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Wisdom Wednesdays: Compelling evidence for a psychophysiological approach to mental health · Hardiness with Dr Paul Taylor

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  Speaker 1: Hey, everybody, Welcome to another edition of Wisdom Wednesdays, and
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  Speaker 1: today I am going to explore a very interesting new
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  Speaker 1: study that shows a psychophysiological approach to mental health is
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  Speaker 1: more effective than a psychological approach on its own. So depression.
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  Speaker 1: We're going to talk about depression here. It affects more
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  Speaker 1: than three hundred and fifty million people globally, and it
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  Speaker 1: is difficult to treat, with up to one third of
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  Speaker 1: patients not responding to psychotherapy or antidepressants, and many can
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  Speaker 1: discontinuing and the treatment due to adverse effects, and they're
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  Speaker 1: mostly from the antidepressants, but there are also some adverse
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  Speaker 1: effects of psychotherapy. Now, Creating monohydrate, which you'll have to
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  Speaker 1: heard me talk about before, is a very well researched
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  Speaker 1: sports supplement. It's good for muscular performance and recovery, and
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  Speaker 1: you may have heard me talk about its effect on
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  Speaker 1: brain function. It has recently been shown to have a
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  Speaker 1: positive effect on brain function, and it is inexpensive and
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  Speaker 1: it's very very safe. It's had lots of studies done
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  Speaker 1: on its safety, and as I said, it's attracted recent
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  Speaker 1: attention because of its role in brain energy metabolism, and
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  Speaker 1: it's documented antidepressant like effects in pre clinical studies. And
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  Speaker 1: I think I've talked about this before. It's the study
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  Speaker 1: that showed that it was a small study, but it
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  Speaker 1: showed that creating was quite effective on its own as
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  Speaker 1: an antidepressant. Now, research shows that individuals with depression often
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  Speaker 1: have lower brain creating levels. They also have imperred cellular
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  Speaker 1: energy regulation and altered monomine functioning, so monomine being dopamine,
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  Speaker 1: serotonin and no adrenaline or if you're in America that's
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  Speaker 1: nowhere epinephrine. And there have been a number of small
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  Speaker 1: clinical trials that suggest that creating can actually enhance the
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  Speaker 1: effects of antidepressant drugs, but almost all of those didn't
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  Speaker 1: have a placebo control, and none of them have investigated
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  Speaker 1: creating as an adjunct to psychotherapy, particularly CBT now because
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  Speaker 1: CBT cognitive behavior therapy itself actually requires quite a lot
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  Speaker 1: of cognitive resources, because you've got to have really good
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  Speaker 1: attention on your thoughts, you're going to have good working memory,
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  Speaker 1: and then there's behavioral activation, which all of those require
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  Speaker 1: cognitive resources, and creating's impact on brain energy metabolism might
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  Speaker 1: theoretically promote better engagement and improve outcomes and this study
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  Speaker 1: that has very recently been published in the European the
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  Speaker 1: Journal of European Neuropsychopharmacology, investigated just that they wanted to
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  Speaker 1: test whether adding creating to CBT improved depressive symptoms versus
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  Speaker 1: CBT alone, and they also wanted to look at it's
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  Speaker 1: the feasibility of doing it, it's tolerability, and its safety.
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  Speaker 1: So they conducted an eight week double blind randomized placebo
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  Speaker 1: control trial. And what that means double blind means that
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  Speaker 1: the individuals didn't know what they were taking. Some of
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  Speaker 1: them were taking creating, some of them were taking a
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  Speaker 1: placebo that they thought was creating. But the researchers also
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  Speaker 1: didn't know. And this is important because researchers can either
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  Speaker 1: sometimes deliberately if they're a bit dodgy, or just kind
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  Speaker 1: of accidentally, you know, in encourage people are having have
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  Speaker 1: biases towards the people who are getting the intervention if
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  Speaker 1: they know who's getting the intervention. So double blind is
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  Speaker 1: the gold standard. And they did it with one hundred adults,
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  Speaker 1: so pretty good sample size. Their men age was thirty
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  Speaker 1: and this was in India, and they met all of
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  Speaker 1: the participants met the DSM five criteria. For major depression.
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  Speaker 1: So we're not talking mindary depression. This is major depression.
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  Speaker 1: They had PHQ nine scores of greater than five. That's
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  Speaker 1: a depressive depression survey, and they were not taking a
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  Speaker 1: psychotropic medication. They were then randomized to a group that
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  Speaker 1: got creating plus CBT, and they got five grams a
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  Speaker 1: day of oral creating monohydrate plus. They got bi weekly,
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  Speaker 1: so once a fortnite individual CBT sessions with the psychotherapist
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  Speaker 1: and then the placebo group they had five grams a
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  Speaker 1: day of starch placebo and in the same CBT protocol.
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  Speaker 1: I wonder why they did five grams a day because
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  Speaker 1: recent research has shown that actually optimizing brain function is
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  Speaker 1: up there about twenty grams a day. So I love
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  Speaker 1: to have seen them. Maybe they'll do other studies where
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  Speaker 1: they'll give a higher dose because some researchers think that
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  Speaker 1: for a lot of the first five grams is going
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  Speaker 1: to get hoovered up by the muscle. But anyway, so
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  Speaker 1: the CBT was delivered at weeks zero, two, four, six,
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  Speaker 1: and eight by a registered clinical psychologist and they actually
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  Speaker 1: used Be's low intensity CBT model that consisted of psycho education,
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  Speaker 1: cognitive restructuring, and behavioral activation actually getting shit done. Outcomes
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  Speaker 1: were measured at each visit and they included doing the
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  Speaker 1: PHQ nine again and asking them about adverse events and
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  Speaker 1: the results. Then, both groups showed meaningful improvement in depression,
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  Speaker 1: which is consistent with typical CBT effects. However, the creating
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  Speaker 1: plus CBT group almost doubled the effectiveness the PHQ nine
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  Speaker 1: reduced to five point eight that's in the mild range
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  Speaker 1: in the creating arm, versus eleven point nine which is
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  Speaker 1: moderate range in the placebo orm. Now, this is this
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  Speaker 1: is what we call clinical significance, right, And often when
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  Speaker 1: they look at antidepressants, they have statistical significance, but not
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  Speaker 1: clinical significance. Clinical significance means does the individual notice a
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  Speaker 1: significant difference in themselves, not fancy statistics. Does the individual notice?
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  Speaker 1: And going from moderate to mild would certainly be clinical significance.
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  Speaker 1: So this is pretty damn good. I think it's a
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  Speaker 1: pretty amazing study that you can double the effectiveness of
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  Speaker 1: CBT just by abbing five grams a day of creating,
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  Speaker 1: And like I said, if they did more, I suspect
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  Speaker 1: there might even be a bigger thing. Now, drop out
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  Speaker 1: rates were high about forty percent in both arms. Likely
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  Speaker 1: influenced by COVID nineteen disruptions because this was actually the
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  Speaker 1: study took place during when there was a lot of
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  Speaker 1: COVID around, but there weren't different between groups, right, So
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  Speaker 1: I think they're probably suggesting that it was COVID. It
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  Speaker 1: wasn't the intervention itself. Adverse events were common, but mild
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  Speaker 1: and similar in total number. There was a bit of
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  Speaker 1: gas owintestinal symptoms, constipation, diarrhea, dominald discomfort, and muscle cramps
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  Speaker 1: were somewhat more frequent in the creating group, so some
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  Speaker 1: of the placebo group actually got some of these things,
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  Speaker 1: but they weren't significant side effects. There was no episodes
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  Speaker 1: of suicidality or mania actually occurred, So one of the
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  Speaker 1: researchers think was going on. There's this few biological and
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  Speaker 1: cognitive mechanisms that could explain the additive effect of creating.
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  Speaker 1: The first I alluded to at the start, which has
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  Speaker 1: improved brain energy metabolism. So creating, if you don't know
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  Speaker 1: that increases FOSPHL creating availability and ATP buffering. So ATP
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  Speaker 1: is the energy currency, and one of our energy systems
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  Speaker 1: is the ATPPC system. Fosphil creating, and then we have
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  Speaker 1: aerobic and then we have anaerobic. So basically the extra
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  Speaker 1: creating supported the energy demands of the neurons. Depressed individuals
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  Speaker 1: often show reduced prefrontal creating. This is really significant. And
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  Speaker 1: then the supplementation obviously may well restore metabolic function in
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  Speaker 1: regions necessary for emotional regulation and the cognitive work that's
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  Speaker 1: required for CBT. The next thing is the modulation of
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  Speaker 1: the monomine systems, so that's the serotonin, the dopamine, the
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  Speaker 1: nohare adrenaline slash no epinephyrine in antidepressant treatments. Right. Then
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  Speaker 1: the other suggestion was there's neuroprotective effects. Creatine actually reduces
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  Speaker 1: oxidative stress, it reduces apoptosis or cell death, it reduces neuroinflammation,
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  Speaker 1: and they are all implicated in the pathophysiology of depression.
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  Speaker 1: And then the last one and possible mechanism is facilitation
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  Speaker 1: of cognitive processes. So there's one other randomized control trial
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  Speaker 1: that reported cognitive improvements with creating in bipolar depression, and
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  Speaker 1: enhance cognitive flexibility or working memory may well amplify cbt's effectiveness.
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  Speaker 1: So in conclusion, this for me is more evidence that
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  Speaker 1: we can't just have a psychological approach to mood disorders.
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  Speaker 1: We need to have a psychophysiological because the physiology is
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  Speaker 1: hugely important and in fact outperforms psychotherapy. It outperforms antidepressant
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  Speaker 1: when you take exercise alone, it outperforms all of those
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  Speaker 1: creating is as effective as antidepressants. And here you can
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  Speaker 1: see it's doubling the effect of CBT. And you add
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  Speaker 1: in sleep, hygiene, good food, all of those things, it
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  Speaker 1: will be so much more effective than just doing psychotherapy
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  Speaker 1: or antidepressants. So this is yet another research paper that
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  Speaker 1: is really calling for that integrated approach to mental health
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  Speaker 1: disorders and not just looking at the brain or the
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  Speaker 1: mind as this isolated part of the system, because nothing
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  Speaker 1: is isolated in the system, that is the human being.
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  Speaker 1: So that's it for this week, folks, catch you next time.