The Wellness Scoop - Understanding Anxiety, Depression and Mental Health

Episode Date: June 8, 2021

Ella and guest, Karl Deisseroth on understanding anxiety, depression and mental health. From the depths of human emotion to why the science can expand our empathy and connectivity; why our view of mental health needs updating; the hidden realms of the mind and the ways in which we can expand our connectivity. Karl Deisseroth - Connections: A Story of Human Feeling See acast.com/privacy for privacy and opt-out information. Learn more about your ad choices. Visit podcastchoices.com/adchoices

Hi and welcome to our podcast with me Ella Mills. Our podcast Delicious Ways to Feel Better is a weekly show focusing on absolutely everything that matters to us at Deliciously Ella. We really believe that feeling good is about a holistic 360 degree approach to our lifestyles and that wellness is about so much more than just what we eat or how we exercise. It's our relationships, our mindset, our sleep patterns, our stress levels, and just how we look after ourselves on a day-to-day basis. On this podcast, we'll be breaking down anything and everything to do with mental and physical health and sharing small, simple changes that'll hopefully inspire you to feel that bit better. So you know that we're very passionate about understanding the why behind things at Delicious

Cielo. It's really the whole kind of reason for being, to be honest, and certainly the reason for being for this podcast. And today we're going to be talking a little bit more about understanding anxiety and depression and getting to understand the depths of human emotion and hidden realms of the mind with Carl Dicey-Roth, who is a professor of bioengineering and psychiatry at Stanford University. And I think this is a particularly interesting topic because it touches so many of us, obviously, with the prevalence of mental health challenges today. I think so many of us, definitely myself and Matt included in that, have struggled with anxiety or depression at

points in our lives. And we understand how perhaps it physically or emotionally feels like, but I think there's a limited understanding for so many of us, and again, us included in that, on what's really going on in the brain. And I think sometimes that can perhaps stunt our empathy for those around us. So I hope this is going to be a really helpful and useful episode. And it is our last episode of this chunk for the year. We're going to be taking a break, as I said last week. Over the summer, we have got some really big things happening at Delicious Cielo that we want to first and foremost kind of really just put all our energy into. And then we'll come back with a bang in September with a podcast as of next week we're

opening plants which is our brand new restaurant which has been the project of 2021 so far and the idea that we're just a week away from opening now feels so good so please do come see us if you want to book a table just head to www.deliciousyellow.com we are working on a new chocolate bar a new caramel cup and two different savory ranges at the moment I am also finishing my nutritional therapy degree and for this semester at the end of this month I've got a few huge assignments I need to write a book over the summer and I'm doing the next 150 hours of my yoga teacher training so basically it's going to be a busy couple of months and I didn't feel like I could give the podcast everything that it needs over those few months as well as all those deadlines, big projects.

So taking some tips from the podcast and really trying to look after mental health and our kids and try and create a bit of space for everything. So we will be back in September and I absolutely can't wait to see you then. And for now, we will dive into this episode with Carl, which as I said a minute ago, I hope will help create a deeper sense of empathy and connection with

one another. So I hope you enjoy it. And welcome, Carl. Thank you so much for joining us. My pleasure. It's nice to be here. So your book's called Connections. I wonder just before we get into it and into your work, if you could just start by giving us an overview of what you do, of what the book's about, and why these connections are so important. Well, I've been working on this for many years. I'm a psychiatrist and a neuroscientist. And the reason this is the right time to share these stories with the public is that there's been an amazing convergence of technology and neuroscience on the one hand, and these very important moving human stories at the nexus of geopolitical upheaval and personal change. These two threads

came together, the science and the personal stories all at once. And for me, this was a very important thing to share with the world. And I think and hope there'll be connections that people see to their own lives. Absolutely. I think there was something you said in the epilogue, sorry, to start at the end of the book. And you mentioned it actually in reference to violence, which made a huge amount of sense. But it also struck me as something that was maybe relevant to all of us more widely. I'm sure that there is a huge number of listeners today who

struggled with their mental health in some capacity, whether that's anxiety, depression, friends and family themselves struggling with other mental health conditions. And when you talked about the need to have these conversations and these needs to open up these conversations about mental health, you were talking about it in relation to violence, but it just struck me as part of the importance was to kind of create this deeper sense of empathy and conversation and understanding of one another, because I think it's so easy to go about our day to day without truly understanding what someone sitting on the other side of the table is maybe going through. You know, this is, you're absolutely right about that. And this is a remarkable thing about psychiatry. On the one hand, we deal with these extreme forms of human emotion that are universal and that we've all experienced emotional upheavals, the emotional swings. What we have in this book is stories that share with people about how we can look at the extremes and use them to

understand the day-to-day as well. Now, we've all seen in the past year or the past few years, we've all seen extremes happening around the world due to the pandemic, due to other things that have happened. But what we're seeing in psychiatry is that we can understand the natural human condition by what goes wrong in the psychiatric setting. And so that's a theme in the book. It's a theme in the human stories that I'm able to share in the book. And I think, as you point out, it's an insight that we should all talk about. Psychiatry actually is being called upon to address things that are very urgent and pressing in society that are not even necessarily related to psychiatry per se. Aggression, violence, extreme reactions to stress.

And we're at a time where finally neuroscience and neurotechnology are giving us ways to speak about this in a precise way, in a scientific way, in a way that really matters. And so this is what I hope to share, this alignment of the stars. There's a lot of hard stuff and a lot of difficult stories, but there's also hope for understanding. So Carl, when you said there, and I know it's a big message of the book, that in studying the extremes in psychiatry and in mental health and human behavior it also as well as creating more empathy there sheds more light into a greater understanding on the day-to-day of I'm sure normal mental health is not the right expression but the sort of normal status of the human mind and as you touched on

things like the end of stress and violence and aggression and again these kind of quite normal to some extent emotions what what are the key takeaways the most obvious learnings there well you know there's a few good examples for example we all know there's a whole chapter on social behavior human stories about people who experience the two extremes people who are on the autism spectrum who have a difficulty with social interaction difficulty with handling the high rate of information that comes with a social interaction that's one extreme on the other extreme you have people who are actually sort of hyper social you might say there are very interesting syndromes

one called williams, where people have just a stunning level of instant connection, instant bonding, rich, expansive storytelling. But these are people who are not entirely healthy. This comes from a chromosomal deletion, amazingly, so a loss of some DNA. And yet these people have extreme hyper sociability. And so we can look at that and we can look at all the natural variation around us and within ourselves. We can see sometimes we're more, we have that social energy and sometimes that feels depleted.

And we can look at these extremes and we can look both across the population and within individuals and we can ask ourselves, what does this mean? And then we can go to the neuroscience and we can say, where are the cells and the circuits that are governing this social resource, this social supply that different people have different amounts of that can get depleted, it seems, even in a person. And it turns out there's some real exciting neuroscience there, ways we can understand that in a quantitative way, even talking about bits of information in the real sense, like bits in your computer, we can talk about bits per second flowing through individual neurons. And we can say, okay, here's an autism related condition. Here's on the other extreme. And here's how it all boils down to real bits in the brain. That is unbelievable. I think one of the things I really took from the book that I really appreciated is that, again, if we go back to thinking, as I said, so many people listening to this will have experienced mental health in some capacity.

I think we all know what, for example, the kind of physical sensations of anxiety feel like or perhaps depression. But I don't think that many of us, definitely myself included, really know what's actually going on in the brain. And even the way there's a few paragraphs you spoke about what's actually happening within the brain if you have anxiety. I found it really profound. I think it gives you a lot more compassion for yourself and again for everybody else and empathy in the fact that this is a kind of biological situation. That's a very important point. You know, it's interesting that and that understanding that it is biological, even before we get to new kinds of treatment, just as you're saying, the understanding that it's real and physical and biological, that by itself allows us to feel so

much empathy for the people who are suffering. When you look at people who have suffered from severe anxiety, severe depression,ically, it's been very hard for friends and family to understand deeply what's going on. And that's led to all kinds of exacerbation of the problem of the issue. There's this frustration, you know, why is this person acting this way? It doesn't make sense. But just understanding the physical biological nature has been incredibly illuminating. You mentioned anxiety. This was, you know, we published a paper in the British Journal of Nature in 2013 on the assembly of anxiety, how the different parts, the different features, if you will, of anxiety

get assembled and put together into a coherent state by the brain. And if you think about anxiety, it's got different parts to it. First of all, we have physical feelings. We have our heart beats faster and we breathe more quickly. Okay. So there's the physical stuff. And then you've got a behavioral change. You avoid risky environments. You avoid, even if there's not a threat, you avoid things where there might be something that goes wrong. And that causes problems very often, that avoidance. And then there's even other features. It feels bad also. And that's actually different from the other two things I said. That inner feeling of negativity, that is its own part of the state. And what we found in 2013, we found out how those

three bits, those three parts are all brought together by a master control region in the brain. There are cells there that reach out and get one part, reach out and get another part, and reach out and get another part. And it all gets bound up into the state of anxiety. When we published that paper, I got emails from around the world from people who had suffered from anxiety, who hadn't been able to leave their house for a long period of time, just saying thank you for showing how physical it is, how biological it is. And that by itself brings hope. Of course, we want to do more than that, but for psychiatric disorders, especially, a big step is understanding. Yeah, no, I couldn't agree more. I think, and you said it as well, which is that in the past, as you said, I think there's been a stigma around a lot of different mental health conditions, and it certainly doesn't help the situation. And that you said that the kind of more traditional approach, which I feel like I heard a thousand and one times growing up, which is that it's just a chemical imbalance. We just can't look at it like that anymore. Well, the exciting thing is we have been able to move beyond that way of looking at it, which honestly was a good first step. You know, that's what science and medicine are. It's

humanity's best current guess at the situation, often informed, but often not enough. The exciting thing is we've now moved beyond that to a whole new level of understanding that is much more well-defined and precise. And that is the nature of these connections across the brain. We now know, if we take this example of anxiety we just spoke about, it's those connections from the master control region that go out to get the different parts of anxiety. We now know exactly what those are. We know where they start, we know where they go, and we know that they matter. This is from the neurotechnology side. We developed a method called optogenetics, which lets us use light

to turn on or off literally one connection or another connection or another connection across the brain. In this case, in vertebrates, mammals like us, mice and rats, we can do this in fish, animals that have much of the same brain structure as we have, just smaller. And we find that we can very precisely cause each of these individual features, these individual bits of anxiety, by using light to turn on or off literally cause or suppress firing of these exact connections across the brain that's a level of insight we never had before because we couldn't do that sort of precise experiment so this is an exciting time because we've gone beyond chemical imbalances to to the actual physical connections in the brain

it's absolutely extraordinary work honestly Honestly, it really is. And I wondered, do these threads, these different connections within the brain, do they help explain the kind of positive or negative internal state that people perhaps are prone to? They do. And this has been one of the most remarkable things

that we've discovered is we now understand exactly how value, positivity or negativity, can be added to or subtracted from even neutral things. It's just like we know when we have a cold, we no longer can smell or taste food as well. And it's always surprising when that happens how completely that whole realm of experience has just been deleted from our lives. In much the same way, people with depression, they cannot experience joy or pleasure or reward, even in things that are normally joyful to them. It's completely gone as completely as taste or

smell are deleted when you have a cold. And this is amazing. It's terrible. It's a source of great suffering and misunderstanding, but it's also quite amazing. How does that happen? And what we found is that there are specific connections that do indeed have the ability to add or subtract value, positive or negative value, and layer those on to even things that are completely neutral, that had no value at all. And this can happen instantaneously. And so this has been a very important insight that this value is just a physical and electrical, well-defined process like anything else in biology. And that will bring understanding. The hope is to communicate that to people.

So now when you have a friend or a loved one who is suffering from depression and is unable to be motivated to get up and do things that they normally would do, to do things that you would think any person should do and show the right level of joy at seeing your children or grandchildren even, now we can understand and relate and empathize to this is physical. This is gone now. And we're working on treatments, but it's gone. And it's not this person's fault.

It's a physical change in the brain. Get groceries delivered across the GTA from Real Canadian Superstore with PC Express. Shop online for super prices and super savings. Try it today and get up to $75 in PC Optimum Points. Visit superstore.ca to get started. You're a podcast listener, and this is a podcast ad heard only in Canada. Reach great Canadian listeners like yourself with podcast advertising from Libsyn Ads. Choose from hundreds of top podcasts offering host endorsements or run a pre-produced ad like this one across thousands of shows to reach your target audience with Libsyn ads.

Email bob at libsyn.com to learn more. That's B-O-B at L-I-B-S-Y-N dot com. And so in that, where does that come from? The sort of age old nature versus nurture question. Are we born predisposed to things how do we get to that point well there's certainly components of both there is of course the nature and the nurture aspects and i think an important thing about the book is to take that long evolutionary perspective though like how did we come as a species to be where we are now with certain predispositions to

feel a particular way in a particular situation? Well, the reason we're like that, the reason we tend to feel some things is that it was important for our forebears to feel that way at a particular time in a particular way. And so those who had a particular connection in the brain that made them feel a particular way at a particular time who had a particular connection in the brain that made them feel a particular way at a particular time, those did better. Those individuals survived their world better, were able to reproduce better. And those connections are set up by genes. There are genes that say during development of the brain, an outgrowing thread, a connection, we call this an axon from one neuron, one brain cell,

that's going to go all the way across the brain to another spot. That's guided by little molecules that are encoded by our DNA, by our genes. If different individuals have different versions of those genes, those threads will be guided in different ways across the brain. They might hit one spot in one person. They might go a little farther in another person and hit a different spot. And over time, depending on the world, what happens in the world, those who had the right connections in their brain that were best suited for their environment did better and ended up giving rise to us in the modern world. And so there's no question that nature is a huge part of it. We were set up by that process, by evolution. Whatever was working

better is how we are now. But there's also a great deal of changeability in the brain. We call this plasticity. People, individuals in the world, in their lives, their brains change, they learn, and they can build upon those connections that are pre-established. We can increase or decrease the power of those connections that were already established by evolution and development, but they can still be turned up or down in strength and in their power. And that happens through experience. It happens through teaching, through learning. And so there's hope that the connections themselves can be tuned somewhat. And how do you do that? What are you seeing

is able to increase those connections and likewise decrease them? Yes. So this now gets to the really exciting hope for the future. We're not at a point now where in human beings, we can reach in and turn up or down those connections instantaneously. There is hope for understanding. Once we know that the cells that are involved are the ones we should target, any kind of treatment, any kind of discovery, medical discovery now becomes more guided, more principled. We could now look for medications that instead of just changing the chemicals across the brain, as you mentioned earlier, this chemical imbalance idea, didn't really get to the specificity of connections in the brain. Now that we know, okay, it is a connection from point A to

point B that's involved, and maybe we find medications that can turn up or down the efficacy of that connection itself, then we can try to translate that to human beings and say, okay, instead of just treating your brain like soup and changing the levels of chemicals all across the brain, maybe we can give a more precise medication that will change the strength of one important connection in the brain, depending on a patient's symptoms. And so that's the hope for the future. We're not there yet, but now we have the foundation to get there. And aside from medication medication does anything else help improve the connections? Yes so the brain is a is a beautiful tunable device it changes with

experience it changes with conversation you and I our brains are changing as we're speaking right now and there's nothing more precise than words sentences and ideas in changing the operation of the brain and even its aspects of its physical structure. So people can learn, people can through experience, through therapy, through working the processing of emotions, through working on using insights into themselves to guide their behavior. People can actually train themselves to not have as extreme negative emotions, for example. This is something we use to treat anxiety and panic disorders. We can actually work on specific behavioral therapies,

specifically very, very precise insight-guided talk therapies that can help change those connections in the brain. So words are potent. Words are specific. They're right now the best tool we have to get into a specific connection in the brain in the long term i will be able to use medications as well wow that's extraordinary that words are that it's amazing to hear that from you that they're that powerful and so thinking about those changes and pathways i know in the book you talk about a few patients for example dealing with grief or kind of post-traumatic stress disorder and trauma

and the way that that changes the way that you're dealing with emotions and dealing with grief or kind of post-traumatic stress disorder and trauma, and the way that that changes the way that you're dealing with emotions and dealing with the world around you. So is it that those sort of, I don't know if extreme events is the right word, but as humans, as we process big changes in our state, big changes in our emotions, in our lives, that that again, really fundamentally changes the pathways and the connections. You know, we all, as we look at our lives, we look at moments that changed everything for us, and we all have them. And in the stories in the book, there are a number of those as well, even single moments where everything changed. And that's pretty interesting how that happens. You know, I recount how I became a psychiatrist, actually. I was planning to be a neurosurgeon, and I had always been interested in the source of human feeling, how it's so powerful, how emotions can be stirred by words.

But I thought that neurosurgery would give me the best access to the human brain to understand and to help treat patients. But then I had a, in an instant that was all changed for me in a single moment in a required psychiatry experience that I had as a medical student. And just seeing one psychiatric patient who was suffering from a terrible disorder called schizoaffective disorder, which is a whole storm of mania and depression and psychosis all wrapped up into one. And I remember the exact moment of looking at that patient and hearing him. He was yelling at me, in fact, at the moment. And I saw the suffering and I saw how completely we had no idea what was going on. And as a scientist, that also intrigued me as well. So it was the mix of the suffering and the mystery that completely upended my life in one moment. How does that happen? That I don't yet know, but there must have been some structural predisposition. You couldn't have complete rewriting of everything.

There had to be something there ready to go and then a switch that could have been flipped in some way to allow the new program to take over. And in other stories, that's a personal story, but there's another good example from the book. There was a patient who became manic after 9-11, September 11, 2001. And this was a person who, you know, he was a retirement age. He had been a successful insurance executive and had never had even the slightest bit of psychiatric dysfunction in his life or nor in his family. Nobody had. So out of the blue, this happened. He was on a trip in the Mediterranean and 9-11 happened. And two weeks later, he flipped into this state that we call mania,

which is a state of extremely high energy, speaking rapidly, not sleeping, having intense plans and risky behavior, supercharged charisma and outgoing connections to other people to a level that can be extreme and even harmful. And it was a full mania triggered by this world event. And, you know, here now, and this is how these extremes can help us understand ourselves. We now understand a little bit more about mania, which is part of bipolar disorder. And that gives us insight into how something can change so quickly, why, what structures might be involved. And optogenetics is giving us some insight into how these energy levels can change, how the reward-seeking, the goal-directed activity can change instantaneously.

So it's a convergence of these human stories and the science that is finally giving us some insight into how it happens. I find it extraordinary to think that the, I think for me, at least as I said, I keep coming back to the word empathy, but I think as you start to unravel this for us, it's very powerful to understand the fact that these connections in the brain start to affect so much of the way that we express ourselves, both physically and emotionally. And that's something, as you said, is changing your energy levels, for example. And I guess just, I was obviously hearing that example and hadn't actually put it together when I was reading the book. But as you said, obviously that is the mania is probably one end of the continuum of the conversation. But obviously

for so many people, there's been a lot of trauma and shock and anxiety and fear of the world event that we've just had or are currently having with COVID and the extremity of life of the last year. And would you imagine that again again perhaps on a smaller scale but that would have impacted on people's brains for the the fear and the anxiety and the kind of yeah I think for a lot of people the trauma yeah and there's no question it's all of the above there's fear anxiety trauma there's social isolation and we're already seeing this in psychiatry a worsening of symptoms it's I think'll have to see, once we collect data over a few years, we'll see are the disease numbers different in terms of the number of people suffering.

But there's no question that the symptoms are worsened by all of these issues. My patients coming to me now, almost all of them have a way of looking at their disorders, their disease, or their psychiatric issues that are all exacerbated, all worsened by the pandemic in very fundamental ways. A lot of them talking about the social isolation as a critical part of it, of course, compounded by, in many cases, the loss, the bereavement, the stress, trauma, anguish of the past year. So everybody is different now. There's no question about it. Symptoms are worse. Emotions surrounding the symptoms are worse. Now, how do we deal with this? The first step is understanding. And going forward, we have to look at each other

and support each other. We have to realize that everybody is suffering in a different way depending on their condition depending on the experiences they had and the second thing is to realize there may be changes in society that that result with the for example with everything that we've seen with the social uh upheaval with the isolation and then a rebound from that. Things may be different in the world, and we'll have to see. That's not going to be easy for people to adjust to as well. Psychiatry is going to have to play a big part in all of this going forward. People have worse symptoms and more extreme emotions about this. We don't know how long it will last and what the long-term impact on society will be. But I think people will turn to the science, I hope they'll turn to the science and say, okay,

what is the physical nature of these changes? What is the real biology behind it? And we'll understand each other and support each other better as a result. Thank you, Carl. Honestly, I think as you put it so succinctly there, as we start to actually understand what's going on, even in just such short terms as we've been talking about today, it gives such a better ability to relate to other people and empathize with other people and perhaps just be that little bit kinder to one another. If you had one closing thing, something that you wanted everybody to reassess when it comes to conversations around mental health, what would that be? You know, I think a theme of the book and a big reason I felt compelled to write it was for people to realize that there's this very deep commonality, that there's this

universality to our interstates that we have. And there's a reason that we have them. And these are shared, these interstates that we have, these inner feelings, they're more extreme in some people, less so in other people, but they're shared, they're universal, and not only all around the world, but far back in human history. These are the shared threads, it's the shared fabric of humanity. And we now know in many ways we can state exactly what these threads these connections are and i i would hope people would come away with a feeling of of unity from the book in a way that that brings all of humanity together across space and across time amazing yeah infinitely more connected than i think we often appreciate well carl thank you so so much for joining us today good luck with the book i'll put all the details in the show notes below

for anyone that's interested in learning more. It's an absolutely brilliant book. Thank you so much, Carl. Thank you, Ella. Delightful conversation. Please do share the episode with friends and family if you've enjoyed it and have a lovely, lovely Tuesday.

Thank you so, so much. Bye. You're a podcast listener, and this is a podcast ad heard only in Canada. Reach great Canadian listeners like yourself with podcast advertising from Libsyn Ads. Choose from hundreds of top podcasts offering host endorsements or run a pre-produced ad like this one across thousands of shows to reach your target audience with Libsyn ads. Email bob at libsyn.com to learn more. That's B-O-B at L-I-B-S-Y-N dot com.