vitamin c from our diet right

it’s kind of like that with us with

depression

our ancestors had they were like frugals

they had all the protection everything

built in

and now our environment has radically

changed why because technology because

we learned to become agrarians and then

finally we had the industrial revolution

and the life that our kids lead today

would have been unrecognizable to our

ancestors they would look at it and they

would be like this might as well be on

mars it’s so different

so what do you take as the most taxing

feature in the in the change right i i i

you’ve talked at least in and while i’m

present with you’ve talked a lot about

uh the fight or flight response yeah as

the most taxing feature and we have it

in the tribal culture certainly there

they have it we also have it as a

genetic code set right and then we are

living in the industrial world

and what is the

what is the tension there what’s

creating the most

yeah i love that yeah so i mean it turns

out we talked about this a little bit

earlier

that the single most important driver

in terms of the neuroscience of

depression is not

a deficit of serotonin the single most

important driver is the brain’s runaway

fight or flight stress response that

just will not shut down

and then all these downstream reactions

because when the brain is in runaway

stress response mode for weeks anyone

who has any genetic vulnerability or any

other acquired vulnerability their brain

shuts down and it’s just like okay dude

you are sick

like literally physically ill like

fighting the flu fighting covet you shut

down you want to crawl into a cave

and so our ancestors and if we look at

modern day aboriginal groups if we look

at modern day hunter-gatherers

when they go into fight-or-flight mode

it’s for a few minutes it’s for an hour

it’s oh i have to escape that predator

oh i have to uh

get down below treeline while there’s a

lightning storm oh i have to run back to

safety there’s this other hostile group

over there they sent a scout out i need

to scurry back to my

my people right does that make sense so

in other words

our fight fight-or-flight reaction is

designed to get us moving vigorously in

the face of physical threat in the

ancestral world that was very

short-lived in the modern world

we have that fight-or-flight reaction

going off all the time we’re sitting in

traffic and it’s going off well we’re

not physically endangered hopefully most

of the time but our brain thinks we are

right and so we’re all revved up

um we’re going to brain think we are

what what’s

started to activate it what keeps you so

activated

because symbolically

we’re our our

our apis brain

is not it’s unprecedented for an ape to

be traveling in the steel can

going down the road at 70 miles an hour

with all these other steel cans and all

these other people and and people are

being mean to us and they’re like

cutting us off and they’re flipping us

the bird i mean not that they would ever

do that in colorado but you know

in kansas they might um

and

and

our our brain is trying to make sense of

this and it’s like this seems stressful

it seems threatening this is like

bad things could happen

here this is unprecedented it looks

dangerous it feels dangerous and

especially the oh no it’s now it’s

congested oh i’m running late oh i’m

gonna miss my thing oh i’m gonna you

know

and by the way we you know we’re

constantly plugged in to a news medium

that’s that’s telling us constantly

your world is dangerous you know bad is

stronger than good and and and news

purveyors know that if they want to grab

our attention with the news if it bleeds

it leads right if it’s if it’s bad well

guess what in a global village of 8

billion people there’s always something

horrible happening there’s always

something scary there’s always something

outrageous always something dangerous so

we’re bombarded with all the outrage we

go on social media and it amplifies it

and pretty soon you have a group of

people walking around constantly in

fight or flight mode

for a million and one reasons

and all of the natural braking systems

the things that would put the brakes on

that in the ancestral environment

they’re missing

so it’s like we have if i can use

another car analogy it’s like we have

many things in the modern world pressing

the accelerator

of our

fighter flight system and the brake

lines have been cut

and our ancestors had lots of

woven in braking systems like what like

time immersed in nature

like

time immersed in the tribe where you’re

surrounded by the people who care about

you

like physical activity which is

profoundly

it’s like um

okay you know how thermostat like when

you when you turn up the heat in the

thermostat in your house it’s getting

cold

and it’s checking constantly for the

feedback like oh did this work did this

work did this work and then when it’s

finally hot enough the thing shuts off

that’s our fight or flight response

system what’s it designed to do what’s

the thermostat it’s get moving get

moving get moving get moving what’s the

feedback it needs to shut off oh yeah

you’ve been moving

you’ve been really really really active

why does exercise turn off or turn down

our stress response circuits in part

because it’s the negative feedback

the the the sort of corrective

sampled experience that says okay yeah

mission accomplished you can calm down

now

um

so many of the protective things that

our ancestors benefited from they’re

just not there anymore so we’re living

the sedentary indoor socially isolated

frenzied media addicted sleep deprived

fast food laden life and we’re just

bombarded with things that are

psychologically toxic

yeah one of the that resonates with me

so much because

i’m trying in my personal life to

not tone it down to get rid of it

because social media is such a great

part of our world podcasts and otherwise

but i find myself

feeling outraged at so many things could

be the slightest of sentence you know

that that ticks me off and that’s the

part that

i don’t enjoy about it i want to

experience it in a more positive way but

uh in tracking that outrage i find

myself not present distracted out in the

future angry at something angry at a

party a political thing an environmental

thing you know whatever’s going on

and

an hour later you know when we find

ourselves consumed by it i’m sure it

happens to a lot of the viewers out

there on social media you’re just

tricking through and you’re pissed off

at the end of it and you feel stuck in

something and

fog headed in this and all this sort of

stuff you know sort of follows at the

end of it um and i think it’s worth

talking about worth having a discussion

about because when we talk about our you

know poor little eight brains

we can’t it feels as a real natural

experience that this is something that

is very disruptive for us yeah and and

and so there’s something that goes with

it that i know you wanted to talk about

today

which is

this really really toxic habit

that a lot of us probably can resonate

with that you know technically we call

it rumination

dwelling brooding

just rehashing over and over again

negative thoughts they could be worry

thoughts things that you know that we

fear that might happen in the future

usually anxiety rumination is future

oriented like things threats that are

looming

and depressive rumination is stuff in in

the rearview mirror that we regret or

that we’re grieving because it feels

like a loss or a setback or an

embarrassment or you know something

painful a failure

and

when do people ruminate

we know that rumination is super toxic

we know that rumination will rev up

those stress circuits so another thing

back to your question of what keeps them

wrapped up we ruminate all the time when

we study

aboriginal groups they don’t tend to

ruminate

why not well in part because they have

very little alone time

and the single biggest risk factor for

rumination is when we’re alone it

doesn’t mean that being alone is always

toxic being alone can be a great a

beautiful opportunity to meditate or to

do something that we really love and

enjoy but for a lot of us especially

when we’re depleted when we’re

psychologically not

at our best when we’re alone we dwell

and we brood either about things that

threats on the horizon

pain in the past

and when people are clinically depressed

they spend hours ruminating when do they

do it when they’re alone

or when they’re disengaged

so they can ruminate when they’re binge

watching yeah they think they’re

watching or they can ruminate when

they’re surfing the net when they’re on

their phone they can ruminate when

they’ve been on social media they can

ruminate

when they are

um

talking with somebody and they zone out

and a lot of my depressed patients i’m

sure your patients as well

have you know when we bring this up

they’re like oh yeah yeah i do that like

i i can’t stay locked in because as soon

as we start talking i just i’m off to

the races

occasionally people will ruminate

together out loud co-ruminate and that’s

also toxic is there a way to like

narrowly define rumination yeah it’s

just so the word rumination comes from

it’s a it’s it’s a farming word believe

it or not

cows are ruminant

animals rumination refers to chewing the

cud

they have a ruminant pouch why because

they get a lot of their nutrition from

grasses which are very

nutritious for them but very hard to

process and so

they they they eat it and then it goes

to the ruminant sack and and there it

gets kind of pre-processed and made into

this pellet that they then

regurgitate and they they can’t they

can’t stomach it so they got a chew on

it well that’s a great metaphor for what

happens when stuff happens to us that we

can’t stomach we chew on it and it’s a

natural

adaptive reaction whenever something

happens that’s upsetting

it’s natural to ruminate about it for a

while why well you know we want to

figure out what happened why did it

happen what can i do to fix it and if i

can’t fix it well how can i make sure it

doesn’t happen again can i at least

understand it so so i don’t get like a

learning mechanism yeah

it’s natural we want to validate for

people like yeah rumination is totally

fine until it’s not

so it’s fine for how long

until we stop extracting fresh nuggets

of wisdom and learning and you know and

how long does that take depends on the

thing but usually half hour hour

and i tell my patients like look if

you’ve been ruminating on this thing for

days you’re probably way past the point

of diminishing returns right

so then you know it’s like well how do

we stop it lots of different techniques

but one of them is to say hey let’s lean

into it

they never see this coming let’s lean

into it

every time you get the urge to ruminate

get out a pad of paper or get you know

on your computer set a timer and knock

yourself out for 10 minutes ruminate as

much as you can for 10 minutes when the

buzzer goes off walk away

you have total permission

and they’re like

wait i only get 10 it’s like well do you

think in 10 minutes if you really knock

yourself out that you can extract

anything new that you can actually learn

from this session room and they’re like

yeah probably within five or ten minutes

and there’s something powerful about you

write something down and then you can

just walk away

um so i don’t know did i define

rumination it’s dwelling at length on

something either that that we fear in

the future or that we regret in the past

or that we’re grieving in the past yeah

no i think that was

far better than i could have defined

absolutely absolutely perfect tonight

and i know i can’t remember the name of

your speech and talks you used to give

in the past conferences but uh you know

the rumination i want to get into the

psychotherapy aspect of that and how we

can approach that and maybe some quick

interventions that can get us there

faster while we’re waiting for you know

per the prior episode for medications to

ramp up in the background and so forth

but

um

we’ve had a lot of experiences i think

in our industry in general as well too

the first thing we do is we take cell

phones i think the first initial take of

that is liabilities you know ordering

drugs onto a campus you know those sort

of things there’s there’s good reasons

for its absence

and then i think we started learning a

lot more about it in the clinical

setting and just hopeful that you can

feel this thing kind of about your

passion around that which yeah

well clinically

hundred years ago when peaks was a new

company uh and when i started um wasn’t

quite 100 but seven years ago

our program was six to nine months in

length and we would um

take people’s phone at the beginning

and then when we decided to give it back

it was usually about four and a half

months into a treatment episode and so

pretty much

our clients would live in this contained

environment with people they were

spending months and months with

while very disconnected from much of the

outside world in fact

sometimes i would start groups with just

kind of going over current events

because they were so disconnected from

the world like hey you may want to know

that like you know there was a tsunami

or something you know what i mean but

like

um

there’s that level of disconnection um

from

uh

from current events but also just like

from

the scroll of facebook or or twitter or

tick tock i’m not sure tick tock was

around seven years ago but um

there was so much of that and then

um i i mean i’ll never forget when we

when when i went to give a client her

phone back uh our first graduate of our

women’s program and she’s just like

i don’t i don’t want that

um and i think uh

and then we would watch our clients kind

of go through a process of beginning to

kind of

put their guard up again and kind of

beginning to escalate and just being

increasingly anxious and activated even

in

anticipation of getting their phone back

and then oftentimes the first thing they

would do would be to delete their social

media apps clinton i know you’ll love

that but like i think

um

it was a pretty fascinating process

um to watch and be a part of and i know

even some of those

uh graduates of peaks have actually

never gotten back on social media just

because they were disconnected from it

and felt such a great relief during that

time

and i do

it’s just mindful for me just thinking

considering this rumination concept how

much

sometimes our regret or rumination isn’t

even about big things it’s about some

some of the most mundane

comparisons that we’re drawing or

whatever it is it doesn’t have to be

you know the grieving of a parent like

it can be just like

somebody looks like they got a promotion

that i didn’t get at a job and i feel

terrible about that yeah i mean some of

my worst bouts of rumination honestly

have been

oh i was just in a faculty meeting

and one of my colleagues said something

mean

you know yeah i might have responded in

real time or maybe not you know maybe i

just i’m like no i’m gonna just bite my

tongue but then i’m driving home and i’m

sitting at the red light and i’m playing

it over and i’m playing it over and i’m

the more i play it over the more upset

i’m getting

and it’s it’ll take your breath away

yeah and and i don’t care

how

like

robust your mental health is i don’t

care what kind of a place of well-being

you’re in

if you have one negative event and you

start brooding about it within five ten

minutes you’re not in a good place

and um

it’s always an opportunity for me to to

put into practice what i preach right to

be like all right

you know like

you got to walk a walk right so what are

you going to do

what are you going to do

how are you going to do yeah what do you

do with the red light then

so

this particular example that i’m

thinking of somebody really really

pushed my buttons at a meeting and i did

bite my tongue very wisely because i was

going to say something that was not

going to be helpful

and i’m sitting at the red light

well i’m by the way i’m brooding all the

way the walk down to you know i have

about a 10 minute walk to my car and

then the drive to that point so it’s

been like a 20 25 minute bout of

rumination so i’m good and worked out

i’m sitting at the red light and i’m

like

and i had just let a therapeutic

lifestyle group the week before we were

talking about rumination one of the

techniques

that we had asked patients to see if

they could put into practice when

they’re ruminating that week

was

gratitude

i knew you’re going to see it in the

moment

in the moment

um and this ideally would be something

if you’re keeping a gratitude journal if

you’re doing a gratitude practice where

every day

ideally three

like little things like you’re talking

about we don’t ruminate necessarily

about the big things

gratitude is i think best

practiced with the little things i mean

obviously the big things we’re grateful

for as well but

um

so i’m sitting at the red light

and i’m like

okay gratitude gratitude

and this is so amazing the the the um i

think we often fail to appreciate just

how much our memory access is guided by

our mood state

if you are in an angry mood most of the

easiest memories to pull up are going to

be other times you are angry

i kid you not

especially other times you’re angry at

that same person

if you’re in a anxious fearful mood

state your memories are way easier if

they’re other worry related sort of does

that make sense yeah absolutely so i’m

sitting there and i’m angry

and i’m i’m like i got nothing

and i’m embarrassed there’s nobody

around and i’m just embarrassed i’m like

i cannot believe i’m freaking

you know

teaching preaching this and i’m i got

nothing

and i’m like

steve you have so much to be grateful

for i’m having a talk with myself

and and the answer is yeah but i can’t

think of anything right now

and and i and i’m like this is i will

never forget this moment

because

i’m getting way deeper insight into what

my patients are telling me because

they’re like you know what in the moment

this is hard it sounds really

reasonable and easy but in the moment

it’s hard

stay with it what do i tell my face stay

with it stay with it it’ll come

stay with it what what about earlier

today

was and and in a flash puppy

puppy jumped in my lap while i was

having my coffee this morning puppy

licked my face

puppy cuddled with me and then i just

melted and the damn broke and now i can

think of a million things i was grateful

for

i don’t know if that makes any sense at

all but yeah but it it um

once i was able to connect with anything

i was grateful for the anger melted the

rumination spell was broken

and i was able to just enjoy the rest of

my drive come home in a much better

space to greet my wife to greet my puppy

to you know is your dog’s name puppy

his name is teddy the wonder dog

even better yeah

that’s your question though yeah yeah so

so we called in puppy yeah this this has

me uh you know brene brown’s dare to

lead book is coming up for me in this

regard because uh and the you the

viewers are just going to have to excuse

my language because it’s in the book

sfds shitty first drafts as she

describes it in her book that we have

she actually gets that from the writer

anne lamotte okay anne lamott and her

extraordinary

us for beginning writers or aspiring

writers called bird by bird

and she has an entire chapter called

shitty first drafts okay yes were we

talking about her on our walk yesterday

no okay

that name sounds familiar but

but in that regard she talks about the

experience of the shitty first draft is

the build up the reason we do it one we

we want to we’re curious we want to

figure out what took place what the

problem was what the solution is those

sort of things

but whether we arrive at a conclusion

that’s accurate or not we per the book

at least if i remember it correctly we

get a dopamine kick and so there’s an

advantage to doing it but for the

depressed patient the trade-off for that

dopamine kick

sounds

uh

massively

off where we get stuck in a

fight-or-flight phase and so maybe i

guess the question here is

from your experiences in research and so

forth is that dopamine kick true

for the depressed patient as they’re

ruminating do they get something even if

the trade-off is significant yeah that’s

i i really like this question so

there’s something incredibly

addictive

and seductive about rumination

it’s tantalizing it offers the promise

and i cannot tell you the number of

patients that i’ve worked with

that when they’re just being very real

and very honest they’re like

yeah i i know it sounds stupid but i i

every time i ruminate about this breakup

i i think like

this time i’m going to figure out why he

left me or this time i’m going to figure

out why he cheated on me or this time

i’m going to figure out why everything

went south or this time i’m going to

figure out why why that job didn’t work

out or why i didn’t get that offer i

thought i was going to get or why didn’t

get into that grad school or

what i’m saying it’s like

rationally i know this makes no sense

because the last 500 times i’ve

ruminated about i got no further into

but it feels like this time it’s it’s

like lucy in the football

you know charlie brown’s like no this

time she’s going to hold this time i’m

really going to kick it

you know

and that’s what rumination does it holds

out this promise of yeah this time it’s

really going to connect and you’re going

to figure it out

so it has this seductive alluring

addictive quality it is dopaminergic

but then at this horrible cost

of ramping up our stress circuits making

us more depressed more anxious more

angry

more disconnected by the way the

opportunity cost

i know that’s an economist term right

but the the like what are we giving up

when we ruin it you know we’re giving up

the world of other people and activity

that we’re designed for we’re not

designed to be living in our heads but

when we ruminate we’re stuck in our

heads

and most americans spend way too much

time lost in their head we give up our

here and now we give up the moment yeah

we’re sleepwalking we’re you know the

zen

meisters throughout history have always

said

be here be now you know right now be

fully awake sure but rumination is so

deceptive right because it it’s almost

uh dressed up as a solution right it’s

like it’s

it presents itself like oh i’m going to

come to a solution i’m actually i’m

coming to resolution at this point but

it’s not it’s completely usual

and the reason it’s like a trojan horse

in a way because it it presents itself

and it says well no look everybody

ruminates and and by the way rumination

not only is it normal and natural but

it’s it’s helped you before yeah like

remember that one time when the thing

didn’t go well and you started thinking

about and you figured out why and then

you made a course correction and it’s

like bro you should be ruminating more

absolutely right because this is the

best thing you can yeah yeah yeah don’t

go to your friend’s house you need to

stay here and figure this out you need

to just stay here

hunker down

absolutely uh

yeah it i mean

it

what’s that unpredictable reward that is

actually the most rewarding right would

people yes receive that but it’s

unpredictable when they’ll receive it

that’s the knowledge that pushes the

lever the most right that’s a condition

yeah can i use that in mind that’s my

next version of the depression career

yeah actually

jason friesman yeah

remind me i gotta give him the credit

for that um seriously that’s that’s

phenomenal so yeah there is this sense

of um it’s like the did you guys ever

study this in in psyc101 whatever you

know the pigeon on the variable yeah

the slot machine it’s like

as long as it’s delivering the reward at

some point you don’t know when

then you’re going to keep at it and yes

rumination even for the addict yeah the

ruminative

ruminative addict it will still pay off

sometimes yeah so they’re going to stay

at it right yeah that’s that’s so good

yeah

genius

yeah

who’s mentoring who here just i don’t

know

i’m gonna steal my thunder we’re done

but we should talk a little bit more

about how to break the rumination habit

maybe yeah yes

you know and i

and i think uh just to kind of set that

up from the prior episode that we were

on you know we were talking about before

our friend friesma arrived here that you

know there are two general approaches

that are taken a lot of medication

pushing for 60 you know 76 percent of

the population major depression

population they go into a setting they

get the medication they walk away

not a great outcome generally usually

their primary care doc yeah they’re

they’re doing all the heavy much of the

heavy lifting

not because they should

they know that

but because they’re they’re standing in

the breach they’re they’re filling the

gap because so many depressed patients

are getting nothing

and they show up at their you know

primary care doctor’s office and they’re

they’re hurting and the doc is like well

i don’t have a lot of time or anything

else but like hey i got some lexapro

like maybe that’ll help i got some

effects or maybe you know

so they’re

they’re getting minimal care

but the doc is thinking correctly this

is better than nothing yeah and maybe

the public is sold in that moment as

well too because they just saw the

commercial like you’re depressed yes i

am we have this pill perfect perfect

yeah i’m suffering so right you know and

then

it uh then you get into those settings

stress environments or otherwise with

the family doc and it matches right it

tells the story that this is going to

provide that relief but we know in from

the prior episode that that

monotherapeutic approach this is not

going to have

the validity that we believe it’s going

to so insert the next possible thing

within a setting like peaks is we can do

psychotherapy well if if the medication

is going to work

we need time for it to work at the same

time the person wants relief right now

so generally speaking the next thing is

you know psychotherapy but so much of it

is group activity as well too but i’m

not ready for that environment so before

we get into the psychotherapy and how we

can get into anti-ruminating you know

features of this what are some of those

quick setups that maybe we can do as a

treatment center or folks can be

thinking about as home to really you

know push this forward in a more

meaningful way so somebody is suffering

which everyone with clinical depression

is suffering and by the way depression

for a lot of patients actually lights up

not just their emotional pain circuits

but those are cross-wired with our

physical pain circuit so a lot of

depressed patients will if they’re

severely depressed they’ll be like

i can’t even describe it but i’m just

hurting

and it’s like yeah it’s emotional but

like it sort of feels physical too

so they’re in agony they’re in torment

and they want relief and they deserve

relief

and so what do we have in our toolkit

that’s like well if we just throw meds

at it

that helps a lot of people but the

average

patient’s gonna take like three four

weeks before that’s kicking in sometimes

up to six weeks

what do we have is faster

the first thing is surprising

bright light therapy photo therapy using

a therapeutic light box or getting

outside for a half hour

typically ideally within the first hour

of the day

for a half hour

that dose of light the

light is measured in units called lux 10

like this in colorado springs is

probably a hundred thousand lux out

there

abroad indoor space is maybe a

be outside or use a therapeutic light

box

effects kick in five to seven days on

average

it’s fast it’s amazing

and we don’t use it nearly enough why

it just doesn’t feel like it’s not very

sexy it’s not very exciting i was going

to say that

i’m glad you did it’s not very sexy it’s

like a light box really a clunky little

or you know getting outside and it’s

like no

light is a drug light hits receptors in

the retina that have a broadband

connection to the center of the brain

and it’s fast okay so there’s number one

we can start using a therapeutic light

box

number two

there is a nutrient

called acetyl l carnitine

that supercharges the mitochondria the

power plants inside our brain cells

and we get depleted when we’re depressed

and as we age we get really depleted so

older or middle-aged depressed

individuals

respond to acetyl-l-carnitine like an

antidepressant drug

it can be purchased over the counter

it’s a nutrient it has minimal side

effects most people have no side effects

it has

therapeutic efficacy on par with

antidepressant meds typically

and it kicks in often within a week

so some listeners viewers might be like

well wait a minute acetyl carnitine

first of all what’s the dose 2 000

milligrams is the best study dose 2000

milligrams a day divided dose 1000

milligrams twice a day wait a minute

acetyl-l-carnitine you can buy it over

the counter

by the way i’m not giving medical advice

talk to your healthcare provider

but i can buy it over the counter

it’s pretty cheap

it’s fast it has minimal side effects it

seems to be about as effective as

anti-depressant meds why the hell is

this stuff not being widely used

there’s no money to be made

pushing acetyl l-carnitine

i have no financial vested interest in

it i just want people to get better and

we can leverage that we can use that

right it’s it’s a really cool little

hack

it’s super charging brain cells

okay number three we talked a little bit

about

chronotherapy

which is a fancy term for basically

we’re going to do a couple things the

first thing we’re going to do this

sounds nuts but it works

if you keep somebody with depression if

you keep them up all night and into the

next day

then

bizarrely miraculously their mood will

brighten after 24 to 36 hours of sleep

deprivation we don’t understand why i

know we talked about this earlier like

doing it we have no idea

there’s a theory that maybe by keeping

somebody up for for 36 hours

we’re basically putting the brain into

emergency brake glass in case of

emergency stimulant mode it’s like oh

this must be life threatening because

why the hell else would somebody stay up

for 24 36 hours

so it seems to recruit stimulant

circuits dopamine they stimulate

circuits in the brain that are bypassing

all the depressive shutdown

and this sounds great it works until it

doesn’t when does it stop working as

soon as a person goes to bed

but

what if we layer that

antidepressant fast rapid acting effect

of sleep deprivation

with shifting the person’s body clock

so instead of keeping them up 24 hours

what if we keep them up 28 hours so

we’re gonna phase

shift their body clock by four hours

lather rinse repeat do that six times

so we’re gonna be phase shifting them

and we’re gonna hit them

with therapeutic doses of light which we

already know is rapid acting

this triple whammy is called

chronotherapy there’s a protocol that’s

been developed and it’s very fast acting

and

it’s probably the fastest thing that

that that i know of that’s also

very physically benign it doesn’t have

lots of side effects it’s not dangerous

unlike say ketamine it doesn’t have like

abuse potential it’s like no we’re just

keeping you up and we’re shifting your

body clock and we’re giving you some

bright light

and

it’s extraordinary

love it so we have to go back to the

clinical team tomorrow and say yeah

we’re working 24-hour shifts

you’re going to feel really good for a

few hours till you fall asleep yeah yeah

yeah

everybody’s experience have you guys

experienced this though when you’ve been

up too long you start to get kind of

punchy oh yeah you know and you get kind

of giddy and you’re kind of you know

it’s the only time that i’m actually

enjoyable

so yeah um so do you want to circle back

to the the anti-ruminative thing

yeah absolutely and that’s going to be

the that’s going to be the heavy-hitting

part of this episode and i you know in

in repeating that though it sounds sort

of drastic i think i want to make the

claim too that

living in the suffering of major

depressive disorder when you’re feeling

that way drastic measures can make sense

and so these are things not to be

ignored but to be explored and

be curious about these sort of

opportunities because if these solutions

are that swift then why not right as an

experience versus the denial of the

effort of it i think that’s common

at least my felt experience within this

industry is like we don’t have time for

that or those sort of things but now

more than ever because we have more

antidepressant medications but

depression anxiety and so forth is

higher than it’s ever been now more than

ever it feels like

we should be thinking about these things

critically and whether we deploy them we

should at least be curious about how it

might work and develop absolutely you

know there’s one other thing we didn’t

mention in the other episode that i

probably should give a shout out

although you may want to edit this out

so we’ll see

there are

psychedelic agents that are

non-addictive they do not target the

addictive reward dopamine-based pathways

in the brain so we’re talking about

psilocybin

um

we’re talking about mdma we’re talking

although mdma has a little bit of reward

activity but

psilocybin lsd

ayahuasca there are others

there is increasing evidence that

taking on their own not particularly

helpful can be dangerous

taken

under the aegis under the guidance of a

skilled therapeutic guide

because the the the psychedelic effect

lasts for several hours

under the direction of a skilled

therapeutic guide the psychedelic has

antidepressant potential that is very

rapid

and so there’s

massive amounts of research

ongoing on this topic

i think there’s been a lot of hype

but i think there’s a there there i

think

i think within five to ten years this

kind of treatment could possibly be

quite mainstream

and even in an addiction center

once we’re very clear to validate with

patients like

this is not an addictive substance

patients who do

psilocybin the active ingredient in

mushrooms

do not become addicted to it

they don’t crave it when they’re done

they don’t want to do it every day for

the next 50 years

typically

i think there’s some real potential

there

again because it’s so fast yeah

we’re in colorado so we can totally talk

about it yeah yeah totally this is uh we

just garnered a whole news i think

denver was the first time

right yeah denver with the suicide then

yeah

it just went up by thousands yeah well

the thing i love about the the idea i

again the proof is in the pudding

i’m like show me you know i’m a

researcher but the thing i love about

the idea of it

is this is a drug that supercharges

psychotherapy

this is not a replacement for therapy

right this is not a replacement

for gaining insight and gaining

better connections with the people that

matter to you gaining a greater sense of

purpose in your life this is a

supercharged catalyst for getting to

that place that we all want to be for

living our best life

and

i’m like hey if this can actually

deliver the goods

this could be a game changer yeah and i

think it’s i like though that i mean the

cure to depression is not to go use

mushrooms like that’s exactly yeah

for sure that’s that’s the opposite

that’s the that’s the take-home message

don’t try this at home boys and girls

right um but it’s a tool it’s a tool

but it’s it like any tool it has it has

great potential for good or not sure it

can be harmful right there are people

that go on mushroom trips that get very

disoriented very dissociated they get to

a very scary place they freak out they

have pan and it’s that’s the start of

their panic disorder right now they’re

freaking out and panicking a lot

that was the genesis of it

um so it’s like we gotta we gotta

respect it it’s powerful

but in the hands of a skilled guide i

think maybe

there’s potential for some real

breakthrough for some patients it’s not

going to work for everyone it’s not

going to be for everyone but maybe for

some yeah and it’s just one tool right

just one

you can’t build a house with just a

hammer you can’t and um

you and i are both big advocates of

let’s do all the things yeah right let’s

let’s take down the web of depression

with all kinds of pebbles and stones and

rocks and

hammers and you know whatever

but occasionally we get lucky

with somebody and it’s like you know

some people with winter onset depression

we can cure it with light only

some patients who are like their

rumination is just so centered around

this one painful thing and we can cure

the rumination we can bring down the

whole web

just

some patients they start exercising

and that’s curative for them it’s not

many but it i mean it does happen you

know what i mean so it’s like we don’t

want to invalidate like

some people it’s like we hit that one

connective thread on the whole web comes

down

but the thing that hits it will be it’s

like 20 different possibilities

most of us are going to require like

multiple things we’ve got to do all the

things to really bring it down yeah and

that’s what peaks is all about yeah and

especially for long-term remission

exactly that’s right too and so

all right so now we have these beautiful

potential things like psilocybin that

can really increase or speed this up uh

we have some sleep deformation along

with some other things that might be

able to really speed up carnitine yeah

and bright light and now we’re in this

moment where the individual okay i’m

starting to experience some relief and

then we’re back to this ruminating sort

of feature right and this is where i

think psychotherapy comes in a big way i

think cognitive behavioral therapy

is one of the things that at least i’ve

read a lot in my googling of the world

but i’m a very poor googler at times so

is that the only thing or no what else

cbt you know that i like it’s a great

insight cbt the core think about what is

the core of cognitive behavior therapy

it’s i’m going to

change my reaction to things

by

basically learning in real time to

notice how i’m interpreting the flow of

experience what are my interpretations

what are my automatic thoughts

and then how can i challenge them how

can i gather evidence how can i have a

different interpretation how can i see

how i’m biased and maybe very negatively

biased right so that’s that’s the

technology of cbt it is anti-ruminative

for sure

patients who get really good at that

cognitive reframing

they utilize it when they’re ruminating

and so it becomes functionally an

anti-ruminative technology

but there are lots of other things that

are anti-ruminative

i think for most patients just learning

to notice mindfully to be very mindful

meta attentionally aware like what am i

aware of right now what am i paying

attention to

oh i’m ruminating huh i caught it in

real time most patients who ruminate

don’t even notice it’s like when you

drive a very familiar route and you pull

into the driveway you know how the hell

did i just like i don’t even remember

were there stop signs were there other

did i were there pedestrians did i hit

anything did i just it’s not just me

i do that in very unfamiliar routes

your mileage may vary but but most of us

like when was over learned you know

you tie your shoes and you’re like i

don’t know what the steps were but when

you’re learning you do it very you know

mindfully right

a lot of our life is lived on autopilot

unmindfully we ruminate unmindfully on

autopilot when we when we learn to slow

it down

and be mindful

throughout the day oh god i’m doing it

again i’m ruminating

so now i’ve caught it

and i’m going to decide to stop it

that’s

more than half the battle but it’s like

okay now i’m going to stop it what am i

going to do

all it takes is something absorbing to

redirect your attention to

it could be good absorbing or bad

absorbing right it could be

a behavioral addiction right it could be

oh i’m gonna play video games for the

next eight hours well that’s

anti-ruminative

not particularly instructive but it

might be better than depressive

rumination

right it might be if we’re in a harm

harm reduction model yeah right it’s

like oh

okay somebody’s depressed because

they’re ruminating

well if they go play video games for an

hour to break the bout of rumination

it’s not great but it’s probably pretty

benign right oh i’m gonna binge watch

netflix for two hours

it’s not great but it’s pretty benign

you with me

but then

maybe you know better anti-ruminative

absorbing things like what well

shared activity with a friend shared

activity with a loved one

taking my dog for a walk

um

you know something where i’m connecting

and belonging something where i feel

purpose something where i feel

you know like like a part of the tribe

and then finally i would say something

generative

that’s like apex level i would say for i

have to be in a good space for this but

like oh i’m gonna go noodle around on

the piano or the guitar and try to write

a song like i’ve had this like four

ideas for it’s like i got this song but

like there’s no bridge

like i’ll noodle on that for a while you

know

and that’s really anti-ruminative for me

it’s like i get so caught up in it like

but i have to be in a pretty good head

space for that right like some

anti-ruminant anti-ruminative activity

is like break glass in case of emergency

like oh i’m just gonna go for the big

gun i’m gonna go for the video game i’m

gonna go for the the binge watch

right

and some is more like oh if i’m in a

better place like i can enjoy my

friend’s company if i’m in a better

place oh i can

um just be alone in nature and that’s

anti-root i can get absorbed and lost in

nature but if i’m not in a good space i

might ruminate while i’m lost in nature

you see it so we got to be nimble we got

to be nuanced but that’s really fun

clinical work and i hope patients i hope

prospective patients their families as

they hear this they can think about oh

wait there’s like detective work there’s

like trial and error there’s like yeah

we’re going to fine-tune

if we’re going to help break the

rumination habit

the rumination addiction as it were

we’re going to have to be doing

personalized medicine we’re going