HealthyGamerGG - Bouncing From One Addiction to Another

Episode Date: April 20, 2022

Today Doctor K talks about how to define an addiction, psychological withdrawal, rehabilitation, and more! Support this podcast at — https://redcircle.com/healthygamergg/donationsAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy Learn more about your ad choices. Visit megaphone.fm/adchoices

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That's D-R-I-Z-L-Y.com today. So how do you know if you have an addiction? or what is an addiction? So when I am addicted to something like alcohol or opiates, the physiological effects on my body are profound. Our GABA receptors get regulated so heavily that if you have, if you're addicted to alcohol and you stop cold turkey, the withdrawal that you go through can conceivably be fatal. As someone who's done a lot of work in addictions, like the main thing that I found is that you can go to AA. You can start this medication, you can go to rehab.

That'll all help. But the truth is it doesn't work for everyone. for everyone, right? So what's the difference? Sometimes you'll have people who have a history of trauma who really just want to be loved. And when it comes to addictions, it's like it's really easy to find someone who you can feel love for if both of you all are addicted to the same substance. So I've managed to abstain from porn and masturbation, but my productivity has lowered significantly. And I am impulsive buying, my impulsive buying came back in full force. Last time I posted I was doing so well. I exercised steadily, not half-assed. Even though I hate exercise, I still

managed to do it. Good job. I did my chores, did my studies, managed to control my impulse of buying to a medium yet manageable level. However, my porn and masturbation addiction was the one I was stumped. Before I did another attempt, I watched the Huberman podcast with Anne Lumbach. The man likes to inform the general public about neuroscience and ways to use it to our advantage. He's quite similar to Dr. K., but highly specialized on neuroscience. Bro got a degree and more on the science stuff. Thankfully, I'm a first year nursing student so I can keep up with the anatomical parts and such.

Not going to lie, some of it are way to advance for me. I finished the podcast and gained some insight and learned some tips now to put them to practice. I felt huge fluctuations in my mood. It made me wonder if this is how women felt during menstruation on the first day. Interesting side benefit of empathy, maybe. Food cravings made me spend more than I should. Exercise has been great difficulty to initiate and finish.

I started living like a slob again. Luckily, I managed to finish most of my assignments before starting detox. So my school load is very light and the deadline is still very far. The fact that I felt definitive withdrawals within two or three days pretty much confirms that I really had a legitimate addiction in those years of porn use and masturbation has really altered my brain's dopamine homeostasis. So the help and advice that I need now, how do I recover from such a difficult process of detoxification whilst juggling my exercise chores, schoolwork, managing finance, and keeping my head in the game? It is legitimately difficult, and I started to understand how some people have great difficulty recovering from addiction.

Once again, empathy plus one. I know the road to recovery is constant and lifelong, and I want to gain some insights and tips to keep myself from becoming worse. So this is the kind of thing where I think this is a really good representation of what the road to recovery looks like. And there are a lot of important principles here that I'm going to sort of share with you having worked with people who have addictions and stuff about kind of how the mind works, what the role of an addiction is and what it feels like to try to get off of it or what are the challenges that it takes to get off of something. So let's start by sort of defining addiction, okay? So how do you know if you have an addiction or what is an addiction? So as human beings, we have a mind and the mind juggles lots of different things.

The mind experiences positive things. It experiences negative things. And generally speaking, when we try to get motivated to do something, the more negative stuff our mind is dealing with, the harder it is to do, right? So let's say that I'm trying to study for an algebra exam. And, you know, my girlfriend just broke up with me the day before. So as a result of those negative emotions, my mind is going to be creating all these thoughts. There's going to be some concerns, maybe anxiety, maybe fear for the future, maybe guilt.

All kinds of different stuff is going to be going on in my mind. And I'm unable to study. So in order to focus our mind, what we tend to do is use something called a coping mechanism. So a coping mechanism is a way that we take some kind of distraction, negative emotion, negative thought, something that gets in the way of us doing what we want to do. And we use some kind of tool to like make that thing calm down. So in the worst case scenarios, people will use things like substances, right?

So like marijuana or alcohol or whatever. Sometimes we'll use things like video games. Sometimes we'll use things like pornography. So we've sort of figured out, is the human race, what are the things that are effective at quite, our mind when our mind is unquiet. And once our mind starts to quiet down, we can start to be more productive. So we've sort of figured out almost in like an individual evolutionary sense what works for us. And that's oftentimes a pattern you'll see with addicts, which is that they'll have something called a

drug of choice. Why do some people have one drug of choice and other people have another drug of choice? Oftentimes when you're dealing with people who have substance use problems, they've tried a lot of stuff, right? But there's a particular thing that's their drug of choice. And that even has been shown to track back to, you know, what kind of neuroscience effect a particular substance has. So, you know, some is one of my mentors once put it. It doesn't actually work like this. But, you know, a particular drug in one person due to genetic variation and all these kinds of other things will light their brain up like a Christmas tree. And for another person, the drug will be different.

That's why we have a drug of choice. So kind of going back, we each sort of figure out, okay, when I have negative emotions and I need to focus, here's what I'm going to use to make myself feel better. And the array of coping mechanisms is like vast, right? So we have everything from video games and substances to pornography to also things like meditation and exercise and, you know, eating comfort food, right? So what is an addiction? So I tend to think about addictions as things that are adaptive and then become maladaptive. So over time, your coping mechanism, which used to help, may still work for that one thing, but the cost of employing that coping mechanism becomes greater than the benefit. So, like, eating comfort food

is great. Like, that can be, like, good. It's nourishing. It feels good. Whatever. Maybe it's not nourishing, depending on your comfort food. But then when we start to, like, cross the realm of, like, comfort food into, like, binge eating or, you know, like food addiction or things like that, that's when it's kind of gone too far. This is where it's starting to affect our health. And sure, it still provides us with some kind of emotional benefit, but it's causing problems in other parts of life. So if we look at someone who's got an addiction, usually there are like two things going on. So we're going to talk about different kinds of addiction for a second. So for a long time, there's been a debate whether marijuana is addictive. And part of that debate has to do with

the principle of physiologic tolerance and withdrawal. So when I am a addicted to something like alcohol or opiates, the physiologic effects on my body are profound. So alcohol works on something called the GABA receptor. Opioids tend to work on different kinds of opioid receptors, but the mu receptor is really, really important. And so we know from studies of neurobiology that when you regularly use a substance, our receptors will adapt to sort of develop a tolerance. So caffeine is another good example where we'll develop a physiologic tolerance. So when we start to use caffeine, it can keep us up all night, but if we use it on regular basis, then it doesn't keep us up all night. In fact, without it, we start to suffer, right? So we experience some kind

of physiological withdrawal. So there are some substances like marijuana, for example, or even things like pornography or video games, that don't appear to develop the same kind of physiologic tolerance and withdrawal that things like alcohol and opiates develop. So how do we sort of know this, or what's the argument for this? So first is that, for example, Our GABA receptors get regulated so heavily that if you have, if you're addicted to alcohol and you stop cold turkey, the withdrawal that you go through can conceivably be fatal or not conceivably. It really can be fatal and is fatal for an unfortunate percentage of people. So what happens is literally when you go through alcohol withdrawal, depending on what kind of tolerance you have, how much you've been drinking in genetics and other individual factors. So alcohol kind of slows down neuronal activity. So in the absence of alcohol, you know, if you've kind of like, you know, really, really, like, accounted for the depressing effect of alcohol, maybe this is the kind of thing where I should draw this out. So let's do this.

So I'll explain, we'll explain physiological tolerance real quick, okay? So let's take a look. There we go. So I'm just going to explain this real quick. Okay? And we're going to go back to the main part. So let's talk about physiologic withdrawal. So let's say I use something called alcohol.

Okay, so here's my, okay, so here's the signal, okay? And then here's my response. Now, if I use alcohol, which is a depressant, so the GABA receptor is a hyper-polarizing receptor, so it's a chloride, usually chloride ion channel is the simplest way to think about it, makes it harder for your neurons to turn on, basically. So when I add alcohol, what happens is that alcohol essentially, oh, sorry, hold on, Gigi. Okay. So what alcohol essentially does is it lowers the effect of the signal.

Okay, so alcohol artificially puts us here. So then our brain is like, oh, we're supposed to be in the middle. So what I'm going to do is I'm going to adapt. I'm going to change the nature of my neurons. I'm going to make them more sensitive because alcohol has a depressing effect. So my physiologic adaptation is going to be in this direction. We can also look at something like caffeine,

where this is my normal function, here's my response. And so what does caffeine do? Caffeine amps it up, right? So this is caffeine. And so then over time, our brain is like, hold on a second, hold on a second. This is like we're too amped up. Let's go ahead and adapt and let's lower our responsiveness. So then what happens is once you add the blue and green arrows together, what you end up with is you end up in the middle, which is why if you look at issues

of withdrawal, like without caffeine, the reason that it sucks is like you operate down here. Right. So you're like you feel sluggish. You feel slow. And so what happens in physiologic alcohol withdrawal is you actually operate up here. And what does this mean practically? What does it mean to like operate up here. So what it means to operate up here is you can actually have seizures. So your neurons are so, so excitable, they depolarize so quickly that you can get unregulated electrical like activity in the brain. And you can actually have a seizure. And then remember, neurons and neuronal functions and depolarizing cells are not just in your brain. So you can also get problematic or electrical activity within the heart, and you can get a cardiac arrhythmia that results in death.

So this is why, like, when people say, like, marijuana is not addictive, what they're referring to is that this physiologic process does not seem to exist with marijuana, or it happens at a much, much smaller level. Okay? So this is what we mean by marijuana is not addictive. But these things like video games, like pornography doesn't do this to your, you know, doesn't do, act like this. So in the case of opiates, for example, we'll get opioid receptors all over the body. So what you'll see is you'll get things like, you know, so opioids are constipating.

They will provide pain relief. Those are two of the biggest things. They'll also kind of slow your mind down. So when people are going through opioid withdrawal, they experience the opposite of those things. They'll have diarrhea. Sometimes they'll feel nauseous or even vomit. They'll get sweaty. they'll start to feel like very agitated and restless. Their pain can actually become more, their pain receptors can become more sensitized. So opioid withdrawal is like a very, very unpleasant experience, which according to some people that I've worked with is like worse than death.

The hands down the worst experience of their life is like the week or two that they go through opioid withdrawal. So this is what we sort of mean by like, you know, some substances are not addictive. they're not, you don't develop a physiologic tolerance. But we clearly develop dependencies on these, these other things like pornography addiction, video game addiction, things like that. So then the question is, okay, like what is that kind of dependency? And this kind of goes back to what we were talking about earlier, where we use coping mechanisms to help deal with negative emotions, right?

So oftentimes what you end up seeing is if I'm using pornography to deal with negative emotions so that I can function and focus and be productive and exercise and stuff like that, right? Because I have all these kinds of like negative stuff going on. I'm unmotivated. I'm ashamed of myself, whatever. And so if I use pornography, it kind of like deadens my mind a little bit, get some dopamine spurts, changes my thinking, and then like it kind of equilibriates me. So what we tend to see is that those underlying psychological things that you need the coping mechanism to cover, okay, Those don't go away when you stop using an addictive substance. So forget about the physiology for a second.

We're talking about kind of the emotional coping or the emotional dependence, for lack of a better term. Maybe more than emotional. Identity related, thought related, et cetera. Mental. Let's call it mental. So oftentimes what you see is that when you take an addiction away from someone or you don't let someone use an addiction, you see an upswing of those negative mental states, which in turn, means that people will reach towards other behaviors. So oftentimes when you work in addictions,

what you find is it feels like you're playing whackamol, where the second that you control someone's opioid use, they'll start doing things like self-injurious behavior. So cutting or something like that. So self-injurious behavior is also actually a coping mechanism. It's really fascinating. When I talk to people who engage in self-harm, they're not actually trying to kill themselves. There's something about, you know, self-harm can be incredible. incredibly focusing for the mind. And so remember that, like, our brains will figure out, like, what works for us. And sometimes people who are, you know, have such a negative emotional state that they need something, like a sensation of physical pain, to obliterate all of their thoughts.

So the third kind of thing, the bucket here that, that tends to pop up as well is sometimes people also develop, like, issues with eating disorders. So, you know, kind of the worst case scenarios are, I mean, if you're in this situation, it's not, you're not hopeless or anything, but is a clinician what can be challenging to deal with until you understand this, is someone who's got like two or three unhealthy coping mechanisms, and the moment you fix one, those negative emotions that were suppressed by the addiction come roaring back. And as those emotions come roaring back, we start to engage in other things. And that's what we see in this situation, right?

So the person stopped watching pornography or dealt with their porn addiction. and their impulsive buying behaviors increased. So for any given person, it may be like, you know, some combination of all of the above, right? So some people engage in self-injurious behavior. Some people engage in video games. Some people engage in pornography. Some people engage in impulsive buying. Some people engage in even like emotionally manipulative tactics to feel loved.

So this is like a common thing that, you know, people don't really think about, which is when I feel bad. in order to get a sense of emotional comfort, sometimes what I'll do is like, lean on someone else to provide that for me. And sometimes that can be frustrating for the other person or I don't know how to ask for it. I'm not really aware of it. So I'll engage in like emotionally like manipulative behavior to evoke a response from someone else. So the key point here is that those underlying emotions that you're using to cope, you can get rid of the coping mechanism. And when you get rid of the coping mechanism, you may recalibrate your neurons after a period of withdrawal, right?

So this is what neuroscience will sort of tell us. So, like, you know, we talk about this when we talk about neuroscience. A lot of neuroscientists will sort of talk about this stuff, right, in terms of like your receptors and stuff like that. But clinicians will also appreciate, like, that there's a, there's kind of a personal, individual, psychological component to this. and that component is what causes the whack-a-mole sort of thing to pop up, right? Because now, like, you used to deal with this with pornography, and now the porn isn't there anymore, so, like, how are you going to deal with it? We're going to start buying more.

Now, the other thing that we tend to see, which is also very common, is this person is saying, as I've quit pornography, it's harder for me to exercise, harder for me to study, harder for me to focus. I don't feel motivated. Why is that? Well, we sort of explain that, right? Because the reason that you use pornography is to get your mental state calm down so that you can focus your mind.

So as you remove that band-aid, as you remove that coping mechanism, expect all of this stuff to happen. So expect, first of all, that you may start leaning on other unhealthy coping mechanisms. You may start to experience more mental discomfort. The good news with both of these things is that there's good strategies that you can use for this. So the first is, this is why we teach healthy coping mechanisms, right? This is why mindfulness is so big, meditation is so big. Because if we want to bring that mental stress down and we don't want to use pornography, if we just take away the pornography, that stress will come back.

So that's where we can use something like meditation to lower that stress over time. That too has like a couple of different angles to it, right? One is like development of empathy, development of compassion. That's all like more mental stuff. And there's also physiologic or neuroscientific stuff, right? So we'll see that we'll disengage things like the default mode network. will lower our cortisol or CRH production, which is cortisol, corticotropic releasing hormone, will sort of affect things physiologically and will sort of affect things kind of like more globally

on a mental or psychological level. So that's why developing healthy coping mechanisms is really, really important and a big, important piece of sort of coming off of a dependence. Now, you don't have to develop a healthy coping mechanism. It just makes it a lot easier, okay? The second thing to understand is that at the end of the day, why are addictions so difficult to get rid of? And it's because of that internal emotional stuff, right? So, like, as someone who's done a lot of work in addictions, like, the main thing that I found is that you can go to AA, you can start this medication, you can go to rehab.

That'll all help, right? So those are all evidence-based interventions, or not evidence-based. but evidence-supported or evidence scientifically validated interventions, that's the right term, that work. But the truth is it doesn't work for everyone, right? So what's the difference? What's the difference between someone who goes to rehab for 30 days, comes out sober, stays sober for a year, and someone who goes to rehab for 30 days and like relapses,

like within three days of coming out? And some of that is luck. Some of it is just the roll of the dice. But some of it is actually the big part of it is the internal work. Right? So what is that emotional stuff that comes up? We talk about coping to kind of bring it down. But where are these feelings originating from? And you can do that core work. Right. So is it feelings of shame? Is it feelings of I've fallen behind? I've screwed up my life. I'm so beyond, you know, like this person is better than me. Is it insecurity? Is it seeking love? Right. So this is all kinds of things that happen in addiction. So a good example is sometimes you'll have people who have a history of trauma who really just want to be loved. And when it comes. comes to addictions, it's like, it's really easy to find someone who you can feel love for if both of y'all are addicted to the same substance, right? Because then y'all are together. You're in it through thick and thin. You're together. You're together. You're together. You feel so good.

Right. Like there are all kinds of other emotional needs that get met through addictions. So you have to do that internal emotional work, right? So this is where when you think a little bit about, let's say impulsive buying or pornography or whatever, what are the actual feelings or mental state that you're trying to improve, right? What is the experience of you off of your drug of choice? So this is where, like, you know, it's going to be negative probably, right? But then, like, you know, is it anxiety? And then, like, then you need to ask yourself, sure, you can use a coping mechanism to kind of reduce it. And hopefully through meditation over time, you'll, you'll change that core part that it's coming from. But in cognitive behavioral therapy, there's

there could be some kind of schema. In Sanskrit, we call it a samskar. Right? So, like, what is it that you're trying to fix? And then where does that thought come from? Where did you start feeling that way? How did you start to think that way? And so ultimately, you know, if I'm working with someone, for example, who's like, I don't know, like, let me just think of an example of someone who's, you know, let's say like you're working with an in-cell.

And so in-cells have all these belief systems, and those belief systems are, you know, there, and sometimes they're also using substances and stuff like that. And the reason is because when, or doomer, let's say. So when I stop using the substance, all my doomer thoughts come back, right? The world is going to end. This is going to happen. I'm never going to amount to anything. And then, so then the question is like, when did you start to lose faith in the world? Right. And how did you lose that faith? And as you go track back to the source of your thoughts, when did you start feeling this way? Where did these thoughts originate from? Don't worry about the evidence. This is where a lot of people get tripped up, right? So like, if you talk to someone who has a negative schema or

negative sumscar, they'll tell you about the evidence, oh, because of this and like alphas and betas and sigmas, and they'll use all this like pseudoscientific kind of BS, right? They'll give you lots of evidence to confirm their belief, but you can try to dispute that if you want to, you're never going to get anywhere. The question is, where did the original belief come from? Because our mind, once we believe something, our mind looks for confirmation. That's what the confirmation bias is. So if you're dealing with an addiction, a couple of things to keep in mind. The first is that as you extract yourself from it, it's going to be a bumpy road. Physiologically, this is where you should actually see a medical professional.

So if you actually have a substance use disorder, you should absolutely see a medical professional because some of these things can be life-threatening. You know, even in the non-substance use category can definitely help to see a medical professional because they'll know these kinds of things, right? they'll help you support you through that sort of stuff. But as you cut back on your pornography, be prepared for the other things to rise up. And watch what happens, right? Why are you doing that?

When do you impulsively buy it? It's when you're emotionally not feeling good. Recognize that as that negative emotional stuff comes up, there's going to be an impact on your productivity. The good news is that that impact is generally speaking temporary. So in the same way that your brain will like reaclimatize, right? So, like, our brain develops a tolerance. And if we cut the substance, that tolerance will go away over time.

In the same way, you'll find a way to get motivated again. It'll just, like, your brain will just kind of recalibrate. It takes longer, though, than some of these physiologic tolerances. Because the physiological tolerances can get better with anywhere from 72 hours to, like, a week. Sometimes there are more, like, long-term effects of, like, sobriety, like a month out, three months out, six months out. You'll start to see cognitive benefits and things like that. People just feel better. So you may be in for that motivational slump for like a couple weeks, month, maybe even two, three.

And that's kind of okay. So your body has a natural tendency to heal. So just have faith in that. The other thing is that if you lean on other coping mechanisms, that equilibrium will happen less. Does that make sense? Because now we're not needing to equilibrate because we're just using something else. So even in, for example, alcohol detox will give people particular medications that work on the GABRAs as a substitute for alcohol and slowly taper that down.

And that's how you sort of safely detox someone from alcohol. So if you're using a substitute, you know, that's going to slow the process of equilibration, but it may smooth it out a little bit. Next thing to remember is that at the end of the day, those negative thoughts, you can use an unhealthy coping mechanism or develop a healthy coping mechanism. That'll smooth out your kind of return to normalcy. and then the last thing to consider is at the end of the day, you may need to do that internal like work, right?

So the kinds of negative states that arise when you are not using, where do those negative mental states come from? Where did they originate from? Where are your actual fears, concerns, et cetera? And this is why, I don't know, it sounds kind of weird, but like this is why, like, you'll see internal, emotional work, cathartic kind of work happen in basically all fields of addiction recovery. So you can see a licensed therapist, right?

who will, like, talk you through that stuff, hopefully accelerate the process. But you also see those kinds of things in Alcoholics Anonymous, where people will go up and they'll say, hi, my name is Alok, I'm an alcoholic, and then they'll share. Right. So there's some kind of like processing, acknowledgement of negative feelings, emotional support, camaraderie. So there's some research even into the common factors between like therapy and other things. So like, how does Alcoholics Anonymous work?

How does therapy work? Is there some overlap? and it turns out that there is. So you have to do that core overlap kind of work, which is like internal emotional processing. So if y'all are in this kind of situation, it's really, really common, right? So there's going to be some neuroscience stuff going on,

but like try to develop healthy coping mechanisms and understand what you're in for. Right? So that's the key thing. That's the reason we're really digging into this is like understand what you're signing up for and the phases of it and what you can do to sort of reduce it.

Questions? Food addiction. is the same. Right? So, like, food, it doesn't matter. So each of these things, depending on your substance or your choice of addiction, the support that you're going to get is going to be like, or the neuroscientific or psychological support you're going to get is going to be a little bit tailored to that thing.

So, for example, with food addiction, we get a lot of very physiologic signals of satisfaction. We also get things. So I've seen this in people who are addicted to food. So when you eat a bunch of food, you get an insulin spike. if you eat carbohydrates, that is. When you get an insulin spike, right, because you get this peak of blood sugar, your blood sugar shoots through the roof, you get a surge of insulin. As you get a surge of insulin, you move from a sympathetic, which is sympathetic nervous system mode to a parasympathetic nervous system mode. So remember, in the sympathetic nervous system mode, my anxiety is going to be worse.

My mind is going to be active, right? Like, I'm going to see danger is more real. all this stuff is in Dr. K's guide. And when I move to a parasympathetic mode, it's going to slow my mind down, right? You go into a food coma. And so what some people with food addiction will do is they'll activate a food coma

to slow down their mind, quiet their thoughts, make it easy for you to sleep. Right? So we'll see like food addiction and insomnia kind of go hand in hand sometimes too because why do you have trouble falling asleep? Because my mind, right? Oh my God. I have all these thoughts. I have all these worries. And they're too much to handle. I can't fix them.

Because when you're going to bed at night, you can't fix anything. So any anxiety or thought that you have is going to be like hopeless, right? The future climate change. And so your mind gets ramped up. You get sympathetically activated. Danger feels more real. And so when you food coma yourself, all that stuff kind of chills out. Like we're content. Right? slows things down. So in each of these addictions, there are going to be unique impacts on your body and mind and ultimately overcoming each and every one of these involves understanding like what you're up against. So then you can tailor things, right? So when I work with people who have a food addiction, one of the key things that I target is insomnia. And so if you can target that insomnia really well,

then somehow it really seems to help them. Yeah, right? So someone's saying, you know, masturbation before sleep. It's another big reason, right? So what is, What do you do? You're all these thoughts and worries, and then you masturbate, and then you get the surge of dopamine. You feel kind of content. You feel a little bit sleepy. So it's like it's almost like a self-medication, right? So you need a healthier coping mechanisms. You can maybe do something like yoga nidra. Sometimes I'll prescribe medication to people, depending on the situation, right? So someone's saying, this is so hard, I can't do it. So I can empathize with that. It is definitely very hard. The thing about a lot of this like over- substance use or especially like the non-substance use addictions, what you really have to do, the main thing that you have to do is nothing. So it's not, it's the avoidance of behavior, right? And that sometimes is the hardest thing of all. Like, what you have to do is just tolerate it because your body will recalibrate.

It's just going to be really painful. Doing nothing sucks. Yes, it does. Sometimes doing nothing is the hardest thing of all. That's why it's so hard to meditate. Yeah, so sometimes there's comorbidity with depression and restless leg. Absolutely. This is kind of interesting.

There's a paper by... Let me see if I can find this. So there's a video in Dr. Kay's guide about Ayurvedic variants of depression. And let me see if I can find the paper. I can't find it right now. There's a good paper by... Let's see if we can find it this way. I know this is kind of a random question.

question, but Fava, depression, anger attacks. Yeah, so there's, this is interesting, if you guys want to know about Restless Leggan. So I think this is the original paper. So 1998, right? So it's a little older. But it's talking, talking about anger attacks and depression. The really interesting thing is that there's like approximately one-third of depressed outpatients present with anger attacks. So this is something that, like, is kind of confusing for many people. A lot of people who have

clinical depression don't realize because they don't feel sad. What they do is they get pissed. And they just have a very, very short fuse. And then they think

they like kind of need to chill out and stuff. But like, really what it looks like is a, it resembles a clinical depressive episode. It just gets, it manifests as anger.

So the interesting thing is that there are some studies in this guy, the guy who wrote this paper was telling me that when he has patients who have depression with anger attacks, he'll provide treatments like repinerol, which actually seem to help depression with anger attacks. And repineral is also a treatment for restless leg. So there's like some comorbidity there for sure, and we don't really know too much about it. If you all have depression and restless leg,

definitely go see a psychiatrist, right, and look into that kind of stuff. It's cool. Science is neat, man. There's like so much information out there. I couldn't find the paper itself in my drive, so sorry about that, but that's the reference if you guys want it. Okay. Restless Leg Syndrome is a neurologic condition where your legs will just like kick. Like so you know that sometimes you'll have muscle twitches, right? So like sometimes we just like twitch. So in Restless Leg Syndrome, oftentimes when people try to go to sleep, their legs will kick. It can be quite profound, can keep people from sleeping and can also keep people from sleeping next to you.

It's actually quite debilitating, or it can be quite debilitating, I should say.