Instant Genius - Mental health and your brain: What happens when it goes wrong

Episode Date: February 15, 2021

In the UK, one in four people experience a mental health problem each year. The reality of living with common problems like depression and anxiety is increasingly well-known. But how much do you actually know about what’s going on in your brain when your mental health suffers? Neuroscientist Dean Burnett, author of the new book Psycho-logical, tells us all about it on this episode of the Science Focus Podcast. Let us know what you think of the episode with a review or a comment wherever you listen to your podcasts. Subscribe to the Science Focus Podcast on these services: Acast, iTunes, Stitcher, RSS, Overcast Listen to more episodes of the Science Focus Podcast: Dean Burnett: What’s going on in the teenage brain? The neuroscience of happiness – Dean Burnett Prof John Drury: The psychology of lockdowns How virtual reality is helping patients with phobias, anxiety disorders and more Elisa Raffaella Ferrè: What happens to the brain in space? Dr Guy Leschziner: What is your brain doing while you sleep? Hosted on Acast. See acast.com/privacy for more information. Learn more about your ad choices. Visit podcastchoices.com/adchoices

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magazine. In the UK, one in four people experience a mental health problem each year. The reality of living with common problems like depression and anxiety is increasingly well known. But how much do you actually know about what's going on in your brain when your mental health suffers? Neuroscientist Dean Burnett, author of the new book, Psychological, is here to tell us all about it. So can you first please just tell us what your book is about, please? Psychological, two words, very clever, I keep saying whenever I say that there. It's basically, it's a book about mental health, but not. unlike most mental health books you find in the market, all of which I find,

it's not a sort of slur against anyone else. But it's a book about mental health as a process, as a scientific phenomenon, which we sort of have a recognition of an understanding of, you know, what's going on internally when our mental health declines or suffers or is compromised in some way. Because there's a big push now, it has been many years for mental health awareness, to raise awareness of it and to increase understanding. But personally, I've always felt that as good as that is and as noble and as useful as that is,

awareness is only part of the battle. I think you need to have an understanding of what's going wrong before you can really have any sort of genuine appreciation for the matters. Because if I'm being very pessimistic, I would say the majority of mental health awareness campaigns, you can boil the message down too. I mean, like, depression is real. Pass it on. And that's, which is fine. It's a very valid thing to say. But it's also like, well, that's not really the most persuasive argument. So I thought, well, given I've spent 20 years, dabbling, dabbling, no. I'm not a dabbler. I'm a neuroscientist. I've got a P-15 and everything. Sorry, I'm all those imposter syndrome phenomenon. But yeah. So I know, I've been working in neuroscience for like well over 20 years now and from undergraduate level. And I spent like seven years as a psychiatry lecturer lecturer for a master's course. So my, my,

knowledge and experience is very much wide and ranging in terms of the underlying science rather than the actual everyday experience. So I thought, well, maybe there's room for that side of things too. To say, like, well, yes, we all, you know, most people agree, now the mental health problems are genuinely real things and they affect us all in many different ways. And if they don't affect us directly, society itself is affected by them. But why? Why does this happen?

What's going on in our heads when mental health declines? What do we know about it? And what can be done about it? and why does it keep happening? That's the sort of questions I wanted to tackle in this book, particularly. So it's a focus on mental health, but the actual science of it

insofar as we know. So that was my attempt to do. Some people might read it and think I failed, but that was the intention. So generally speaking, what is it in our brains that can go so wrong and cause mental health problems?

Well, that's a whole thing of the bottom, isn't it? There's a lot happening in any one brain, which any one part of which can be compromised in some way, which can sort of suffer for just pure quirks of biology due to external experiences, to unrecognize issues with development. There are so many different factors which feed into it. And like a mental health problem manifests in so many both varied and intangible ways. I mean, you can't, that's one of the big problems I throw address early on in that there's a lot of comparisons made. lately with between mental and physical health problems.

And again, I think my argument would be that there are times when that is a very valid thing to do, a very suitable and helpful approach. When you're dealing with someone who doesn't recognize mental health problems or doesn't agree that they're a thing, it's almost inevitable that you will contextualize them in the form of something they will recognize. So even if someone says depression is not real, there's no such thing as mental health problems, you very rarely find a similar person who would say the same thing. They've got physical ailments because everyone's had something at some point.

I mean, the human body is not a purfully flawless machine and he don't go through life without ever have it even as much as a stubbed toe or a cold or a headache or a broken bone or an injury of some sort. So these are, you know, people recognize these. Even if they don't have themselves, they can other people have around them. And you can see them. You can see like, well, we know how the human body's meant to look. So it's growing extra lumps and it's turned green.

You know, well, that's wrong. There's something really, really got awry there. But you can't really do that mental health problems because the manifestation of them in the real physical world is via other people's behavior, which is always changing, always in flux because we are complex creatures. But even, I haven't said all that, you know,

I thought, well, it'd be good to maybe try and impose some tangible aspect to it looking at the brain. Obviously, that's where all our thoughts and behaviors and emotions and moods arise from. So, yeah, there's plenty of going on in the brain which can go physically awry or physically wrong, and we can look at that and say, well, that's what's causing this mental health problem and to recognize it. So in terms of the underlying biology, again, there's a lot of things going on, but a lot of it seems to come down to a lot of it, in terms of the more common mental health ailments, we talk in anxiety and depression and things related to those, come down to sort of, it seems to be like a, a,

an end result of stress in some form. And I think stress is a common term now. Sorry, you say, almost an offhand manner. It's a bit work stressed or not the stress of everyday life. But it's a genuine physiological process in that it's the precursor to the fight or flight response. Like your body getting warmed up to deal with dangers and threats. The thing that way I describe it is if the fight or flight response is like the big bad boss end of a computer game, stress is like the hordes of minions.

they send it you, sort of wait through to get to that point. And they're not as potent and powerful as the big boss, but they can do a lot of damage. If there's more of them, then, yeah, they wear you down eventually. And one thing, you know, as impressive and brilliant as the human brain is and all it's evolved to do, one thing it seemingly hasn't evolved to do, insofar as it's evolved to do anything, you know, evolution doesn't have a end point, it's just, it keeps happening.

But long-term chronic stress isn't something the brain has a good ability to deal with because that's not meant to happen. In the wild, think of things that stress you out will be immediate dangers and threats or things like, you know, even if it's like low food supplies, as soon as you find something, the stress goes away. But because we have these big powerful brains, though, we can

envisage scenarios which will negatively impact us without physically hurting us, like losing a job or a relationship going sour or people get stressed out by the idea of the economy going downhill and their savings not having as much value,

These are things which do not have any direct physical impact on you and you have no control over, but you can worry about them, and they might never happen. People can get really stressed out about things which haven't happened and may never happen. And sometimes we get stressed about things which definitely did not happen and now cannot happen. We've probably all done it. Like you think, you cross the road on a car speeds past, like, oh, my second earlier, if I crossed earlier, that could have hit me and I'd been killed. And that stresses us out.

That didn't happen. We know it didn't happen. We know it didn't happen. We were fine. And it cannot physically happen, and we cannot go back in time. but we get stressed anyway. So the constant low-level pulse of stress chemicals impacts on our brain and body in various different ways, and it can sort of lower the immune system.

It can exhaust neurons. That's one of the leading theories of how depression works now. It's not about chemical imbalances as kind of an old-school theory now. It's more to do not that the chemicals aren't gone different, how they should be, but that seems to be more of a symptom, not a cause, in that neurons become exhausted by the constant stress chemicals. So, those are shut down, they're going to stand by. Like, they just do the bare minimum what they can.

And some of those are parts of the brain which control mood and how would change mood and shift and respond well to things. So that feeds in quite nicely with a lot of the typical symptoms of depression. The inability to change from a low mood, the inability to feel anything in response to something positive or, you know, like the complete lack of motivation. It's, you know, it makes sense. think big chunks of my neural networks, which allows behavior, that's currently suppressed. They've

just been spent by the stress response. And similarly, in different parts of the brain, stress chemicals are like the threat recognition, they stimulate those parts of the brain, which keep us on edge and look for dangers. And if those parts are overworked, maybe they'll become like a muscle. They get more powerful and stronger, and they tip the balance. And therefore, you get anxiety where people are constantly worried about things, which aren't there, which may not be there, is a low-level state of panic because the parts of your brain which respond

to threats and dangers are now being overworked and they're overstimulated and they've sort of beefed up. But these are very simplistic ways of looking at it in that it's obviously a lot more complex than that, but if you look at these terms, you can sort of understand, well, it makes perfect sense that would happen out because the modern world is so

generous with things that stresses out and the modern human brain can find them if even if it aren't any. And therefore you get all these abundant cases of anxiety and depression and things like that because the world is seemingly set up and the brain works in a way that these things are pretty much inevitable. Right. So let's talk more specifically about depression.

And if, as you say, the world's generally quite stressful, surely we're all exposed to that. So what is it that triggers depression in particular people? people and not in everybody. Yeah. Also, again, a valid point. We're all kind of exposed to that. I mean, I think it's sort of misleading to think there will be one root cause

of depression or any mental health problem. It's always going to be a combination of factors. Like, there are heritability factors when it comes to depression. People are certain genotypes from certain families. They have a higher risk of depression. So, like, if your parents or one of the parents had depression, like the odds of you having depression,

are increased because it's known to have, there are genetic factors which lead to it or lead to a vulnerability to it. But that doesn't mean that if you have this gene, you will have depression. If you don't, you won't. It's just, you know, it's a balance of risks in that. So if the average person is 5% chance of developing depression,

then someone with this gene type will have 10% chance, both unlikely, but one is twice as unlikely as the other and so on. So there will be genetic factors, which like, you think, like a certain gene which doesn't, which is sort of slightly distorted or just different to the point where it doesn't produce enough like neutrophic growth hormone, which like certain parts of your brain won't be as resilient or well connected as others and therefore depression can occur because it doesn't lead to the right stress suppression and so on and so on. So even like little things like that. Childhood experiences, if you were if you've grown up in a sort of more traumatic environment or just a less, um, stable, more chaotic, more confusing, more stressful one, then your brain will develop in certain ways, which perhaps will be wary of stress. So it'll seek it out even more because you've grown up thinking,

well, I should be, well, I got them. My childhood experiences say that the world is a dangerous place, so I will be constantly wary of dangerous things, and therefore you seek them out and then become more stressed that way. Or even just similar to nutrition. You don't build up the physical resilience in terms of how the brain works to fend off things. I mean, again, the brain has so much redundancy in it,

so much fail-safe and so much extra processing which can take over, and it's so flexible that people with brain injury can make good recoveries, especially if they're young, because the brain is still developing, and it'll find workarounds. But anyway, these abilities are finite. And some people, if you've been dealing with stress a long time,

or if you're already sort of running out a bit of a loss is perhaps a hard way of saying it, but if you're already dealing with a predisposition to stress or low mood, then your brain's constantly working harder to fix that or to do that, to deal with the consequences of that. So then when something else happens, like a particularly strong life stress, like the Holmes-Rahi stress scale,

like the maximum thing, the worst thing that happens is the death of a partner, death of a spouse, and it goes down from there, like things like retirement can be very stressed when you plan to do it because it's a massive change to your life. or divorce and things like that. These are all big triggers of stress.

And if you already have a lot of stress to deal with, then that can be enough to push you over the edge into, right, now your brain's suddenly gone right. I genuinely cannot handle this anymore. And therefore, you know, just spirals from there. So I can't handle this. They're going to shut down for a bit. And then you have your depression.

You have your anxious episodes. You have your, quote, unquote, nervous breakdowns as people will tend to refer to them. It pushes you over the limit to the brain can't cope. The way that line resides is going to differ from many different people. And some will have predisposition. Some will have a lot of cognitive reserve. And that can be a big deal.

There's a lot of studies we show like how adept and healthy and how much resource your brain has can be a massive protective factor. You can even stave off things like dementia. I mean, if you have the underlying pathology, people who have lived healthy lives and constantly kept learning things and stayed active and used their brain, they tend to show very little symptom or sign of dementia, even if their brain has,

if you took a sample of their brain, who shows a person's got terrible dementia, but they don't because the brain's sort of alert and active and capable. But then, for many people, the modern world doesn't allow them to build up this reserve. It takes and takes rather than allows them to give and give, and some people will end up with depression as a result of that. So, yeah, there's loads of different factors,

but it's not, I think, important a point of, no one's a failure if you've got depression. That's the thing. It'll lead to that sort of thinking, but it's going to happen in the way the world works, and it's often the case of someone who's got depression or had depression, it just had a lot more to deal with than most people.

You mentioned earlier that bereavement was one of the most stressful events that the brain could deal with. So in grief, people tend to feel a lot of the same sort of things as you'd expect to be symptoms of depression. So, you know, the low mood for a long period of time, things like that. So what exactly is the difference between grief and depression? Yeah, so obviously this is a really big issue at the moment because we're living in the middle of the pandemic. and as I've been in the record myself,

like I lost my father very young on the pandemic and it was very unexpected. He was no prior to health problems. He wasn't even 60 yet. And it came out of nowhere. And I had to deal with that all by myself. So I do delve into that, obviously in the book and stuff.

And it was extremely traumatic. He was extremely debilitating and very hard time. So I can speak from experience in this regard. And it was less than a year ago. I wouldn't say I'm over it, but I'm functioning. and again, people who asked me, being a neuroscientist

who del's mental health, was that helpful for dealing with your own grief and stuff? And I think it was, in hindsight, at the time, I didn't feel like he was helping. I never got the point where I couldn't function.

So maybe there was a protective factor in knowing how this works, what's going on in my head when this is going on. But on the other hand, it's also, I think, analogy I use. It's like being a trained mechanic

trapped in a car with no brakes on the motorway. I know what the problem is, but I can't think about it right now. I've just got to wait until this is over and hopefully I'll survive the whole thing. So, yeah, so it can be a helpful thing.

So this is why I always try and educate people or say the more you know about what's going on, the more resilient you can be because at least it's not scary or uncertainty. You've got to handle on what's happening. But back to the riddle question. Yeah, so how you diagnose grief and depression is a tricky one.

It is actually an ongoing debate and it can be a source of controversy, like the DSM, which is the American Psychiatric Association. They go-to-manual for what counts as a mental health problem, what doesn't, you know, a diagnosis or not. And the fifth edition was revised a few years back and people were quite alarmed by how many things now count as a psychiatric diagnosis, where before you think that was just general human behavior, like people cite tantrums. Like children having tantrums is now recognized as a psychiatric problem. I think, well, kids just have tantrums. That's just another case of over-medicalizing, trying to sort of find problems if pharmaceutical companies can charge for medicines

and make lots of money off. And, you know, that's definitely a problem which does have to be or should be addressed and paid more attention to. But the other side of the coin is the, you know, the people who put that in, they would argue, you know, before now, kids who had chronic tantrums, the point where they couldn't control their behavior and their parents couldn't do anything about it, where it's clearly caused interruption.

they would be diagnosed as having bipolar problems and if it would end up on far more severe medication, like more more powerful stuff, which you'd rather not do for a small child. So if there's a tantrum as a separate diagnosis, oh, well, you can do this, and maybe you can give them much milder interventions or some sort of therapy rather than powerful medications.

So, no, there's two sides for every argument. The grief thing is a tricky one in that. Like you say, when you lose someone close to you, it's the most traumatic, harrowing experience possible, and you will show behaviour and thinking and emotional and mood symptoms which are very similar to that. Depression. The general approach, as far as I can make out, is that it's a question of how long it lasts. Because, you know, people experiencing grief will be laid low for weeks, months at a time.

It depends on the nature of how it happened. But if it's like after six months, nine months, then they still show no signs of any change. and their behaviour and thinking, then that's where a chronic grief reaction comes in, or like this, like, okay, so now we can probably have to move into intervention here because they clearly aren't moving on. They aren't processing this. It's a serious emotional change or serious emotional impact on them,

and these things take time to work through. But they do eventually happen, and the brain is adept at doing that. We are very emotional creatures, but we also have a lot of processes in place in our brains to work through, these things. And if you're not show any sign of that, that's when you can say, okay, this seems like it's a problem rather than just the normal process.

So more it comes down to how much change there is. I mean, that's how depression is sort of diagnosed anyway, not over a period of months, but weeks. And that people have low moods all the time. You know, it's very common to be sad about things, especially now we're in the middle of a pandemic. You know, lots of things are going wrong and there's lots of

things to be unhappy about in the wider world. So people being in a low mood state, being unhappy, being sad, being just like, I can't be bothered, I can't do this anymore, is common. But the difference between that and depression is, but a severity, you know, people of depression tend to be very, very low mood rather than just a brief melancholy. But perhaps even more indicative is how long this lasts, because a mood doesn't normally last two weeks. Your mood can change a couple of days or you have ups and downs. So the mood is unchanged or stays the same for two weeks or like the best part thereof, that's when you think,

okay, this doesn't seem right because one in the brain doesn't do, it stay the same constantly in mood and emotion and thinking. So yeah, a lot of it comes down to just the duration of the symptoms rather than what the symptoms actually are themselves. That's like a big interesting aspect which people seem to not really recognize and that, yes, we have, we all have these different emotions and we all have these bad and good experiences, but how long they live? last can be the deciding factor between general brain behavior and mental and health problem. So as you say, there will be a lot of people at the minute going through bereavements. Knowing what you know now, what advice would you give to them to, I suppose, experience grief in a healthy way?

yeah it's a it's not a tricky in that it's tricky in that they're obviously everyone's going to be different it's going to each their own people are going to have different uh experiences of what they're going through how it happens how it manifests who they have with them what the situation is because like i would say it was particularly hard for me when it happened because um it was like middle of the most of the earliest lockdown we were cut off from family i don't live down the road from my family. I'm like 30 miles away from my closest relatives. So I had no one I could really depend on. When someone normally, when this sort of happens, you lose somebody close to you, people rally around. They gather around. They do things for you. Like they take care of the kids,

the house, the cooking and stuff. And they just pop in to see if you're okay. It's a very human compulsion and a good one, a very healthy one. But you couldn't do that. And on top of that, I live with my wife and my two small children. And both they were pretty, so it was lockdown. They were scared. They're out of school. They just lost their grandfather. They didn't know what's happening. So I couldn't really afford to indulge my grief in terms of just sit around doing nothing, which is what I wanted to do. I had to still be, dad still be strong and provide a reassurance for them. So it's really hard to do that. I did it. I'm not saying it didn't cost me, but I did it. And that's going, I was lucky enough to have the resources to do that. I've lived a relatively

charmed existence the past three years in terms of nothing particularly bad happening. There's no particular concerns and stuff. So it's, yeah, so I was in the position where I could do that. I was hit with a particularly hard version of it, but also

had the resources to throw at it, mentally, cognitively. Not everyone will have that. And I think it's important to recognize that there's no particular path through grief, which have to take or you should be following.

I mean, it's a very common cultural reference, the whole five stages of grief thing. You know, was it, denial, anger, fear, bargaining, acceptance, or some variation of that. I mean, it pops up in sitcoms all the time, in films. And like, when you experience grief, you go through these five stages, and that's how it works. But that's not really how it works at all,

in that, I mean, the human brain is never that predictable and that reliable in any case, especially when it comes something, which is a really profound emotional experience. That's when it gets its most chaotic and most unpredictable. But even the psychiatrist who first came up these grief stages, she never said originally that everyone will go through these stages of grief at all times and in this order.

They're more like a recognition of the parts of grief which can occur, more sort of common clustering things in, oh, this person is grieving and they seem to be experiencing denial, or this person seems to be angry, and that's fine. But it doesn't mean like, oh, that's before fear, that's after a denial. So there's no logic to that. So if you're grieving and you find yourself confused by your emotions, your experiences, your reactions,

then that's fine. There's no sort of template for this, which you have to be following. And I think it's really important to keep that in mind. Everyone's grief is going to be their own. They're going to deal with the own way. I mean, I got very angry a lot for no reason. I mean, people message me with very positive things, wanted to experience in expressing sorrow on my behalf

and saying, I wish they could help and stuff. And I would clearly well meant, clearly a friendly gesture, clearly sort of heartfelt, comes from a place of love. But I kept getting really angry at that at first, and that you wish you could help, but you know you can't. It's a lockdown. My father's died. There's nothing you can do.

Just make yourself feel better. How dare you? I didn't say that to anyone, but it would keep, went through my head a lot. And that, you know, at the time, it felt weird. It felt wrong. But in hindsight, I realized, well, that's, that's okay. Because as long as I wasn't hurting anyone, I want to express my feelings that way, then so be it. That's what I'll do. So, yeah, I think it's important to recognize, especially now, when we sort of cut off from so much and we have so few options for venting our stress or, you know, make ourselves feel better, all your pastimes,

or leisure pursuits, they're all cut off for the time being. So, yeah, when you experience some grief, you would be doing it in your own way, and that's important to recognize that you are, your grief is your own. And if it's going this way for you, then that's how it is. You know, if it's going another way, that's fine. If you stay stuck in one place for too long, then, yeah, then you can sort of start being concerned. But you work through it how you need to work through it.

And nobody can tell you that this is wrong. You should be doing this. That's when it can be made worse, I think. So if someone is suffering from depression and they decide to go get help for it, they might get prescribed antidepressants. What do antidepressants actually do in the brain? So it's kind of an interesting one. I mean, I think it's, to me, it's been a good sign that the mental health awareness campaigns are working in recent years.

Because when I started writing about stuff like this, we talked about, at least like 10, 15 years ago, between that sort of time. You know, we still see a lot of arguments or like online, obviously online arguments. That's where arguments happen. We know that. But it's, it was always like, you know, people dismissing depression as a thing. And no, no, not the thing as depression is people attention seeking. It's, you know, drama queens.

It's just snap out of it and all that sort of stuff. You still get that occasionally from the more, you know, extreme controversial pundits. but more than often are not now depression is accepted as a real thing. Now the more go-to argument is that antidepressants aren't a thing rather than depression. It's just a scam. They're just something pharmaceutical companies push on us to make money. Or like you hear so many people say in encountering someone like a personal trainer. The first thing we do is get you off those pills and then this judgment and sort of stereotyping and pill shaming of people on antidepressants.

So there's a lot of work to be done there, but yes, it's a controversial area, I suppose. People have been written books about it, I mean, how you shouldn't take antidepressants, which is wrong and bad in many ways. And so what they do, it turns to the class of antidepressants you've got in that there are lots of different variations available at the moment, like the mainstream ones, which have been validated and sent through trials and are just readily available. And, you know, you've got your tricyclicamines, you've got your monoamine oxy's inhibitors, you've got your SSRIs, your SNRIs and so on. But what they all do is some variation on increasing the levels of certain neurotransmitters in the brain,

which I believe is where this whole chemical imbalance argument or belief comes from, in that you've got your regular brain. You've got levels of certain chemicals, namely neurotransmitters, which the brain, which the brain, needs to do everything it does. That's how neurons communicate with each other. And in people with depression in this case, some of those chemical levels are reduced for reasons unknown, and that causes depression. So you take an antidepressant, it puts those levels back up, and that cure is depression. That seems to be the assumption or the view of it by a lot of people, hence this chemical imbalance claim is quite widespread. But that was, I mean, it's logical to make that conclusion because that's, like,

antidepressants were discovered essentially by accident in the 50s when they were looking for different things, like things to take on a deal with surgical shock or soothe people and they found people's mood started being elevated and they took them long enough and no, something was up here and they found out their antidepressants. And that's what they do. Like they stop the removal of neurotransmitters after they've been used, they stay around longer. brings levels back up and so on and so on. But the main thing is, like, they, neurotransmitters, antidepressants work on the chemical level right away. You take one,

your neurotransmitter levels are increased, like, minutes later. But most of the widely available transmitters, most of the widely available antidepressants now, they take like between two and three weeks to kick in, which is a long time. And it's weird. If they work straight away chemically, why do they take so long than any actual relief of the symptoms of depression? And which this reveals that it's not just on the chemical levels, it's something more profound than that, it's something more deep and complex. And to go into like the neuroplasticity thing from earlier, it's now sort of believed by many that what antiretasters do. They sort of slowly but surely build up the activity in these suppressed neurons by causing more activity to

act on them by boosting transmitter levels. Sort of like sort of blowing on the spark of a campfire. Just like coaxing it back to life. One of the things of that is that the, pretty much all modern antidepressants, not all, but all the main ones, they work on monoamine neurotransmitters, all the various neurotransmitters,

your noradrenalins, your dopamine, your oxytocin, these are all monoamine class. It just means like there's an amine molecule. you'll attach to the general thing, which are very important neurotransmitters in the brain, but they take up a sort of relatively small percentage of the brain, sort of, like in terms of how the brain mass is layered or how it works, the monoeumane systems are like sort of the veins that run through marble, kind of everywhere, but a small part of it.

And so if you boost the activity in the monoamian system, which all antidepressants do at the moment, or pretty much all of them, they will have sort of a more slow and gradual effect because they're not really affecting that many neurons of the brain, but the activity sort of spreads out slowly, like, you know, like sort of like fertilizing a plant to sort of just put it in there and it slowly seeps out.

But there's been sort of a lot of developments recently into more potent antidepressants, like, well, it was of 2019, the end of, I think America first, in the States, the first ketamine antidepressant was released for use and early trials and stuff. And it's a nasal spray, it's not even a pill.

And it seems to work next day or maybe in a few hours because ketamine, for all it's false, it's a very potent chemical. It's not a lot of that. It works on the glutamate system, which makes about 80% of brain activity.

So it's, rather than sort of blowing gently on a campfire, it's sort of like, cranked up the flamethrower and just firing at it and just like, take this, ah, screaming at it. And it's like the brain just kick

up into like several gears like whoa hello and um sorry so just like to pause there for a second so we're not actually recommending that people go and take ketamine in so yeah yeah yeah so um uh so yeah so yeah so yeah so yeah so yeah so kentmin does that and the same thing with um no um hallucingenics like magic mushrooms and things and the chemicals thrive from those they stimulate so much of the brain that it's believed they can sort of get those sluggish neurons back to our regular activity a lot faster. But obviously, the downside of that is if you stimulate all the brain in one go with one chemical, you're stimulating all the brain in one go.

The brain does a lot of things, and that can be seriously dangerous, if not done right, and not done with extreme expert interventions and refinement. So again, this is not a recommendation that you go find some kind of mean and take it, because that will – if you do that, maybe depression would be the last year problems because it's going to cause a lot more problems than that. Okay, thank you. And so we've talked about depression in terms of your brain's ability to change its neurons and neuroplasticity and stress and chemical hormones and balances and things like that. But I know that a lot of people who are suffering from depression get talking therapies.

So what can a talking therapy do? to the physical structure and behaviour of your brain? Yeah, I mean, it just seems sort of like a bit of an odd leap to make in that you can talk someone into having sort of re-energized brain. It, well, I think the best therapies seem to be a combination of antidepressants and talking therapies, because you could argue that antidepressants will boost your brain activity back up to normal levels, but talking therapies can then sort of channel that activity into more helpful beneficial routes.

Because I think a lot of talking therapies, the essential gist of them is trying to coach people or train people to think in or instinctively think in ways which are more beneficial than their usual negative roots. Like some of the depression will just tends to have a very negative mindset. Like they think, you know, reflexively think of the worst is going to happen or the worst has happened or like they are unpleasant person, unworthy of love and respect and concern and things like that.

And if you can stop them doing that, that can sort of break the cycle. Because a lot of these mental health problems are kind of self-fulfilling. If you're anxious, you look for things to be worried about. And because of how powerful our brains are, you'll find them. You'll find them.

Exactly, I should have worried about that. That should have been a big thing to worry about. I mean, I think it's quite telling that for diagnosis of depression you have to have the symptoms for two weeks for diagnosis is recorded to both the ICD 10 and the ICD and the DSM

the main two texts for mental health diagnosis so for depression it's like two weeks of sustained symptoms but for anxiety it's got to be in the region of six months and which shows like how much of how much of modern life anxiety is kind of a default

and that yes are you worried about this? Well, yeah, you would be. Yes, it's hard to think of that. I think if you're planning a wedding, that's a really big, big deal. It's a lot of work, a lot of pressure, a lot of effort, and there's a massive life change, is your wedding, of course. And, you know, that can take six months, so you can have six months of symptoms of anxiety, it would just be constantly anxious and stress for six months and have a perfectly valid reason for it. So, it's kind of hard to separate anxiety from other things like that. But talking therapies is sort of

tend to, in terms of CBT, like cognitive behavioral therapies at least, you try coach people to think in ways which don't cause this sort of unhelpful outcome. So some of depression, making them think in ways which don't result in them feeling so negative about themselves or the world or someone's got anxiety, talk about, you know, talk them into doing things or thinking in ways which do not trigger this nervous, anxious, fearful mindset. And it's, you can argue, it's kind of like, you know, reprogramming a computer. Just thinking, like, this is a bad pathway.

Do this one instead and do a workaround. And I guess the analogy I use in the book, which I'm sort of kind of happy with and people have approved of in that, if you think of, like, your functioning mental state as your home and how you, you know, how that works is you know, you're, and you know, you travel to and from it, it depends on what you're doing. So one day, there's a bridge that leaves your house. That's how you normally achieve your good mental state, your regular mental state, then one day it collapses. Could be because of trauma, because of general wear and tea, or just a flaw in the structure we didn't know about. So you've got, you know, the bridge

collapses while you're on the other side. So you need to get back to your home, your regular state, and you can't get there because the usual route is denied to you now. So the medical route, like using drugs and stuff, would be someone come along, and build a new bridge. Maybe not as good, or maybe it's like a pontoon, or maybe it's a scaffolding or a big plank or something. But you can get you there. It's not perfect, and it's a bit more treacherous.

But that also involves you just sat there waiting for that to happen. And while you're outside, cold and went. Whereas, sort of a talking therapy would be more like someone come along and saying, okay, so you can't get back to your house. I've got a spare pair of boots. I've got a map. I've got a compass. Let's find another way around.

And so they'd guide you. We go downstream, see if you can find another way. across and they sort of help you to find another route to your destination, which is your, you know, a healthy functional mental state. Ideally, you'd use both. Okay, so this person's fixing the bridge while I'm going to find another way around. Between us, we'll get back, you know, eventually. And that's why sort of combined therapies tend to be the most effective overall because you're taking two bites of the cherry. You've got, you know, double the chance and the brain's being helped in two different ways,

and that's at least two, and that's always going to be more helpful, I suppose. You touched on this a bit with your wedding metaphor. So something that I wonder about anxiety disorders is that there are often things going on in the world, which are a genuine cause of anxiety, the emotion, so anxiousness like climate change or I suppose right now the pandemic going on so there's a lot of people who would reasonably be feeling anxious about that and so I sort of think of I don't know if this is correct but I sort of think of an anxiety disorder is when you're feeling a lot of anxiety and for something that's sort of unwarranted so it's something that doesn't really require that level of anxiety so where's where's the line between feeling anxiety all the time over something that's real and out there, is that like a disorder or does it

have to be something that's not, you know, feeling anxiety over the things that aren't actually going to hurt you? Yeah, you've pretty much got a spot on there, and that's anxiety disorders are normally recognised by the anxious response being disproportionate to what the source is. And like I say, someone's worried about climate change. And yeah, that's obviously something big and massively important that we should be worried about. do it's an existential issue. So yeah, be worried about that is logical. So if you've been anxious about climate change for five years,

I imagine Greta Thunberg has been, then yes. She's not going to disorder. She's just got a logical perspective on what's going on. But I guess it's the case of if you're anxious about climate change, the point where you're in your room sort of huddled in the pillow, just constantly in the feet of position, cringing, shivering about the possibility of climate change, that would be a disproportionate response because, yes, it's right to be anxious about it,

but this is debilitatingly anxious about, it's a very much a long-term thing. You're not going to walk out your front door and be hit in the face by climate change because it's not a thing that can do that. And I think that's where a lot of the distinction comes in. Yes, you should be anxious about this thing, but should you be this anxious about it?

And that's also where, like, the... Again, diagnosing these things is really tricky. It's not like it's, you know, there's one clear bullet point. You can write these three things. Boom, bum, bum, you're anxious now. Well done. Have a certificate or whatever they do in that respect. It's really quite marked in that, you know,

they're so nebulous. Like this person, you can just have an anxious personality. You can be someone who is constantly worried about stuff. And that's not a disorder. That's your default state of being. Whereas someone else who's far more upbeat and far more chilled, if they became like that person, then that would maybe suggest an anxiety disorder

because it's atypical for them. And there's been some interesting data which shows that during the pandemic and the lockdown, you'd expect people with depression and anxiety to have worse problems because obviously there's more to worry about and more to be depressed about. But what data there is suggests that, if anything,

they've sort of plateaued. There's been no obvious increase. And some people reported a lessening of their symptoms if they had pre-existing conditions. And it does sort of make sense in a way in that, like you say, if you're anxious about things which aren't there, which haven't happened, then a pandemic hits,

that sort of justifies your anxiety. Like people who worry the worst was going to happen, then it does happen. I think, oh, I wasn't, and well, I'm just rational. I was correct. And that can be oddly reassuring. It can be a de-stressor. Because, you know, there's nothing,

when the worst has happened, there's nothing to worry about anymore, I guess. It does take, before my father passed away, I was hyper-stressed for weeks on end. And afterwards, I wasn't stressed. I was grieving. I was the impact, but it was not as fraught because, you know, the worst happened. And I'm not going to say that's a good thing, but it was a very different way of, you know, it was a very different emotional experience in that respect.

And that's going to be something which, John, obviously, we're manifest in a lot of different people. But, yeah, like, it's the, it's how. proportionate it is. Anxiety disorders are so wide-ranging as well. PTSD is an anxiety disorder, but so is generalized anxiety disorder. Generalized anxiety disorder has no specific cause for the anxiety you're feeling. PTSD has a very obvious cause for the anxiety problems you're feeling because, you know, there's one major traumatic event which causes us to happen. But they're both classed as anxiety disorders because symptomatically they have similar properties and seem to have affected in similar ways in the brain.

But even like low-level things like phobias are one of the more common anxiety disorders. Like arachnophobia is a very well-known phobia. And a lot of people don't like spiders, but arachnophobia, if you got arachnophobia, you're really terrified of them. And I think the most perhaps frustrating part of it is, people with that, they know that it's not logical. You can tell them all you want. Don't be afraid of that spider. It's like the size of a two-pence coin. on the other side of the room, it's not going to hurt you.

On a logical level, people of Ractophobia will know that, but the fact is that they don't react like that because the more fundamental subconscious parts of their brain, which deal with that, they're in control there. So they think, spider, scream, jump, run, they fire up a fight or flight response, whether you like it or not. And you have this extreme panic reaction,

which is illogical, but that doesn't stop it. And yeah, so what comes to anxiety disorders? It's like the response is disproportionate or unwarranted to what the trigger is if there is one. Sometimes they don't have a trigger. Like panic disorder is a real pain like that in that there's no obvious cause for these panic attacks. And that's why they're so debilitated and so problematic, you can't anticipate them. You can't do anything about them. And again, it addresses in the book too.

Some evidence suggests that panic attacks are normally caused by novel stimuli. So it literally has to be something unexpected. which causes it and therefore you can't do anything about it. And they become so problematic because there's no real workaround outside of therapies and things. So yeah, so you're writing that it's got to be something, you know, people have anxiety all the time. But when this anxiety has no obvious cause

or is way more than the cause warrants, that's when you think, okay, that's not meant to be happening. That was Dean Burnett, author of Psychological. His book is out now. Thank you for listening to this episode of the Science Focus podcast. The January issue of BBC Science Focus magazine is out now. Also in this issue, we explore the greatest mysteries of the universe. Dr Michael Mosley shares his top tips for keeping your blood pressure on track, and as always, our panel of experts

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