Will lifestyle interventions be accepted as alternative treatments for depression? | Charles Raison

Will lifestyle interventions be accepted as alternative treatments for depression? | Charles Raison


– [Rhonda]: Right now I would say that if
a person was depressed or anxious, if it hasn’t sort of life event that may be induced that,
a divorce or something like that, they go and see a psychiatrist and they get prescribed… – [Charles]: A medicine. – [Rhonda]: A medicine, typically you know. – [Charles]: SSRI. – [Rhonda]: SSRI, or something like that. Which aren’t necessarily always effective
and could have side effects. There are many of these different lifestyle
interventions: the weight loss, the exercise, the whole body hyperthermia via your favorite
method, sauna, hot yoga or hot bath. There’s meditation, there’s these, you
know, psychedelics which of course, that would be something that you can’t really, it’s
not legal yet. But for the ones that are, do you think there’s
any hope that the medical community will embrace them, that we’ll start to have a treatment
centers that people are now can, they can go and meditate, or do hot yoga or sauna,
or they can at least be told by their physician, “Try this?” – [Charles]: Oh, yes. Oh, yes, yes. Yes, the science is going to go this way. So it’s very interesting. I mean, I specialize in depression, that’s
kind of what I do. And it’s a very, and actually my colleague,
Christine Whelan and I, are writing a book about these ancient practices we’re talking
about, and looking at it in relationship to the pluses and minuses of antidepressants,
right? So there’s an interesting truth, or there’s
an interesting thing about antidepressants that’s not widely known, which is… And it’s a lot like a lot of things. So, you know, if you look at, there’s these
studies showing that if you start out depressed here, and you do eight weeks with an antidepressant
or a sugar pill, the antidepressant gets you down, less depressed. Here’s the antidepressant. Sugar pill, you know, will also get you un-depressed
but lesser, right? So you say, “Antidepressants seemed to work
pretty well for everybody. You know, they seemed to work better than
a sugar pill for people,” but that’s not the truth. – [Rhonda]: Yeah. – [Charles]: John Krystal at Yale did this
great study where they were able… I won’t bore you with the details, but what
really happens is about 70% of people will do much better short-term with an antidepressant
than they will with a placebo. I mean, they really feel better. So there’s a group of people that really
do well with antidepressants. And by ‘well’ here, what I mean is that
they were really coming apart with depression and now, you know, couple or three weeks later,
they feel like they’ve got their life back. They feel better. They feel fantastic. Twenty five percent of people that are depressed
will do much worse with an antidepressant than they would with a sugar pill. And that’s what’s not widely known. We’ve seen a very similar pattern in some
of our immune interventions studies. It seems like all interventions, or many interventions,
may share this. That if they help some people, they may actually
hurt others. So the first thing I say to people is, you
know, if you’re depressed and anxious, and if it is impairing your life, I mean, where
you’re really having trouble, you know, where you just, you really have it, there
is some very good chance that if you take a regular antidepressant, you will feel considerably
better, and there’s some chance that you’ll feel like way better, right? That could be very useful, and so it’s just
bracket that. I mean, that these agents are very powerful
for a not insignificant subset of the population that’s depressed. It’s also possible if you take one of those
agents, that in fact, it’s not going to help you. That happens a lot. Now, what you don’t know in fact, is that
by it not helping you, you know… So if you look at these studies where what
happens is if you don’t respond to an antidepressant, most the time if down is good, you just stay
the same. But if I’d given a sugar pill, you would
have done much better, right? So you come to me and you say, “I’m just
not responsive to antidepressants.” What’s actually happening is that those
antidepressants are a absolutely non-optimal intervention for you, right? So there’s a whole bunch of people that
antidepressants are not optional for, or are not optimal for. So that’s the first thing. So if you’re one of those people, then what
do you do? And that’s where these other things become
very, very interesting. But the problem with antidepressants, as I
sometimes say, and I, you know, I’m a psycho-pharmacologist. I have seen antidepressants save many lives,
and I’ve seen many people benefit from them. But they are a bit of an unearned grace. They take you from a state, when they work,
they take you from a state where you just feel horrible about yourself, feel horrible
at the world, you’re anxious, you’re miserable, you’re not eating, you’re not sleeping,
or eating too much and, you know, you’re just, you’re down yourself. Everything is dark. You can barely get out of bed. You know, you’re scared of your shadow. You can’t make decisions. They can take from that and in a month, you
can become like super yourself, when they work. Now you’re confident, you feel better, all
that stuff that was bothering, you’re like, “Yeah, what’s the big deal? You know, sue me.” All of a sudden the world responds better. They go, “Oh, I’m so happy to see you.” This is “Listening to Prozac,” that famous
book from the 90s, that’s a real phenomenon. But the problem is, and it goes back to what
I said about the spring versus the thing where you become dependent on. You’re only that person when you’re taking
the antidepressant. You take away the antidepressant, and it fades. So that’s problem number one. What you would really like to do is find a
treatment that whatever it does, it induces something that’s less dependent on something
external for your sense of wellbeing. The other thing about antidepressants is there’s
some data, there are some data that the longer you take them, you may become more and more
reliant. You may need them to feel good. There’s some evidence that they may induce
a vulnerability, so you have to make a decision in your life, you know, are you going to to
be Rhonda alone, or are you going to be Rhonda plus Prozac? And that’s a weird thing. – [Rhonda]: Yeah. I think I’ve even seen some evidence where
there’s changes in, there’s down regulation of serotonin receptors, for example, and you’re
constantly, you have serotonin synapses that’s not, you know, being the reuptake like it
should. It’s staying around, and so the receptors
are like, “Oh, there’s more serotonin and so we should down regulate.” So again, if you were to take that away, all
of a sudden you have down regulation receptors and it, your baseline is now even, you know. – [Charles]: So relapse rate, so you can take
people, and there’s a lot of studies now. You can take people that have been in full
remission, taking an antidepressant for two years, you take it away and 60% to 80% of
them will have relapsed within a month. I mean, especially if stop it quickly, right? – [Rhonda]: Yeah. – [Charles]: Whereas initially, if you take
away a placebo, a lot of people do pretty well. So placebo responses are more stable and more
long lasting than antidepressant responses. And that is a shocker real, I mean, for those
of us in the field. So it really speaks to the fact that the strategy
of dealing with the adversities of life, and dealing with depression, which is really sort
of an involved response to adversity, I think it’s mostly involved response to microbial
adversity, like we were talking about. Just now, that’s what it is, all around
the world. You know, if you’re sick, if you’re stressed,
if things are going badly and you’re vulnerable to it, that’s what sets you off into depression. Well, you know, it’s much better to take
an antidepressant than to kill yourself, or to have your life come apart, or to just fall
apart. – [Rhonda]: Of course. – [Charles]: But it would be even better if
you could find something that would allow that antidepressant response to become endogenous
to your own brain-body system. That’s where these alternative practices,
and I think some of these ancient practices, have promise. I don’t think any of them are antidepressants
the way an antidepressant is an antidepressant. I think all these things, what they do is
that they set you on a path, or they open a door, for you to begin to transform yourself
in ways that are going to protect you from depression. Because one of the things that when you live
with depression for a long time, and you watch it, what you see is that the things that tend
to make people depressed are those things in their life that are the sort of challenges
that emerge out of who they are in terms of their behavior, their thoughts, their feelings,
right? So they have a lot of examples, but like a
lot of times, people become depressed when they, the person who always chooses the wrong
partner. No matter what they do, they always end up
with somebody that’s abusive to them, or somebody that, yeah. So what they need to do is transcend that
pattern, and if they can transcend that pattern, then a huge driver of their depression goes
away. But, you know, when they get depressed it’s
because they’re approaching it again, or they give up, or they lie to themselves about
it, or they, whatever. Life is like, I believe this deeply actually,
that life is like a series of challenges to perfect sort of the functioning of who I am,
who you are, as a being, the sort of behavioral and biological organization of yourself as
an entity. This is mystical mumbo-jumbo, but I do think
that for reasons I don’t fully understand, that this is the challenge of human beings. Is to sort of perfect it. If you do that, that is the ultimate antidepressant
strategy. Dalai Lama doesn’t get depressed, as far
as I can tell, you know. Because what he’s done, it seems to me,
and I know him somewhat, is that he’s transformed the way his brain-body complex works. So he’s in states of mind that are just,
they’re just inimical to depression, right? So I think that that in fact, is the ultimate
antidepressant strategy. But the problem is that it’s a lifetime’s
worth of work, and it’s extremely difficult. But I think that these alternative things
are more likely to drive you that direction than our modern pharmacology. – [Rhonda]: You make yourself more resilient,
right? – [Charles]: I think when they work, you make
yourself more resilient, and you begin to develop perspectives that line up very strongly
with many ancient wisdom traditions about the truths of what it means to be alive in
this particular universe with its challenges, which are, there’s a myriad challenges. So I think that that is the ultimate way forward. How that works is interesting, because there’s
not, it’s very hard to monetize that. And that’s an interesting challenge, right? Because these other ways are far more easy
to make you know billions of dollars off of. Now, how you combine standard pharmacology
with this pursuit for the sort of, what I call personal transformation view of antidepressant,
you know, thing, that’s another really challenging thing. Sometimes people take antidepressants as an
excuse not to face what’s going on in their lives. Like I’ve known many people, and patients
that they knew, take an example, they’re in a marriage and they know that it’s just
they need to get out, right? But there’s a famous saying that many marriages
are saved by the, usually the women, because the guys are dolts, you know. Like many American marriages have been saved
by the woman just being put on Prozac, because when it works, she goes, “Yeah, you know
I can play bridge. I can play golf. He’s not so bad.” You know, you basically just medicate yourself
away from the truth of what you know at a deeper level to be true for you. In that way, you know, the antidepressant
is actually working against what I would see is this more optimal way of sort of transforming
into to coming into full ownership of who you are. But on the other hand, you know, you can imagine
somebody that gets up to a wall, and they know they need to do this, whatever it is,
but it’s overwhelming. They can’t do it. You know, you put them on antidepressants
for a while and it gives them the sort of chops to hop the wall. Then maybe the antidepressant has become sort
of a tool for transformation. I’ve never seen anybody talk much about
this, and I’ve only been thinking about it for the last six months or so, but it’s
an interesting question. So there’s a lot of complexities around
this dance of, are their optimal ways of combining these things too?

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