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How Antidepressants Work · Stuff You Should Know

0:01
Speaker 1: Welcome to Stuff You Should Know, a production of iHeartRadio.
0:11
Speaker 2: Hey, and welcome to the podcast. I'm Josh, and there's
0:13
Speaker 2: Chuck and Jerry's here too. Well. Actually, that's not true,
0:17
Speaker 2: isn't it. It's a dirty, dirty lie.
0:19
Speaker 1: You're talking about.
0:19
Speaker 2: It's just me and Chuck. We're producing our own jam today.
0:25
Speaker 2: I guess you could say, and this is stuff you
0:27
Speaker 2: should know.
0:28
Speaker 1: That's right, and the listener will never hear where we
0:31
Speaker 1: edit out when Jerry burst into the room in two minutes.
0:36
Speaker 1: We'll just cut that out nice and clean.
0:38
Speaker 2: We should just leave it in once, just a really
0:40
Speaker 2: kind shure.
0:41
Speaker 1: Yeah, guys.
0:42
Speaker 2: Uh, she's got like a little bit of miso in
0:46
Speaker 2: the corner of her mouth.
0:47
Speaker 1: Oh, always a little crusty miso.
0:50
Speaker 2: So Chuck. Today, we are doing something in grand Stuff
0:55
Speaker 2: you should Know Fashion. We're doing a tangential episode where
1:02
Speaker 2: we haven't done like the core episode that it relates to.
1:06
Speaker 1: Have We never done one on depression.
1:09
Speaker 2: Actually, I could not believe. I looked on the stat
1:13
Speaker 2: sheet maintained by Jill Hurley, which is infallible. I looked
1:17
Speaker 2: all over the internet. I sat there and had a
1:21
Speaker 2: conversation with myself. Nothing. It's not there.
1:26
Speaker 1: Yeah. I mean that's so like us to hit stuff
1:29
Speaker 1: like bipolar first.
1:31
Speaker 2: Yeah. Yeah, we did do bipolar, we've done PTSD, we've
1:34
Speaker 2: done ADHD obviously all that, but we'll definitely do depression
1:39
Speaker 2: at some point.
1:41
Speaker 1: Okay, I think it makes sense maybe to cover this first.
1:44
Speaker 1: So how about that?
1:46
Speaker 2: Sure? Think it to me?
1:47
Speaker 1: Yeah, put that in your paulm and wash it down
1:50
Speaker 1: with some water. How's that for a segue?
1:53
Speaker 2: Oh that was a good one. That was great man.
1:56
Speaker 2: So yeah, we're talking about antidepressants. That was a great one.
1:59
Speaker 1: Thanks.
2:00
Speaker 2: And to talk about antidepressants, we really do have to
2:03
Speaker 2: kind of give at least the briefest overview of what
2:05
Speaker 2: depression is.
2:06
Speaker 1: Like.
2:08
Speaker 2: It's kind of everywhere. I saw something like sixty million
2:12
Speaker 2: adults in America and I think they define that over
2:15
Speaker 2: age eighteen these days for this kind of stuff have
2:19
Speaker 2: some sort of diagnosed depression. I think twenty million of
2:27
Speaker 2: those have major depressive disorder, which also is called clinical
2:33
Speaker 2: depression or unipolar depression, as opposed to say, like bipolar
2:37
Speaker 2: where you have ups and downs, mania and depression unipolars
2:41
Speaker 2: like just depression. And it apparently is picking up so
2:46
Speaker 2: much that the World Health Organization is saying like, hey, guys,
2:49
Speaker 2: by twenty thirty, that will be the leading disease essentially
2:54
Speaker 2: in the entire world. Depression will be just the way
2:57
Speaker 2: that things are going and everyone in the world. I
3:00
Speaker 2: was like, yeah, you know, and it just kind of
3:03
Speaker 2: is going from there.
3:05
Speaker 1: Yeah, I mean, that's a good overview, you know, without
3:08
Speaker 1: getting into the weeds as far as numbers go. Symptoms
3:14
Speaker 1: as you might imagine are they're sad, disrupted sleep, feeling
3:22
Speaker 1: like you're worthless. Sometimes it affects your concentration. Sometimes it
3:27
Speaker 1: affects your ability to even experience pleasure at all. Even
3:32
Speaker 1: you know, when you're you know, doing something that might
3:36
Speaker 1: ordinarily be fun for you, it's not fun. It's not
3:41
Speaker 1: being sad in a moment or being blue for a
3:44
Speaker 1: little while. It is a persistent thing where it disrupts
3:48
Speaker 1: your life. It interferes with your life. It can interfere
3:51
Speaker 1: with your relationships and interfere with your relationship with yourself
3:55
Speaker 1: in a big, big way.
3:56
Speaker 2: Yeah, and for a lot of people, I think for
3:59
Speaker 2: most people, statistically speaking, it's chronic or recurring. You don't
4:04
Speaker 2: just have one episode. It can keep coming back and back,
4:08
Speaker 2: and it's nothing new like depression is not new, although
4:11
Speaker 2: it does it has really kind of picked up as
4:14
Speaker 2: far as diagnoses and prescriptions go. But I mean, we
4:17
Speaker 2: used to call it melancholy and they associated it with
4:20
Speaker 2: black bile all the way back to Hippocrates. And depending
4:25
Speaker 2: on what culture you were from, they would either say
4:29
Speaker 2: tell you that you needed positive rewards. It's say you
4:32
Speaker 2: lived in Persia in the ninth century, or if you
4:35
Speaker 2: were in medieval Europe, they might burn you at the
4:38
Speaker 2: stake or something like that. Luckily, we've come a long
4:42
Speaker 2: way with treating depression. That's the that's I think we
4:46
Speaker 2: should say here at the outset. That's the message we're
4:48
Speaker 2: trying to say, like it is highly treatable. Like if
4:52
Speaker 2: you have depression and you're you're not treating it, there's
4:55
Speaker 2: definitely hope, So please don't feel like there's not. There's
4:59
Speaker 2: plenty any of hope that if anything, hopefully. That's what
5:02
Speaker 2: we get across this in this episode. But there used
5:06
Speaker 2: to be they used to give people edemas, they used
5:08
Speaker 2: to give people baths, positive thinking, diet, exercise, And what's interesting,
5:13
Speaker 2: Chuck is some of those are still prescribed today. Depending
5:16
Speaker 2: on the severity of your.
5:17
Speaker 1: Depression, yeah, for sure, and those things very much help.
5:22
Speaker 1: And I'm glad you said that what you said just
5:24
Speaker 1: a second ago, because when I said, I sounded very
5:27
Speaker 1: very down when I said that the symptoms are and
5:31
Speaker 1: I pause and just said sad. There is a lot
5:34
Speaker 1: of hope. But you know, I have everybody you know
5:38
Speaker 1: has if they don't suffer from the depression. You have
5:41
Speaker 1: people in your life and your family and your friends
5:44
Speaker 1: that do it. And it makes me very sad because
5:46
Speaker 1: these are, you know, great people who have a hill
5:51
Speaker 1: they need to consistently hike up. And I imagine it
5:55
Speaker 1: is something that drains your life force. And we're here
5:59
Speaker 1: to talk talk about some of the ways that you
6:01
Speaker 1: can change that.
6:03
Speaker 2: Yeah, just as an aside, every time I think of
6:06
Speaker 2: depression being like really accurately portrayed, I think of Kirsten
6:11
Speaker 2: Dunst in Melancholia, the large von Trier movie. Yeah, Lars
6:15
Speaker 2: von Trier, of all people, seems to have most accurately
6:18
Speaker 2: portrayed clinical depression in that movie. It is a great movie,
6:23
Speaker 2: but she just does an amazing job. Like there's a
6:26
Speaker 2: part where she's just in physical pain, such physical pain
6:30
Speaker 2: from being so depressed that like she can barely crawl
6:34
Speaker 2: into a bath.
6:36
Speaker 1: Yeah, it's really so.
6:37
Speaker 2: It's hard to watch.
6:38
Speaker 1: That was a one timer for me. Yeah, not the
6:41
Speaker 1: kind of movie you watch over and over. But Lars
6:45
Speaker 1: Lars von Trier can make a great, great plack and
6:47
Speaker 1: I love Kirstend She's great for sure.
6:50
Speaker 2: So we should say that you rarely will get an
6:53
Speaker 2: enema when you present yourself to a physician and are
6:57
Speaker 2: diagnosed with clinical DEPRESSI major depressive disorder. Instead, they will
7:03
Speaker 2: prescribe you pills antidepressants. And the reason that they will
7:07
Speaker 2: prescribe you any depressant is because, ever since the seventies,
7:10
Speaker 2: people have kind of basically treated depression based on what's
7:15
Speaker 2: called the biological model. And the biological model says that
7:19
Speaker 2: you're depressed because there's an imbalance of neurotransmitters chemicals in
7:24
Speaker 2: your brain, and usually they zero in on serotonin. They
7:28
Speaker 2: say you are depressed because you have low levels of serotonin.
7:33
Speaker 2: And that's been the dominant view for decades now. That's
7:37
Speaker 2: how we treat depression as based on that presumption.
7:40
Speaker 1: Yeah, and it's accepted, and it's not like it's accepted with,
7:44
Speaker 1: you know, through gritted teeth. I think most people agree
7:46
Speaker 1: That's what most people agree on, is they don't really
7:50
Speaker 1: understand what might be the underlying issue or the mechanism
7:54
Speaker 1: behind that is. We do know like a lot of
7:58
Speaker 1: the things that may lead to depression. If you're a woman,
8:03
Speaker 1: you're more likely to get would you call it MDD?
8:07
Speaker 2: Yeah, major depressive disorder.
8:09
Speaker 1: Yeah, major depressive disorder if you have suffered a loss
8:13
Speaker 1: or unresolved grief, and these are things that can compound.
8:17
Speaker 1: It's not like, again, that's different than being sad about
8:20
Speaker 1: you know, losing a loved one or something like that,
8:23
Speaker 1: but it can help contribute to MDD. Same as if
8:25
Speaker 1: you suffer through a stress early in your life, that
8:28
Speaker 1: can all contribute. So we know some of those things,
8:31
Speaker 1: but we don't know that underlying mechanism that actually causes it.
8:35
Speaker 1: And because that, we don't exactly know how antidepressants work.
8:41
Speaker 1: We know that they do work, and we know what
8:43
Speaker 1: they do, but if you really don't know the underlying cause,
8:47
Speaker 1: you can't just say like, yeah, we have antidepressants completely
8:49
Speaker 1: figured out because we know they work and we know
8:51
Speaker 1: how they function.
8:53
Speaker 2: Yeah. So much so we have so little of a
8:55
Speaker 2: grasp on how people become depressed, especially like depressed. That
9:03
Speaker 2: studies show that people with MDD don't have aren't likely
9:08
Speaker 2: or to have lower levels of serotonin than other people,
9:13
Speaker 2: and that just throws out basically the whole premise of
9:16
Speaker 2: the biological model. And yet we know that antidepressants work,
9:20
Speaker 2: They work better than placebo. They're definitely doing something, and
9:24
Speaker 2: we know that by design what they're doing is going
9:27
Speaker 2: in and messing with the concentration of neurotransmitters in your brain.
9:33
Speaker 2: We know they're doing that. We just don't know how
9:35
Speaker 2: that mechanism is treating the depression. We just know it works.
9:40
Speaker 2: And I guess over the years psychologists or psychiatrists and
9:45
Speaker 2: doctors have been like, let's just not ask questions.
9:48
Speaker 1: Well, thankfully we know that's not one hundred percent true
9:53
Speaker 1: because they are still studying and trying to figure this out.
9:56
Speaker 1: There was a study that I guess you dug this
9:58
Speaker 1: one up from last year from the University of Colorado,
10:01
Speaker 1: Go Buffalo's that hypothesize that increasing well, increasing serotonin, we
10:10
Speaker 1: know that alleviate symptoms, but it's not like it's just
10:14
Speaker 1: rebalancing your brain and picking up a level that you
10:18
Speaker 1: had that was low. They are saying from the study
10:22
Speaker 1: that maybe it's helping to repair the neuroplasticity in the
10:25
Speaker 1: brain and just sort of like their brain circuits that
10:29
Speaker 1: become just sort of stuck and lodged in that depressed state,
10:32
Speaker 1: and it helps to unstick those.
10:35
Speaker 2: Yeah, that's a newish from what I can tell. Rival
10:38
Speaker 2: theory to the biological model. Even though it's biological itself.
10:43
Speaker 2: It's very very confusing stuff. But the idea remember you
10:47
Speaker 2: said earlier that like you differentiate you know, MDD or
10:52
Speaker 2: even just non major depression, but you know diagnosable depression
10:57
Speaker 2: from just a passing feeling of the blues right for
11:02
Speaker 2: like a day or so.
11:03
Speaker 1: Yeah, or mood swings you might call it whatever.
11:05
Speaker 2: Sure, So this theory basically says that thing that people
11:10
Speaker 2: normally come out of people get stuck and it just
11:13
Speaker 2: seems to get worse and worse and worse the longer
11:16
Speaker 2: you're stuck in it, or the harder you're stuck in it.
11:19
Speaker 2: So that's a I love that theory, and there's actually
11:23
Speaker 2: support for it because some of the newer, more far
11:28
Speaker 2: out treatments psychedelics in particularly like ketamine and psilocybin, they
11:33
Speaker 2: have been basically irrefutably shown to treat major depressive disorder
11:40
Speaker 2: really well. And we know that psilocybin, for example, goes
11:45
Speaker 2: in and basically rewires your brain. So that would support
11:49
Speaker 2: the idea that it's a change in neuroplasticity that you
11:52
Speaker 2: need a pressance create that helps treat depression.
11:55
Speaker 1: Yeah, for sure. And we also know you know you
11:58
Speaker 1: mentioned serotonin and nora epernephrine and and you know, messing
12:02
Speaker 1: or balancing out the brain chemistry. What's what's literally going
12:06
Speaker 1: on and what they're designed to do. Antidepressants that is,
12:09
Speaker 1: and we're going to talk about I guess all of
12:11
Speaker 1: them probably right by god, we are, Uh. They interfere
12:16
Speaker 1: what's what's called the synaptic transmission of these things of
12:19
Speaker 1: serotonin and norepinephrine, dopamine.
12:22
Speaker 2: Uh.
12:22
Speaker 1: And that transmission is is the movement of neurotransmitters from
12:27
Speaker 1: one neuron to another. They're they're they're leaping from one
12:30
Speaker 1: to another, they're talking to each other, they're getting to
12:33
Speaker 1: know one another. And it's that transmission that we know
12:38
Speaker 1: is what antidepressants affect.
12:40
Speaker 2: Right, That's where the money is. They go to the
12:44
Speaker 2: horse's mouth, that's another word for the synapse. That's that's
12:49
Speaker 2: what we're all just call it the horse's mouth.
12:50
Speaker 1: That's right, with the ultimate goal for all of these
12:53
Speaker 1: to increase levels of of those things usually I mean
12:59
Speaker 1: some neuro epineph and as you'll see as we talk about,
13:01
Speaker 1: but more along the lines of serotonin.
13:05
Speaker 2: Right. Here's the twist to all that. Though neurotransmitters do
13:09
Speaker 2: all sorts of other things besides say, like regulate your mood.
13:14
Speaker 2: I think serotonin does all sorts of crazy stuff like
13:17
Speaker 2: it helps regulate sleep, digestion, nausea, blood clotting, bone growth,
13:23
Speaker 2: It does everything right, So if you start messing with
13:26
Speaker 2: the serotonin in your brain, it can also start to
13:29
Speaker 2: mess with the other functions that serotonin does. Hence side effects,
13:35
Speaker 2: and so those are something that we are still figuring
13:38
Speaker 2: out too. But luckily that's another thing we're getting a
13:41
Speaker 2: handle on, is the side effects.
13:44
Speaker 1: That feels like a good break point. That's a big
13:47
Speaker 1: old table setting.
13:48
Speaker 2: Yeah, yeah, yeah. We've got a dessert knife and a
13:52
Speaker 2: butter knife.
13:53
Speaker 1: I don't know which is, witch pal, can you help
13:55
Speaker 1: me out.
13:55
Speaker 2: The dessert knife is a little smaller, fancy er. It's
13:58
Speaker 2: got a kind of a sharp point and that you
14:01
Speaker 2: could easily drive through the hand of the person sitting
14:04
Speaker 2: next to you at the.
14:05
Speaker 1: Table, Well, I no, I mean when I reach for
14:07
Speaker 1: the wrong one, just give my hand a little smack.
14:09
Speaker 2: I'll drive my dessert knife through your hand.
14:11
Speaker 1: Have perfect? All right, Well, we'll be right back and
14:14
Speaker 1: start off with the star of the show, the SSRI.
14:53
Speaker 1: All right, so we promised to start off with SSRIs,
14:56
Speaker 1: and we're starting off with that. We're kind of gonna
14:58
Speaker 1: jump around, starting with the most frequently prescribed sort of
15:02
Speaker 1: modern version of antidepressants, and then we'll jump back in
15:06
Speaker 1: time and talk about drugs that you know, maybe your
15:10
Speaker 1: parents took, who knows, but these came around in the
15:14
Speaker 1: mid nineteen eighties. I think the very first one to
15:18
Speaker 1: become to become available was fluoxetine in nineteen eighty eight.
15:25
Speaker 1: And we're gonna, I guess we'll say both their regular
15:29
Speaker 1: name and their trade name or trademark name, just so
15:32
Speaker 1: everyone knows kind of what we're talking about.
15:34
Speaker 2: Yeah, so the people who take them can like be like, yeah.
15:36
Speaker 1: Yes, fluoxetine is prozac, paroxetine is paxel, sertraline is zoloft,
15:46
Speaker 1: fluvoxamine is lubox. These are the challenge for me, I
15:53
Speaker 1: appreciate Ititalopram is selexa and why don't you take that
16:00
Speaker 1: lex lexapro for me? What is that escalopram escatala pram
16:05
Speaker 1: Oh Okay, I just had a little yes at the
16:07
Speaker 1: beginning of that.
16:07
Speaker 2: You did fantastic. My favorite on all of them is
16:10
Speaker 2: flu voxamine.
16:12
Speaker 1: Yeah, that's a good word.
16:14
Speaker 2: I like all those letters together like that. It's great. Yeah,
16:16
Speaker 2: and I'm not saying the drug itself, just the GG.
16:20
Speaker 1: Yeah. So these are the SSRIs that are going to block.
16:24
Speaker 1: They're called re uptake inhibitors, and what that means is
16:26
Speaker 1: they're going to block that that bus trip that serotonin
16:30
Speaker 1: takes back to that original cell, the pre synaptic cell,
16:35
Speaker 1: the one who sent that transmission, huh, and it leaves
16:38
Speaker 1: it floating around in that space in between. I believe
16:41
Speaker 1: that's probably you that said that's where all the action happens. Yes,
16:45
Speaker 1: but that's in the what's called the synaptic cleft. So
16:48
Speaker 1: it sends that that serotonin out and when it comes back,
16:51
Speaker 1: instead of uptaking it or re uptaking it, it blocks
16:54
Speaker 1: that from happening. So that just means there's more of
16:57
Speaker 1: it where you need it.
16:58
Speaker 2: They're just hanging out there like, where's my uber?
17:01
Speaker 1: Yeah?
17:02
Speaker 2: Exactly, So that was lame. I'm sorry, everybody.
17:06
Speaker 1: Pretty good, it's an uber share.
17:09
Speaker 2: There is so many other things I could have said,
17:11
Speaker 2: and I just I don't know. I couldn't come up
17:13
Speaker 2: with anything better.
17:14
Speaker 1: You're trying to wedge ind jokes in an unfunny episode.
17:17
Speaker 2: Okay, thank you for that.
17:19
Speaker 1: That's what we try and do, wedgend jokes where they're
17:22
Speaker 1: not appropriate.
17:24
Speaker 2: So that's what that's specifically what you just said. Ssriyes too,
17:28
Speaker 2: And they live up to their name essentially.
17:31
Speaker 1: Yeah. I don't think I even read out what it
17:33
Speaker 1: stands for. Selective serotonin reuptake inhibitor or I may have,
17:36
Speaker 1: but there is I.
17:37
Speaker 2: Think you did. But yes, So they specifically focus on
17:41
Speaker 2: serotonin and they prevent its reuptake from the synapse that
17:45
Speaker 2: senate or the neuron that scent it out right. So
17:50
Speaker 2: the great thing about SSRIs is that they work really, really,
17:53
Speaker 2: really well on most people with the fewest side effect
17:58
Speaker 2: and it's in part because they selectively target serotonin. And
18:03
Speaker 2: despite the fact that there's fewer side effects and fewer
18:06
Speaker 2: people than other types of antidepressants, some people do not
18:11
Speaker 2: respond particularly well to it. It depends on the brand.
18:17
Speaker 2: Not necessarily the brand, but the type of drug. I mean,
18:20
Speaker 2: all of the SSRIs aren't exactly the same. So if
18:23
Speaker 2: one's not working for you, you can try another one,
18:26
Speaker 2: and another one, another one, and if that doesn't work,
18:28
Speaker 2: then you might move on to another class of antidepressants.
18:31
Speaker 2: But from what I can tell, SSRIs are essentially still
18:36
Speaker 2: today like basically the the flagship antidepressant, if there is
18:41
Speaker 2: such a thing.
18:43
Speaker 1: Yeah, I think you're right, And I think that when
18:46
Speaker 1: it comes to getting that if you're on more than one,
18:50
Speaker 1: either that cocktail right or that single ssri correct, that
18:55
Speaker 1: is where your doctor comes into play. But that even
18:58
Speaker 1: though I've never been through this, I've been a plenty
19:00
Speaker 1: of people who have, I believe it's safe to say
19:02
Speaker 1: that's also where you come into play though as advocating
19:06
Speaker 1: for yourself in concert with your doctor.
19:10
Speaker 2: Right for sure?
19:12
Speaker 1: Is that a good way to say that?
19:13
Speaker 2: It is? And patient education is a really important part
19:16
Speaker 2: of treating depression. Like it's not one of those things
19:19
Speaker 2: where you just turn up and say what you know here,
19:22
Speaker 2: treat me like you're going to be armed with a
19:24
Speaker 2: lot of stuff on how to help yourself too. And
19:26
Speaker 2: I guarantee you they're going to say, exercise every day
19:30
Speaker 2: for twenty thirty minutes a day will be one of
19:32
Speaker 2: the things that they say because it works so well,
19:37
Speaker 2: it's crazy what it does. Yeah, And that's part of
19:40
Speaker 2: also treating things with any depressants is if you are
19:44
Speaker 2: suffering from major depressive disorder, you probably can't get yourself
19:48
Speaker 2: up in exercise, right, So on ndepressants increases the chances
19:54
Speaker 2: that you can exercise, and then that just makes it
19:57
Speaker 2: even more effective.
19:59
Speaker 1: Yeah. I if you suffer from depression and you feel
20:02
Speaker 1: a little lost and you are a fan of comedy,
20:07
Speaker 1: I can highly highly recommend the great comedian Gary Golman.
20:11
Speaker 1: He's a comedian who has he's been around a long
20:14
Speaker 1: long time and it's not like that's his act, but
20:16
Speaker 1: he did have one tour in one sort of set
20:19
Speaker 1: where he really really dug into this and one special
20:22
Speaker 1: and then lately he wrote about it in his book,
20:25
Speaker 1: which is great. I read the book. This is all
20:27
Speaker 1: about his childhood growing up. But lately on Instagram he
20:30
Speaker 1: has been posting just daily things he's kind of written
20:34
Speaker 1: down on a paper that helped him when he was
20:36
Speaker 1: at his darkest. And you take a walk things like that,
20:40
Speaker 1: but drilled down and got more specific and advice on
20:45
Speaker 1: if you're a friend of someone like what you can do, Like,
20:47
Speaker 1: it's really really, really helpful. So Gary Goleman's awesome, and
20:50
Speaker 1: I encourage you to check out that Instagram. As silly
20:53
Speaker 1: as that sounds, it can really help.
20:56
Speaker 2: It doesn't sound silly at all.
20:58
Speaker 1: Well, anytime you're like, oh, go to a social media
21:00
Speaker 1: thing and look at what this comedian said, but you
21:02
Speaker 1: know what I mean.
21:04
Speaker 2: No, I still don't think it was Kelly. I think
21:06
Speaker 2: it was a great shout out for sure.
21:08
Speaker 1: Good.
21:09
Speaker 2: So a couple more things real quick on SSRIs before
21:12
Speaker 2: we move on. They have fluoxetine in particular, Prozac has
21:17
Speaker 2: a long half life. Yeah, so you can get away
21:21
Speaker 2: with just one dose, which you're like, who cares one
21:23
Speaker 2: a day? Yeah, but that actually decreases your chances of
21:26
Speaker 2: missing a dose. So that's a good thing. And then
21:29
Speaker 2: one of the other things too is when you go
21:31
Speaker 2: to the doctor, especially if you're a kid, they start
21:34
Speaker 2: treating you with any depressants, they're going to start out
21:36
Speaker 2: really really low dose and just kind of slowly move
21:38
Speaker 2: it up and as you get adjusted to it, it
21:41
Speaker 2: cuts down on the chances of side effects, but there
21:43
Speaker 2: can be side effects with SSRIs, from anxiety to sexual
21:47
Speaker 2: dysfunction to vertigo. So I mean you need to go
21:51
Speaker 2: into it understanding what you're facing. But a good psychiatrist
21:55
Speaker 2: or doctor will be like, Okay, let's just do this
21:57
Speaker 2: a little at a time to get you on your
22:00
Speaker 2: feet as gently as possible.
22:02
Speaker 1: Yeah, for sure. All right, So that's a quick overview
22:06
Speaker 1: of the SSRIs and how they work. Now we're gonna
22:08
Speaker 1: move on to we're gonna jump back in time, getting
22:12
Speaker 1: the way back machine. That's fun.
22:13
Speaker 2: Okay, let's do it.
22:21
Speaker 1: To the nineteen fifties and sixties when tricyclic antidepressants made
22:27
Speaker 1: their debut.
22:29
Speaker 2: Yes, those were some of the first, but not the
22:32
Speaker 2: first strangely, but these were really kind of early pioneering
22:39
Speaker 2: antidepressants that they worked on serotonin. That was kind of
22:43
Speaker 2: their goal. They were a reuptake inhibitor as well. The
22:48
Speaker 2: problem with these things are is that they weren't selective.
22:54
Speaker 2: That's why SSRIs are just so desirable. Tricyclic antidepressants are
22:58
Speaker 2: just like, come me here a neurotransmitter and they kind
23:02
Speaker 2: of dry homp the neurotransmitter, no matter what kind of
23:05
Speaker 2: neurotransmitter it is, and prevent it from being taken back
23:09
Speaker 2: up again.
23:10
Speaker 1: All right, there's one way to put it. All right,
23:13
Speaker 1: We're gonna name these and these again might be things
23:15
Speaker 1: you saw if you're a gen xer, you might have
23:19
Speaker 1: seen them in your in your grandparents medicine cabinet.
23:23
Speaker 2: Even Yeah, you probably associate these names with the smell
23:26
Speaker 2: of moth balls.
23:28
Speaker 1: That's right, exactly. Let me see here. Here's the first one.
23:31
Speaker 1: Nor nor try, nor tripetilen nor trip to Lene.
23:37
Speaker 2: These are no SSRIs.
23:39
Speaker 1: Jeez, I even practice these, nor trip to Lene. Why
23:40
Speaker 1: am I getting all these? That's pamelaura. How about you
23:42
Speaker 1: take the next one?
23:44
Speaker 2: I I can't.
23:45
Speaker 1: Yeah, sure you can.
23:47
Speaker 2: Protelene that's the brand names even worse, ludio mil Yeah,
23:55
Speaker 2: does a prey mean? That's nord Promean is the brand name?
23:59
Speaker 2: Am a trip to lean a little bit job? Yeah,
24:03
Speaker 2: clametpramine that does not roll off the tongue. That's anapernil,
24:07
Speaker 2: and then emipremine, which is trophonil. I've never heard of
24:12
Speaker 2: any of these, but they apparently work fairly well. It's
24:18
Speaker 2: just the side effects that are really problematic. I mean, strangely,
24:22
Speaker 2: they treat it just as well as Ssriyes, but again
24:27
Speaker 2: they treat everything, all the neurotransmitters, and because as we've seen,
24:31
Speaker 2: neurotransmitters perform more than one function in the body, they
24:35
Speaker 2: have a whole host of side effects that you just
24:38
Speaker 2: don't want it.
24:39
Speaker 1: Yeah, I mean, yeah, we could go through them, but
24:42
Speaker 1: it sounds like one of those commercials, but you're way
24:44
Speaker 1: more likely to experience those with those than the ssries.
24:49
Speaker 1: It's also they were the tricyclic were easier to overdose on. Yeah,
24:55
Speaker 1: and you're just not going to see them a lot
24:57
Speaker 1: for depression these days. They're still around. I think orpathic
25:00
Speaker 1: pain is something they found use for. Yeah, and if
25:04
Speaker 1: you you know, if you don't tolerate SSRIs, they might say,
25:07
Speaker 1: you know, they might pitch you a drug from the
25:09
Speaker 1: nineteen fifties.
25:10
Speaker 2: Right that has I saw a black box warning that
25:14
Speaker 2: the FDA slapped on it that's how we can cause
25:17
Speaker 2: suicide And I was like, how how does that stuff happen?
25:23
Speaker 2: And the way that I saw it explained is that
25:27
Speaker 2: if you have like if you are if you're suicidal,
25:32
Speaker 2: and you have depression, you're thinking of suicide, you may
25:35
Speaker 2: be too immobilized to actually carry it out. A tricyclic
25:41
Speaker 2: may lift the depression just enough for you to act.
25:45
Speaker 2: And apparently there's a warning on the box that says that. So, yeah,
25:52
Speaker 2: tricyclics don't sound particularly desirable. Yeah, but they probably saved
25:57
Speaker 2: to quite a few people. Yeah, in the fifties and
26:00
Speaker 2: sixties when they came out.
26:01
Speaker 1: Yeah for sure. I mean that was a long time ago.
26:03
Speaker 1: So this is early sort of you know, medicine at work. Yes,
26:06
Speaker 1: we have snur eyes serotonin not just serotonin, but serotonin
26:12
Speaker 1: and nor epinephrine re uptake inhibitors. They came around in
26:15
Speaker 1: the mid nineties, so after the SSRI is a little
26:18
Speaker 1: bit after and they do exactly what you would think.
26:20
Speaker 1: They've blocked the reptake of both of those in the
26:24
Speaker 1: same way.
26:25
Speaker 2: Yeah. And what's weird is snur eyes. You think it's better, right, Yeah,
26:31
Speaker 2: despite selectively targeting two neurotransmitters, it's basically just as good
26:35
Speaker 2: as the Ssriyes, yeah, I think they have about the
26:40
Speaker 2: same number of side effects too.
26:43
Speaker 1: Yeah, and those are there's only a couple of those
26:46
Speaker 1: effectsor and simbalta, and in Symbalta's case, that's dueloxatine an
26:52
Speaker 1: effectsor is vin lavaccine not.
26:57
Speaker 2: The best name ever?
26:58
Speaker 1: Vin laugh fixine Affle scene, What just happened?
27:04
Speaker 2: That's great man, Ben Affleck scene is duncan.
27:07
Speaker 1: Yeah, you're right.
27:08
Speaker 2: There's another related class called nor adrenergic and specific serratonergic.
27:15
Speaker 2: I'll bet the psychiatrists are just laughing, laughing or else
27:20
Speaker 2: they turned this off a long time ago. Yeah, but
27:23
Speaker 2: those type of antidipressants na SSA's lowercase A first, So
27:28
Speaker 2: I'm pretty sure there's no other I guess you could
27:31
Speaker 2: say not ssays. Surely people don't.
27:34
Speaker 1: Say that NASAs.
27:37
Speaker 2: Sure, that's even better. It's better than ben Laughic scene.
27:42
Speaker 1: Yeah. Yeah, they came around in the what mid eighties?
27:45
Speaker 2: Yeah, they the nassas have. They do the same thing,
27:51
Speaker 2: but they have different side effects. It's just so bizarre. Yeah,
27:54
Speaker 2: like you can experience weight gain insedation rather than say,
27:58
Speaker 2: sexual dysfunction like on a SNRI. But they're all doing
28:03
Speaker 2: the same thing. But again, none of them seem to
28:06
Speaker 2: be any better than SSRIs and SSRs have the fewest
28:09
Speaker 2: side effects. This episode is brought to you by SSRIs By.
28:15
Speaker 1: The next thing we're going to talk about are MAOIs
28:18
Speaker 1: or monoamine. Is that right, monoamines, monoamine, oxidase inhibitors. You
28:25
Speaker 1: got all fancy and yeah, I don't think we've mentioned
28:27
Speaker 1: yet that that's what that group is called. Serotonin, norepernephrin,
28:30
Speaker 1: and dopamine are all monoamines because of the molecular structure
28:36
Speaker 1: of those things.
28:37
Speaker 2: Yes, so I've heard ma aoi is like basically my
28:40
Speaker 2: whole life, haven't you. Uh Now, Okay, So they're this
28:45
Speaker 2: like very like widespread class of drugs, but they have
28:49
Speaker 2: a weird twist to them in that they prevent you
28:54
Speaker 2: from breaking down something called tyramine, which is an amino acid.
28:58
Speaker 2: And tyramine is great because it regulates blood pressure, but
29:01
Speaker 2: you don't want too much tyramine. It gets out of
29:04
Speaker 2: whack and your blood pressure gets out of whack. And
29:06
Speaker 2: tyramine is present in a lot of different foods from
29:09
Speaker 2: like soy sauce to fish to sausage, age, cheese, the
29:14
Speaker 2: best cheese, and as a matter of fact, it's called
29:17
Speaker 2: the cheese reaction where people get hypertensive from taking MAOIs
29:22
Speaker 2: and accidentally eating the wrong food. So what the monoamines
29:27
Speaker 2: get broken down by is monoamine oxidase MO, and an
29:33
Speaker 2: ma AOI is a monoamine oxidase inhibitor, so it prevents
29:39
Speaker 2: this thing from breaking down the monoamines. And that's why
29:44
Speaker 2: you can't eat age cheese.
29:46
Speaker 1: Do you think anyone ever goes in and they're like,
29:48
Speaker 1: can I just do the SSRIs because everyone kind of
29:51
Speaker 1: knows those, right, should we name check those?
29:57
Speaker 2: I've never heard of any of them, but sure if
29:58
Speaker 2: you want.
29:59
Speaker 1: No, I don't feel they need to.
30:00
Speaker 2: Well. I think what's also interesting is that it was
30:03
Speaker 2: discovered by accident.
30:05
Speaker 1: Oh yeh, that's right. This is one where I think
30:09
Speaker 1: it was in the early nineteen fifties. They were testing
30:12
Speaker 1: drugs for TB for tuberculosis, and it was one of
30:16
Speaker 1: those deals where they said, Hey, these people over here
30:19
Speaker 1: taking this thing, they're sleeping pretty good, they have a
30:22
Speaker 1: good appetite, they're they're bouncing around the room, they seem
30:25
Speaker 1: pretty happy, and so that's that's how it was born.
30:29
Speaker 1: They found that I think that when they gave it
30:31
Speaker 1: to patients with depression, that seventy percent of them showed
30:34
Speaker 1: an improvement. So they said, I guess we've got a
30:36
Speaker 1: new thing here.
30:37
Speaker 2: Yeah, so I think they started in nineteen fifty eight
30:40
Speaker 2: with marsalid, the first ever m AOI antidepressant. But again,
30:46
Speaker 2: because you can't eat age cheese, people don't usually prescribed
30:50
Speaker 2: as an antidepressant anymore.
30:52
Speaker 1: I had that cheese duck.
30:54
Speaker 2: Sure, I mean yeah, that don't make anybody depress not
30:58
Speaker 2: being able to eat age. Jeez.
31:01
Speaker 1: I guess now we can jump over to or should
31:04
Speaker 1: we take a break or should we cover nutraceuticals?
31:07
Speaker 2: I think it's I think it's break time.
31:10
Speaker 1: All right, we'll take a break and then we'll come
31:11
Speaker 1: back and talk about something that you can just get
31:15
Speaker 1: over the counter. It's called a nutriceutical.
31:17
Speaker 2: Right after this, okay, chuck, So we started to talking
31:54
Speaker 2: about nutraceuticals, and that's just a fancy name for a
31:57
Speaker 2: supplement that you could conceivably used to treat a malady.
32:01
Speaker 2: And in this case, people have long been seeking supplements
32:05
Speaker 2: to treat depression with whether it's clinical or you know,
32:09
Speaker 2: diagnosable or passing depression. Who knows. People don't necessarily want
32:15
Speaker 2: to take pharmaceuticals, and it's tough to blame them. So
32:19
Speaker 2: they'll follow studies and they will read about new discoveries
32:23
Speaker 2: with people poking around trying to figure out what causes depression,
32:27
Speaker 2: and very often they'll turn up some specific amino acid
32:32
Speaker 2: or something like that that they show that there's low
32:36
Speaker 2: levels of that in the brain of people with depression,
32:38
Speaker 2: and so they'll go off and test this amino acid
32:41
Speaker 2: and they'll show like, yep, actually it improves symptoms, and
32:44
Speaker 2: then people go out and buy tons of that supplement.
32:47
Speaker 2: But the problem is in the United States, if it's
32:48
Speaker 2: a supplement, it's essentially totally unregulated, so there's no one
32:53
Speaker 2: checking out, like to make sure that the dose is
32:55
Speaker 2: the same pill to pill, that they actually have what
32:58
Speaker 2: they say they have in them, that they don't have
33:02
Speaker 2: old newspapers ground up with it. Like it's just the
33:05
Speaker 2: wild West when it comes to supplements, which makes it
33:08
Speaker 2: really a tricky thing to treat your depression with. Even
33:12
Speaker 2: though I totally understand how somebody would not want to
33:16
Speaker 2: take pharmaceuticals if they don't.
33:17
Speaker 1: Have to, yeah, for sure. And you know, this is
33:20
Speaker 1: a real shame because a lot of these studies on
33:22
Speaker 1: these have come back with some results that are that
33:25
Speaker 1: look pretty good. Some of them show you know, can
33:28
Speaker 1: kind of be over the all over the place. Again,
33:30
Speaker 1: maybe because it's not regulated is the reason. Because some
33:34
Speaker 1: studies show that results can can treat MDD pretty effectively.
33:38
Speaker 1: Others show it's not any better than at placebo. They
33:43
Speaker 1: can also have side effects, so it's not like, oh,
33:45
Speaker 1: it's just a supplement, so I don't you know, I
33:48
Speaker 1: don't hear the commercial listing, you know, a laundry list
33:50
Speaker 1: of things that could go wrong then and I can
33:52
Speaker 1: buy it just over the counter, then there can be
33:54
Speaker 1: any side effects, right, But that's not true at all.
33:57
Speaker 1: There are side effects to supplements as well, and it
34:00
Speaker 1: can you know, there have been plenty of situations where
34:04
Speaker 1: there's a supplement that becomes kind of the the all
34:07
Speaker 1: the rage, yeah, and people just start like Saint John's
34:11
Speaker 1: work used to be when people were just like, hey,
34:13
Speaker 1: Saint John's Work's the best, we just should take tons
34:15
Speaker 1: of it. And that can result in its own set
34:18
Speaker 1: of issues.
34:19
Speaker 2: I remember that that was our parents taking Saint John's wart.
34:22
Speaker 2: Wasn't that Uh?
34:24
Speaker 1: Yeah? I remember my parents even at one point signed
34:28
Speaker 1: up for one of the uh supplement you know, pyramid schemes.
34:33
Speaker 1: I guess no, really sort of like the Avon Lady.
34:36
Speaker 1: But it's supplements that I remember a short time. I mean,
34:39
Speaker 1: they were always trying to hustle some side gig because
34:41
Speaker 1: they were teachers. But I specifically remember when I was
34:44
Speaker 1: a kid that we just had like a house full
34:46
Speaker 1: of this stuff for a while. And I can't remember
34:49
Speaker 1: which system or brand this was, but if someone wrote
34:53
Speaker 1: in and told me, I would be like, oh, yep,
34:55
Speaker 1: that's the one.
34:56
Speaker 2: Yeah. I can't bring it to mind either, but I'll
34:59
Speaker 2: bet I know what you're talking about. Yeah. So, yeah,
35:03
Speaker 2: Saint John's Ward. It was all the rage in the eighties,
35:05
Speaker 2: and I think one of the other things that lent
35:07
Speaker 2: it a lot of credibility is people have been using
35:09
Speaker 2: Saint John's Wart to improve mood for probably thousands and
35:13
Speaker 2: thousands of years, if not longer.
35:15
Speaker 1: Yeah.
35:17
Speaker 2: The problem is is all that time through history, people
35:20
Speaker 2: weren't also taking like birth control pills or pharmaceutical antidepressants,
35:24
Speaker 2: both of which Saint John's Wart reduces the effectiveness of.
35:29
Speaker 2: You don't really want to reduce the effectiveness of your
35:31
Speaker 2: birth control pills if you're trying not to get pregnant
35:34
Speaker 2: at that time. It also breaks down It also prevents
35:37
Speaker 2: the breakdown of antihistamines. It does all sorts of unwanted stuff,
35:41
Speaker 2: And that's just such a great stellar lesson in the
35:45
Speaker 2: problems with using a supplement to treat something like major
35:49
Speaker 2: depressive disorder. But it's also a lesson in just how
35:54
Speaker 2: far we need to go to look into non pharmaceutical
35:58
Speaker 2: treatments for stuff and actually study them and figure out
36:01
Speaker 2: exactly how to do it and start producing that treatment
36:05
Speaker 2: as well, because you know, I think most people do
36:08
Speaker 2: prefer something that you could conceivably consider more natural than
36:13
Speaker 2: a pharmaceutical.
36:15
Speaker 1: No, for sure.
36:16
Speaker 2: The problem with that, though, is that it's we're not
36:20
Speaker 2: set up the United States at least isn't set up
36:22
Speaker 2: to make a trillion dollars off of Saint John's ward.
36:25
Speaker 2: It's tough to do that that as opposed to creating
36:28
Speaker 2: a new proprietary compound that that treats depression.
36:33
Speaker 1: Yeah, for sure. So I mean that leads very nicely
36:36
Speaker 1: into psychedelics. We promised talk of those earlier with ketamine
36:40
Speaker 1: and psilocybin, and here we are they at least for
36:44
Speaker 1: ketamine that is one that is way out in front
36:48
Speaker 1: of psilocybin. As far as like official studies in the
36:50
Speaker 1: government kind of getting behind some of this stuff.
36:53
Speaker 2: Yeah, they love K.
36:54
Speaker 1: Yeah, they love that K. They're being tested ketamine that
36:57
Speaker 1: is as a breakthrough treatment and breakthrough as a lay
37:00
Speaker 1: or a designation rather that the FDA says, hey, where
37:04
Speaker 1: you can fast track this through the approval process because
37:06
Speaker 1: we think it has so much potential and these still though,
37:10
Speaker 1: even though like ketamine has shown a lot of promise,
37:13
Speaker 1: it's still looked at and studied as a last resort
37:16
Speaker 1: if you're resistant to other more traditional treatments.
37:18
Speaker 2: Yeah, so the government was all about, I should say,
37:21
Speaker 2: the FDA back in twenty nineteen, they prescribed or they approved, sorry,
37:28
Speaker 2: a prescription version of ketamine called esketamine. And apparently that
37:33
Speaker 2: to ketamine i've seen compared to CBD to THC, right,
37:39
Speaker 2: there were a couple double colons in there.
37:41
Speaker 1: If you don't a water down version.
37:44
Speaker 2: Exactly that like say a geriatric person might take.
37:48
Speaker 1: Yeah, exactly. They started to develop ketamine in the nineteen
37:53
Speaker 1: sixties in Belgium, and you know they've been like you said,
37:59
Speaker 1: I think arty in two thousand it's when they really
38:02
Speaker 1: started kind of looking into stuff. So it had a
38:04
Speaker 1: big jump on psilocybin. That's one that's just now starting
38:08
Speaker 1: to kind of people are starting to say, hey, you know,
38:12
Speaker 1: you know, magic mushrooms I now has a bad connotation
38:16
Speaker 1: for a lot of people. So let's call it psilocybin,
38:19
Speaker 1: you know the medical or you know the I guess
38:20
Speaker 1: biological name, and let's let's study this stuff.
38:24
Speaker 2: Yeah, so psilocybin is just gangbusters at treating depression. Ketamine
38:29
Speaker 2: is too. We should say also that psychiatrists are like,
38:32
Speaker 2: we need a more potent version of ketamine, so please
38:35
Speaker 2: approve that FDA. They're not, as far as I know,
38:40
Speaker 2: on the way to do that, but who knows. But
38:43
Speaker 2: psilocybin in particular, there's just study after study after study
38:49
Speaker 2: that's like, this stuff really works, and it works in
38:54
Speaker 2: like you don't have to stay on it. You don't
38:55
Speaker 2: have to take mushrooms every day for the rest of
38:57
Speaker 2: your life, which you know, but there's only take them
39:00
Speaker 2: a couple of times, and it can have effects that
39:04
Speaker 2: last up to a year. There was a I think
39:06
Speaker 2: a Johns Hopkins study from twenty twenty two where they
39:10
Speaker 2: gave two doses of psilocybin to patients two weeks apart,
39:16
Speaker 2: and so they gave each patient a dose of psilocybin
39:19
Speaker 2: two weeks apart. They didn't just wait two weeks to
39:21
Speaker 2: go to the next patient, I guess, is what I'm saying. Yeah,
39:24
Speaker 2: so they found that this the effects could last like
39:28
Speaker 2: a year after a year from the second dose they
39:33
Speaker 2: and the effects were like just mind blowing too as
39:37
Speaker 2: far as the I guess quantifying the symptoms of depression, right.
39:42
Speaker 1: Yeah, do you know how what the dose was before
39:45
Speaker 1: I give this number.
39:47
Speaker 2: I think it was like melt your face half a bag,
39:52
Speaker 2: two handfuls.
39:54
Speaker 1: I'm very curious, but this is a I think it
39:57
Speaker 1: was a depression rating scale they were using, where twenty
39:59
Speaker 1: four was to be and seven or below was no depression.
40:03
Speaker 1: And before they had the psilocybin, they scored twenty two,
40:06
Speaker 1: an average of twenty two point eight out of twenty
40:10
Speaker 1: four as far as being severely depressed, and then afterward
40:14
Speaker 1: it went all the way down to seven point seven,
40:17
Speaker 1: which is just a scoche above no depression.
40:20
Speaker 2: Yeah, and that seven point seven was that follow up
40:22
Speaker 2: a year later.
40:23
Speaker 1: Yeah, that's remarkable.
40:25
Speaker 2: Yeah, so that was twenty twenty two. I wonder if
40:28
Speaker 2: they check in with these people now, what the scores
40:32
Speaker 2: will be, you know, is it do you have to
40:34
Speaker 2: take psilocybin every two years twice over two weeks and
40:38
Speaker 2: maintain control over depression. That's it's pretty amazing. There's another
40:44
Speaker 2: study from twenty twenty four that found that psilocybin is
40:48
Speaker 2: at least as effective at treating MDD as SSRI is
40:53
Speaker 2: probably more.
40:54
Speaker 1: Yeah, and I think they had did try to follow
40:56
Speaker 1: up those people, but they got no self service out
40:59
Speaker 1: there on Joshua Tree.
41:03
Speaker 2: So just real quick, there's we because we'll probably go
41:06
Speaker 2: over this a little bit in the depression episode. But
41:08
Speaker 2: if you go in for treatment of depression, they're going
41:11
Speaker 2: to treat you in three different phases, two possibly, but
41:16
Speaker 2: probably three. The first is acute where you show up
41:20
Speaker 2: and you're like, I can't take this anymore. I need treatment.
41:23
Speaker 2: They're going to get you on ss or yeah, probably
41:25
Speaker 2: an SSR. They're going to get you on some antidepressant
41:28
Speaker 2: to start. They're going to try to work their way
41:31
Speaker 2: up while also balancing getting you feeling better as soon
41:34
Speaker 2: as possible, and time was they would try an antidepressant
41:40
Speaker 2: for like four to six weeks. That was what was
41:43
Speaker 2: generally prescribed, like that's what all psychiatrists did. And if
41:46
Speaker 2: after four to six weeks there wasn't more than a
41:49
Speaker 2: twenty five percent reduction and symptoms, they would say, this
41:52
Speaker 2: isn't working for you, let's try another one. But I
41:54
Speaker 2: guess something happened to the psychiatry zeitgeist, and now they're
41:58
Speaker 2: waiting as long as six months to give it a chance,
42:02
Speaker 2: which has got to be tough when you're suffering from
42:05
Speaker 2: major depressive disorder. But that's the acute phase and once
42:09
Speaker 2: they get a once they find an antidepressant that can
42:13
Speaker 2: manage your symptoms, you'll move into what's called the continuation phase.
42:19
Speaker 1: That's right, and that's after remission has begun, and that
42:23
Speaker 1: is when they're trying to you know, knock down or
42:26
Speaker 1: outright eliminate the symptoms that are still sticking around and
42:31
Speaker 1: get you back to where you were before your MDD episode.
42:36
Speaker 1: After six months of that, if there's no relapse, then
42:39
Speaker 1: they may wean you down or completely off of something.
42:43
Speaker 1: You know, it just sort of depends. Like again, like
42:46
Speaker 1: talk talk a lot to your doctor through all this stuff,
42:49
Speaker 1: so you really have a good handle on what's going on.
42:53
Speaker 2: So I think I said most people will suffer multipolar,
42:58
Speaker 2: chronic or recurring episodes of major depressive disorder once they
43:02
Speaker 2: have one. Yeah, something like fifty to eighty five percent
43:05
Speaker 2: of people who have one will have another episode. So
43:10
Speaker 2: there's it's probable that your continuation phase will eventually turn
43:14
Speaker 2: into a maintenance phase where they'll just keep an eye
43:17
Speaker 2: on you. You'll probably keep up with say therapy or psychoanalysis
43:22
Speaker 2: or something like that, and if your episode starts to
43:27
Speaker 2: come back, they'll put you on the antidepressant that worked before. Yeah,
43:30
Speaker 2: And this can go anywhere from a year to indefinite.
43:35
Speaker 2: Just the point is to stay on top of your
43:38
Speaker 2: symptoms so that you don't have another episode or if
43:41
Speaker 2: one starts to come along, the nipp it in the
43:43
Speaker 2: butt very quickly.
43:44
Speaker 1: Yeah, for sure, Which kind of all leads to the
43:47
Speaker 1: question are these being prescribed too much? That's you know,
43:52
Speaker 1: you can't hardly bring this up without hearing somebody say, yeah,
43:55
Speaker 1: they're just doctors are just willing nelly prescribing this stuff
43:57
Speaker 1: to everybody, like young children all the way to senior citizens,
44:00
Speaker 1: Like they'll just throw anyone on that. And that's just
44:02
Speaker 1: a very sort of dumb down way to look at this.
44:07
Speaker 1: There are critics who you know, have valid points about stuff,
44:11
Speaker 1: but you have to look at real numbers as far
44:14
Speaker 1: as like an increase in prescriptions. If you look at
44:18
Speaker 1: the numbers, part of it is that they are they
44:22
Speaker 1: are staying on something for longer. So if they're keeping
44:25
Speaker 1: you on something for six months rather than just switching
44:28
Speaker 1: something out at six weeks, then the numbers for that
44:31
Speaker 1: prescription are going to be higher over a six month period.
44:34
Speaker 1: So there's just a lot more nuance in those numbers.
44:37
Speaker 1: As far as there's been a big increase, like a
44:39
Speaker 1: sweeping statement, like there's been a big increase in the
44:42
Speaker 1: number of prescriptions.
44:43
Speaker 2: Right, Plus, if you're just counting prescriptions of antidepressants, you
44:47
Speaker 2: might miss that, say, the tricyclic antidepressants are now being
44:50
Speaker 2: prescribed for neuropathic pain, right, so that would get lumped
44:54
Speaker 2: into that as well. And yet you can totally get
44:58
Speaker 2: the viewpoint of people who are like, yeah, that probably
45:00
Speaker 2: accounts for some of it. But dude, I saw a
45:03
Speaker 2: statistic that in the United States people ages twelve to
45:07
Speaker 2: twenty five between twenty sixteen and twenty twenty two, monthly
45:12
Speaker 2: prescriptions that antidepressants went up sixty six percent.
45:17
Speaker 1: Yeah, I mean twenty sixteen to twenty twenty two is
45:21
Speaker 1: also a period of a lot of upheaval in the
45:23
Speaker 1: United States and starting in twenty twenty with COVID around
45:27
Speaker 1: the world, so all of that stuff comes into play
45:30
Speaker 1: for sure.
45:31
Speaker 2: Yeah. I think from twenty twenty to twenty twenty two,
45:33
Speaker 2: if you just look in that window, especially for I
45:37
Speaker 2: think girls and women age twelve to twenty five, it
45:40
Speaker 2: went up like one hundred and fifty percent in those
45:43
Speaker 2: two years.
45:44
Speaker 1: Kids pulled out of school in their entire social structure
45:47
Speaker 1: sometimes yep.
45:48
Speaker 2: Yeah, yeah, So it's also possible that the stigma has
45:55
Speaker 2: been reduced, thank you gen Z around seeking treatment for
45:59
Speaker 2: mental health, talking about your mental health, so more people
46:02
Speaker 2: could be seeking help, which could lead to a higher
46:05
Speaker 2: increase in diagnoses, which would of course lead to an
46:08
Speaker 2: increase in prescriptions. At the same time, some people are like,
46:12
Speaker 2: we're just a lot of this is just pathologizing human sadness,
46:16
Speaker 2: and we need to especially so everybody agrees basically that
46:20
Speaker 2: if you have a low level diagnosable depression that's not MDD,
46:27
Speaker 2: then you should not start out with any depressants. You
46:29
Speaker 2: should start out with lifestyle changes like changes in your diet,
46:33
Speaker 2: exercise again, getting good sleep, just stuff you can do
46:37
Speaker 2: without pharmaceuticals. Everyone agrees except I'm sure for the pharmaceutical
46:42
Speaker 2: companies that you should not start with that for like
46:45
Speaker 2: low level depression.
46:47
Speaker 1: Yeah. I was curious too about kids about I wondered
46:50
Speaker 1: if there was just a minimum age, and from what
46:53
Speaker 1: I found, each drug is FDA approved starting at a
46:56
Speaker 1: certain age.
46:57
Speaker 2: What's the youngest you found?
47:00
Speaker 1: The youngest I found was seven years old.
47:02
Speaker 2: I would have guessed five.
47:04
Speaker 1: Yeah, I mean that may be, but I just found seven.
47:08
Speaker 2: So there's just a couple of other things we want
47:11
Speaker 2: to cover real quick that fall under the umbrella of
47:14
Speaker 2: antidepressants making depression worse, right, because you would probably be
47:18
Speaker 2: bewildered if you were taking any deepressants and you're like,
47:21
Speaker 2: I actually feel way worse than I did before. And
47:24
Speaker 2: there's a whole kind of little suite of possible reasons
47:28
Speaker 2: for why that might happen.
47:30
Speaker 1: Yeah, I mean, you may be just may be simple misdiagnosis.
47:34
Speaker 1: It could be bipolar disorder. It could be BPD, which
47:38
Speaker 1: we've talked about borderline personality disorder h but those are
47:42
Speaker 1: not the same things. So you just might be misdiagnosed.
47:45
Speaker 2: Yeah, you might have a chump for a doctor. Yeah,
47:49
Speaker 2: genetics is also one apparently that also determines whether you
47:53
Speaker 2: have whether a risk factor like you said earlier, like
47:57
Speaker 2: grief or something like that pushes you into major depressive disorder.
48:02
Speaker 2: There's a gene, the SLC sixty four a, the serotonin
48:05
Speaker 2: transporter gene. I think there's a variation in that where
48:09
Speaker 2: you can actually get feel worse after taking an adepressants
48:13
Speaker 2: because of that gene.
48:15
Speaker 1: Yeah, your metabolism might affect it if some people just
48:19
Speaker 1: don't clear drugs out of their system as quickly. Yeah,
48:23
Speaker 1: so if it's taking longer than usual then it usually
48:27
Speaker 1: a dose adjustment can help with that, but that could
48:30
Speaker 1: imbalance things even more.
48:32
Speaker 2: Yeah, and then being under twenty five before your brain
48:36
Speaker 2: is fully developed, that's one. There's something called acathesia, which
48:41
Speaker 2: it's basically just an internal restlessness that keeps you from sleeping,
48:45
Speaker 2: makes you anxious, and then those will make your depression
48:49
Speaker 2: symptoms worse. And then just being on too many drugs, right.
48:53
Speaker 1: Yeah. Polypharmacy pretty good band name, but not a great
48:57
Speaker 1: thing to live with, because, you know things, interacting with
49:01
Speaker 1: other drugs is a real thing, and if you're on
49:04
Speaker 1: a lot of them, then it's some kind sometimes can
49:07
Speaker 1: be hard to even tell what might be affecting what
49:10
Speaker 1: you had to get at a certain point.
49:11
Speaker 2: Right, exactly. So that's it for antidepressants, right, you got
49:16
Speaker 2: anything else?
49:17
Speaker 1: Got nothing else?
49:18
Speaker 2: Okay, Well, go forth and seek treatment. If you have depression,
49:23
Speaker 2: especially if you think you have major depressive disorder, go
49:26
Speaker 2: get help. Things can get a lot better. And since
49:29
Speaker 2: I said things can get a lot better, everybody, it's
49:32
Speaker 2: time for a listener.
49:32
Speaker 1: Mayw This is one of a couple I'm going to
49:37
Speaker 1: read in the next few episodes about the inner monologue episode.
49:40
Speaker 1: We heard a lot from people about that. Yeah, and
49:44
Speaker 1: specifically in this case, my inner monologue when I'm falling
49:48
Speaker 1: asleep getting really weird. Hey, guys, Chuck mentioned before falling
49:52
Speaker 1: asleep with his thoughts start to get weird, and that's
49:53
Speaker 1: how he knows he's falling asleep right away. A newt
49:56
Speaker 1: he was talking about. And the reason I read this
49:58
Speaker 1: one because I had and dozens of people that have
50:01
Speaker 1: the same thing. Right, It's because it's very common, but
50:03
Speaker 1: this person names it. There's a term called hypnagogic imagery,
50:08
Speaker 1: which I think we've talked about that in something It
50:10
Speaker 1: might have been lucid dreaming, which I learned about from
50:13
Speaker 1: Jeff Warren's awesome book of the head Trip. It's basically
50:16
Speaker 1: the stage before falling asleep, when our brains start to
50:18
Speaker 1: produce hallucination like images. This happens to me, though I'm
50:22
Speaker 1: not consciously aware of it on nights when I fall
50:24
Speaker 1: asleep quickly. Often I'll drift into the hypnagogic stage and
50:28
Speaker 1: then catch myself and think that was weird, which is
50:31
Speaker 1: what happens to me, and then drift back in. Chuck
50:33
Speaker 1: described his experience as a series of nonsensical thoughts, so
50:37
Speaker 1: I wonder if his is truly verbal versus visual. I
50:41
Speaker 1: would love to hear more. I think mine are a
50:43
Speaker 1: little bit of both. Jill and that is Jill in Connecticut.
50:45
Speaker 2: Thanks Jill, that was a great one. We'd love naming
50:48
Speaker 2: stuff that we experience and didn't know there was a
50:51
Speaker 2: name for right right, So okay, Well, if you want
50:56
Speaker 2: to be like Jill, send us an email. Send it
50:58
Speaker 2: off to stuff podcast at iHeartRadio dot com.
51:05
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51:08
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