Latest / The You Project / #2185 New Depression Science - Dr. Bill Sullivan

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#2185 New Depression Science - Dr. Bill Sullivan · The You Project

• 0:00
  Speaker 1: I'll get a team. It's doctor Bill. Well, I'm not
• 0:03
  Speaker 1: doctor Bill. Doctor Bill's here. My name is Craig Harper.
• 0:06
  Speaker 1: If your first time enter the U project, where have
• 0:09
  Speaker 1: you been? But welcome and to the rest of you,
• 0:13
  Speaker 1: bloody hanger honor as Geez Week. Glad you're here, Geez Week,
• 0:16
  Speaker 1: Glad you stick around, and thanks for being so loyal
• 0:18
  Speaker 1: and patient and long suffering. I'm sure I'll get good
• 0:21
  Speaker 1: at this soon, so just hang around and watch me
• 0:25
  Speaker 1: just fly out of the nest. Hi, doctor Bill, Hello,
• 0:29
  Speaker 1: doctor Craig, how you doing? Oh nearly, Doctor Craig, That
• 0:33
  Speaker 1: Jesus if soon you can call me that.
• 0:36
  Speaker 2: I'm just getting you ready and prepare it for what
• 0:39
  Speaker 2: it's going to sound like.
• 0:41
  Speaker 1: Oh thanks, dude. I kind of feel yeah, I think
• 0:45
  Speaker 1: this is more about my shitty self esteem and fear driven,
• 0:50
  Speaker 1: neurotic bloody underpinnings. But yeah, I feel like a fraud
• 0:55
  Speaker 1: all the time. Even when I finish, I think I'll
• 0:56
  Speaker 1: feel like a fraud. But you really, academics, you just
• 1:01
  Speaker 1: wear that, you know so. But did it take a
• 1:04
  Speaker 1: while for you to feel like when you first when
• 1:08
  Speaker 1: people first started talking calling you doctor Bill or doctor
• 1:12
  Speaker 1: Sullivan or whatever the case is. Did it take a
• 1:14
  Speaker 1: while to get adjusted?
• 1:16
  Speaker 3: Oh?
• 1:16
  Speaker 1: Yeah, yeah.
• 1:17
  Speaker 2: It still takes me aback when I hear that, even
• 1:20
  Speaker 2: after all these years, because like everybody in my lab,
• 1:25
  Speaker 2: they just call me Bill, and if we're on a
• 1:26
  Speaker 2: very informal, you know, basis, we're more like colleagues. And
• 1:32
  Speaker 2: I only hear like doctor Sullivan when it's a real formality.
• 1:37
  Speaker 2: And I know if I get an email that says
• 1:38
  Speaker 2: doctor Sullivan, it's either from a stranger or somebody who
• 1:42
  Speaker 2: wants something or I'm in trouble.
• 1:45
  Speaker 1: Yeah, I do. You got to say that, I call it. Well,
• 1:49
  Speaker 1: he doesn't like it. But my senior supervisor, his name
• 1:52
  Speaker 1: is Chris, but he's a professor where I'm at, and
• 1:55
  Speaker 1: I call him prof and he kind of hates it,
• 1:58
  Speaker 1: and then he's like, you know, I ayprof, but he
• 2:01
  Speaker 1: knows all right. So I love this. I read this article,
• 2:05
  Speaker 1: this not insignificant article. By the way, folks, if you
• 2:07
  Speaker 1: want to go read this article, which I would recommend highly.
• 2:12
  Speaker 1: It's online, so it's easy, pasy tacess. It's called treating
• 2:16
  Speaker 1: depression by calming the immune system. It takes a whole
• 2:20
  Speaker 1: new look at the potential the potential underlying factors that
• 2:27
  Speaker 1: may be involved in depression. It's in psychology today, So
• 2:32
  Speaker 1: if you go doctor Bill Sullivan or even put in
• 2:34
  Speaker 1: the name of the article Treating Depression by Calming the
• 2:38
  Speaker 1: Immune System Psychology Today was published, oh about two weeks ago,
• 2:45
  Speaker 1: June three. Now I'm going to tell you my snapshot
• 2:50
  Speaker 1: of it, tell me what I get wrong, and then
• 2:54
  Speaker 1: do bloody enlighten us if you'd be so gracious. So
• 3:00
  Speaker 1: this bit's actually a grab from your article. For about
• 3:03
  Speaker 1: three hundred and thirty two million people worldwide, the depressive behavior,
• 3:07
  Speaker 1: usually reserved for recovering from illness or injury, never lets
• 3:10
  Speaker 1: up like a dark cloud that won't vacate the sky.
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  Speaker 1: It raises an intriguing question, could depression or at least
• 3:18
  Speaker 1: some instances of it? This is so written by you
• 3:22
  Speaker 1: because I know how you talk. Arise with the immune system,
• 3:26
  Speaker 1: arise when the immune system doesn't know when to quit.
• 3:29
  Speaker 1: So some of the snapshots were that not all depressive
• 3:33
  Speaker 1: patients respond to conventional treatments. We know that chronic inflammation
• 3:40
  Speaker 1: is gaining traction as a as being understood as a
• 3:44
  Speaker 1: potential driver of or associated with depression. A small clinical
• 3:50
  Speaker 1: trial identified an anti inflammatory drug that alleviates depression, I
• 3:54
  Speaker 1: would say in some people, of course, and rethinking the
• 3:59
  Speaker 1: causes of depression expands treatment options for patients, and the
• 4:03
  Speaker 1: central argument is that for a subset of people, depression
• 4:07
  Speaker 1: may be driven in part by chronic inflammation and immune
• 4:10
  Speaker 1: system dysfunction, rather than or in addition to all abnormalities
• 4:16
  Speaker 1: in neurotransmitters such as serotonin. I had no idea that
• 4:20
  Speaker 1: this was even an idea or a school of thought,
• 4:23
  Speaker 1: let alone research that was happening. How did you stumble
• 4:27
  Speaker 1: across this and enlighten us if you would?
• 4:31
  Speaker 2: Yeah, absolutely, well, you gave a really good summary of
• 4:35
  Speaker 2: what this article touches on some of the high points.
• 4:38
  Speaker 2: And it's new to you, Craig, because it's relatively new
• 4:42
  Speaker 2: to the field. This is a relatively novel idea and
• 4:48
  Speaker 2: about I guess it had its origins maybe fifteen twenty
• 4:51
  Speaker 2: years ago. It started to bubble a little bit, make
• 4:55
  Speaker 2: a little noise, but it was all theoretical. So now
• 5:00
  Speaker 2: scientists and researchers are more aggressively testing what has become
• 5:04
  Speaker 2: known as the inflammation hypothesis of depression as a possibility,
• 5:11
  Speaker 2: and we have some really good tools medications to run
• 5:15
  Speaker 2: some small pilot clinical trials to see if this idea
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  Speaker 2: has any merit at all or if it just should
• 5:22
  Speaker 2: go right directly into the dustbin. So I got intrigued
• 5:27
  Speaker 2: by this article or to write this article when I
• 5:30
  Speaker 2: saw the pilot's study results that we'll get into in
• 5:33
  Speaker 2: a little bit, But just to reiterate, hundreds of millions
• 5:38
  Speaker 2: of people worldwide suffer from depression, and it's a disease
• 5:42
  Speaker 2: that only very recently started to get proper attention because
• 5:49
  Speaker 2: in the past it was just considered to be morose, sadness,
• 5:53
  Speaker 2: people are brooding, and it was very tempting to kind
• 5:56
  Speaker 2: of blame the victim and just say, you know, get
• 5:59
  Speaker 2: over it.
• 5:59
  Speaker 1: You know, why can't you get happy?
• 6:01
  Speaker 2: Just you know, go for a walk, get some sunshine,
• 6:04
  Speaker 2: you'll feel better, Play some happy songs.
• 6:07
  Speaker 1: That's not poppy, Yeah, yeah, go get a puppy.
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  Speaker 2: That's not what clinical depression is now. Of course everyone
• 6:15
  Speaker 2: gets depressed from time to time, but we're talking about
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  Speaker 2: a spectrum of severity here, and where people are clinically depressed,
• 6:24
  Speaker 2: there's just like no escape, there's nothing you can do.
• 6:28
  Speaker 2: You can get a hundred puppies and it's not going
• 6:30
  Speaker 2: to solve the situation. It's not going to make anyone
• 6:33
  Speaker 2: feel happier. And then you know, the mystery of why
• 6:39
  Speaker 2: this is the case for a growing number of people
• 6:42
  Speaker 2: really started to take center stage and to kind of
• 6:45
  Speaker 2: set up the two hypotheses that are being considered in
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  Speaker 2: the medical field, one of which has been around a
• 6:52
  Speaker 2: lot longer. Everyone knows this depressive state of mind or
• 6:59
  Speaker 2: these feels when they get sick. You know, say you
• 7:02
  Speaker 2: get the flu or you get some other infection.
• 7:06
  Speaker 1: No one feels good. You know, you feel down, and.
• 7:09
  Speaker 2: You feel exhausted. You don't really feel like talking to anybody.
• 7:13
  Speaker 2: You even lose interest in things that appeal to you.
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  Speaker 2: You know, things that you used to find entertaining and enjoyable.
• 7:19
  Speaker 2: When you're sick, you don't get that same amount of
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  Speaker 2: joy out of them. You just want to crawl under
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  Speaker 2: the covers and you know, wait it out. And that
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  Speaker 2: has a term in psychology. It's called sickness behavior, and
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  Speaker 2: it has a lot of parallels to what people with
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  Speaker 2: depression experience, except the accelerator always is down. You know,
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  Speaker 2: you always have that sickness behavior going on. It's like
• 7:46
  Speaker 2: nothing can alleviate it, and that can obviously be very frustrating,
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  Speaker 2: and it can spiral into even further depression because it's
• 7:54
  Speaker 2: like this hole you just can't dig yourself out of.
• 7:57
  Speaker 2: So what is the mechanism behind this? People started to think, well,
• 8:02
  Speaker 2: there's parallels with sickness behavior, so could it be that
• 8:07
  Speaker 2: when we were.
• 8:08
  Speaker 1: Going through evolution.
• 8:09
  Speaker 2: You know, there's clear advantages for sickness behavior when you're
• 8:13
  Speaker 2: actually sick. You know, if you do have an infection,
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  Speaker 2: all the things that we just described are rather rational
• 8:20
  Speaker 2: things to do. There's social isolation involved, which would minimize
• 8:25
  Speaker 2: the spread of the contagion to other members of the tribe.
• 8:29
  Speaker 2: You know, you're getting rest so that you can fight
• 8:31
  Speaker 2: off the infection and you're not expending energy that needs
• 8:35
  Speaker 2: to be diverted to your immune system. So these sorts
• 8:38
  Speaker 2: of sickness behaviors actually have an evolutionary benefit. The problem
• 8:43
  Speaker 2: is what if they don't get turned off in some people,
• 8:48
  Speaker 2: or they get turned on for the wrong reasons. That
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  Speaker 2: can lead to sickness behaviors. Even though there's not anything
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  Speaker 2: physically wrong with the person. They don't have an injury,
• 8:59
  Speaker 2: they don't have any but they're acting like they're sick.
• 9:03
  Speaker 2: So that is kind of the genesis of this new
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  Speaker 2: hypothesis we'll get into in a moment, but I'd like
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  Speaker 2: to first describe what comes to most people's mind when
• 9:13
  Speaker 2: they think about medical solutions for depression. And again, as
• 9:19
  Speaker 2: of like the nineteen fifties, there were none, you know it,
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  Speaker 2: really we had no idea what was going on. And frankly,
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  Speaker 2: I think the medical community back then, in the you know,
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  Speaker 2: prior to the fifties, grossly minimized what was going on
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  Speaker 2: with the depressive individuals, and they just misunderstood it not
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  Speaker 2: as a disease but just kind of as a mood.
• 9:41
  Speaker 2: And it's much more complicated than that. So what was
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  Speaker 2: happening in the nineteen fifties, Well, there was some really
• 9:49
  Speaker 2: serendipitous observations made by doctors who were treating patients for
• 9:56
  Speaker 2: other things. So two cases are predominant in the literature
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  Speaker 2: in the history of depressive treatments. And some doctors started
• 10:05
  Speaker 2: noticing that there were individuals on a certain high blood
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  Speaker 2: pressure medication that seemed that when these patients took this
• 10:14
  Speaker 2: medicine for high blood pressure, all of a sudden, they
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  Speaker 2: would get really depressed. And it was like, well, that's weird.
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  Speaker 2: Why would that be happening? And it wasn't everybody, but
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  Speaker 2: there was a high number of people taking this particular
• 10:28
  Speaker 2: blood pressure medication who were getting depressed. And then in contrast,
• 10:34
  Speaker 2: there were people taking this new tuberculosis drug to fight
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  Speaker 2: off that infection, and very shortly after they started taking it,
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  Speaker 2: they started feeling euphoric, They started feeling wonderful, you know,
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  Speaker 2: And that was really weird because it was happening way
• 10:52
  Speaker 2: before they would have been feeling better because tuberculosis was
• 10:55
  Speaker 2: being killed. This was happening almost immediately after they started
• 10:59
  Speaker 2: taking the medication. And as you know, throughout the fifties
• 11:02
  Speaker 2: and then even more in the sixties, people started experimenting
• 11:06
  Speaker 2: with psychedelics, okay, and these medicines or certain mushrooms would
• 11:12
  Speaker 2: make you, would make your brain do all sorts of
• 11:16
  Speaker 2: crazy things. You can feel everything from euphoria to depression.
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  Speaker 2: And the upshot of this whole conversation here, Craig, these
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  Speaker 2: observations is that we have started to appreciate in the
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  Speaker 2: fifties and sixties that there are things we can ingest
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  Speaker 2: that will change our brain chemistry and change our mood
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  Speaker 2: and our depressive status. As a consequence of that. That
• 11:42
  Speaker 2: was a really novel idea at the time. It's hard
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  Speaker 2: to stress today because we take so much for granted
• 11:48
  Speaker 2: in terms of medications that are available, but back at
• 11:51
  Speaker 2: the time that was a revolutionary idea. So they started
• 11:55
  Speaker 2: looking at these people who were on these high blood
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  Speaker 2: pressure medications and getting depression, or on these tuberculosis antibiotics
• 12:02
  Speaker 2: and feeling euphoria, and they found parallels to changes in neurotransmitters,
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  Speaker 2: and we know them now as monoamines. This is a
• 12:12
  Speaker 2: type of neurotransmitter that includes things like serotonin, nourepernephrine, and
• 12:17
  Speaker 2: dopamine substances today that we appreciate are very potent brain chemicals,
• 12:23
  Speaker 2: and it leads to the monoamine hypothesis, whereby these chemicals
• 12:29
  Speaker 2: are out of balance or you're not making enough of
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  Speaker 2: one of them, and that is causing the clinical depression
• 12:36
  Speaker 2: that we see in some patients, which was a really
• 12:40
  Speaker 2: novel idea and it's still one of the front running
• 12:43
  Speaker 2: ideas in terms of the mechanisms of depression. It is
• 12:47
  Speaker 2: the basis for the mainline depression drugs that work in
• 12:52
  Speaker 2: many people. These would be the SSRIs, these selective serotonin
• 12:56
  Speaker 2: reuptake inhibitors. These are drugs like prozac that work in
• 13:01
  Speaker 2: the brain to keep serotonin around longer and allow it
• 13:05
  Speaker 2: to do its sting. And it is well established that,
• 13:08
  Speaker 2: you know, serotonin levels indepressive people are low. So there's
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  Speaker 2: some really good, you know, rationale behind this monoamine hypothesis.
• 13:17
  Speaker 2: And for many people these drugs do work. Wonders, they
• 13:20
  Speaker 2: can be life changers, but as you allude it to,
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  Speaker 2: they don't work for everybody, and there's some very strange
• 13:28
  Speaker 2: peculiarities that have been observed. Sometimes these drugs don't work
• 13:34
  Speaker 2: right away. They take weeks or maybe a month or
• 13:37
  Speaker 2: longer before the patient starts to get any sort of
• 13:40
  Speaker 2: or feel any sort of difference from taking these drugs,
• 13:43
  Speaker 2: which is weird because the brain chemistry changes before that.
• 13:48
  Speaker 2: So there's some discrepancies in what should be going on here,
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  Speaker 2: which you know, it might be ignorance in that we
• 13:56
  Speaker 2: don't fully understand how these brain chemicals work and in
• 13:59
  Speaker 2: our act and you know, there's just a lot more
• 14:02
  Speaker 2: to be learned, but there are some very interesting gaps
• 14:07
  Speaker 2: in our knowledge regarding the monoamine hypothesis. It reis is
• 14:12
  Speaker 2: the question, well, what else could it be.
• 14:15
  Speaker 1: Yes, so very I mean, obviously this is brand new
• 14:20
  Speaker 1: to me, so excuse my ignorance and potential dumb question
• 14:23
  Speaker 1: also doctor Bill. But so it was mostly considered a
• 14:30
  Speaker 1: brain chemistry problem for one of a better term, with
• 14:34
  Speaker 1: no real even awareness or consideration of what was happening
• 14:39
  Speaker 1: in the immune system or on an inflammatory level in
• 14:43
  Speaker 1: the cells or and so it's almost like you're looking
• 14:50
  Speaker 1: for something in one room and it's in well, some
• 14:54
  Speaker 1: of it's in there, but also there's another room over
• 14:57
  Speaker 1: here that holds a lot of answers, but you're not
• 15:00
  Speaker 1: old potential answers, but you're not looking in there at all.
• 15:03
  Speaker 1: So I guess there was because I think that maybe
• 15:06
  Speaker 1: figured it out in this this is purely a Brian
• 15:09
  Speaker 1: chemistry problem. We don't need to look anywhere else, and
• 15:14
  Speaker 1: so it.
• 15:14
  Speaker 2: Could be part of it. I mean, what we knew
• 15:17
  Speaker 2: about the immune system in the fifties and sixties was
• 15:20
  Speaker 2: even worse than what we knew about these brain chemicals.
• 15:22
  Speaker 2: I mean, we really didn't understand the immune system very
• 15:25
  Speaker 2: well at all either.
• 15:26
  Speaker 1: So it was like a thing that it was like.
• 15:28
  Speaker 2: An unknown unknown, you know, there wasn't a room that
• 15:32
  Speaker 2: we that was revealed to us that we could even search.
• 15:35
  Speaker 2: So the monoamine hypothesis had a really good medical basis
• 15:40
  Speaker 2: and there was some evidence to support it, and I
• 15:43
  Speaker 2: will I'm not going to say that it's wrong because
• 15:46
  Speaker 2: these drugs do work in a large number of people.
• 15:50
  Speaker 2: Whether they work better than placebo, I think is a
• 15:53
  Speaker 2: discussion that could be had. There's certainly some placebo effects
• 15:57
  Speaker 2: going on, and there's other lifestyle changes that people with
• 16:01
  Speaker 2: depression are advised to undertake. How can you tease apart
• 16:07
  Speaker 2: those lifestyle changes from the medication that they might be on.
• 16:10
  Speaker 2: It's a very difficult thing to do. But what I
• 16:14
  Speaker 2: think might also be true is that these are not
• 16:18
  Speaker 2: mutually exclusive ideas. What we might find out maybe a
• 16:23
  Speaker 2: decade or two from now, is that the immune system
• 16:26
  Speaker 2: is highly tied with our brain chemistry, and there's some
• 16:32
  Speaker 2: preliminary data that supports those ideas. So I think all
• 16:37
  Speaker 2: of the things we're talking about here, Craig, from sickness
• 16:40
  Speaker 2: behaviors to the monoamine idea, the brain chemistry, yes, as
• 16:44
  Speaker 2: well as what's going on with inflammation and the immune response,
• 16:48
  Speaker 2: they could all overlap at the end of the day,
• 16:51
  Speaker 2: and there could be some like grand unified theory for
• 16:55
  Speaker 2: wide depression emerges at the moment, we're still gathering puzzle
• 16:59
  Speaker 2: pieces and trying to see what the picture looks like.
• 17:02
  Speaker 1: Can you get on that, please and develop that. Just
• 17:04
  Speaker 1: hurry up and just solve that. The grand unified theory
• 17:07
  Speaker 1: You've got not much on So but you know what
• 17:10
  Speaker 1: I find interesting silliness society is it's like when I
• 17:15
  Speaker 1: talk to people about, you know, mind stuff versus brain stuff,
• 17:19
  Speaker 1: but mind stuff. When we talk about the psychology of
• 17:21
  Speaker 1: behavior and the human experience and why we do the
• 17:24
  Speaker 1: things that we do, choices, decisions, actions, reactions, conversations, like
• 17:31
  Speaker 1: just the way that we kind of operate on a
• 17:33
  Speaker 1: psychological level. Well psychology or the you know, thinking is
• 17:37
  Speaker 1: intertwined with emotions. Maybe emotions drive thinking. That's intertwined with physiology.
• 17:42
  Speaker 1: That's brain chemistry, that's your immune system, that's your gut biome.
• 17:48
  Speaker 1: That's like everything on a way, on a level is integrated.
• 17:54
  Speaker 1: Like nothing operates in isolation, do you know what I mean?
• 17:58
  Speaker 1: But we try to look at these single kind of
• 18:01
  Speaker 1: variable answers or this one factor reason where maybe it's
• 18:07
  Speaker 1: there is a significant factor, but maybe there's fifteen variables
• 18:11
  Speaker 1: or factors that influence that person's cognitive state or emotional
• 18:16
  Speaker 1: state or their ability to focus. In the moment, you
• 18:20
  Speaker 1: and I were chatting off air briefly about, you know,
• 18:23
  Speaker 1: the fact that my dad's gone through some stuff right
• 18:25
  Speaker 1: now cognitively, like big, big cognitive stuff, and you know,
• 18:30
  Speaker 1: it could be driven by a myriad of variables. But
• 18:33
  Speaker 1: one of two of the variables that I think are
• 18:35
  Speaker 1: almost affecting him is that his blood sugar is catastrophically high,
• 18:40
  Speaker 1: so blood sugar and this is affecting his cognitive capacity,
• 18:45
  Speaker 1: and also that he probably has some kind of infection
• 18:51
  Speaker 1: in his body at the moment, because there's been this
• 18:53
  Speaker 1: very gradual cognitive decline, but in the last week he's
• 18:56
  Speaker 1: fallen off the metaphoric cliff, and you go, yes, it's
• 19:00
  Speaker 1: affecting his cognitive capacity and awareness and focus and everything.
• 19:06
  Speaker 1: But it's not a brain chemistry problem as much as
• 19:10
  Speaker 1: it is a consequence of other problems or other issues
• 19:15
  Speaker 1: which at the surface you might not think are related.
• 19:19
  Speaker 1: But yeah, so there's so many drivers. And it's like
• 19:23
  Speaker 1: even when I and I'll shut up after this, but
• 19:25
  Speaker 1: even when I talk to people about my area or
• 19:29
  Speaker 1: original area of expertise. I suppose you know exercise science.
• 19:35
  Speaker 1: People will talk to me about that and I'd go, yeah,
• 19:37
  Speaker 1: but yes, we do need progressive overload, and we do
• 19:40
  Speaker 1: need to lift and run and stretch and stimulate our
• 19:44
  Speaker 1: cells to respond so we can build muscle, build power, strength, speed, endurance,
• 19:50
  Speaker 1: all these things. But getting your body in shape is
• 19:54
  Speaker 1: largely not about your body. It's largely about your ability
• 19:58
  Speaker 1: to control your thoughts and emotion and choices and behaviors,
• 20:02
  Speaker 1: and the body is the consequence. Like it's almost an
• 20:07
  Speaker 1: emotional and psychological journey with a physical outcome because your
• 20:13
  Speaker 1: elbows not making decisions, you know, your left ear is
• 20:17
  Speaker 1: not like you are the driver of the behavior which
• 20:20
  Speaker 1: creates the outcome. And yes, your physiology is a variable
• 20:24
  Speaker 1: and it's an issue trying to optimize and operationalize that.
• 20:29
  Speaker 1: But it's ironically I talk to people so much about
• 20:32
  Speaker 1: stuff other than physiology, even though we're talking about their body.
• 20:37
  Speaker 2: Yeah, yeah, no, I think there was a really valid
• 20:41
  Speaker 2: points to make. And before I go on any further,
• 20:44
  Speaker 2: very sorry to hear about your dad. I'm keeping you
• 20:47
  Speaker 2: guys in my thoughts and hoping that everything works out
• 20:50
  Speaker 2: for the best. But I've come to appreciate that body
• 20:57
  Speaker 2: and mind are not separate at all. They are fully integrated,
• 21:03
  Speaker 2: and I think medicine is appreciating that fact much more
• 21:08
  Speaker 2: these days. Most people separate body in mind because it
• 21:12
  Speaker 2: feels intuitive. You know, in our heads, the mind feels
• 21:17
  Speaker 2: very separate from the body, and part of the reasons
• 21:21
  Speaker 2: is because our mind can think about things that we
• 21:25
  Speaker 2: want our body to do, but sometimes our body doesn't cooperate.
• 21:29
  Speaker 1: You know.
• 21:29
  Speaker 2: We experience this a lot as we get older, right,
• 21:33
  Speaker 2: you know.
• 21:33
  Speaker 1: But that's it's you just have.
• 21:37
  Speaker 2: To always keep in mind that what's going on in
• 21:39
  Speaker 2: your body, even though the sites are very distant from
• 21:43
  Speaker 2: you know, that lump of flesh in your head, the
• 21:46
  Speaker 2: microbiome is spitting out all sorts of chemicals. Your blood
• 21:51
  Speaker 2: is full of all kinds of chemicals. When you put
• 21:53
  Speaker 2: food into your body, all kinds of chemicals get released.
• 21:56
  Speaker 2: So this changes your bodily chemistry, and that of course
• 22:00
  Speaker 2: courses through your neurons in your brain. Yes, so almost
• 22:05
  Speaker 2: everything you do, you eat, you know, what happens to
• 22:10
  Speaker 2: your body, what's going on in your environment is ultimately
• 22:12
  Speaker 2: going to go through your brain and that is going
• 22:15
  Speaker 2: to affect your mind. So I think we need to
• 22:19
  Speaker 2: keep in mind that they're not separate. You know, one
• 22:25
  Speaker 2: affects the other and vice versa, and I think that
• 22:28
  Speaker 2: can radically change, you know, medicine moving forward. And it's
• 22:34
  Speaker 2: probably something that you know, us as general public should
• 22:38
  Speaker 2: learn to appreciate as well. Because one of the things,
• 22:40
  Speaker 2: and this is probably the topic for a whole different show, Craig,
• 22:43
  Speaker 2: is that one of the most fascinating things about you know,
• 22:48
  Speaker 2: us as a living creature is that our brain has
• 22:51
  Speaker 2: the ability to change itself. You know, we we create
• 22:57
  Speaker 2: these things called thoughts which alter our brain, chemistry, our electrophysiology,
• 23:05
  Speaker 2: and then in turn affect our brain and our body.
• 23:09
  Speaker 2: You know, we can surprise ourselves sometimes when we mentally
• 23:12
  Speaker 2: say you can run one more mile. You can do
• 23:16
  Speaker 2: this even though the body wanted to quit one mile ago.
• 23:20
  Speaker 2: Sorry I should be using kilometers.
• 23:23
  Speaker 1: But miles. We're way more used to miles than you are.
• 23:27
  Speaker 1: We grew up with American television, so we're fine, you
• 23:30
  Speaker 1: got it.
• 23:32
  Speaker 2: But you see my point. Sometimes our mind can get
• 23:35
  Speaker 2: our body to do things that it doesn't feel like doing,
• 23:39
  Speaker 2: or that it doesn't feel capable of doing. So, yeah,
• 23:43
  Speaker 2: it's a really interesting connection, and it's fascinating that it
• 23:46
  Speaker 2: has the power that it does.
• 23:49
  Speaker 1: So coming back just on that one sick you might
• 23:53
  Speaker 1: find this interesting. You might already know this, but in
• 23:57
  Speaker 1: exercise science slash psychology, there's a concept called rate of
• 24:06
  Speaker 1: perceived exertion RPE is how hard someone thinks they're working.
• 24:12
  Speaker 1: One to ten. We'll just go one to ten, So
• 24:15
  Speaker 1: how hard they think they're working compared to their actual potential.
• 24:20
  Speaker 1: Have you ever heard of that?
• 24:22
  Speaker 2: No, I don't believe.
• 24:23
  Speaker 1: Yeah. So when somebody is doing an activity, like in
• 24:27
  Speaker 1: the gym, for example, they're doing a certain activity and
• 24:30
  Speaker 1: they do a certain weight, same activity, same and they do,
• 24:33
  Speaker 1: say twelve reps. And I've had this happen probably a
• 24:40
  Speaker 1: thousand times because I did work in gyms for decades,
• 24:44
  Speaker 1: where I've said to somebody, how and I look at
• 24:47
  Speaker 1: like I know them recently, well, I know their body.
• 24:50
  Speaker 1: I have a fair idea of their genetic potential, and
• 24:54
  Speaker 1: they'll do you know what lap pool downs are? You
• 24:56
  Speaker 1: know where you pull the weight to the top of
• 24:58
  Speaker 1: your chest anyway size like that, just to pull down.
• 25:02
  Speaker 1: And let's say they do one hundred pounds or forty
• 25:06
  Speaker 1: five kilos and they pull it to the top of
• 25:09
  Speaker 1: their chest, and they do, say fifteen repetitions and on.
• 25:13
  Speaker 1: As they get to twelve, you can see them they
• 25:16
  Speaker 1: know they're nearly finished, and then they start to grunt,
• 25:19
  Speaker 1: screw up their face, and then they just put the
• 25:23
  Speaker 1: weight down. They're like dead right fifteen And I know
• 25:26
  Speaker 1: that they're not anywhere near their capacity. And obviously I'm
• 25:31
  Speaker 1: not doing this with a high risk client. But I
• 25:34
  Speaker 1: would say to them, how hard do you reckon you work?
• 25:36
  Speaker 1: And ten is your human limit? How hard do you
• 25:39
  Speaker 1: reckon you're working? And they'd say, oh, eight, nine, And
• 25:45
  Speaker 1: I'd go, okay, do you know what I think? And
• 25:47
  Speaker 1: they go what I go? I think four or five?
• 25:51
  Speaker 1: And they would get a bit pissed off. I'd say,
• 25:55
  Speaker 1: I get it, but it's actually a compliment. I think
• 25:59
  Speaker 1: you you are so much more capable. In fact, I
• 26:03
  Speaker 1: know you are because I've worked with thousands of bodies,
• 26:07
  Speaker 1: and I know how much muscle you have, and I
• 26:10
  Speaker 1: know how young you are, and I know all these things, right,
• 26:13
  Speaker 1: And the same person, I would say, so that little
• 26:16
  Speaker 1: bit of anger and resentment you've got towards me right now,
• 26:19
  Speaker 1: I want you to get a little bit pissed off
• 26:22
  Speaker 1: and I want you to I want you to do
• 26:25
  Speaker 1: this set. So we're going to do the same exercise
• 26:28
  Speaker 1: at the same weight, and I want you to do
• 26:30
  Speaker 1: it like your life depends on it. Still with good technique.
• 26:33
  Speaker 1: We're not going to do anything stupid or reckless, but
• 26:37
  Speaker 1: like your life depends on it. And many of them
• 26:40
  Speaker 1: have gone from fifteen up to somewhere close to fifty
• 26:45
  Speaker 1: five zero.
• 26:46
  Speaker 2: Big difference, Right, that's amazing, and they should be thanking
• 26:50
  Speaker 2: you in homesight, right because I go your probably couldn't imagine, right, So.
• 26:56
  Speaker 1: Now they all of a sudden start to understand their
• 26:59
  Speaker 1: actual potential. There's also a term called a perform the
• 27:07
  Speaker 1: performance capacity gap, which is, so what's your current performance?
• 27:13
  Speaker 1: Where are you at? And obviously often it relates to
• 27:16
  Speaker 1: sport or strength or some kind of conditioning thing, but
• 27:19
  Speaker 1: it can also be applied to, you know, your performance
• 27:23
  Speaker 1: as a student or as a business owner or as whatever.
• 27:26
  Speaker 1: But so, yeah, performance capacity gap, So that is where
• 27:29
  Speaker 1: am I at in terms of my absolute what where
• 27:32
  Speaker 1: am I working at right now? And what's my story
• 27:35
  Speaker 1: about it? But again, what is my actual capacity? Because
• 27:40
  Speaker 1: I think most people underestimate how powerful and capable they
• 27:46
  Speaker 1: are of doing amazing stuff. And I think part of
• 27:51
  Speaker 1: that comes because I was. I always say like, mediocrity
• 27:55
  Speaker 1: is my gift, because I wasn't great at anything. Ever,
• 28:00
  Speaker 1: It's not like, oh, yeah he was a standout this
• 28:02
  Speaker 1: or that. Nope, nope, straight up mediocre across the board.
• 28:06
  Speaker 1: May be pretty good at communication maybe, but and so
• 28:12
  Speaker 1: for me to become above average in terms of outcomes
• 28:17
  Speaker 1: and performance is just work. But then you go, oh,
• 28:21
  Speaker 1: my potential isn't the problem. My thinking about my potential,
• 28:26
  Speaker 1: you know, my genetics that's the root of the problem. Yeah,
• 28:29
  Speaker 1: my genetics aren't the problem. My capacity to optimize what
• 28:34
  Speaker 1: I've got to work with, or my willingness to get
• 28:37
  Speaker 1: that uncomfortable that's the problem. I don't know how I
• 28:40
  Speaker 1: got there, but I love that shit. No, it's it's great.
• 28:44
  Speaker 2: And we see that in like in academia as well,
• 28:49
  Speaker 2: with like training students who don't think they can learn
• 28:53
  Speaker 2: certain topics, but you know, with a little bit of
• 28:55
  Speaker 2: encouragement and pushing the rate mentorship, they can get there.
• 28:59
  Speaker 2: And they often surprise themselves with not only how much
• 29:05
  Speaker 2: they can increase their knowledge base, but how they can
• 29:07
  Speaker 2: use it to get more innovative and creative in moving
• 29:11
  Speaker 2: forward because they got so much more to draw on.
• 29:14
  Speaker 2: We have to I think as a human being, just
• 29:18
  Speaker 2: remember our brain likes to take the lazy way out,
• 29:22
  Speaker 2: and it'll invent all sorts of scenarios and play head
• 29:26
  Speaker 2: games with us if you will, to minimize the amount
• 29:29
  Speaker 2: of effort that we can put into something and to
• 29:32
  Speaker 2: be satisfied with mediocrity, you know, we can look at
• 29:35
  Speaker 2: it as quite an achievement. But if you have the
• 29:37
  Speaker 2: right mentor a coach or a teacher, they can push
• 29:41
  Speaker 2: you beyond limits that maybe you didn't recognize, or that
• 29:45
  Speaker 2: your brain subconsciously is saying where I'm at is good enough,
• 29:51
  Speaker 2: or this is all I can do, and that becomes
• 29:53
  Speaker 2: an excuse.
• 29:54
  Speaker 1: And you know, I.
• 29:56
  Speaker 2: Think that just underscores how important it is to try
• 29:59
  Speaker 2: to have some sort of you know, rule modeling your
• 30:02
  Speaker 2: life that you can aspire to that takes you beyond
• 30:05
  Speaker 2: your comfort zone and allows you to achieve things either
• 30:08
  Speaker 2: physically or intellectually that you never thought you were capable of.
• 30:12
  Speaker 1: Yeah, yeah, yeah, yeah. I just find that that, like
• 30:18
  Speaker 1: I love working with people who aren't aren't gifted in
• 30:22
  Speaker 1: that way, I love people who underestimate themselves or I
• 30:27
  Speaker 1: love working with them, or who don't have any grasp
• 30:31
  Speaker 1: and I won't bore you with stories, but so many
• 30:34
  Speaker 1: people that have come into my gyms over the years
• 30:36
  Speaker 1: where their biggest handbreak metaphoric handbreak, was just their lack
• 30:43
  Speaker 1: of self belief and awareness. And when you can start
• 30:46
  Speaker 1: to open that door, actually you could do some amazing stuff.
• 30:52
  Speaker 1: And they're like, exactly, and all of these people that
• 30:55
  Speaker 1: just start doing this mind blowing stuff despite the fact
• 31:00
  Speaker 1: that they're not in the top ten percent of anything.
• 31:03
  Speaker 1: But it's like, well, yeah, but how you work and
• 31:06
  Speaker 1: how you study, and how you run, and how you
• 31:08
  Speaker 1: make choices around food and how you build your lifestyle
• 31:11
  Speaker 1: and how you respond, all of these things are optional.
• 31:14
  Speaker 1: These are not said in stone, Like there's not a
• 31:17
  Speaker 1: lot you can do with your genetics other than try
• 31:19
  Speaker 1: and optimize them, you know. But what you've got is
• 31:22
  Speaker 1: what you've got, how you use them, how you you know,
• 31:25
  Speaker 1: how you activate things epigenetically or I don't know if
• 31:29
  Speaker 1: that's right. You know what I'm saying, It's like, this
• 31:32
  Speaker 1: is what I've got to work with, how can I
• 31:33
  Speaker 1: optimize it? Like that's where it's at.
• 31:36
  Speaker 2: No exactly you can have the worst hand at the
• 31:39
  Speaker 2: poker table but still win the game.
• 31:42
  Speaker 1: Yeah, how you play the cards you were dealt? Yeah,
• 31:47
  Speaker 1: So about since.
• 31:51
  Speaker 2: Actually, this has been a great segue, believe it or not,
• 31:55
  Speaker 2: into how the immune system works. We were talking about,
• 31:58
  Speaker 2: you know, training things. Your immune system gets trained every
• 32:02
  Speaker 2: time you get an infection or a vaccine. Your immune
• 32:06
  Speaker 2: system sees that and it's going to remember it and
• 32:08
  Speaker 2: it's going to attack it even more rigorously next time around.
• 32:12
  Speaker 2: So that's the wonderful thing about the immune system and
• 32:16
  Speaker 2: the inflammation that comes along with it. Inflammation is also
• 32:19
  Speaker 2: great to heal an injury. So inflammation, we don't want
• 32:23
  Speaker 2: to demonize it. It is an absolutely essential component to
• 32:27
  Speaker 2: a healthy life, but sometimes it doesn't know when to
• 32:33
  Speaker 2: shut off. And this could be part of the depression
• 32:38
  Speaker 2: of equation. Because inflammation, when you experience it, it's kind
• 32:44
  Speaker 2: of a bummer, and again you get these sickness behaviors
• 32:48
  Speaker 2: related to it. So what happens when people in today's
• 32:52
  Speaker 2: day and age, this is actually increasingly common people experience
• 32:57
  Speaker 2: a low level, sustained amount of inflamm and there's a
• 33:01
  Speaker 2: wide variety of reasons as to why this could be
• 33:05
  Speaker 2: happening to someone so when it does, people are now
• 33:11
  Speaker 2: hypothesizing that this inflammation sustained over time, even at a
• 33:16
  Speaker 2: low level, could be producing sickness behaviors that maybe either
• 33:21
  Speaker 2: mirroring or leading to depression symptoms. And if the inflammation
• 33:26
  Speaker 2: never dissipates, then you've got a situation where the patient
• 33:30
  Speaker 2: is probably going to get into a downward spiral and
• 33:33
  Speaker 2: go into depression. So this is a really intriguing hypothesis,
• 33:38
  Speaker 2: relatively new. That's why many people haven't heard of it yet,
• 33:42
  Speaker 2: and it doesn't seem to you know, we're not suggesting
• 33:45
  Speaker 2: this applies to everybody. As we said, or as we
• 33:49
  Speaker 2: wrote in the article, about one third of people who
• 33:54
  Speaker 2: are on the SSRIs don't get a benefit from them.
• 34:00
  Speaker 2: So that suggests to us that there might be more
• 34:03
  Speaker 2: to the monoamine hypothesis. We might need to start looking
• 34:07
  Speaker 2: at depression as we look at cancer. Cancer is not
• 34:11
  Speaker 2: caused by one thing, it's not limited to one system
• 34:14
  Speaker 2: in the body, and there's not going to be a
• 34:16
  Speaker 2: single cure for it. We have to attack all the
• 34:19
  Speaker 2: different kinds depression might be like that. There may be
• 34:22
  Speaker 2: different types of depression that we've yet to appreciate and
• 34:25
  Speaker 2: fully categorize. There could be depression that's brought on because
• 34:29
  Speaker 2: of an imbalanced monoamines. There could be depression brought on
• 34:33
  Speaker 2: because of the inflammation. Both hypotheses could be correct, and
• 34:37
  Speaker 2: like we said earlier, they may actually overlap once we
• 34:41
  Speaker 2: continue to do more research and find out about them.
• 34:44
  Speaker 2: But what we do see that supports this inflammation hypothesis
• 34:48
  Speaker 2: of depression is that in some people who are resistant,
• 34:52
  Speaker 2: who are not responding to the SSRIs, they tend to
• 34:57
  Speaker 2: have inflammatory markers in their bloodstream that are higher than
• 35:02
  Speaker 2: normal inflammatory markers. There's quite a few of them, but
• 35:06
  Speaker 2: the ones that are most commonly looked at are immune components,
• 35:10
  Speaker 2: like this substance called interleucn six or IL six, that
• 35:14
  Speaker 2: is a critical inflammatory molecule that's necessary for the immune
• 35:19
  Speaker 2: system to function. There's another one called CRP, which stands
• 35:23
  Speaker 2: for C reactive protein. This is a protein that kills
• 35:27
  Speaker 2: dead or dying cells or attacks germs that invade your body,
• 35:31
  Speaker 2: so again critically important. But in some of these depressive
• 35:34
  Speaker 2: patients who are resistant to SSRIs, these inflammatory markers are
• 35:39
  Speaker 2: higher in their blood than in the average population, which
• 35:42
  Speaker 2: is intriguing and lends a little support to this and
• 35:47
  Speaker 2: we also know that people who are suffering from severe infections,
• 35:51
  Speaker 2: they have high levels of inflammatory markers in their blood,
• 35:55
  Speaker 2: which is expected because they're fighting an infection, but they
• 35:58
  Speaker 2: are predisposed they have a heightened risk of developing depression
• 36:03
  Speaker 2: if they remain ill. So and that makes perfect sense,
• 36:07
  Speaker 2: right of course, if you're sick all the time, you're
• 36:10
  Speaker 2: probably going to be at risk for depression. But what
• 36:13
  Speaker 2: if we could get rid of those inflammatory markers that
• 36:16
  Speaker 2: might be lingering even in the absence of an illness.
• 36:20
  Speaker 2: And that's what this small pilot study wanted to address.
• 36:23
  Speaker 2: Because we have medical treatments now for inflammation diseases like
• 36:29
  Speaker 2: arthritis for example, or inflammatory bow disease, we have treatments
• 36:34
  Speaker 2: that can specifically target that inflammatory marker that I spoke
• 36:37
  Speaker 2: of IL six. So there was a small pilot's study
• 36:43
  Speaker 2: done just back in May. So this is very new,
• 36:45
  Speaker 2: very hot off the presses. It's a very small clinical
• 36:49
  Speaker 2: trial done at the University of Bristol in the UK where.
• 36:52
  Speaker 1: They gave one of these new arthritis drugs.
• 36:57
  Speaker 2: It's a monoclonal antibody that targets the receptor for IL six.
• 37:02
  Speaker 2: In other words, it's going to mitigate the activity of
• 37:06
  Speaker 2: IL six.
• 37:06
  Speaker 1: In the body.
• 37:07
  Speaker 2: And at the end of the day, what that does
• 37:09
  Speaker 2: it calms the immune system down, It brings inflammation down.
• 37:14
  Speaker 2: And they did this trial in just thirty people. Okay,
• 37:18
  Speaker 2: fourteen of the patients got the anti inflammatory drug and
• 37:23
  Speaker 2: sixteen got a placebo and they monitored them for one month.
• 37:28
  Speaker 2: All the people in this trial were severely depressed, so
• 37:33
  Speaker 2: they were clinically depressed, and they were not responsive to
• 37:38
  Speaker 2: the SSRIs. So what happened is that they saw a
• 37:44
  Speaker 2: significant difference in the people who were treated with the
• 37:47
  Speaker 2: authritis drug that mitigated IL six activity, which implicates and
• 37:55
  Speaker 2: supports this hypothesis that the inflammatory can do are perhaps
• 38:01
  Speaker 2: predisposing them to depressive symptoms. The exact results of the trial,
• 38:09
  Speaker 2: and I'm quoting it here, the patients who got that
• 38:12
  Speaker 2: anti inflammatory drug generally showed greater improvement over time in
• 38:17
  Speaker 2: several areas including depression, severity, fatigue, anxiety, and overall quality
• 38:23
  Speaker 2: of life. And I thought this was really striking. Half
• 38:28
  Speaker 2: the patients that were given the drug achieved complete depression
• 38:32
  Speaker 2: remission for the months that they were monitored. And again,
• 38:37
  Speaker 2: these are people who were resistant to drugs like prozac,
• 38:40
  Speaker 2: so that's pretty amazing, but we should emphasize no, go ahead,
• 38:46
  Speaker 2: I want to emphasize limitations of the study.
• 38:48
  Speaker 1: But if you've got a question, I was just going
• 38:51
  Speaker 1: to say, like, that's pretty profound. So all of these
• 38:54
  Speaker 1: people with clinical depression SSRIs don't work for them, they
• 39:03
  Speaker 1: probably never really have a good day, so to speak.
• 39:06
  Speaker 1: And then using a drug that wasn't designed for that
• 39:09
  Speaker 1: issue or that medical problem, fifty percent of them are
• 39:17
  Speaker 1: relieved of all symptoms and for one of a better term,
• 39:20
  Speaker 1: happy not sad. Right, that is profound. What so what
• 39:29
  Speaker 1: would happen next? Because I feel like the timeline between
• 39:32
  Speaker 1: this revelation, which was a month or two ago, and
• 39:37
  Speaker 1: that being something that's available in the real world to
• 39:41
  Speaker 1: the average punter is going to be ten years. It
• 39:44
  Speaker 1: just seems like that's the way that works. Is So,
• 39:48
  Speaker 1: what would happen next? With that? We go, Okay, we
• 39:50
  Speaker 1: know this.
• 39:52
  Speaker 3: Did we then run another study that refines, you know,
• 39:56
  Speaker 3: or changes the protocol a bit to get more clarity
• 40:00
  Speaker 3: or I don't know, So is there just another study
• 40:02
  Speaker 3: or ten done after that?
• 40:04
  Speaker 1: What happens?
• 40:05
  Speaker 2: No, that's a great question because it's a very exciting result.
• 40:09
  Speaker 1: Right, and that's amazing.
• 40:12
  Speaker 2: Humanly, we want to help these patients. We're desperate to
• 40:15
  Speaker 2: give them some relief, and we're talking about a new
• 40:19
  Speaker 2: but FDA approved drug. I mean, this could really be
• 40:23
  Speaker 2: rapidly repurposed to treat depression if these results hold up.
• 40:29
  Speaker 2: And it's a big if, because let me, I don't
• 40:32
  Speaker 2: mean the damp and enthusiasm too much, but it's important
• 40:35
  Speaker 2: to highlight the limitations of this pilot's study. It was
• 40:39
  Speaker 2: only thirty people, and only half of them actually got
• 40:43
  Speaker 2: the drug. The other half got placebo, and they were
• 40:46
  Speaker 2: only monitored for a month, So we don't know if
• 40:51
  Speaker 2: these people are still going to be happy another month
• 40:53
  Speaker 2: from now. They may need to be on this drug
• 40:56
  Speaker 2: long term, which might be fine. That's oba better than
• 41:00
  Speaker 2: the alternative, which is severe depression that doesn't respond to
• 41:04
  Speaker 2: any other treatment. So I think, as you were saying, Craig,
• 41:08
  Speaker 2: what needs to be done and what can be done,
• 41:11
  Speaker 2: I think this study screams that it should be done.
• 41:14
  Speaker 2: Is a much larger clinical trial involving tens of thousands
• 41:18
  Speaker 2: of people with a much more diverse patient population, so
• 41:24
  Speaker 2: this was being so limited. We want to make sure
• 41:27
  Speaker 2: that this works and all sorts of people who are
• 41:29
  Speaker 2: taking many different medications, perhaps or who have other pre
• 41:33
  Speaker 2: existing conditions from different walks of life. Does it work
• 41:38
  Speaker 2: in people who live in different areas, have different genetic backgrounds.
• 41:44
  Speaker 2: All those are really legitimate good questions, because the last
• 41:47
  Speaker 2: thing we want to do is to rush what appears
• 41:50
  Speaker 2: to be a promising treatment out to the masses when
• 41:54
  Speaker 2: in fact it doesn't work or actually could produce harm.
• 41:58
  Speaker 2: Sometimes when we get in exting result like this from
• 42:01
  Speaker 2: a pilot's study and blow it up into a much
• 42:03
  Speaker 2: larger study, sometimes you find out that there's people who
• 42:07
  Speaker 2: are hurt by this treatment and get even worse. I
• 42:11
  Speaker 2: would hope that's not the case here, because this drug
• 42:14
  Speaker 2: has already been through a wide variety of clinical trials
• 42:18
  Speaker 2: for other indications, and there were no major side effects
• 42:22
  Speaker 2: associated with it, other than maybe an increased propensity for
• 42:26
  Speaker 2: infection since you're decreasing the immune response a little bit.
• 42:30
  Speaker 2: So that's what has to happen next. But I think
• 42:32
  Speaker 2: it can happen quickly if people get on board with
• 42:36
  Speaker 2: this idea that you know, sustained chronic inflammation could be
• 42:40
  Speaker 2: a driver of depression in perhaps thirty percent of patients.
• 42:47
  Speaker 1: A couple of things come to mind, Doc one or
• 42:52
  Speaker 1: one question first, between the first day the first dose
• 42:58
  Speaker 1: treatment have long been for the for the fifty percent
• 43:03
  Speaker 1: of people who had a complete kind of separation from
• 43:08
  Speaker 1: or departure from depression or relief, whatever we want to
• 43:11
  Speaker 1: call it, how long before they felt that, how many days?
• 43:16
  Speaker 1: Any idea you will take.
• 43:19
  Speaker 2: I don't know. It probably varied from person to person,
• 43:22
  Speaker 2: but what most of what I took away from the
• 43:26
  Speaker 2: study is that the patients were monitored over the course
• 43:29
  Speaker 2: of one month, so it had to happen pretty fast.
• 43:33
  Speaker 1: You know.
• 43:33
  Speaker 2: The maximum amount of time would have been three to
• 43:35
  Speaker 2: four weeks, so I think we're looking at a pretty
• 43:39
  Speaker 2: quick response here.
• 43:41
  Speaker 1: Also, thank you too. Point two. It's probably a question
• 43:47
  Speaker 1: in here as well. It seems to me like it
• 43:49
  Speaker 1: would not be a bad idea and a pretty safe
• 43:54
  Speaker 1: idea to try to have a almost like an inflammatory
• 44:01
  Speaker 1: diet or a low inflammation diet because obviously, and I'm
• 44:06
  Speaker 1: not an anti carb person or anything, but obviously you
• 44:10
  Speaker 1: know some diets predispose you more to an inflammatory response
• 44:14
  Speaker 1: than others. That wouldn't hurt to try as well.
• 44:19
  Speaker 2: Oh, Craig, you're so right, and you nailed like where
• 44:22
  Speaker 2: I was going at the end of this article, you know,
• 44:24
  Speaker 2: what can people do in the here and now, because
• 44:28
  Speaker 2: what this study really brings to the surface, if you're
• 44:32
  Speaker 2: reading between the lines, is that there's a high percentage
• 44:36
  Speaker 2: of people who have chronic sustained inflammation. I think the
• 44:41
  Speaker 2: real question at the end of the day is what's
• 44:43
  Speaker 2: causing that? You know, what are we doing that's causing this?
• 44:48
  Speaker 2: And there is no single answer, but a lot, you know,
• 44:54
  Speaker 2: and it's probably not a single answer. So there was
• 44:58
  Speaker 2: a study I found a review article that was done
• 45:00
  Speaker 2: in twenty thirteen that answered the question you're raising, which
• 45:04
  Speaker 2: is an excellent one. What are some of the drivers
• 45:07
  Speaker 2: of sustained low level inflammation that we're seeing in people.
• 45:12
  Speaker 2: So again I'll remind you and your listeners that these
• 45:17
  Speaker 2: individuals who are refractory to SSRIs already have inflammatory markers
• 45:23
  Speaker 2: in their blood and they don't have an infection, or
• 45:27
  Speaker 2: at least none that was detected. So something else in
• 45:31
  Speaker 2: the environment's going on, or they're putting something into their
• 45:34
  Speaker 2: body that's causing inflammation. And you can imagine what some
• 45:38
  Speaker 2: of these things are because we talked about them in
• 45:41
  Speaker 2: previous episodes, and I know You've had guests who have
• 45:44
  Speaker 2: reiterated the same thing. But the Western diet that is
• 45:50
  Speaker 2: loaded with sugar, fats, and salts, these ultra processed foods
• 45:55
  Speaker 2: have definitely been linked to causing inflammation in a large
• 45:59
  Speaker 2: number of people. They are disastrous to the microbiome, and
• 46:05
  Speaker 2: the microbiome is critical in keeping in systemic inflammation at BAY.
• 46:11
  Speaker 2: Another thing you can do besides quitting those ultra process
• 46:15
  Speaker 2: foods or at least minimizing those eating more real foods,
• 46:20
  Speaker 2: is to eat things that are healthy for the microbiome.
• 46:24
  Speaker 2: We're talking about prebiotic foods, fermented foods, and things of
• 46:29
  Speaker 2: that sort. We talked about the microbiome extensively before, so
• 46:34
  Speaker 2: I'll just refer people to those episodes. But another interesting
• 46:37
  Speaker 2: factor is exercise. People who exercise generally have a lot
• 46:42
  Speaker 2: less inflammation in their body, which might be counterintuitive because
• 46:46
  Speaker 2: a lot of people think if I'm using my body,
• 46:48
  Speaker 2: if I'm working out, I must be injuring it and
• 46:51
  Speaker 2: getting inflammation. But overall, in the grand scheme of things,
• 46:56
  Speaker 2: and you can correct me if I'm wrong here, exercise
• 47:00
  Speaker 2: wonders not only for your microbiome, but in driving inflammation,
• 47:05
  Speaker 2: keeping inflammation at Bay.
• 47:08
  Speaker 1: Also there was a I'd have to relook at because
• 47:12
  Speaker 1: I might get the dates wrong, but University of South Australia,
• 47:15
  Speaker 1: so they call it UNISA. They did a study I
• 47:19
  Speaker 1: think it was the end of twenty twenty four, comparing
• 47:24
  Speaker 1: I can't remember the protocol, but basically they had a
• 47:28
  Speaker 1: whole bunch of people who were dealing with depression or
• 47:31
  Speaker 1: suffered from depression. It was a it was a reasonable
• 47:36
  Speaker 1: size sample, I can't remember, but it was hundreds, so
• 47:40
  Speaker 1: it might have been a few hundred in each group.
• 47:42
  Speaker 1: But one group took their medication and one group exercised.
• 47:48
  Speaker 1: And you know what I'm going to say. The exercising
• 47:52
  Speaker 1: group didn't take the medication. All they did was exercise,
• 47:55
  Speaker 1: and that group way outperformed, Like the reduction in symptoms
• 48:01
  Speaker 1: was quite drastic. And yeah, so one group took their SSRIs,
• 48:07
  Speaker 1: one group exercised without any medication, And yeah, I guess
• 48:13
  Speaker 1: part of the thing for me, I think with medication
• 48:16
  Speaker 1: is that because most of us love instant gratification, most
• 48:22
  Speaker 1: of us hate discomfort. You know, exercises discomfort, especially when
• 48:27
  Speaker 1: you're a newbie and it's not quick and it's not fast,
• 48:32
  Speaker 1: and the results aren't evident on day three.
• 48:35
  Speaker 2: So for me, it's a lifelong commitment. It's not something
• 48:38
  Speaker 2: you do for a little while. I mean, it's a
• 48:40
  Speaker 2: lifestyle change one.
• 48:42
  Speaker 1: Hundred, you know, and that there are just you've probably
• 48:46
  Speaker 1: got more. But I've got so many cases of people
• 48:49
  Speaker 1: who have just changed something about their lifestyle but forever
• 48:54
  Speaker 1: that's just had a profound effect on you know, pain, function, performance, sleep,
• 49:01
  Speaker 1: emotional health, mental health. Where they've and again we're not
• 49:06
  Speaker 1: suggesting anything specifically anyone, but yeah, they've come off all
• 49:10
  Speaker 1: their medication and you know, they've lost a certain amount
• 49:14
  Speaker 1: of weight, some of them, but their day to day
• 49:17
  Speaker 1: function and emotional state is so through the roof that
• 49:22
  Speaker 1: you would think it's a miracle drug that they're using.
• 49:26
  Speaker 1: You know a friend of mine who's been on the show.
• 49:28
  Speaker 1: In fact, I just did a three day program whether
• 49:31
  Speaker 1: in Queensland last weekend, which I spoke to you about briefly,
• 49:34
  Speaker 1: doctor Denise Vaness. She's a geneticist and a whole bunch
• 49:37
  Speaker 1: of other stuff. We had a mutual friend, Danielle, whose
• 49:46
  Speaker 1: son was is I'm going to say where was autistic.
• 49:52
  Speaker 1: This was maybe six or seven years ago, quite quite
• 49:58
  Speaker 1: severely impacted, not communicative, had never spoken, had never like,
• 50:05
  Speaker 1: couldn't write, couldn't And so they got together and Denise
• 50:10
  Speaker 1: is a practitioner and all not all she did significant,
• 50:15
  Speaker 1: but she took all of the stuff that she considered
• 50:18
  Speaker 1: toxic out of his life and totally changed his diet,
• 50:24
  Speaker 1: like a completely one U turn diet, and in less
• 50:31
  Speaker 1: than two weeks he started talking.
• 50:34
  Speaker 2: Amazing, Yeah, just amazing, I mean really illustreets.
• 50:39
  Speaker 1: Sorry, just the impact on his brain and his function
• 50:42
  Speaker 1: was like profound, doesn't even really cover it. Yeah, yeah, yeah.
• 50:48
  Speaker 2: I wrote about this concept in my book Pleased to
• 50:51
  Speaker 2: Meet Me, that we are evolutionarily mismatched with today's environment.
• 50:56
  Speaker 2: We evolved for tens of thousands of years in a
• 51:01
  Speaker 2: very different environment, eating real foods, getting lots of exercise,
• 51:05
  Speaker 2: lots of sunshine, lots of what oh, I forget who
• 51:08
  Speaker 2: called it? This vitamin N N for nature, just getting
• 51:13
  Speaker 2: outside and enjoying the sunshine, which actually creates vitamin D,
• 51:19
  Speaker 2: which was highlighted in this review as one of the
• 51:21
  Speaker 2: risk factors for inflammation a vitamin D deficiency. So it
• 51:26
  Speaker 2: all starts to make sense. The other things they highlighted
• 51:28
  Speaker 2: Craig was sleep deprivation or getting poor quality sleep.
• 51:31
  Speaker 1: Just as you said, sometimes.
• 51:33
  Speaker 2: There's allergies and you really can't do much about that
• 51:36
  Speaker 2: one other than seeing an allergist and seeing what you
• 51:39
  Speaker 2: can do to treat it. But allergies will cause sustained
• 51:43
  Speaker 2: inflammation in some people. And then there's environmental factors. So
• 51:47
  Speaker 2: all of what we listed are things you can take
• 51:49
  Speaker 2: action on. You know, clean up your diet, get exercise,
• 51:54
  Speaker 2: get outside. That's going to create what's called a virtual
• 51:57
  Speaker 2: cycle because when you do those things, you are going
• 51:59
  Speaker 2: to sleep better, you are going to feel less stress.
• 52:03
  Speaker 2: And if you're outside getting exercise, you're going to make
• 52:05
  Speaker 2: vitamin D because it needs sunshine in order for you
• 52:08
  Speaker 2: to make that hormone. So all those things can are
• 52:13
  Speaker 2: within your power. I'm not saying they're going to cure
• 52:16
  Speaker 2: every case of depression. Some legitimately have like a you know,
• 52:20
  Speaker 2: a genetic or some other risk factor that's going to
• 52:24
  Speaker 2: kind of lock them into depression no matter what sort
• 52:26
  Speaker 2: of lifestyle changes they make. But these are lifestyle changes
• 52:30
  Speaker 2: that everyone should be abiding by. This is how we
• 52:33
  Speaker 2: were evolutionarily designed to thrive, and we got to be
• 52:37
  Speaker 2: in sync with that. There are some things outside of
• 52:41
  Speaker 2: our control. I mean, unless you get into politics and
• 52:44
  Speaker 2: start changing things.
• 52:46
  Speaker 1: Air pollution is.
• 52:47
  Speaker 2: One of the biggest factors that is consistently linked with
• 52:51
  Speaker 2: causing inflammation and people. This is from the burning of
• 52:54
  Speaker 2: fossil fossil fuels creating small creating air pollutants we can't see,
• 53:01
  Speaker 2: but are causing inflammation inside our bodies as we breathe
• 53:04
  Speaker 2: these things. And you can see big differences between people
• 53:07
  Speaker 2: who live in cities where there's a lot more air
• 53:09
  Speaker 2: pollution and people who live out in the countryside where
• 53:12
  Speaker 2: there's a lot less. People in the cities tend to
• 53:15
  Speaker 2: have a lot more allergies, another driver of inflammation, whereas
• 53:19
  Speaker 2: people in the country don't have those allergies. Very interesting
• 53:23
  Speaker 2: contrast there, But that's not something we can do, you know,
• 53:27
  Speaker 2: if you don't have the freedom to move out to
• 53:29
  Speaker 2: the sticks of the country, but you do have the
• 53:32
  Speaker 2: freedom to vote for people who will get on board
• 53:35
  Speaker 2: with clean energy and cleaning up our environment, which is
• 53:37
  Speaker 2: going to benefit all the health of everyone.
• 53:41
  Speaker 1: Yeah, I read I was looking at a a year ago.
• 53:47
  Speaker 1: I stumbled across this bit of research from the Journal
• 53:51
  Speaker 1: of Behavior Therapy, and I couldn't remember I was trying
• 53:54
  Speaker 1: to I was writing a post for Instagram today and
• 53:57
  Speaker 1: I knew it was I roughly got I actually got
• 54:00
  Speaker 1: the figure right, but I couldn't remember all the details.
• 54:03
  Speaker 1: But anyway, talking about anxiety and worry and in a
• 54:08
  Speaker 1: chaos and overthinking and not so the paper was what's
• 54:15
  Speaker 1: called I wrote it down the paper. Oh no, I
• 54:20
  Speaker 1: didn't have the title, but yeah, twenty twenty Behavior Therapy
• 54:26
  Speaker 1: is the journal. But they looked at people who were
• 54:28
  Speaker 1: chronic worriers and overthinkers. And of all of the things
• 54:34
  Speaker 1: that people worried about in this study anyway, nine yeah,
• 54:41
  Speaker 1: ninety one point two percent of the time on ninety
• 54:44
  Speaker 1: one point eight those things never happened. So they invested
• 54:48
  Speaker 1: all that thought and energy and oh yeah, like almost
• 54:53
  Speaker 1: all of what you worry about, well, you know, over
• 54:56
  Speaker 1: nine out of ten of the things that you worry
• 54:58
  Speaker 1: about don't happen. And of the remaining group that where
• 55:02
  Speaker 1: it did happen anyway, it was significantly less traumatic than
• 55:06
  Speaker 1: they envisaged it to be, you know. And it's like
• 55:13
  Speaker 1: so rather than going well, today is pretty good today,
• 55:15
  Speaker 1: I feel all right, and the weather's good, and I've
• 55:18
  Speaker 1: got a job and I don't hate my job, and
• 55:20
  Speaker 1: I'm making okay money and someone loves me that's good.
• 55:23
  Speaker 1: Instead of having that and I don't mean to be
• 55:26
  Speaker 1: critical or judgmental, but instead of just going this is
• 55:30
  Speaker 1: good and having a level of whatever contentment, we're perpetually
• 55:33
  Speaker 1: worried about the thing that might happen but probably statistically won't.
• 55:39
  Speaker 1: That the bad thing that might happen in the future.
• 55:42
  Speaker 1: So the bad thing that might happen in the future
• 55:44
  Speaker 1: but probably won't actually hijacks us today, hijacks our mental
• 55:49
  Speaker 1: and emotional system today, you know, and our brain and
• 55:53
  Speaker 1: our nervous system. And now I'm flat, or now I'm anxious,
• 55:57
  Speaker 1: and now I'm worried, or now I'm depressed, or now
• 55:59
  Speaker 1: I'm scared, or all of it for something that doesn't.
• 56:02
  Speaker 2: Come absolutely and and that's just a bad habit we
• 56:07
  Speaker 2: have to break. Corey ten Boom said, worry does not
• 56:12
  Speaker 2: empty tomorrow of its sorrow. It empties today of its strength.
• 56:18
  Speaker 1: And it's good. Yeah.
• 56:20
  Speaker 2: I love that quote, and it reminds me very much
• 56:23
  Speaker 2: of what you were just saying. So much of what
• 56:26
  Speaker 2: we worry about never happens anyway, So just relax, enjoy
• 56:30
  Speaker 2: the moment the best you can be present.
• 56:32
  Speaker 1: There was was that is Corey is a lighty right
• 56:38
  Speaker 1: or is and also a preacher. I'm pretty sure she
• 56:44
  Speaker 1: was a preacher, but I love that sign.
• 56:51
  Speaker 2: A Dutch watchmaker and later Christian writer and public speaker.
• 56:56
  Speaker 1: Right right, cool? Hi? Do you want I quickly wrap
• 57:00
  Speaker 1: this up? What are the takeaways? Do you want to
• 57:03
  Speaker 1: one or two or three point point type?
• 57:06
  Speaker 2: Sure?
• 57:06
  Speaker 1: Sure, yeah, yeah.
• 57:07
  Speaker 2: We had a wonderful, sprawling discussion, So just kind of
• 57:11
  Speaker 2: to summarize all the high points for people. You know,
• 57:15
  Speaker 2: there's a there's a small subset of people with severe
• 57:18
  Speaker 2: depression who don't respond to the conventional therapies, which usually
• 57:23
  Speaker 2: target the mono of means, the neurotransmitters in the brain.
• 57:26
  Speaker 2: So what else could be going on? Well, there's an
• 57:29
  Speaker 2: alternative hypothesis that it's chronic inflammation, which can be caused
• 57:33
  Speaker 2: by a wide variety of things, some of which are
• 57:36
  Speaker 2: in our controls, some are not. And a small clinical
• 57:39
  Speaker 2: trial was done at University of Bristol that identified an
• 57:43
  Speaker 2: anti inflammatory drug that is currently being used for arthritis
• 57:47
  Speaker 2: that alleviated depression in a in you know, this small
• 57:52
  Speaker 2: clinical trial and participants there. So it's causing researchers to
• 57:56
  Speaker 2: rethink their ideas about what the drivers of depression could
• 58:00
  Speaker 2: be and whether some of these anti inflammatory drugs could
• 58:04
  Speaker 2: be useful for people who don't respond to the SSRIs. Yeah,
• 58:10
  Speaker 2: and as we said at the end, there's some things
• 58:11
  Speaker 2: you can do in your personal life with respect to
• 58:15
  Speaker 2: diet and exercise, stress reduction and sleep that could control
• 58:20
  Speaker 2: inflammation and just make you feel better overall, whether you
• 58:23
  Speaker 2: suffer from depression or not.
• 58:26
  Speaker 1: Love it so interesting. My last quick question because we're
• 58:29
  Speaker 1: out of time, but so would be would there be
• 58:32
  Speaker 1: doctors We're not suggesting this is a good idea or
• 58:36
  Speaker 1: should happen anyone, but would there be doctors who prescribe
• 58:40
  Speaker 1: that right now for people in an off label use
• 58:42
  Speaker 1: kind of scenario. That's a great question. I don't know that.
• 58:49
  Speaker 2: I mean, this trial was done in the UK, so
• 58:52
  Speaker 2: I don't know how regulation of medicine works there as
• 58:57
  Speaker 2: much as I do in the US. I think in
• 58:59
  Speaker 2: the US it would be a lot more tightly controlled,
• 59:02
  Speaker 2: and I think a larger clinical trial would need to
• 59:06
  Speaker 2: be performed to definitely rule out that depressive patients don't
• 59:11
  Speaker 2: get any worse when they take this. So I think
• 59:16
  Speaker 2: we can be cautiously optimistic about this, and since the
• 59:18
  Speaker 2: drug is FDA approved, I think a lot of the
• 59:21
  Speaker 2: hurdles are already surmounted, so this could progress much more
• 59:27
  Speaker 2: rapidly than like a brand new medication that has not
• 59:30
  Speaker 2: been in masses of people before.
• 59:33
  Speaker 1: Yeah, mizink, Please to make me what's the second pot
• 59:39
  Speaker 1: to that fear book?
• 59:41
  Speaker 2: Please to meet me Jenes, germs and the curious forces
• 59:44
  Speaker 2: that make us who we are. You can find information
• 59:47
  Speaker 2: about the book, as well as this article in Psychology
• 59:51
  Speaker 2: Today at my website www. Author bill Sullivan dot com.
• 59:57
  Speaker 1: So it's great. So we appreciate you. Thank you so
• 1:00:00
  Speaker 1: much for donating that big fat brain of yours and
• 1:00:03
  Speaker 1: all the contents and your time. We appreciate you.
• 1:00:07
  Speaker 2: Oh it's my pleasure.