The One You Feed - Alex Riley on Emerging Perspectives on Depression

Episode Date: April 12, 2022

Alex Riley is an award-winning science writer. In 2019 he received a Best Feature award from the Association of British Science Writers for his reporting on the Friendship Bench, a project that began in Zimbabwe in 2006. Alex’s articles have been published by New Scientist, Mosaic, Nautilus Magazine, the BBC, and others.In this episode, Alex and Eric talk about his new book, A Cure for Darkness: The Story of Depression and How We Treat It.But wait – there’s more! The episode is not quite over!! We continue the conversation and you can access this exclusive content right in your podcast player feed. Head over to our Patreon page and pledge to donate just $10 a month. It’s that simple and we’ll give you good stuff as a thank you!Alex Riley and I Discuss Emerging Perspectives on Depression and…A Cure for Darkness: The Story of Depression and How We Treat ItEric’s telltale sign he’s in a depressive episodeThe cause of Alex’s most recent depressive episodeEric and Alex’s experiences taking SSRIs for depressionHow he makes the decision to come on and off antidepressantsHis experience of psilocybin treatment for depressionThe role of nutrition in supporting his mental health and wellnessA working definition of depressionThe connection between depression and “thinking too much”The “P” factor – an idea that all mental illnesses are fundamentally connected at their rootThe winners curseEric’s experience with LSD earlier in lifeAlex Riley links:Alex’s WebsiteTwitterWhen you purchase products and/or services from the sponsors of this episode, you help support The One You Feed. Your support is greatly appreciated, thank you!If you enjoyed this conversation with Alex Riley, you might also enjoy these other episodes:Strategies for Depression with Therese BorchardRecovering from Depression with Brent WilliamsSee omnystudio.com/listener for privacy information.

Would you like to hear your voice on an episode of The One You Feed? We sure would. Our 500th episode is coming up in May, and to celebrate, we'd like to feature listeners of the show during the episode. If The One You Feed has meant something to you, we'd love to hear from you. You can go to oneufeed.net slash message and leave a voicemail. Tell us how the podcast has impacted you, or tell us how the Wolf Parable applies to your life. Go to oneufi.net slash message by May 1st and leave us a voicemail. We're excited to celebrate this milestone with you, our dear listeners. These drugs, you know, they're not going to cure anything.

They're going to be able to support you as you try new things, as you battle the depression with all these different avenues that we have, and finding the one that fits, because everyone's journey is going to be really, really different. Welcome to The One You Feed. Throughout time, great thinkers have recognized the importance of the thoughts we have. Quotes like, garbage in, garbage out, or you are what you think, ring true. And yet, for many of us, our thoughts don't strengthen or empower us. We tend toward negativity, self-pity, jealousy, or fear. We see what we don't have instead of what we do. We think things that hold us back and dampen our spirit.

But it's not just about thinking. Our actions matter. It takes conscious, consistent, and creative effort to make a life worth living. This podcast is about how other people keep themselves moving in the right direction. How they feed their good wolf. Wolf. I'm Jason Alexander and I'm Peter Tilden. And together our mission on the Really No Really podcast is to get the true answers to life's baffling questions like why the bathroom door doesn't go all the way to the floor what's in the museum of failure and does your dog truly love you we have the answer go to really know really.com and register to win 500 a guest spot on our podcast

or a limited edition signed jason bobblehead the really know really podcast follow us on the i heart radio app apple podcasts or wherever you get your podcasts. in 2006. Alex's articles have been published by New Scientist, Mosaic, Novatext, Nautilus Magazine, the BBC, and many others. And his new book is A Cure for Darkness, The Story of Depression and How We Treat It. Hi, Alex. Welcome to the show. Hi. Thanks for having me. We are going to be discussing your book, A Cure for Darkness, The Story of Depression and How We Treat It, which listeners will know is right up my alley, the kind of thing I love to read. And it's a wonderful book. But before we do that, we'll start like we always do with the parable. In the parable, there is a grandparent

talking with their grandchild and they say, in life, there are two wolves inside of us that are always at battle. One is a good wolf, which represents things like kindness and bravery and love. And the other is a bad wolf, which represents things like kindness and bravery and love. And the other is a bad wolf, which represents things like greed and hatred and fear. And the grandchild stops and thinks about it for a second, looks up at their grandparent and says, well, which one wins? And the grandparent says, the one you feed. So I'd like to start off by asking you what that parable means to you in your life and in the work that you do. Well, I think the parable, it really speaks, you know, quite intimately with depression.

Some of the words that you just said there, I mean, hatred, greed, depression is often related to a hatred of yourself. And in my personal experience, that seems quite apt. It came from a Freudian background, but it seems to be, you know, relevant to a lot of people. People don't have that love for themselves. So I think the two wolves in terms of depression is, do you love yourself or do you hate yourself? And which one are you going to allow to win that battle? And sometimes you can't really control which one. You seem to be, you know, helpless and hopeless when you are faced with a productive episode and unfortunately the self-hatred wins and so the parable really does connect quite deeply with some of the basic underlying symptoms and experiences of depression and it's very difficult to love yourself when you've experienced

a depression or you're going through a depression but for me that's been one of the main elements of recovery is through therapy and using pharmacological tools is to enable yourself to open up to love yourself there are other things that this parable really does speak in terms of you know which one do you feed with depression and as i write in the book a large part of depression they come from what you actually eat. So literally, which wolf are you feeding? Are you feeding this depression? Are you feeding this healthier side of yourself? What do you eat? Are you eating a healthy balanced diet or eating very high saturated fat content and feeding this beast that will only lead you down the path of depression? I love that. I love the idea of the wolf of hating yourself versus loving

yourself. And it's funny, one of the ways that I can tell I'm having a bit of a depressive episode is I actually will hear my brain say, I hate myself. I'll actually hear those words. And for me, it's an immediate like, hang on a second. It's like a harbinger for me of old scripts starting to run and of something being off because it's so out of character for broadly speaking, how I relate to myself most of the time now, because I agree with you. I think learning to love myself, to care about myself, to take care of myself has been a huge part of what all this healing has been about for me. So when I hear something that stark, it kind of sets me off. So I love the way you said that, because it kind of made that come to mind for me. And that's amazing that you can do that. I mean, that takes a lot of time, I'm sure. And,

you know, it's very easy to believe what your brain is telling you in that moment. You know, there's a real disparity between what's real and what isn't when you're going through a depression or that first instance of where a depressive episode might be starting that voice is just as real as a voice that's saying no I don't hate myself that I'm actually proud of myself for doing this thing that I've done or I feel you know great affection for myself because I've been through these quite torturous experiences. I'm still probably not at that level, I think. I mean, I let that voice overtake me. I mean, I've just come out of quite a severe three months. Often my depressions are quite associated with seasons, so it's quite seasonal. So often during the winter and worse. Yeah, so I'm coming out of

that depression over the last month or so and it's still very difficult for me to to stop that voice like you just mentioned yeah and it's interesting i don't know that i would say that i can always stop it but i recognize it and it may just be that maybe i have a benefit of having a very dramatic inner voice sometimes like when it says something like that like it's just that stark. I'm like, whoa, you know, or I wish I was dead. I'm like, all right, hold on. Like, I almost laugh at it a little bit because I'm like, it is so dramatic. And I am not by nature a very dramatic person. So when it does that, it just sort of catches me. I don't necessarily say that I can always turn it

off. But what I have gotten better at, and I've talked about this on the show a lot over the years is like, you know, is my depression better than it used to be? And we're going to talk about this in a little while. Is it depression? What do you even call it? All this different stuff. But one of the things I unequivocally know is that I respond to it in a much wiser and more sane way than I used to. And I can sort of recognize it a little bit as sort of that bad wolf and be like, okay, I can't turn you off, but I'm going to try not to give you a ton of attention either. You know, I'm going to try and just go, all right, there it is again. You know, there it is again. I know from previous experience, it's not true. It feels very real,

but depending on how severe it is, obviously has to do with how we're able to do that. So you just kind of came out of a difficult period. Do you have any sense of what caused you to either go into it or come out of it? You mentioned the seasons being part of it. Was there anything else? And what do you think led to the emergence? Or is it just sort of it followed its cycle and now it's done? So I think my depression is quite recurrent. It seems to come and go maybe every few months or you know I think once it was 18 months and you know it lasts for anywhere between you know a few weeks to a few months but actually with antidepressants I can really reduce that amount of time. I think that's what antidepressants have done for me is they don't remove the depression

they allow it to have a shorter course. You know people think of depression as being you know you're constantly disabled you can't do anything for that amount of time where it still fluctuates within that episode for me where some days I'm incredibly disabled from it and then other days I might feel like a bit of lucidity I might feel like it's over and then it slams me back into it. So people are often surprised that, you know, I turn up to either events and stuff and I can seem to be able to switch it off. But actually it's just sort of almost this sort of sound wave that's going through this episode. Yeah, I'm still trying to understand the triggers. I mean, there obviously are triggers.

I think even publishing this book has been really difficult. the triggers. I mean, there obviously are triggers. I think even publishing this book has been really difficult, given the topic, given that it took me four years and now it's been released into the world. And it's been really well reviewed, but during a pandemic, books just aren't selling. We talk about hating yourself and then this voice comes in your head where you're saying you're a failure. This this hasn't been successful so you know it's kind of trying to rationalize that and just almost wait until you're in a more stable position to kind of climb out of this hole that depression has thrown you into and like you say i think as you become older so i've been dealing with this for for many years now you become experienced in

your own sort of depression, and you can kind of hear the telltale signs. It's incredibly stressful. But at the same time, you almost have this thought in your head where you're saying, I know this isn't forever. And that's a really hard thing to think about. Yeah, you know, it's gonna end. I know that the other side, I'll be sociable, I'll be hopefully interesting and my relationship won't be failure like my partner still loves me and everything like that along with the book I think we had our first child just before the book was published so it's been a bit of a stressful year so I think these things do even subconsciously add to the triggers I'm just happy that it's not as severe and as permanent as a lot

of depressions are, that it responds to certain types of therapy and antidepressants. That's what I'm really, really thankful for. Yeah. So let's talk about antidepressants. You know, in the book, you talk about sort of going on them, coming off of them, going back on them, you know, and the debate that a lot of people have, myself included, because I have done that dance, the on again, off again dance. And at the time of the book being published, the answer for you was back on antidepressants, and you felt like that's kind of where you were. But you mentioned to me in our conversation beforehand that that's not kind of where you are now. So let's kind of where you were. But you mentioned to me in our conversation beforehand that that's not kind of where you are now. So let's kind of talk about that back and forth a little bit and sort of what causes you to think sometimes that you should be on, you should be off, and maybe we could just swap experiences on that.

Yeah, sure. So it's a balance, really. The drugs aren't without side effect or impact on your life. Compared to some of the older drugs, they are almost without side effect. But some of the older drugs are more effective in really severe depression, so it's different for every person. And the side effects that I really struggle with and try to, this is the reason I keep coming off them or trying to come off them, is it's almost like it puts up a force field between you and the world so I don't really experience the world I don't feel connected to it

and that has problems with my relationship I was on a very very high dose just after my daughter was born and I realized that I was not really connected to her like I should be like I thought I would feel more when I said of my daughter and you know that just wasn't happening if it did feel sort of being surrounded by some force field and then that emotion couldn't come in so I came off them in order to try and experience the world a bit more but in doing that you become more delicate and that's when the depression might come back in is is through these these stressful events and these triggers and you're not bubble wrapped anymore so you know it's easier for it to do some damage right now i'm off them again and that was actually because i recently had a dose as i explained in the book of um of psilocybin

so that the key sort of ingredient of magic mushrooms and they're in the book of psilocybin, so the key ingredient of magic mushrooms. And they're almost the opposite of SSRIs, the drugs that I take, the antidepressants, in that, in my experience, they don't shield you from anything, they open you up. And it feels like this overwhelming sense of love for yourself and for the people around you.

It allows you to have a different perspective. And for me, that's really powerful, that even though it's about six hours long it can have lasting effects of you can relate back to that moment you feel yeah this overwhelming sense of love that other drugs seem to take away from me and so I'm still going back and forth between therapy between different types of pharmacological options some of them are legal, some of them legal. And it is a dance, and often it's not a very good dance. Painful dance. So, yeah, right now I'm kind of hopefully riding a wave out of a depression,

and that hopefully will see me on for a few more months. And it's something that everyone has to kind of, you know, decide for themselves the cost- cost benefit of being on these drugs that are effective for a lot of people. And they're certainly effective for me, but then they're also come with these side effects that sometimes, you know, you wonder whether it's all worth it. So yeah, that's kind of my story right now. Yeah, that sort of mirrors mine in a lot of ways. Certainly the thought being, hey, are these medicines shrinking my overall emotional range is the thought. And certainly what certain people say is what they do. My experience of coming off of them, and when I've come off of them, I've done it in the past in really not wise ways at not good times and had, you know, it went poorly. And I've come off of them in more recent years in a very, very long taper periods with a great deal of support, a lot of clarity on the things that I know treat my depression in addition to medicine, you know?

So for me, my approach to it is I say I throw the kitchen sink at it, right? I check every box I can think of to check that, you know, we know helps. And I know help me. And so I've come off of them. And where I am right now is I am in the on phase, a much smaller dose than I used to be on, much, much smaller. I'm in the on phase, a much smaller dose than I used to be on, much, much smaller. But what I have found is that when I come off of them, it's not that my emotional range expands across the board. It's just that the bottom falls out of it, right?

It's not that it's like, oh, I'm feeling more of everything, the good and the bad. Wonderful. Okay, I'll take a little more down for a little more up. It's just the sort of bottom falls out. The better way I can describe it is, A, I just become extraordinarily irritable with everything. And then B, every activity, I feel like I'm carrying like a hundred pound bag of rocks around with me. And so like you described, I can function with a hundred pounds of rocks in a backpack, you know, like I'm functioning, but it sure feels like a lot of work.

You know, I've gone through this a couple times over the last decade and done it in a really smart and intelligent way. And then I've gone back on and I've almost immediately been like, oh, I feel like myself again. So, you know, the question I never know is I've been on them a long time, right? So what I don't know is have I just habituated my body to needing them and that's just kind of what I've done. For me, the side effects are really pretty minimal and the benefit seems fairly obvious. I am right sometime in the next few years, my brain will go, well, I wonder. And, you know, maybe we'll do the dance again. I don't know. And you mentioned that I went back on them just before my book was published. And as I describe in the book, it was those signs of suicide.

I realized that I was becoming dangerous to myself. These fantasies and these thoughts of killing myself were almost taking up all of my waking time. I discussed it with my partner because I like to be open about these things. Previously, that maybe saved my life because she knew what I was planning you're almost trying to stay step ahead of your depression so when it does become more severe she knows and maybe there have been some signs in in what I've been saying that she can you know take action and you know I feel so much guilt for the load that I put on her but it's unfortunately part of a relationship with someone who has you know severe mental illness yeah she's just thrilled that I do have these

moments where I almost come back and you know whether that's with drugs often it is with the antidepressants and someone asked me recently you know which of these I talk about so many different treatments in the book ones that I've taken and also historical examples and someone asked me which ones worked best for you and i couldn't really say which one had worked best as like a percentage something but i know for a fact which one i probably wouldn't be able to do without and that's antidepressant and sometimes that's quite hard to get your head around that you're almost dependent on this drug existing. And so that can almost add to your self-hatred. Sure. and alcohol abuse and schizophrenia and environmental sort of triggers from my childhood, you know, probably going to exacerbate these genetic sort of vulnerabilities. So you just

got to remind yourself of these drugs don't show that you're in any way weak or malfunctioning or anything like that. It's just something that my body sometimes needs a bit of help because that's just what's happened in our family. Yeah. And we'll get to this in a minute. What are we even talking about with depression? Because we don't really even know what we're wrestling with, right? And we don't even really know why these drugs work. But I often think of it as, you know, there are just different people, you know, some people have family histories and they need a certain type of medication to keep their cholesterol down, even if they live a healthy lifestyle. You know, there are people who need insulin, even if they live a healthy lifestyle. So for me,

I feel like antidepressants get me almost just to the starting line. It's still up to me from there to craft a life that has meaning and has purpose and has value and has enjoyments and love. And I mean, all that still has to happen. It's not like I just take the pill and it's like, boom, it's all there, right? I mean, I tried that with heroin for a long time and it didn't really, it didn't work. So, you know, it's more than like a pill fixes everything, at least in my case. It's like a pill almost in a lot of cases. And you reference this in your book at one point in talking about, we know exercise and nutrition are really powerful tools for dealing with depression. However, if you are really in the depths of it, for a lot of people, the depression is so severe, they can't

even get to the point they do those things, but you give them a little bit of medicine. And all of a sudden now they're at a point where they can say, all right, now let me incorporate exercise. Let me incorporate good nutrition. Let me incorporate meaningful connections. That's kind of how I think about it really as just sort of like getting me to a starting line at which then I can make the decisions about the other aspects of life that make it meaningful. It's the same for psychotherapy as well. I mean, since the 1970s, as I mentioned in the book, we've got the rise of CBT and personal psychotherapy. And the whole thing about using antidepressants then was to, for psychologists at least, was to get them into a state where they were able to discuss their problems. It's kind of got a psychoanalytical theme to it. But yeah, you're right. These drugs, you know, they're not going to cure anything. They're going to be able to support you as you try new things, as you battle the depression with all these different avenues that we have and finding the one that fits because everyone's

journey is going to be really, really different. In the mental health world, the medicine debate can be a very fierce one, right? I certainly understand the argument in a lot of cases around over-medication. What I feel more concerned about is just the walk-in to your primary care physician and you're given a pill after answering a seven question survey. And that's all that's done to treat what might be a condition that has a lot of other aspects to it. I think it's good that we've gotten to the point where you can talk with your primary care physician about this stuff. I mean, it's a nuanced area. I would always hope for people that like medicine is step one in a series of other interventions that lead to a

better quality of life. Step one suggests that you would give the antidepressant as the sort of starting point for every person. Whereas I would maybe say that if someone isn't in a dangerous position, if someone's in a critical condition and they need something that's going to work within a month, then yes, I would agree. But if someone walks into their family practitioner and they are showing some signs of almost like a sub-threshold depression then i would argue that maybe you know exercise and diet these things that don't have the same side effects or problems with coming off um withdrawal impacts of these drugs try those first but, it's difficult when you're working with a vulnerable patient and you don't know how. It's very difficult to gauge

in what state they're in. So it's a very complex decision to make. I just think if everyone is given the medication first, it's quite hard to come off them. And if they don't work, that can then make people switch off from reaching out again whereas these other sort of alternative approaches of exercise and diet and a social connection of course to really boost someone's someone's own sort of more natural reserves i think would be a really positive way that both psychiatry and just general practitioners could go down 🎵 I'm Jason Alexander. And I'm Peter Tilden. And together on the Really No Really podcast,

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I think that's always been my approach is like on meds when I'm doing everything else that I know treats depression and it's still there, then I go, okay, I'm comfortable. And like a lot of things in life there, we often overcorrect. And so I think we went from a point where it was like so taboo for people to take medicine. There was a positive swing in which we went, okay, you know, that's not a bad thing. And, you know, talk to your doctor about it and that's all good. Right. But I think we've overcorrected. And now we're at the point where unfortunately, for a lot of people, medicine is the very first thing they're given. It's just, again, you answer this eight question

survey in your primary care physician office, at least here in America in a lot of practices, and you're going to walk out with a script for, you know, an antidepressant. And that is not ideal. All right. Anyway, let's change direction because I want to talk a little bit about what is depression, right? You say in the book, a single diagnosis doesn't capture the reality of depression. It's a syndrome, a collection of different but overlapping mental states. So let's just talk a little bit about what do we know today about what we're calling depression, what it is, you know, we can get into its relationship with other conditions, we can talk about the p factor that you also write about, which is fascinating, but let's just kind of wade into, we've been tossing this word around, like it's this clearly

defined thing, oh, I have depression. And like it can be measured and diagnosed in a simple way. And that is very far from reality. Yeah, it's incredibly diverse. And I wouldn't say that any diagnosis is very accurate when it comes to depression. I think we go to things like the DSM. So the American sort of Bible that tries to put labels on different symptom clusters. And you look at the one which is major depression, and there isn't a mention of anxiety in there. And that just struck me as either trying to put another diagnosis on anxiety disorder, but for me and everyone I've spoken to

and looking through history, even back to Hippocrates and ancient Greece depression and anxiety are almost one and the same it's very rare to see a pure depression it's very rare to see anxiety that might not slip into a sort of state of helplessness and incredibly low mood so here in the west we kind of focus on this symptom of low mood you know depression means something that's, you know, been decreased. So the mood has lowered. Historically, it came from depression in pulse or heart rate, blood pressure. And that's what's stuck here.

But in the book, I kind of try and find alternatives. You know, depression almost fuses with one's cultural sphere. And the language that people use almost shapes it into slightly different forms of the same disease. So I traveled to Zimbabwe to meet some amazing psychiatrists and scientists and the local grandmothers that they work with. And they are providing problem solving therapy for people in really low income neighborhoods. problem-solving therapy for people in really low-income neighborhoods. And the psychiatrist tried to, you know, do a survey, as you would do for any study, of how prevalent is depression in our area, in Harare, the capital city of Zimbabwe. And there wasn't a word for it. So they had to talk with the grandmothers, who were community health workers since the 1980s, but haven't worked

on mental illnesses, mainly sanitation and things like that and they had to kind of come up with okay what are people describing here that might allow us to see if they're suffering from something that is depression and they found the phrase uh thinking too much um which you know it has a huge amount of like rumination, the anxiety that makes you fall into a depression. It's a really common and amazing phrase, and it's kafungisisa in the Zimbabwean language of Shona. So it kind of shows that depression is not this thing that you can just simply label and just say, okay, this is it, like you would with a cancer that's got a specific cell, or even a specific gene that has

mutated to allow this cell to divide and continue to divide. But depression is part of everything that surrounds us as well as our biology. So we're thinking too much. This actually is really common in South America and across Africa. There's also some political influence in how we sort of define depression. So when Mao was in power in China and communist state there, it was almost illegal to be depressed. And so you couldn't really have this mental disease because that would be seen as an insult to this great leader. And so there was more of a physical term, neurasthenia, which means a weakness of the nerves. So you weren't mentally ill, you were physically ill,

even though the symptoms were very much similar to what we would see and diagnose as depression. And this sort of global view just made me realize that it's very diverse and you can call it a lot of things, but there's still this same core, whether it's low mood, thinking too much, anxiety, rumination, the effect on sleep historically that used to be you don't sleep but there are people who sleep too much and so you can have almost the opposite of each other when you're sort of treating two people with depression one might

sleep too much the other might be suffering with insomnia another person might be not eating and the other person might be overeating and be overweight yeah so depression is yeah it's just a very diverse illness and it makes it almost more remarkable that we have treatments that work for for this really really unique disorder what i try to learn from not only from around the world but historically is how we have become so fixated on this one word of depression and there are other ways of describing it so there are terms that have almost been forgotten where you have like endogenous depressions that are more biological in nature so there don't seem to be many social triggers for why this person is feeling this way

and is in a very dangerous position whether they're suicidal or not eating or not sleeping and then you have more reactive depressions more in tune with someone's social sphere so there are obvious triggers in their environment that are causing them to feel this way and each of these has had its own sort of treatment in the past to then just fast forward to the 1980s where we came up with this term major depression and everyone just started calling it depression really just obliterates this really rich history that we've had of understanding all these types of depression that can be then understood treated and almost communicated better so you know you can not only just say that i struggle with depression but i struggle with a certain form of depression or melancholic depression, which comes from ancient Greek.

The idea that you're more psychotic is a type of depression that has really been lost. It responds really well to electroconvulsive therapy, which is the treatment that when I first started writing this book, I was hesitant to mention it. But after meeting the practitioners of today and seeing how this treatment has been reshaped and remolded, it's really a remarkable treatment for this specific type of depression. A lot of people my age would have seen or read the book by Ken Kesey, One Who Flew Over the Cuckoo's Nest. Yeah, that's right. And you see ECT used as this really awful way to control this person. And so it, yeah, it has these awful connotations. But I know a couple people personally who have benefited greatly from it as a treatment.

I think what you're saying is really interesting. And I want to ask a question there, because on one hand, you're sort of saying, hey, depression is too broad. There's actually these sort of maybe more narrow lanes that we might look at. We recently interviewed somebody, you may be familiar with her book. It's called Pathological, The True Story of Six Misdiagnoses, Sarah Fay. I don't know if that rings a bell. I haven't come across that. No, I'll make a note of that. Yeah, it's right up your alley. She's covering the same ground. Her point is basically over her course of her life, she was diagnosed six different ways. And so she started digging into the DSM and, you know, sort of coming

up with what happens if you dig far into the history of the DSM. You're like, oh, none of these things are a real diagnosis in the sense that like cancer is that you could get a scan. And talking about how one of the criticisms of the DSM is that it's splintered into, I don't remember how many, but you know, 700 diagnoses or 500. And it sounds crazy. And a lot of people believe maybe it's less diagnosis. And I know you sort of talk about that too. And maybe what we're calling depression and in another case, we're calling anxiety are all manifestations of a similar thing. So I kind of hear you on one hand saying, hey, maybe we need more nuance in how we

talk about it. And then I've also seen you write about, hey, maybe there's more similarity between these different things than we think. Say a little bit about that. Yeah. So this came from my own family where, you know, my cousin has schizophrenia, a mood disorder. So these have historically been opposite sides of psychiatry. Yeah. You have mood disorders and you have psychotic disorders. We can have more nuance in how we describe our depression, but I don't think it needs to be a clinical, like how we describe it in terms of a diagnosis. I just think if we appreciate that we can take all of these different parts from all

of these so- from all of these so-called diagnoses so I have some parallels with autism hypersensitivity to sound other things that really kind of you know make me wonder well maybe I'm kind of a little bit of autistic and maybe one of the reasons I could research a book like this for you know four years and you know absolutely love my time just completely embedded in a library i don't know but it's these sort of taking these pieces from what we've kind of historically thought of as diagnoses so you can have you know some sort of recurrence such as in bipolar you have anxiety disorders and they really do seem to kind of almost tie together and so the way i kind of like

appreciate my own depression is it can have any of these sort of facets that come from a wide range of the spectrum of mental illness in general so it doesn't have to be just depression and what's in the DSM I don't think that's very helpful for the for someone who's trying to kind of understand what they're feeling right now like I said it doesn't even include. It's really for psychiatrists to understand with a very short amount of time, what's the most likely situation here? And what's the most likely treatment that's going to work, which I think has been quite a successful thing for a lot of people. But as you just mentioned in that book, you can be misdiagnosed several times and often be put on the wrong treatment, because we do see

it as this sort of tunnel vision of we need to pick one of these options. And so when you get to a stage where your mental illness is sort of almost matured, I think that you do become more better into either depression or schizophrenia, like me and my cousin are, you know, very different in how we express our mental disorders. But look further back back in times like where did that actually come from and I think the unity in mental illness comes from maybe a childhood a shared vulnerability to going down certain paths and it can be shaped by your own life and what you experience so I think right now 31 year old I think you know I have a pretty good idea of this is quite a stable part of my mental illness and it could go into more of an anxiety state or could go into more of a depression

state or it could go into alcohol use because these are things that really they cluster together in adulthood if you go back into childhood we're probably showing quite similar symptoms and you know we still haven't kind of been funnelled down. These men can become more close to a strict diagnostic system. Something I'm really interested in is trying to understand how people almost become put onto a certain track in their own life and how that changes over adulthood as well is quite fascinating. I'm Jason Alexander. And I'm Peter Tilden.

And together on the Really No Really podcast, our mission is to get the true answers to life's baffling questions like why they refuse to make the bathroom door go all the way to the floor. We got the answer. Will space junk block your cell signal? The astronaut who almost drowned during a spacewalk gives us the answer. We talk with the scientist who figured out if your dog truly loves you and the one bringing

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And register to win $500, a guest spot on our podcast, or a limited edition signed Jason bobblehead. It's called Really, No Really, and you can find it on the iHe it on the I heart radio app on Apple podcasts or wherever you get your podcasts. I love the way you say this that you know, it's a syndrome of collection of different but overlapping mental states. And then you go on to say, you know, it can be a product of upbringing, trauma, financial uncertainty, loneliness, social bonds, diet, behavior, sedentary lifestyles, neurotransmitters, and genetics, right? It's all these different things, you know, so many different contributing factors. I have alcoholism and addiction, you know, and you look at that and you go, all right, well, what's the genetic component of that? It appears there are genetic components to these things, but genetics are certainly not destiny.

there are genetic components to these things, but genetics are certainly not destiny. So to your point, the phrase I've always heard is sort of like genetics, loads the gun, environment pulls the trigger, right? Something to that effect. So I do think there's a lot to this. Say a little bit more about this idea, though, that there's an emerging argument that all mental illnesses are interconnected, like the branches of a tree growing from the same trunk. Is that what you're saying, that we believe there are some underlying vulnerabilities, and then depending on what happens sort of determines a little bit about like which branch you go down? Yeah, it's quite recent in terms of giving a name, but it's got roots in psychoanalysis and other sort of non-diagnostic approaches to psychotherapy. And so it became

known as the P factor, so the psychopathology factor. And I think that's a terrible name in terms of, you know, trying to make something understandable, don't call it psychopathology. Yes, it received a lot of attention. And some people really hate the term, people who really have been dependent on using a diagnostic system but there's no doubt that it's changing how we study because Thomas Inzel who used to lead one of the major sort of scientific institutions in the US, he left and said we need to change how we approach the scientific research towards mental illness that you know this hasn't been working over decades we're still no closer to wondering where they come from we still can't find the genetic basis of any of these diagnoses and treatments haven't improved since the 1950s

and what his approach is is to change the fundamental way we we study them so we don't use symptoms is his argument we use different dimensions of how we experience mental illness so they can be more linked to your personality linked to sort of just patterns of sleep or behavior and it really kind of breaks the mold of thinking of mental illness as, like you say, this checklist of seven symptoms that you get given. It becomes a bit more nebulous and it's quite hard to understand. But hopefully, once we dig into these elements of personality and genetic vulnerabilities, the genetic patterns that don't just lead to, say, schizophrenia or studying depression, to say schizophrenia or studying depression, study all of them at the same time with the tools we have available now

and seeing if the genetics are actually more understandable as we see them as a whole. So if we've been studying them separately over time, of course we haven't seen a genetic risk factor for schizophrenia because it might not exist. It might be a risk factor for bipolar. It might be a risk factor for autism it might be a risk factor for autism as well and there are some really interesting studies into you know this idea that we have

schizophrenia and bipolar very closely related and there are some strong genetic risk factors involved in those two one is a mood disorder and one is historically a psychotic disorder so that breaks down that old sort of division there and then if you study the more sort of um the colonizing disorders so you know depression and anxiety and see whether we can find the genetic risk factors for that collective group rather than just saying can we find a specific genetic risk factor for depression because that might not exist it might be more can we find this sort of part of the genome that, together with environmental triggers, sends someone down this path towards, you know, thinking about themselves constantly, of rumination, of self-hatred,

that then can become depression or anxiety. And so, yeah, this idea of the p-f the p factor i think it really changes our conception it gives me a lot of comfort actually in my own experience of mental illness it allows me not to just think of me myself as a depressed person but more of a human because it's it's it's this broader richer palette from which from which we experience the world there's a lot of negativity of course to it but it makes me feel more connected to people who have mental illnesses and especially with my cousin who you know has been institutionalized and given really horrendous sort of treatment as soon as he started hallucinating and having

delusions and stuff yeah it kind of makes me think well hopefully this idea of a shared p factor will allow people to reduce the stigma not only for for me but for people who have psychotic disorders like my cousin and to think of him as not this sort of fringe sort of person who can just be institutionalized but actually as someone who's got this shared predisposition that has been you know funneled down a path that has led him to you know have these vivid hallucinations this vivid imagination and rather than locking him away, can we find some common treatment that can work across that P factor? And I think that might be what we're heading towards, especially in children, is trying to find if there is such a thing, when does it happen? What does it look like? And how can we

prevent someone from becoming fully psychotic or fully depressed? It's fascinating to think about where this field has come from and where it might go and the treatments that might be coming. Let's sort of spend the last part of this conversation talking about treatments that are available, treatments that you have tried or treatments you've heard of. Like, let's try and sort of stay in the lane of depression right now. What's the menu look like for people who are dealing with depression? You know, we've covered the obvious SSRIs.

We've talked a little bit about diet and exercise. Like you, if I had to pick one tool for my depression, it would be a toss up between perhaps medicine and exercise. That's how critical and fundamental exercise is to my overall well-being. We could talk about diet and exercise for two hours and not even cover how important it is, but we've already sort of hit it. What else is out there? What are other things that people can do? What are other things that you've done? Let's explore a few others. So yeah, I think exercise, like you said, they're two that are really fundamental to my own stability. Antidepressants, we mentioned that there are SSRIs, but often it's kind of forgotten

that there's this rich history of antidepressants. If people don't respond to these SSRIs, then there are other options that have maybe in some ways a more severe list of side effects. So we have mipramine, which is a tricyclic antidepressant. So that family. And then we have another group that it was the first antidepressant to discover that it's an MLI. It was the first antidepressant to discover that it was an MOI. And they do come with more physical side effects, such as dry mouth and constipation and things like that. But I've talked to people who SSRIs didn't work for them,

and these drugs did for a long time. So it's not just about thinking of antidepressants equals SSRIs. There are other options that other people really do respond well to. Some of them don't come with the emotional blunting that SSRIs are often associated with I think one of the researchers I spoke to he actually mentioned he was on imipramine for 10 years and you know he'd take constipation all day if you know because it worked it was the first drug that really worked for him there are also blunting of the libido in SSRIs, which a lot of people struggle with. And if you're already in a depression and you're struggling to connect with someone, then that can be one of the reasons that it's probably not the drug that's best for your

situation. Thankfully, I haven't had as severe a spill in that domain, but that can be a real issue for a lot of people. And from pharmacology i think mindfulness which is you know becoming part of cognitive behavioral therapy kind of meditation is something that i try to practice quite regularly so it's this sort of like almost this eastern approach of you kind of take time out and i won't describe my methods and stuff but everyone's probably familiar with using meditation and it seems to have effects to books in some ways so psychedelic substances from either mushrooms or in brazil the people i speak to there from types of plants that are mashed up into a tea called ayahuasca and this

meditation kind of silences this default mode network in the brain that is almost, it's completely associated with yourself, what you're going to do next and what you've been doing in the past. It's really this self-obsessed network in the brain that seems to be overactive in a lot of people with depression. Mindful meditation allows you to kind of silence it, at least for a time, and really think about others. So compassionate meditation is where you think about someone usually someone that you really kind of love and trying to imagine them in a difficult situation and you sort of building that affection for them and it kind of breaks you out of this constant interceptive sort of thought process i think that's been really helpful for me try to do every day it's difficult

because it's not something that you can just see benefits from like with antidepressants but added together i think that it's certainly something from my menu as you put it that i think is is critical yeah it might be like a starter or a dessert it's not a main course but it's it's it's something that you know you really do depend on and you really like to have now and again and for people who are really severely depressed there are options that are really exciting at least from my point of view and the people i've reported on and interviewed of deep brain simulation where you can also related to this sort of this idea of the neural circuits in your brain being completely hardwired for depression

and being able to insert an electrode to kind of almost switch it off yeah and allow yourself to have this moment where you can break free from um what has become your default state which is a really powerful powerful tool for a few people who haven't responded to every other traditionally so it's not going to be you know something you can just pop down and get a prescription for but it's something that i think it really gives me hope when thinking about depression is we have all of these things from exercise and diet to mindfulness to these aggressive treatments for people who have failed all the other options when we say treatment resistant depression i think you think that okay this person hasn't responded to anything but there's so much more out there that's right and treatment resistance the actual

definition only needs two different types of antidepressant to be And treatment resistance, the actual definition only needs two different types of antidepressant to be considered treatment resistance. It's not a full stop on their story whatsoever. And kind of linked to exercise and diet, but trying to understand depression as inflammation is quite a powerful message. And anti-inflammatory is now being tested for certain types of depression. I think it's around a third of depressions can be linked to a high amount of pro-inflammatory molecules in the blood. And so this sort of stress response

just becomes flooded with these inflammatory molecules. And I think that's an avenue that really excites me because there are some really good studies coming out showing that for a third of people, which is a huge amount yeah these tools can be effective and the beautiful thing about it is if you reduce inflammation antidepressants become more effective one thing we know about antidepressants is they're not very good at working when someone is suffering under an inflammatory storm or a cloud of inflammation in their bodies so they can work synergistically as well these treatments and i'm just psychedelics there they're not really a treatment that you

can go out because they're still schedule one and you know illegal to have and to take but this is why i focused on some of the work in brazil because they're legal there for religious ceremonies in the s Santo Daime church and the Brazilian scientists who are working you know really closely with this more cultural element of these of these drugs yeah really sort of excites me and thinks that you know this does have a future because it has this really rich history from decades and centuries ago in South America and across the world depending on which psychedelic substance we're talking about. For me, I self-experimented with psilocybin, with magic mushrooms. And yeah, I think I'm not as dependent on it as I would be with an SSRI, but I think that it can sometimes

help to provide an alternate perspective on your life at the current state. And for me, that returning to the parable, for me, it really feeds the love part of that parable. And the wolf that is full of hatred and greed really just gets almost laughed away in these psychedelic trips. Yeah, there's a lot happening around psychedelics these days in a variety of mental health treatments. And if people are interested, you know, as you said, they are illegal. There are more and more clinical trials, though, that are starting to open up where that is one way that people can explore that. And of course, there are plenty of people offering treatment, even though it's not legal. And I think a lot of people are getting benefit out of it. You've described something called the winner's curse. Can you say a little bit about what the winner's curse is? And I'm kind of curious whether you think any of that might be happening with some

of what we're seeing around psychedelics. I was told this by someone in the psychedelic field, and he was describing this winner's curse. He used Prozac as an example. So you have this drug that has all of this hype around it. You know, people who have been working on marketing campaigns for other companies, such as like automobiles and McDonald's, and you have these same marketing strategies that have pushed this new antidepressant into the mainstream. Because it was one of the first SSRIs to be put into prescription, all this excitement builds into this being a winner, even if it isn't. And over the decades since, we now know that Prozac is no different to most of

the SSRIs. And in some cases, it's actually not as effective. And so these drugs and these new treatments can't be seen just in terms of what comes out in peer-reviewed science because they are part of the societies that sort of create them and put them into people's bodies. So with Prozac, you know, people were responding to this drug in the 1980s and they hadn't responded to anything else. And suddenly this new drug comes out, people are excited about it,

it's got new catchphrases and it just seems very popular. And it's suddenly they respond. And that's often not the drug. It's often the hype around it. So it's this beautiful thing of the placebo effect. It's something that we often try to take away from clinical trials. And rightly so. We need to find out whether a drug works above a placebo.

When you're working with something like depression, which is a mental state where people are often hopeful that they can get better, and someone then gives them this new thing that's really exciting and they do get better, then it takes time for them to understand, you know, this placebo effect starts to wane and then we get what was once a miracle drug becomes a very average SSRI. And I think that, unfortunately, this might be the case for psychedelics as well, because we see everywhere at the moment, it's become this sort of trendy thing to do to microdose, to take, you know, large doses every three months for depression.

And some of the people that I've spoken to and interviewed for this book, they've almost become like celebrities, they've got like a real cult following of, you know, you see them on the front of magazines, you see their work on the front of magazines. And looking at this historically, it really kind of brings up a bit of concern that we might be repeating history here, that we're building up this bubble that might suddenly burst. And there was a study published last year where psilocybin psilocybin was put in a trial alongside estetalopram and there wasn't a significant difference between the two in terms of people responding to it i think this is really positive because it shows that both are effective like these are two effective treatment options that we have

the psychedelic showed some sort of pattern towards being significantly better but it wasn't statistically and what concerns me is when prozac came out it was significantly better it was you know people responding to this thing that hadn't responded to anything and now we have these trials with psilocybin and we're struggling to find significance between the drug and the regular antidepressant. And we're not finding it. And that makes me worried. It's like when this hype starts to drop, whether it's in 20 years or 30 years, what state are these new therapies going to be in?

Are they going to be average? Or is that sort of winner's curse going to become the truth of the matter for these drugs? I think that's one caution I'd like to put on psychedelics is we still don't know whether they are a really long-term treatment. And there are risks involved, especially for taking high doses of them. And especially if you have a history of psychosis, there can be enduring psychotic episodes with these drugs. For me, the risk of my depression seemed so high that I was willing to try them. Thankfully, I've only had, you know, very safe and very meaningful experiences with them, but I don't see them as a replacement for anything that I've had before. We'll see how the field is in the next, you know, 10 years, but we've also got to remind ourselves that these

drugs have been used for potentially millennia, and to then say that they're not effective or not safe is almost an insult to indigenous populations around the world who know a lot more about these substances than science ever will. Yeah, yeah. And I think to say that they're not effective, you know, clearly for some people, they are proving to be effective. I don't think they would be getting all the noise they were getting if there was not some degree of effectiveness. And I share your concern that, you know, the coverage of it is so breathless that I'm always a little bit like, I'm not sure that there's really a golden ticket, you know, or a silver bullet or use whatever analogy you want. You know, I think likely they can be another tool that can be effective for certain people used in the right circumstances. And, you know, we can use as many tools, you know, as many items on the menu as we

can, given that, you know, we don't know what works for which people and in what circumstances. So I think more options is better options for sure. Yeah. I think just a comment on the self-experimentation, I think these aren't recreational drugs when used in this setting. I it's a often a horrifying experience to take these drugs it's not like something that you can just take it for a day and then it has you know long-lasting effects some people describe it as a nightmare that goes on for eight hours and you can't wake up so there's an element of and i tried to put this in the book of it being really hard labor it can be horrifying and this is why it's so important that it's not just seen as a drug. It's seen as, you know, you're having a therapist there with you and someone who can guide you. Because if you don't have that guide

and you don't have that knowledge of how to get through these really dark moments, you can become trapped. It can make you feel a lot better, but it also can make you feel worse. And it's quite, yeah, it's quite dangerous. I think I've shared this story on the show before. I don't remember if I, I'm pretty sure I probably have. But to your point, I experimented with psychedelics a lot, a long time ago, you know, my late teens, early 20s, and I was using them recreationally. And my stupid brother one night, it was the night of my grandmother's funeral and he convinced me we should do lsd that night and i knew it was a bad idea i just i was like this no i kept saying no and he kept being like no it's gonna be somehow he talked me into it and you talk about like a dark

a dark night of the soul like i mean you talk about eight hours of like torment. Like it was unquestionably one of the worst, one of the worst nights of my life. I can laugh about it now, but, but yeah, I could have used a therapist for sure that night, probably for, for quite some time afterwards. But to your point, I think there are real ways to use these things as tools of healing. And then there are ways to use these as a drug. And I think it is so much in the intention. And as they say, set and setting, right? You know, the approach. Yeah, exactly. The history of that set and setting is part of the book. And it comes from a lot from Betty Eisner,

a woman who's often forgotten in psychedelic circles. It's often a very masculine, dominated field. And she was really pivotal of creating this setting of comfortable space, music, photographs, like trying to really kind of like harness as much as you can from someone's trip while also being in a very, very safe space. For people with depression in particular, you know, there is going to be a dark moment there, whether it's a moment in your past or something that you're growing with in the present, you really need to be sure to get past that to get through it. Yeah, Betty would clearly have come down on my side in the debate with my brother about whether LSD was a good idea that night. Betty would have been like, uh-uh, don't do it.

Don't do it. Her second taste of LSD in the 50s, I think it was in the 50s. Yeah, she said it felt like the universe had collapsed upon her. So she would definitely sympathize. And she didn't try it again after that. My memory is of laying on a bed, feeling like, literally thinking that what was happening to me was I was being crucified. All I could hear is my brother outside laughing like the devil. That's my recollection of that eight hours.

All right. On that note. That's recreation. I sure knew how to have a good time. Yep. You can certainly have some moments there. Well, Alex, thank you so much for coming on. The book is really wonderful.

You know, there's certainly a memoir aspect of it, and there's a lot of really deep and really good science writing in it. It's a wonderful combination of both those things. We'll have links in the show notes to where listeners can get access to it and how they can find you. And so Alex, thank you so much for coming on. I've been looking forward to this one. Oh, thanks for having me. It's been brilliant. If what you just heard was helpful to you, please consider making a monthly donation to support the One You Feed podcast. When you join our membership community with this monthly pledge, you get lots of exclusive members-only benefits. It's our way of saying thank you for your support. Now, we are so grateful for the members of our community. We wouldn't be able to do what we do without their support, and we don't take a single dollar

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