Alex Riley on Emerging Perspectives on Depression

May one and leave us a voicemail. We're excited to celebrate this milestone with you, our dear listeners. These drugs, you know, they're not going to cure anything. They're going to be able to support you as you try new things, as you battle the depression. With all these different avenues that we have and finding the one that fits, because everyone's journey is going to be really, really different. Welcome to the One You Feed. Throughout time, great thinkers have

recognized the importance of the thoughts we have. Quotes like garbage in, Garbage out, or you are what you think ring true, and yet for many of us, our thoughts don't strengthen or empower us. We tend toward negativity, self pity, jealousy or fear. We see what we don't have instead of what we do. We think things that hold us back and dampen our spirit. But it's not just about thinking. Our actions matter. It takes conscious, consistent and creative effort

to make a life worth living. This podcast is about how other people keep themselves moving in the right direction, how they feed their good wolf. Thanks for joining us. Our guest on this episode is Alex Riley, an award winning science writer. In two thousand nineteen, he received a Best Feature Award from the Association of British Science Writers for his reporting on the Friendship Bench, a project that

began in some bobwe in two thousand six. Alex's articles have been published by New Scientist, Mosaic, Nova, Text, Nautilus Magazine, the BBC and many others, and his new book is A Cure for Darkness, The Story of Depression and How We Treat It. Hi, Alex, Welcome to the show. Hi, thanks for having me. We are going to be discussing your book, A Cure for Darkness, The Story of Depression and How We treat it, which listeners will know, is right up my alley, the kind of thing I love

to read, and it's a wonderful book. But before we do that, will start, like we always do, with the Parable. In the Parable, there is a grandparent talking with their grandchild and they say, in life, there are two wolves inside of us that are always at battle. One is a good wolf, which represents things like kindness and bravery and love, and the other is a bad wolf, which

represents things like greed and hatred and fear. And the grandchild style ups and thinks about it for a second, looks up at their grandparents, says, well, which one wins, and the grandparents says, the one you feed. So I'd like to start off by asking you what that parable means to you in your life and in the work that you do. I think the parable it really speaks, you know, quite intimately with depression. Some of the words

that you just said there, I mean hatred, greed. Depression is often related to a hatred of yourself, and in my personal experience, that seems quite apt. It came from a Freudian background, but it seems to be relevant to a lot of people. People don't have that love for themselves. So I think the two wolves in terms of depression is do you love yourself or do you hate yourself? And which one are you going to allowed to win

that battle? And sometimes you can't really control which one you seem to be, you know, helpless and hopeless when you are faced with a precative episode, and unfortunately the self hatred wins. And so the Parable really does connect quite deeply with some of the basic underlying symptoms and experiences of depression. And it's very difficult to love yourself when you've experienced a depression or you're going through a depression.

But for me that's been one of the main elements of recovery is through therapy and using pharmacological tools, is to enable yourself to open you to love yourself. There are other things that this parable readers speak in terms of you know, which one do you feed with depression? And as I write in the book, a large part of depression they come from what you actually eat. So literally, which wolf for you feeding? Are you feeding this this depression?

Are you feeding this healthier side of yourself? What do you eat eating a healthy, balanced diet or eating very high saturated fat content and you know, feeding this beast that will only lead you down the path of depression. I love that. I love the idea of the wolf, of hating yourself versus loving yourself. And it's funny. One of the ways that I can tell I'm having a bit of a depressive episode is I actually will hear

my brain say I hate myself. I'll actually hear those words, and for me, it's an immediate like hang on a second. It's like a harbinger for me of old scripts starting to run and of something being off, because it's so out of character for broadly speaking, how I relate to myself most of the time now, because I agree with you, I think learning to love myself, to care about myself, to take care of myself, has been a huge part of what all this healing has been about for me.

So when I hear something that's stark, it kind of sets me off. So I love the way you said that because it kind of made that come to mind for me. And that's amazing that you can do that.

I mean, that takes a lot of time, I'm sure, And you know, it's very easy to believe what your brain is telling you in that moment you know, there's a real disparity between what's real and what isn't when you're going through a depressional that first instance of where depressive episode might be star thing that voice is just as real as a voice that saying no, I don't hate myself, that I'm actually proud of myself for doing this thing that I've done, or I feel, you know,

great affection for myself. Because I've been through these quite portress experiences, I'm still probably not at that level I think. I mean, I I let that voice overtake me. I mean, I've just come out of quite a severe three months. Often my depressions are quite associated with seasons. It's quite seasonal, so often during the inter worse. Yes, I'm coming out of that depression over the last month or so, and it's still very difficult for me to to stop that

voice like you just mentioned. Yeah, And it's interesting. I don't know that I would say that I can always stop it, but I recognize it, and it may just be that maybe I have a benefit of having a very dramatic inner voice sometimes, like when it says something like that, like it's just that stark, I'm like, whoa

you know, or I wish I was dead. I'm like, all right, hold on, Like I almost laugh at it a little bit because I'm like, it is so it is so dramatic, and I am not, by nature or a very dramatic person, so when it does that, it just sort of catches me. I don't necessarily say that I can always turn it off. But what I have gotten better at, and I've talked about this on the show a lot over the years, is like, you know,

is my depression better than it used to be? And we're going to talk about this in a little while. Is it depression? What do you even call it? All this different stuff, But one of the things I unequivocally know is that I respond to it in a much

wiser and more sane way than I used to. And I can sort of recognize it a little bit as sort of that bad wolf of me, like, Okay, I can't turn you off, but I'm gonna try not to give you a ton of attention either, you know, I'm gonna try and just go are there it is again? You know? There it is again. I know from previous experience it's not true. It feels very real, but depending on how severe it is, obviously has to do with how we're able to do that. So you just kind

of came out of difficult period. Do you have any sense of what caused you to either go into it or come out of it? You mentioned the seasons being part of it. Was there anything else and what do you think lad to the emergence or is it just sort of it followed its cycle and now it's done. So I think my depression is quite recurrent. It seems to come and go maybe every few months or you know, I think once it was eighteen months, and you know, it lasts for anywhere between, you know, a few weeks

to a few months. But actually with antidepressants, I can really reduce that amount of time. I think that's what antidepressants have done for me, is they don't remove the depression, they allow it to have a short course. You know, people think of depression as being you know, you're constantly disabled. You can't do anything for that amount of time where it's still fluctuates within that episode. For me, where some days I'm incredibly disabled from it, and then other days

I might feel like a bit of lucidity. I might feel like it's over, and then it slams me back into it. So people are often surprised that, you know, I turn up to either events and stuff and I can seem to be able to switch it off, but actually it's just sort of obviously this sort of sound wave that's going through this episode. Yeah, I'm still trying to understand the triggers. I mean, they're obviously our triggers. I think even publishing this book has been really difficult

given the topic. Given you know that it took me four years and now it's been released into the world, and you know, it's been really well reviewed. But during a pandemic, books just aren't selling. We talked about hating yourself and then this this voice comes in your head where you're saying you're a failure. Yeah, this isn't being successful, So you know, it's kind of trying to rationalize that and just almost wait until you're in a more stable position to kind of climb out of this hole that

depression has thrown you into. And like you said, I think as you become older something dealing with this for for many years now, you become experienced in your own sort of depression and you can kind of hear the tell tale signs. It's incredibly stressful, but at the same time you almost have this thought in your head where saying, I know this isn't forever, and that's a really hard

thing to think about. Yeah, you know it's going to end, and I know that on the other side, I'll be sociable, I'll be hopefully interesting, and my relationship won't be failure, like my partner still loves me and everything like that along with the book. I think we had our first child just before the book was published, so it's been a bit of accessful years. I think these things do,

even subconsciously add to the triggers. I'm just happy that it's not as severe and as permanent as a lot of depressions are, that it responds to certain types of therapy and antidepressants. That's what I'm really really thankful for. Yeah, so let's talk about antidepressants. You know, in the book, you talk about sort of going on them, coming off of them, and going back on them, you know, and and the debate that a lot of people have, myself

included because I have done that day. It's the on again, off again dance, and at the time of the book being published, the answer for you was back on antidepressants and you felt like that's kind of where you were, but you mentioned to me in our conversation beforehand that that's not kind of where you are now. So let's kind of talk about that back and forth a little bit, and you know, sort of what causes you to think sometimes that you should be on you should be off,

and maybe we could just swap experiences on that. Yeah, sure, So it's a balance. Really, the drugs aren't, you know, without side effect or you know, impact on your life. Compared to some of the older drugs. They are almost without side effect, but some of the older drugs are more effective and really severe depressions. So it's different for

every person. And the side effects that I really struggle with and try to this is the reason I keep coming off them or trying to come off them, is it's almost like it puts up a force field between you and the world, so I don't really experience the world. I don't feel connected to it, and that has problems

with my relationship. I was on a very very high dose just after my daughter was born, and I realized that I was not really connected to her like I should be, like I thought I would feel more when I said my daughter, and you know that just wasn't happening if it did feel sort of being surrounded by some force field, and then that emotion couldn't come in. So I came off them in order to try and

experience the world a bit more. But in doing that, you become more delicate, and that's when the depression might come back in is through these the stressful events and these triggers, and you're not bubble wrapped anymore, so you

know it's easier for it to do some damage. Right now, I'm off them again, And that was actually because I recently had a dose, as I explained the Book of silo Cybin, so that the key ingredient of magic mushrooms, and they're almost the opposite of s RI, is the drugs I take the antidepressant in that in my experience, they don't shield you from anything. They open you up and it feels like this overwhelming sense of love for

yourself and for other people around you. It allows you to have a different perspective um and for me that's really powerful that even though it's about six hours long, it can have lasting effects of you can relate back to that moment you feel, yeah, this overwhelming sense of love that other drugs seem to take away from me. And so I'm still going back and forth between therapy, between different types of pharmacological options. Some of them are legal, some of them legal, and it is a dance, and

often it's not a very good dance for dance. So yeah, right now I'm kind of hopefully riding away out out of a depression and that hopefully we'll we'll see me on for a few more months. And it's something that everyone has to kind of, you know, decide for themselves the cost benefit of being on these drugs that are effective for of people, and they're certainly affective for me, but then they're also with these side effects that sometimes you know, you wonder whether it's all worth it. So yeah,

that's that's kind of my story right now. Yeah, that sort of mirrors mine in a lot of ways. Certainly, the thought being, hey, are these medicines shrinking my overall emotional range is the thought. And certainly what what certain people say is what they do. My experience of coming off of them, and when I've come off of them, I've done it in the past in really not wise ways. At not good times and had you know, it went poorly.

And I've come off of them in more recent years, in a very very long taper periods, with a great deal of support, a lot of clarity on the things that I know treat my depression in addition to medicine, you know. So for me, my approach to it is, I say, I throw the kitchen sink at it. Right, I check every box I can think of to check that you know, we know helps and I know help me.

And so I've come off of them. And where I am right now is I am the on phase a much smaller dose than I used to be on, much much smaller. But what I have found is that when I come off of them, it's not that my emotional range expands across the board. It's just that the bottom falls out of it. Right. It's not that it's like, oh, I'm feeling more of everything, the good and the bad, wonderful, Okay, I'll take a little more down for a little more up.

It's just the sort of bottom falls out. The better way I can describe it is a I just become extraordinarily irritable with everything and then be every activity I feel like I'm carrying like a hundred pound bag of rocks around with me, and so, like you described, I can function with a hundred pounds of rocks in a backpack, you know, like I'm functioning, but it sure feels like

a lot of work. You know. I've gone through this a couple times of the last decade and done it in a really smart and intelligent way, and then I've gone back on and I've almost immediately been like, oh, I feel like myself again. So you know, the question I never know is I've been on him a long time, right, So what I don't know is have I just habituated my body to needing them? And that's just kind of what I've done. But for me, the side effects are

really pretty minimal and the benefit seems fairly obvious. So I am right now in the on camp. But my experience is any indication sometime in the next few years, my brain will go, well, I wonder, and you know, maybe we'll do the dance again. I don't know. Yeah, I mean they are amazing that, you know, you can stay on these drugs for so long and the side effects I I describe are so minor compared to you

very severe depression, right and right. You mentioned that I went back on them just before my book was published, and as I'm describing the book, it was those signs of suicide that I realized that I was becoming dangerous to myself self. These fantasies and these thoughts of killing myself were almost taking up all of my waking time.

You know, I discussing with my partner because I like to be open about these things, and previously that's maybe saved my life because she knew what I was planning. You're almost trying to state up ahead of your depression, so when it does become more severe, she knows. And maybe there have been some signs in what I've been saying that she can, you know, take action. And you know, I feel so much guilt for the load that I put on her, but it's unfortunately part of a relationship

with someone who has, you know, severe mental illness. Yeah, she's just thrilled that I do have these moments where I almost come back, and you know, whether that's with drugs, often it is with the antidepressants. And someone asked me recently, you know which of these I talked about? So many different treatments in the book ones that I've taken and

also historical examples. And someone asked me which one's worked best for you, And I couldn't really say which one had worked best as like a percentage thing, but I know for a fact which one I probably wouldn't be able to do without. And that's an antidepressant. And sometimes that's quite hard to get your head around that almost dependent on this drug existing, and so that that can almost add to your you know, self hatred. You are depending on something that is a prescription, but you know

this is a disease. You know, I have a family history of depressions and alcohol abuse and schizophrenia and environmental sort of triggers from my childhood, you know, probably going to exacerbate these genetic sort of vulnerabilities. So they just got to remind yourself of these drugs don't show that you're in any way weak or malfunctioning or anything like that. It's just something that my body sometimes needs a bit of help, because that's just what's happened in our family. Yeah,

and we'll get to this in a minute. What are we even talking about with depression because we don't really even know what we're resting sailing with right, we don't even really know why these drugs work, but I often think of it as you know, there are just different people. You know, some people have family histories and they need a certain type of medication to keep their cholesterol down, even if they live a healthy lifestyle. You know, there are people who need insulin even if they live a

healthy lifestyle. So for me, I feel like antidepressants get me almost just to the starting line. It's still up to me from there to craft a life that has meaning and has purpose and has value and has enjoyments and love, and I mean, all that still has to happen. It's not like I just take the pill and it's like boom, it's all there, right. I mean I tried that with heroin for a long time and and uh,

it didn't really it didn't work. So you know, it's more than like a pill fixes everything, at least in my case. It's like a pill almost in a lot of cases. And you reference this in your book at one point in talking about we know exercise and nutrition are really powerful tools for dealing with the pre However, if you are really in the depths of it. For a lot of people, the depression is so severe they can't even get to the point they do those things.

But you give them a little bit of medicine, and all of a sudden, now they're at a point where they can say, all right, now, let me incorporate exercise, let me incorporate good nutrition, let me incorporate meaningful connections. That's kind of how I think about it really, as as just sort of like getting me to a starting line at which then I can make the decisions about the other aspects of life that make it meaningful. It's

the same for psychotherapy as well. I mean since the nineties seventies, as I mentioned the book We've Got the Rise of CBT and personal psychotherapy, and the whole thing about using antidepressants then was to for psychologist at least, was to get them into a state where they were able to discuss the problem. It's kind of kind of a yeah, psycho analytical theme to it, but yeah, you're right. These drugs, you know, they're not going to cure anything.

They're going to be able to support you as you try new things, as you battle the depression with all these different avenues that we have and finding the one that fits. Because everyone's journey is going to be really, really different. Yeah, in the mental health world, the medicine debate can be a very fierce one, right, I certainly understand the argument in a lot of cases around over medication.

What I feel more concerned about is just the walk into your primary care physician and you're given a pill after answering a seven question survey, and that's all that's done to treat what might be a condition that has a lot of other aspects to it. I think it's good that we've gotten to the point where you can talk with your primary care physician about this stuff. I mean,

it's a nuanced area. I would always hope for people that like medicine is step one in a series of other interventions that lead to a better quality of life stuff. One suggests that you would give the antidepressant as the sort of the starting point for every person, whereas I would maybe say that if someone isn't in a dangerous position, if someone's in a critical condition and they need something that's going to work within a month, then yes, I

would agree. But if someone walks into their family practitioner and they are showing some signs of almost like a sub threshold depression. Then I would argue that maybe you know, exercise and diet, these things that don't have the same side effects or problems with coming off with draw the

impacts of these drugs, try those first. But again it's difficult when you're working with a vulnerable patient and you don't know how it's very difficult to gauge in what state they're in, so it's a very complex decision to make. I just think if everyone is given the medication first, it's quite hard to come off them, and if they don't work, that can then make people switch off from

reaching out again. Whereas these other sort of alternative approaches of exercise and diet and social connection of course, to really boost someone's someone's own sort of more natural reserves, I think would be a really positive way that both

psychiatry and just general practitioners could go down. I think that's always been my approach is like on meds, when I'm doing everything else that I know treats depression and it's still there, then I go Okay, I'm comfortable, and like a lot of things in life, there we often overcorrect, and so I think we went from a point where it was like so haboo for people to take medicine.

There was a positive swing in which we went, Okay, you know, that's not a bad thing, and you know, talk to your doctor about it, and that's all good, right, But I think we've overcorrected and now we're at the point where, unfortunately, for a lot of people, medicine is the very first thing they're given. It's just again, you answer this eight question survey in your primary care physician office, at least here in America, in a lot of practices, and you're going to walk out with a script for

you know, an antidepressant, and that is not ideal. All right, Anyway, Let's change direction because I want to talk a little bit about what is depression? Right, you say in the book, a single diagnosis doesn't capture the reality of depression. It's a syndrome, a collection of different but overlapping mental states. So let's just talk a little bit about what do we know today about what we're calling depression, what it is. You know, we can get into its relationship with other conditions.

We can talk about the P factor that you also right about, which is fascinating, But let's just kind of wade into we've been tossing this word around, like it's this clearly defined thing or I have depression, and like it can be measured and diagnosed in a simple way, and that is very far from reality. Yeah, it's incredibly diverse, and I wouldn't say that any diagnosis is very accurate when it comes to depression. I think we go to

things like the DSM. So the American sort of Bible tries to, you know, put labels on different symptom clusters, and you look at the one which is major depression, and there isn't a mention of anxiety in there, and that just struck me as either trying to put another diagnosis on anxiety disorder. But for me and everyone I've spoken to and looking through history, even back to Hippocrates and ancient Greece, depression and anxiety are almost one and

the same. You're very rare to see a pure depression. It's very rare to see anxiety that might not slip into a sort of state of helplessness and incredibly low mood. So here in the West, we kind of focus on this symptom of low mood. You know, depression means something that's been decreased, so the mood has lowered. Historically it came from depression in pulse or heart rate, blood pressure, and that's what stuck here. But in the book, I

kind of try and find alternatives. You know, depression almost it fuses with one's cultural sphere and the language that people use almost shapes it into slightly different forms of the same disease. So I traveled a Zimbabwe to meet some amazing psychiatrists and scientists and the local grandmothers that they work with and they are providing problem solving therapy

for people in really low income neighborhoods. And the psychiatrists tried to do a survey, as you would do for any study of how prevalent is depression in the area in Hararia, the capital city of Zimbabwe, and the wasn't

a word for it. So they had to talk with the grandmothers who were community health workers since the nineteen eighties but haven't worked on mental illnesses, mainly sanitation and things like that, and they had to kind of come up with, okay, what people describing here that might allow us to see if they're suffering from something that is depression. And they found the phrase thinking too much, which you know, it has a huge amount of like the rumination, the

anxiety that makes you fall into a depression. It's it's a really common and amazing phrase and it's kafungi see so in the local in the Zimbabwean language of Shauna. So it kind of shows that depression is not a thing that you can just simply label and just say, okay, this is it, like like it would be a cancer that's got a specific cells, even a specific gene that has mutated to allow this cell to divide and continue to divide. But depression is part of everything that surrounds

us as well as our biology. So we're thinking too much. This actually is really common in South America and across Africa. There's also some political influence in how we sort of defined oppression. So when Mao was in power in China and communist state there, it was almost illegal to be depressed, and so you couldn't really have this mental disease because that would be seen as an insult to this great leader.

And so there was more of a physical term near a senior which means a weakness of the nerves, So you weren't mentally ill, you were physically ill, even though the symptoms were very much similar to what we would see and diagnosed as depression, and this sort of global view just maybe realize that it's very diverse and you can call it a lot of things, but there's still the same core, whether it's the low mood, thinking too much,

anxiety and rumination, the effect on sleep. Historically that used to be you don't sleep, but there are people who sleep too much, and so you can have almost the opposite of each other. When you're sort of treating two people with depression, one might sleep too much, the other might be suffering with insomnia. Another person might be not eating, and the other person might be overeating and be overweight.

So depression is yeah, it's just a very diverse illness, and it makes it almost more remarkable that we have treatments that work for for this really really unique disorder. What I try to learn from, not only from around the world but historically is how we have become so fixated on this one word of depression, and there are other ways of describing it, so there are terms that

have almost been forgotten. We have, like endogenous depressions that are more biological in nature, so there don't seem to be many social triggers for why this person is feeling this way and is in a very dangerous position, whether

they're suicidal or not eating or not sleeping. And then you have more reactive depressions, more in tune with someone's social sphere, So there are obvious triggers in their environment are causing them to feel this way, and each of these has has had its own sort of treatment in the past. To then just fast forward to the nineteen eighties where we came up with this term major depression

and everyone just started bulling it. Depression really just obliterates this really rich history that we've had of understanding all these types of depression that can be then understood, treated and almost communicated better. So you know, you can not only just say that I struggle with depression, but I struggled with a certain form of depression or melancholic depression, which comes from ancient Greek the idea that your more psychotic is a type of depression that has really been lost.

It responds really well to electroc convulsive therapy, which is the treatment that when I first started writing this book, I was hesitant to mention it. But after meeting the practitioners of today and seeing how this treatment has been reshaped and remolded. It's really a remarkable treatment for this

specific type of depression. A lot of people my age would have seen or read the book by Ken Kesi when he flew Over the Cuckoo's Nest, and you see E. C. T used as this really awful way to control this person, and so it, Yeah, it has these awful connotations, but I know a couple of people personally who have benefited greatly from it as a treatment. I think what you're saying is really interesting, and I want to ask a question there, because on one hand, you're sort of saying, hey,

depression is too broad. There's actually these sort of maybe more narrow lanes that we might look at. We recently interviewed somebody you may be familiar with. Her book. It's called Pathological The True Story of Six Misdiagnosis is Sarah Fay. I don't know if that rings about not having to come across that I'll make Yeah, it's right up your alley.

She's covering the same ground. Her point is basically, over her course of her life, she was diagnosed six different ways, and so she started digging into the d s M and you know, sort of coming up with what happens if you dig far into the history of the d s M and you're like, oh, none of these things are a real diagnosis in the sense that like cancer is that you could get a scan, and talking about how one of the criticisms of the d s M is that it's splintered into I don't remember how many,

but you know, seven hundred diagnosis is or five hundred and it sounds crazy and that a lot of people believe maybe it's less diagnosis, and I know you sort of talk about that too, And maybe what we're calling depression and in another case we're calling anxiety are all manifestations of a similar thing. So I kind of hear you on one hand saying, hey, maybe we need more nuance and how we talk about it, And then I've also seen you write about, hey, maybe there's more similarity

between these different things than we think. Say a little bit about that. Yea. So this came from my own family where you know, my cousin has schizophrenia or a mood disorders. So these have historically been opposite sides of psychiatry. Yeah, um, you have mood disorders and you have psychotic disorders. We kind of have more nuance and how we describe our depression. I just don't think it needs to be a clinical like how we describe it in terms of a diagnosis.

I just think if we appreciate that we can take all of these different parts from all of these so called diagnoses. So I have some parallels with autism, hyper sensitivity to sound, other things that really kind of, you know, make me wonder well, maybe I'm kind of a little bit of autistic. And maybe one of the reasons I could research a book like this for you know, four years and you know, absolutely love my time just completely

embedded in a library. I don't know, but it's these sort of taking these pieces from what we've kind of historically thought of as diagnoses. So you can have, you know, some sort of recurrence such as in bipolar you have anxiety disorders, and they really do seem to kind of

almost tie together. And so the way I kind of appreciate my own depression is it can have any of these sort of facets that come from a wide range of the spectrum of mental illness in general, So it doesn't have to be just depression and it's in the d s M. I don't think that's very helpful for the for someone who's trying to kind of understand what they're feeling right now. Like I said, it doesn't even

include anxiety. It's really for psychiatrists to understand with a very short amount of time, what's the most likely situation here, and lots of the most likely treatment that's going to work, which I think has been quite a successful thing for a lot of people. But as you just mentioned in that book, you can be misdiagnosed several times and often be put on the wrong treatment because we do see it as a sort of tunnel vision that we need

to pick one of these options. And so when you get to a stage where your mental illness is sort of almost matured, I think that you do become more better into either depression or schizophrenia. Like me and my cousin, are you very different in how we express our mental disorders. But look further back in times like where did that actually come from? And I think the unity in mental illness comes from maybe a childhood, a shared vulnerability to going down certain paths, and it can be shaped by

your own life and what you experience. So I think right now thirty one year old. I think, you know, I have a pretty good idea of this is quite a stable part of my mental illness, and it could go into more of an anxiety state, to more of a depression state, or it could go into alcohol use. Because these are things that really they clustered together in adulthood. If you go back into childhood, we're probably showing quite similar symptoms, and you know, we still haven't kind of

been funneled down. Then can become more close to a strict diagnostic system. Something I'm really interested in is trying to understand how people almost become put onto a certain track in their own life and how that changes over

adulthood as well. It is quite fascinating. I love the way you say this that you know it's a syndrome of collection of different but overlapping mental states, and then you go on to say, you know, it can be a product of upbringing, trauma, financial uncertainty, loneliness, social bonds, diet behavior, sedentary lifestyles, neurotransmitters, and genetics. Right, it's all these different things, you know, so many different contributing factors.

I have alcoholism and addiction, you know, and you look at that and you go, all right, well, what's the genetic component of that? Appears there are genetic components to these things, but genetics are certainly not destiny. So to your point, the phrase I've always heard is sort of like genetics loads the gun, environment pulls the trigger right, something to that effect. So I do think there's a

lot to this. Say a little bit more about this idea, though, that there's an emerging argument it all mental illnesses are interconnected, like the branches of a tree growing from the same trunk. Is that what you're saying that we believe there are some underlying vulnerabilities and then depending on what happens sort of determines a little bit about like which branch you

go down. Yeah, it's quite recently in terms of giving a name, but it's it's got roots in psychoanalysis and another sort of non diagnostic approaches to psychotherapy, and so it became known as the P factor, so the psychopathology factor. And I think that's a terrible name in terms of, you know, trying to make something understandable. Don't call it psychopathology. Yes, received a lot of attention, and some people really hate

the term. People who really have been dependent on using a diagnostic system, but there's no doubt that it's it's changing how we study because thomasin's All, who used to lead one of the major sort of scientific institutions in the US, he left and said, we need to change how we approach the scientific research towards mental illness that you know, this hasn't been working over decades. We're still

no closer to wondering where they come from. We still can't find the genetic basis of any of these diagnoses, and treatments haven't improved since the nineteen fifty And what his approaches is to change the fundamental way we study them so we don't use symptoms, is his ar Can we use different dimensions of how we experience mental illness so they can be more linked to your personality, linked

to sort of just patterns of sleep or behavior. And it really kind of breaks the mold of thinking of mental illness as like like you say this checklist of seven symptoms that you get given, it becomes a bit more nebulous and it's quite hard to understand. But hopefully once we dig into these elements of personality and genetic vulnerabilities, the genetic patterns that don't just lead to say schizophrenia or studying depression, stud all of them at the same time.

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

some strong genetic risk factors involved in those two. One of the mood disorder and is historically a psychotic disorder, So that breaks down that old sort of division there. And then if you study the more sort of the commernalizing disorders, so depression and anxiety, and see whether we can find the genetic risk factors for that collective group.

Rather than just saying can we find day specific risk factor for depression, because that might not exist, it might be more can we find this sort of part of the genome that, together with environmental triggers send someone down this path towards you know, thinking about there themselves constantly of rumination of self hatred that then can become depression or anxiety. And so yeah, this this idea of the

P factor, I think it really changes our conception. It gives me a lot of comfort actually in my own experience of mental illness. It allows me not to just think of me myself as a depressed person, but more of a human because it's it's it's it's broader, richer

palette from which from which we experience the world. There's a lot of negativity, of course to it, but it makes me feel more connected to people who have mental illnesses, and especially with my cousin, who you know, has been institutionalized and given really horrendous sort of treatment as soon

as he started hallucinating and having delusions and stuff. Yeah, it kind of makes me think, well, hopefully this idea of a shared P factor will allow people to reduce the stigma not only for me, but for people who have psychotic disorders like my cousin, and to think of him as not this sort of fringe sort of person who can just be institutionalized, but actually as someone who's got this shared predisposition that has been you know, funneled down a path that has led him to you know,

have these vivid hallucinations, this vivid imagination, and rather than locking him away, can we find some common treatment that can work across that p factor. I think that might be heading towards, especially in children, is trying to find if there is such a thing, when does it happen, what does it look like, and how can we prevent

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

You know, we've covered the obvious ss R eyes, We've talked a little bit about diet and exercise. Like you, if I had to pick one tool for my depression, it would be a toss up between perhaps medicine and exercise. That's how critical and fundamental exercise is to my overall well being. We could talk about diet and exercise for two hours and not even cover how important it is. But but we've already sort of hit it. What else is out there? What are other things that people can do?

What are other things that you've done? You know, let's let's explore a few others. So, yeah, I think exercise, though you say that to the really fundamental to my own stability. Depressents. We mentioned that there are SSR ees, but often it's kind of forgotten that there's this rich history of antidepressants. If people don't respond to these rise then there are other options that have maybe in some

ways a more severe list of side effects. So we have mipromine, which is a tricyclic nddepressant, so that family, and then we have another group that it was the first depressant to discover that it's an m I and they do come with, you know, more physical side effects, just dry mouth and constipation and things like that. But I've talked to people who you know, esse didn't work for them, and these drugs did for a long time.

So it's not just about thinking of antidepressants equals s s. There are other options that other people really do respond well to. Some of them don't come with the emotional blunting that arise are often associated with. I think one of the researchers I spoke to, he actually mentioned he was on the mipromede for ten years and you know, he'd take constipation all day, if you know, because it worked. It was the first drug that really were it for him.

They are also blunting of the libido, in which a lot of people struggle with. And if you're already in a depression and you're struggling to connect with someone, then that can be one of the reasons that is probably not the drug that's best for your situation. Thankfully, I haven't had as severe stable in that domain, but that can be a real issue for a lot of people.

And away from pharmacology, I think mindfulness, which is becoming part of cognitent behavioral therapy kind of meditation, is something that I tried to practice quite regularly. So it's just sort of like almost this Eastern approach of you kind

of take time out. And I won't describe my methods and stuff, but everyone's probably familiar with using meditation and it seems to have effects to looks in some ways, so psychedelic substances from other mushrooms or in Brazil, the people I speak to there from types of plants that

mashed up into a t called ayahaska. And this meditation kind of silence is this default mode network in the brain that is almost it's completely associated with yourself, what you're going to do next, and what you've been doing in the past. It's it's really this self obsessed network in the brain that seems to be overactive, and a lot of people with depression. Mindful meditation allows you to kind of silence it, at least for a time and

really think about others. A compassionate meditation is where you think about someone, usually someone that you really kind of love, and trying to imagine them in a difficult situation, and you sort of building that affection for them, and it kind of breaks you out of this constant, interceptive sort of thought process. I think that's been really helpful for

me try to do every day. It's difficult because it's not something that you can just see benefits from, like with depressants, but added together, I think that it's certainly something from my menu as you put it, that I think is critical. It might be like a starter or a dessert. It's not a main course, but it's it's it's something that you know, you really do depend on

and you really like to have now and again. And for people who are really severely depressed, there are options that are really exciting, at least from my point of view, and the people have reported on and an interviewed of deep brain simulation where you can have also related to this sort of this idea of the neural circus in your brain being completely hardwired for depression and being able to in certain electrode to kind of almost switch it off and allow yourself have this moment where you can

break free from what has become your default state, which is a really powerful powerful tool for a few people who haven't responded to every other trench relea. So it's not going to be, you know, something you can just pop down and get a prescription for, but it's something that I think it really gives me hope when thinking about depression, is we have all of these things from exercise and diet of mindfulness to these aggressive treatments for

people who have failed all the other options. When we say treatment resistant depression. I think you think that, Okay, this person hasn't responded to anything, but there's so much more out there, and treatment resistance the actual definition on your needs two different types of antidepressant to be considered treatment resistance. It's not a full stop on their story whatsoever,

and kind of linked to exercise and diet. But trying to understand depression is inflammation is quite a powerful message, and antien Planet is now being tested for certain types of depression. I think it's around the third of depressions that can be linked to high amount of pro inflanmetory molecules in the blood, and so this sort of stress

response just becomes flooded with these inflammatory molecules. And I think that's an avenue that really excites me because there are some really good studies coming out showing that for a third of people, which is a huge amount, these tools can be effective. And the beautiful thing about it is if you reduce inflammation, antidepressant become more effective. One thing we know about antidepressants is they're not very good at working when someone is suffering under inflammatory storm or

a cloud of inflammation in their bodies. So they can work synergistically as well. These treatments and psychedelics there they're not really a treatment that you can go out because there's still Schedule one and you know, illegal to have

and to take. But this is why I focused on some of the work in Brazil because they're legal there for religious ceremonies in the Santa Diamd Church and the Brazilian scientists who are working, you know, really closely with this more cultural element of these of these drugs really sort of excites me and thinks that, you know, this does have a future because it has this really rich history from decades and centuries ago in South America and

across the world, depending on which psychedelic substance we're talking about. For me, I self experimented with psilocybin with magic mushrooms, and yeah, I think I'm not as dependent on it as I would be with the necessary but I think that it can sometimes help to provide an alternate perspective on your life at the current state. And for me, that returning to the Parable, for me, it really feeds the love part of the Parable and the wolf that is full of hatred and greed. Really just it gets

almost laughed away in these psychedelic trips. Yeah, there's a lot happening around psychedelics these days, in a variety of mental health treatments, and if people are interested, you know, as you said, they are illegal. There are more and more clinical trials though, that are starting to open up where that is one way that people can explore that. And of course there are plenty of people offering treatment even though it's not legal, and I think a lot

of people are getting benefit out of it. You've described something called the winner's curse. Could you say a little bit about what the winner's curses? And I'm kind of curious whether you think any of that might be happening with some of what we're seeing around psychedelics. I was told this by someone in the psychedelic field, and he was describing this winner's curse of he used Prozac as an example. All so, you have this drug that has

all of this hype around it. You know, people who have been working on marketing campaigns for other companies, which as like automobiles and McDonald's, and you have the same marketing strategies that have pushed this new antidepressant into the mainstream. Because it was one of the first sri is to be put into prescription. All this excitement builds into this

being a winner, even if it isn't. And over the decades, since we now know that prozac is, it's no different to most of the size and in some cases it's actually not as effective. And so these drugs and these new treatments can't be steen just in terms of what comes out in in peer reviewed science, because they are part of the societies that sort of create them and

put them into people's bodies. So with prozac, you know, people responding to this drug in the and they hadn't responded to anything else, and suddenly this new drug comes out. People are excited about it. It's gotten new catchphrases, and it just seems very popular, and it's suddenly they respond. And that's often not the drug, it's often the hype around it. So there's this beautiful thing of the placebo effect.

You know. It's something that we were often try to take away from clinical trials, and rightly so, we need to find out whether a joke worse above a pacebo. When you're working with something like depression, which is a mental state where people are often hopeful and they can get better and someone then gives them this new thing

that's really exciting, and they do get better. Then it takes time for them to understand, you know, this placebo effect starts to wane, and then we get what was once a miracle drug becomes a very average s R. I and I think that unfortunately, this might be the case for psychedelics as well, because we see it everywhere at the moment, it's become this sort of trendy thing to do, to micro dose, to take large doses every three months for depression, and some of the people that

I've spoken to an interviewed for this book, they've almost become like celebrities have got like a real cult following of you know, you see him on the front of magazines, you see their work on the front of magazines. And looking at this historically, it really kind of brings up a bit of concern that we might be repeating history here. We're building up this this bubble that might suddenly burst.

And there was a study published last year where psilocybin silocybin was put in a trial alongside est telegram and there wasn't a significant difference between the two in terms of people responding to it. I think this is really positive because it shows that both are effective, Like, these are two effective treatment options that we have. The psychedelic showed some sort of pattern towards being significantly better, but it wasn't statistically. And what concerns me is when pros

that came out it was significantly better. It was, you know, people responding to this thing that hadn't responded to anything. And now we have these trials a style of cybin and we're struggling to find significance between the drug and regular antidepressant and we're not finding it, and that makes

me worried. It's like, when this hype starts to drop, whether it's in twenty years or thirty years, what state of these new therapy is going to be in and they're going to be average or is that sort of winner's curse going to become the truth of the matter

for for these drugs. And I think that's one caution I'd like to put on psychedelics is we still don't know whether they are a really long term treatment, and there are risks involved, especially for taking high doses of them, and especially if you have a history of psychosis that can be enduring psychostic episodes with these drugs. For me, the risk of my depression seemed so high that I

was willing to try them. Thankfully, I've only had very safe and very meaningful experiences with them, but I don't see them as a replacement for anything that I've had before.

We'll see how that the field is in the next ten years, but we've also got to remind ourselves at least have been used for potentially millennia, and to then say that they're not effective or not safe is almost an insult to indigenous populations around the world who know a lot more about these substances than science and will yeah, yeah, And I think to say that they're not effective, you know, clearly for some people they are proving to be effective.

I don't think they would be getting all the noise they were getting if there was not some degree of effectiveness. And I share your concern that, you know, the coverage of it is so breathless that I'm always a little bit like I'm not sure that there's really a golden ticket, you know, or a silver bullet, or use whatever analogy you want, you know, I think likely they can be another tool that can be effective for certain people used

in the right circumstances. And you know, we can use as many tools, you know, as many items on the menu as we can given that, you know, we don't know what works for which people and in what circumstances. So I think more options is better options for sure. Yeah, I think just a comment on the self experimentation, I think these aren't recreational drugs when used in this setting. I mean, it's often a horrifying experience to take these drugs.

It's not like something that you can just take it for a day and then it has you know, long lasting effects. Some people describe it as a nightmare that goes on for eight hours and you can't wake up. So there's an element of and I tried to put this in the book of being really Hard Labor. It can be horrifying. And this is why it's so important

that it's not just seen as a drug. It's seen as you know, you're having a therapist there with you and someone who can guide you, because if you don't have that, guys, and you don't have that knowledge of how to get through these really dark moments, you can become trapped. Yeah, it can make you feel a lot better, but it also can make you feel worse, and it's quite yeah, it's quite dangerous. I think I've shared this story on this show before. I don't remember if I

I'm pretty sure I probably have. But to your point, I experimented with psychedelics a lot a long time ago, you know, my late teens, early twenties, and I was using them recreationally and my stud good brother. One night, it was the night of my grandmother's funeral, and he convinced me we should do LSD that night. And I knew it was a bad idea. I just I was like this, No. I kept saying no, and he kept being like, no, it's going to be Somehow he talked

me into it. And you talk about like a dark a dark night of the soul like I mean, you talk about eight hours of like torment like it was unquestionably one of the worst, one of the worst nights of my life. I can laugh about it now, but but yeah, I could have used a therapist for sure that night, probably for for quite some time afterwards. But to your point, I think there are real ways to use these things as tools of healing, and then there

are ways to use these as a drug. And I think it is so much in the intention and as they say, set and setting right, you know, the approach exactly. The history of that setting setting is part of the book, and it comes a lot from Betty Eyes and a

woman he's often forgotten in psychedelic circles. It's often a very mascular and dominated field, and she was really pivotal of creating the setting of comfortable space music photographs, like trying to really kind of like harness as much as you can from someone's trip while also being in a very very safe space for people with depression in particular, you know there is going to be a dark moment there, whether it's a moment in your past or something you're

growing within the present. You really need to be sure to get past that, to get through it. Yeah, Betty would clearly have come down on my side in the debate with my brother about whether LSD was a good idea that night. Betty would have been like, huh, don't do it. Don't her second taste of LSD in the fifties, I think it is in Yeah, she said it felt like the universe had collapsed upon her, So she would definitely sympathize and yeah, she didn't try it again after that.

My memory is of laying on a bed feeling like literally thinking that what was happening to me was I was being crucified. All I could hear is my brother outside laughing like the devil. That's my recollection of that, of that eight hours. All right, On that note, I sure knew how to have a good time. Yep, yep, you can certainly have some moments there well. Alex, thank you so much for coming on. The book is really wonderful.

You know, there's certainly a memoir aspect of it, and there's a lot of really deep and really good science writing in it. It's a wonderful combination of both those things. We'll have links in the show notes to where listeners can get access to it and how they can find you. And so, Alex, thank you so much for coming on. I've been looking forward to this one. Thanks for having me. It's been brilliant. If what you just heard was helpful to you, please consider making a month donation to support

the One You Feed podcast. When you join our membership community with this monthly pledge, you get lots of exclusive members only benefits. It's our way of saying thank you for your support now, we are so grateful for the members of our community. We wouldn't be able to do what we do without their support, and we don't take a single dollar for granted. To learn more, make a donation at any level and become a member of the

one you Feed community. Go to when you feed dot net slash Join the One You Feed podcast would like to sincerely thank our sponsors for supporting the show.