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0:35

Jessie Gold saw some of the first signs of

0:37

her depression back when she was in college.

0:41

We kind of put the bar at, well,

0:43

I'm getting good grades, so I'm fine. I'm still

0:45

seeing friends, so I'm fine. And I was very

0:47

much that kind

0:49

of person for a long time, so

0:52

really I kind of blew it off

0:54

until I couldn't anymore. And some friends

0:56

and some family members were like, you need to go talk

0:58

to someone about this. And I saw

1:01

a therapist for the first time in

1:03

college my junior year.

1:06

Ultimately, Jessie was able to get help, but

1:08

says the experience of finding treatment

1:10

simply wasn't easy. And that's what

1:13

motivated her to become a psychiatrist, an

1:15

assistant professor at Washington University in

1:17

St. Louis.

1:18

I want to be a safe

1:20

space for people to get help where they don't feel

1:23

like that experience. A lot of

1:25

people are asking for help for the first time in college, and

1:27

I don't want them to be scared to do

1:29

it. I don't want them to have an experience

1:31

where they don't understand what's going on, and I don't want them

1:33

to feel like for some reason they did

1:36

it wrong.

1:36

Today, she's in

1:38

her mid-30s, and Jessie is busy

1:40

helping her students and her patients with

1:43

some of the same struggles she experienced in her

1:45

own life. And she's been really open about the

1:47

journey. But during the pandemic,

1:49

something happened. Dr. Gold says

1:51

she started to do some reflecting and realize

1:54

there's one part of her therapy journey she's

1:57

never been as open about.

1:59

medication for years at

2:01

this point, no changes, say meds, they

2:03

work for me. I haven't really had an episode

2:06

of depression in years. I don't understand

2:08

why I'm hiding that

2:10

in some capacity.

2:12

Now what Jessie did next was honestly

2:14

a little bit meta because she took the

2:16

anxieties about being treated for

2:18

anxiety

2:19

to her own therapist.

2:21

So I talked to my therapist about it for a while and

2:23

she was kind of like, what does medication mean to you?

2:25

And I was like, well I give medicine to everybody

2:27

all the time. It's the same as taking medicine for blood

2:30

pressure. What do you mean by what does medicine mean to

2:32

me? And she was like, no but for you not

2:34

for other people. When I thought

2:36

about it deep down what I thought was

2:38

like if I'm on medicine and people

2:40

know I'm on medicine that will mean to them at some

2:43

point I was sicker or at some point

2:45

maybe I'm not as good of a doctor as I should

2:47

be. My therapist actually told

2:49

me she took medication too and said,

2:51

did that make you think any differently about

2:53

me?

2:54

And I said absolutely not. And she

2:56

was like, see it doesn't make you any

2:59

worse at your job or it doesn't make you change

3:01

your mind about someone you already think is a good doctor

3:03

or professional.

3:05

Here's the reason I wanted to start with this today. I think

3:08

Jessie's story is relatable for a lot

3:10

of reasons.

3:11

We've come so far when it comes to talking

3:13

about mental health but let's

3:15

be honest here there's still a lot of stigma out

3:17

there. After all even a psychiatrist

3:20

like Jessie was reluctant to talk

3:22

about her medications. And at the same

3:24

time now rates of depression are

3:26

rising. You can see where I'm going with this.

3:29

Nearly one in five Americans has been diagnosed

3:31

with depression at some point in their lives.

3:34

And now according to most recent CDC health

3:36

statistics more than one in eight Americans

3:39

report taking an antidepressant drug.

3:42

But the story I'm telling you today is even more

3:44

complicated than that. Because while antidepressants

3:47

can be lifesavers for some people the

3:50

other truth is they don't work so

3:52

well for others if they work at all.

3:55

And for me as a brain scientist

3:57

it raises a fundamental question. What

4:00

exactly is going on in our brains when

4:02

we are depressed? And along

4:05

those lines, why do certain treatments

4:07

like antidepressants help some people like Jesse

4:10

but not as much with others? And

4:13

then there's a lot of discussion about new treatments

4:15

on the horizon, psychedelics, for example.

4:18

So today we're going to explore all of this,

4:21

the inner workings of the depressed

4:23

brain. I'm Dr. Sanjay Gupta,

4:26

CNN's chief medical correspondent. This

4:29

is Chasing Life. You

4:34

know, as we started to research this episode,

4:36

one thing really became clear to all of us. There's

4:39

a lot we don't know about depression.

4:42

Despite how common it is, we still don't

4:44

know exactly what causes it, and

4:46

we don't know how treatments, including

4:49

antidepressants, actually

4:51

work. And there's also a lot

4:53

of debate, controversy, sometimes

4:55

even misinformation, when we do talk

4:58

about the best way to treat depression. So

5:00

when it came to this topic, I knew I wanted to

5:02

turn to someone I could trust.

5:04

I'm Charles Raison. I'm a doctor. I'm

5:07

a psychiatrist. I carry a title

5:09

of professor of human ecology and

5:11

psychiatry at the University of Wisconsin,

5:14

Madison. But I do some other interesting things. I am

5:17

the director of clinical translational research

5:19

for an entity called USONA Institute,

5:21

which is a nonprofit medical

5:23

research organization that's developing psilocybin

5:26

as potential treatment for depression.

5:30

Charles and I go way back. He used to be

5:32

a mental health contributor at CNN. He's

5:35

a really trusted voice in this field for

5:37

me and for so many others. And

5:40

I'll tell you this personally, I would

5:42

sometimes call Charles after covering a

5:44

particularly tough assignment, being in

5:46

a war zone, covering a natural disaster.

5:49

Those were tough times. And sometimes I'd ask his

5:51

advice in terms of how to care for my own

5:53

mental health. So I decided I wanted

5:55

to share some of his wisdom with all of you. I

5:58

wanted to turn to him to talk about the best. these topics.

6:00

And right off the bat, Charles said something

6:03

that really surprised me, that the very

6:05

origins of depression could actually

6:07

go back to our evolutionary drive to

6:09

survive. Depression could

6:12

serve a purpose.

6:13

I actually think depression evolved as

6:15

a way of helping us cope with adversity, even

6:17

though it's very painful. I don't endorse

6:20

depression as a good thing, but that doesn't mean

6:22

that it's not always unhelpful. So, you

6:24

know, a lot of the work that we did at Emory back

6:26

in the days when you and I were working

6:28

together was looking at inflammation and depression.

6:31

And there's some really pretty interesting evidence

6:34

that depression caused by

6:36

inflammation across evolutionary time might

6:38

have helped humans survive infection, right?

6:40

And there's some interesting data that, at least

6:43

in certain contexts, depression

6:45

may actually help people sort of recalibrate

6:47

how they're dealing with their lives, how they're dealing with

6:50

other people, and begin to sort

6:52

of take more productive pathways.

6:55

But if we think about it, that's

6:57

thinking about it sort of like an adaptation.

6:59

One of the interesting questions is, why

7:01

is depression so common if it's so maladaptive?

7:04

And I think the answer is that,

7:07

like a lot of adaptations, like the

7:09

immune system, it can overshoot.

7:13

And when it overshoots, it can really cause problems.

7:16

And then I think a lot of things may cause us

7:18

depression now in the modern world that

7:20

we just didn't evolve to cope with.

7:23

So how does someone know then

7:25

that they should try

7:27

and make a visit with someone like you?

7:30

If you're feeling, you know, unremittingly

7:33

down, if you've lost interest in life, if you're

7:35

asleep and your appetite are altered,

7:37

if you feel hopeless, if you are having

7:39

thoughts of hurting yourself, these sorts of things, that's

7:42

what depression is, right? And people have different combinations

7:44

of them, but that's what it is. You

7:47

need to come see somebody like me when those symptoms

7:49

are interfering with your life. That's, I

7:52

think, the simple answer, right? And especially

7:54

you need to come and see me if those symptoms

7:56

have been going on for a while. You know, if something

7:58

bad happens, you know, it's not a bad thing. happens in your life and

8:01

you have those symptoms for a couple of few weeks,

8:04

I think people like me now increasingly think, you

8:06

know, let's watch and see if it resolves

8:08

rather than immediately pull out a pill. But

8:11

you know, if you say, oh, I've been like this for two or three

8:13

months, yeah, it's time to go see a doctor or

8:15

to go see a clinician and get help. Dr. Justin Marchegiani

8:17

One of the things that we're really focused on in the podcast

8:19

is trying to understand what is happening

8:21

in the brain during various conditions

8:24

of life. If you were to do a

8:26

scan of the brain and you pick the scan, a PET

8:28

scan or MRI scan, functional

8:31

MRI scan, and someone who is depressed,

8:34

could you see depression? Dr.

8:36

Justin Marchegiani With an MRI scan, no. Just looking at

8:38

the brain, no, no, you just the structure of the brain

8:40

would not tell you that. But if you looked

8:42

at the function of the brain with a fMRI,

8:44

let's say, could I put

8:46

you in it, look at it and say, oh my God,

8:48

Sanjay, you're depressed. No, no,

8:51

I couldn't do that. If you give me 40

8:54

people who are depressed and 40

8:56

people who are not depressed and

8:59

I do certain things in the scanner,

9:01

on average, the depressed people's brains

9:04

look different to some degree. But

9:06

that doesn't always pan out across studies

9:08

also. For instance, if you give me a group

9:11

of depressed people, there are several studies that

9:13

have shown that if I put the depressed

9:15

folks in the scanner and I show them

9:17

pictures of faces, their

9:20

brain is less likely to notice happy

9:22

faces and more likely to

9:24

notice scary, angry, sad faces

9:26

and they get more of an activation in

9:29

an area called the amygdala down deep in the

9:31

brain as you know, which is activated by

9:33

danger and threat. And there are

9:35

some, there's some older work by a woman named Yvette

9:37

Shilleen showing that if you treat people

9:39

with an antidepressant, their brains, that

9:42

overshoot of the amygdala calms

9:44

down and they start looking more like folks that aren't depressed.

9:47

So this is it though, right? There's nothing that's anywhere

9:49

near like a brain test for depression.

9:53

Is that a goal? I mean, or

9:56

is that a lark to try and say

9:58

one day we... could

10:01

objectively measure depression

10:03

or is the very nature of what we're talking about something

10:05

that is immeasurable?

10:07

Dr. Seheult Well, sort of interesting. Again,

10:10

it depends what kind of thing depression

10:12

turns out to be. One

10:15

possibility is that it'd be a little bit like trying

10:17

to measure something like dropsy. Remember dropsy

10:20

was this disease back in the 19th century, water

10:22

on the lungs. But water

10:24

on the lungs turns out to be, could be your heart failure,

10:26

it could be pneumonia, it could be cancer. There's

10:29

different reasons to produce those symptoms, right?

10:31

So will we ever find a test for

10:34

diagnosing depression? No, because

10:36

depression is like dropsy. It's

10:38

a cloud, it's a probabilistic

10:40

cloud. It's not a specific sort

10:42

of mechanistic neurobiological

10:45

disorder. The problem is it has to

10:47

do with get fancy, kind of the ontological

10:49

status of depression. Depression is

10:51

not a single thing that's going to yield

10:53

itself to a single test. So we

10:56

got to either break depression down into its component

10:58

parts if we could ever do that, or

11:00

we need to think differently about depression.

11:02

Dr. Seheult You

11:03

know, one of the things that I think really

11:05

sort of inspires a conversation like this is that

11:07

it is seemingly so common.

11:10

I mean, nearly one in five adults diagnosed

11:12

with depression at some point in their lives, that

11:15

number seems to be rising. First

11:17

of all, just broadly speaking, would

11:19

you characterize the state of mental

11:21

health in the United States right now?

11:24

Dr. Seheult Yeah, so you've

11:26

been asking me all these questions. I've kind of

11:28

been equivocating this is an easy one. It's

11:30

bad. It's bad. Oh, you know, I mean,

11:33

there is just no doubt that depression

11:36

and anxiety and suicide and substance

11:38

abuse have been on the rise in the United States. They've

11:41

been on the rise in the United States for probably 20, 25 years,

11:44

maybe longer, but they've really been on the rise

11:46

over the last 10 years. And the data

11:48

are really consistent, you know, the rise is not

11:51

equal amongst all age groups, the

11:53

people that are really suffering are young

11:55

people. So people between the ages of

11:57

like 15 and 35, that's where you see the really,

12:00

really disturbing increase.

12:03

So something's going on in America

12:06

that is really counterproductive

12:08

to the emotional well-being, especially

12:11

of young people. Not every country in the world is

12:13

seeing this, but it's pretty common in industrialized

12:16

societies that whatever we're

12:18

doing in this sort of zeitgeist

12:20

that we're in right now may be good for

12:22

productivity, but it's not good for our emotional

12:25

well-being.

12:26

There is always this this question, are

12:28

we more aware and able

12:31

to identify depression, or

12:34

is it true that the numbers are really going up?

12:37

It's a good point, it's a complex question. They're

12:40

going up, meaning that if you ask Americans

12:42

the same questionnaire, the

12:45

scores are rising. Now, does

12:47

that mean that they're actually feeling more miserable,

12:49

or does it mean that they're aware that they're feeling more miserable?

12:52

But I think most of us think that people

12:54

really are, in fact, more anxious

12:56

and more depressed. And so yeah, you know,

12:59

again, you see this just the same

13:01

scales, these large-scale sort

13:03

of surveys of American populace, and

13:06

you know, the numbers are kind of creeping up. So

13:08

yeah, I'm one of these people who thinks it's a real

13:10

effect.

13:11

One thing, though, that's clear is

13:14

that parallel to that rates of the use of

13:16

antidepressants in the United States

13:18

have skyrocketed

13:20

over the last 20 years, rate in line

13:23

with the increase in rates of depression and suicide.

13:26

So, you know, at the very least, it

13:29

suggests that something's

13:31

not working right, you know, it's a thorny

13:33

and frightening problem. That seems

13:35

to be a big topic of discussion

13:38

lately that, as you mentioned in

13:40

the United States, rates of depression, suicidal

13:44

behavior, anxiety have

13:46

all gone up. Interestingly,

13:49

even before the pandemic, life expectancy in

13:51

the United States had gone down, and one of

13:53

the top drivers of premature death was suicide.

13:56

At the same time, we're taking more drugs, including

13:59

antidepressants, than ever before. So

14:02

despite the fact that we have higher rates

14:04

of depression, we take more medications, the numbers

14:06

just keep getting worse. If someone

14:08

were to sort of piece that together, you know, visit

14:10

from another planet and say, hey, what's going on here?

14:12

That would not make sense.

14:15

Yes. So this is the question

14:18

of the use of antidepressants, which are

14:20

the first line treatment for depression in the United States

14:23

is incredibly complex. I always, whenever

14:25

I start with this, I always start by saying,

14:27

you know, anybody that's worked as a psychiatrist

14:29

or in mental health knows that these agents, you know,

14:31

standard antidepressants are have, man,

14:33

they are lifesavers for some folks. But,

14:37

but as we've gone along in

14:39

the last 20 years, we've had to metabolize

14:42

as a field, a number of very

14:44

hard truths about antidepressants

14:47

and their effectiveness. One hard truth

14:49

and the most obvious one is that they

14:51

don't work nearly as well as we thought they did 30

14:54

years ago. And in fact, they probably

14:56

if I give me a whole group of depressed people,

14:59

and let me start an antidepressant and

15:01

have them take it every day, probably 30%

15:04

max are going to get a full response

15:07

and probably another 20% 25% are

15:09

going to feel better. And there's gonna be a

15:11

bunch of people that really don't get much benefit. Now that's

15:13

a huge problem. And studies we

15:16

now know from studies that you know, see, didn't first

15:18

one didn't work. So we're gonna try a second one. Okay,

15:21

but by the time you're doing third and fourth, your chances

15:23

of responding go down, down, down, right? So it's

15:26

like there's a group of people that are antidepressant

15:28

responsive. And then there's a lot of people

15:30

that aren't really very antidepressant responsive.

15:33

And that's a problem. And you know,

15:35

there, there is some evidence not

15:37

much talked about that at

15:40

least sometimes antidepressants might

15:42

set you up for having more depression if

15:44

you decide to stop them. And

15:46

that is something to worry about. And,

15:49

you know, I talk about this often just

15:51

because the data are

15:53

not conclusive, but they're, they're concerning,

15:56

right? It really highlights the fact that you

15:58

know, it's a good thing we have treatments.

15:59

But man, we need to keep looking for new treatments

16:02

for these things because there's a lot of room for improvement.

16:05

Is depression a chemical

16:08

imbalance? Not

16:10

the way that it's meant colloquially,

16:13

meaning that, you know, I can't, you know, look

16:15

into your brain and like a dipstick and measure your

16:17

serotonin or your norepinephrine. No,

16:19

in fact, the vast majority of people with depression don't

16:22

have, you know, obvious measurable

16:25

abnormalities in any brain chemicals. Nowadays,

16:28

I think many of us think that if there is a brain

16:30

thing that we can understand, it probably has to do more with

16:33

how the brain areas talk to each other. So,

16:35

no, you know, I think that it's becoming

16:37

increasingly clear that these older

16:39

simple ideas of chemical imbalance,

16:42

they don't fit the data very well. Yeah,

16:44

it's a nice narrative, right? I think,

16:46

again, and we like narratives. We like

16:48

to hear that your cholesterol is too high and

16:50

that's going to cause you to have heart disease. Your

16:53

serotonin is too low. So, we'll give you an

16:55

SSRI, a selective serotonin

16:57

reuptake inhibitor, just to keep your

17:00

serotonin around longer and that should help.

17:03

But it's interesting.

17:05

You know, on one hand, I was reading an article

17:07

that said you can give aspirin

17:09

for pain and that should help

17:12

your pain, but that doesn't mean you're, quote unquote,

17:14

aspirin deficient. You

17:16

can give serotonin or you can create

17:18

more serotonin for your brain. Doesn't necessarily mean

17:20

you're serotonin deficient, even if that serotonin

17:23

does help alleviate your symptoms

17:25

of depression. And I know that sounds

17:27

like maybe talking in circles, but I think it makes the

17:30

point that you're making, which is it's very hard

17:32

to call this a chemical imbalance. Even if

17:34

a selective serotonin reuptake

17:36

inhibitor, SSRI, works, it doesn't

17:39

necessarily mean that there was a chemical imbalance.

17:42

It meant that getting more serotonin actually

17:44

just made you feel better. That's right. But

17:46

there's an implication of that, which is that,

17:49

yeah, antidepressants are not doing something

17:51

natural. So they're not, you know, it's not

17:53

that your serotonin is low. So we're just going to fill

17:55

your tank. It's that if you give people

17:58

an agent that sort of pushes. serotonin

18:00

signaling in the brain for some

18:02

group of depressed people, it makes them feel better.

18:05

But that antidepressant is pushing on the brain to

18:07

make them have that benefit, which

18:10

again is why when people take away the antidepressant

18:13

rates of relapse are probably so high because

18:15

the brain was needing that

18:17

sort of push of the medication.

18:20

The medication was not restoring some sort

18:22

of pre-existing balance that

18:25

was lost. It's doing something novel

18:28

to make the person feel better.

18:31

Look it's all still pretty mysterious

18:33

in reality, but I've got to say I

18:35

do like the way Charles approaches all

18:37

of this. It's important to acknowledge

18:39

that for some people like Jesse who you heard from

18:42

earlier, antidepressants

18:44

not only work, but they're a lifeline. But

18:46

at the same time there is data to show it's

18:49

definitely not a one size fits all treatment

18:51

and we're not even entirely sure why

18:54

or how they even work. That's

18:56

why after the break Dr. Rizan and I are going to talk about

18:59

other options, newer options on the horizon,

19:02

including psychedelics. They

19:04

are probably the most interesting development

19:06

in the treatment of mood and anxiety and

19:08

post traumatic stress disorder, probably alcohol

19:11

and drug abuse that I've seen in the 40

19:13

years that 30, 40 years that I've been a psychiatrist.

19:16

That's a significant statement coming

19:18

from you. Oh yeah. Oh yeah. That's

19:21

quite remarkable. We're going

19:23

to talk about the future of depression treatment in just

19:25

a moment. But you know, before we go, a reminder,

19:28

if you or someone you love is struggling,

19:31

there's help available for you right

19:33

now. You can call the national suicide

19:36

and crisis lifeline anytime 988.

19:47

We're less than a year out from a presidential

19:49

election in the US. I realized

19:52

that may kind of stress you out, but CNN

19:54

five things is here to help. We're

19:56

a podcast that gets you caught up on five

19:58

big stories in five minutes. whether

20:01

it's keeping up with politics or anything else

20:03

that's going on in the world, we've got you covered.

20:06

That's the CNN Five Things Podcast. Listen.

20:09

On your favorite podcast.

20:21

One of the things that's come up quite a bit is

20:23

psychedelics, and this is an area of interest of

20:26

yours as well. You know, I've got

20:28

to say it's pretty compelling, and I'm

20:30

pretty conservative

20:32

on these things, even on cannabis. It took

20:34

me a while to sort of fully appreciate, which

20:37

I do now, the medical benefits

20:39

that cannabis can offer for certain things. What

20:42

about psychedelics? You're a well-regarded,

20:45

well-known psychiatrist in

20:47

this country. I listen to you. You're the guy

20:49

I go to. What do you think

20:51

about psychedelics and depression? You've

20:54

come to the right place, actually, because

20:57

this is what I spend much of my life doing these

20:59

days, is trying to understand, do

21:01

psychedelics work? What do they work for? And

21:03

then how do they work? And so one

21:06

of the hats I wear is directing research

21:08

for a kind of very novel medical

21:11

research organization called Usona Institute,

21:14

which is one of the entities in the world that's working

21:16

to get FDA approval for psilocybin,

21:18

which is a psychedelic, as a treatment

21:20

for major depression. This

21:23

is mushrooms? It's the psychedelic substance

21:25

in mushrooms. We produce the psilocybin,

21:27

as do other commercial entities. We produce

21:29

it. So it's a synthesized substance,

21:32

but it's based on what's in mushrooms? Exactly.

21:34

It's the same thing. We just did this 104-person study with

21:37

people who are really depressed,

21:41

gave them a single high dose of psilocybin with

21:43

psychosocial support. Huge improvement

21:46

in their depression. One

21:48

dose, and the study lasted for six weeks.

21:50

At the end of six weeks,

21:51

a lot

21:55

of the folks that were really depressed were significantly

21:58

better with psilocybin.

21:59

been showing over and over again, you know.

22:02

There are now just a handful, you know,

22:05

growing handful of studies, some of them like ours,

22:07

fairly large, showing that a single

22:10

high dose of psilocybin produces a

22:12

very rapid, very, very robust

22:15

and sustainable antidepressant effect. So

22:18

yeah, I mean, I think, you know, of, of

22:20

I'm one of these people that thinks that although these agents

22:22

are going to have their challenges, of which there are many, and

22:25

they're going to have their risks, they are probably

22:27

the most interesting development in the treatment of

22:29

mood and anxiety and post-traumatic stress

22:31

disorder and probably alcohol and drug

22:33

abuse that I've seen in the 40 years, the 30,

22:36

40 years that I've been

22:38

a psychiatrist. That's, that's a significant statement

22:41

coming from you.

22:42

Oh yeah. Oh yeah. No, it's quite

22:44

remarkable.

22:45

What do psychedelics do in the brain

22:48

that causes such a benefit

22:50

when it comes to depression? Yeah, we don't

22:53

fully know. But you know, it's interesting,

22:55

the most consistently observed predictor

22:58

of response is not

23:00

at this point, a brain measure, it's actually

23:02

a behavioral measure. So you know, psychedelics

23:05

are very different, you know, let's Prozac, Paxil,

23:07

whatever the SSRIs, you know, you're depressed,

23:09

you start taking them, and maybe you feel

23:11

a little bit weird because they have side effects. And if they

23:13

work, you know, you feel better in a couple of weeks, but you

23:15

don't know why you feel better. It's not like

23:17

you had a eureka aha moment. Psychedelics

23:20

is totally different though, you know, so in

23:22

our studies, when you come in, I give you a 25

23:24

milligram dose of psilocybin, almost

23:27

everybody is now going to have a very

23:29

intense psychedelic experience. And

23:31

those experiences tend not

23:34

to be random, they tend to have characteristics

23:36

that if those characteristics occur, people

23:39

are going to be undepressed afterwards. And so

23:41

for instance, one of the things that psychedelics

23:44

tend to do is they induce these things called mystical

23:46

experiences, which are really these

23:48

states where people feel much more

23:50

deeply connected than they had previously to

23:53

other things, to the universe, to God, to other

23:55

people, they have this feeling that their lives

23:58

are meaningful in ways that they didn't realize.

23:59

before and just sort of fills them often with

24:02

the sense of joy. They're like, wow, I

24:04

am meaningfully part of something larger

24:07

that matters, that's going someplace good.

24:10

When that happens, during the psychedelic

24:12

experience after you take the drug, the

24:14

more that happens, the more likely you are to

24:16

be undepressed six weeks later, six

24:19

months later. And then the other thing

24:21

that psychedelics do is quite interesting is that

24:23

they tend to bring people face-to-face with

24:25

the issues that they're dealing with. So one of

24:27

the things we know about depression is when you're

24:29

depressed,

24:29

you tend to avoid things that are very painful

24:32

and you get depressed because you avoid things

24:34

that are very painful. Psychedelics interrupt

24:36

that process, you know. So if you're struggling,

24:39

if you're depressed because you're feeling bad about yourself

24:41

because of something, psychedelics

24:44

will very often

24:45

put that something right in front of your face.

24:47

And this can be very, very difficult for people.

24:50

And so many people in our studies

24:52

that have depression will really have

24:54

a rough go during the psychedelic experience. They'll

24:56

cry, they, it's

24:59

just emotionally very powerful.

25:02

There's no escape, you know. It's not like I could say,

25:04

oh, I'm just going to forget about it. If

25:06

that happens to you

25:08

and if you deal with it, if

25:10

you face the problem, if you feel like you've either

25:13

faced it in a way that's going to let you make a change

25:16

or faced it in a way that's going to let you accept something

25:18

that you cannot change, in the field

25:20

it's called an emotional breakthrough. And if

25:22

that happens, people are also much

25:24

less likely to be depressed and anxious, like

25:27

weeks and weeks later. So that's

25:29

the thing we know about these agents at this

25:31

point is that it seems like there's something,

25:34

it's more like psychotherapy in that

25:36

regard, right? And this is where sometimes people say

25:38

it's like a year of psychotherapy in a day. You

25:40

just, it recalibrates how you

25:43

see your life.

25:44

This eureka moment Dr. Raisan is

25:46

describing highlights, I think, a key

25:48

difference in the way traditional SSRIs work

25:51

versus psychedelics in terms of treating

25:54

depression. Compared to SSRIs,

25:57

psychedelics are going to work much faster

25:59

and And they're going to appear to have longer

26:01

lasting effects. That's because they

26:03

seem to ignite this explosive

26:06

neuroplastic response. Your

26:08

brain just starts to light up all over the place.

26:11

And it causes the brain to create these entirely

26:13

new pathways or at least unobstruct

26:16

existing pathways making these

26:18

connections between parts of the brain that

26:21

normally don't communicate much. For

26:24

example, he said the feelings we keep

26:26

buried away in the emotional centers of the brain,

26:29

they kind of suddenly pop

26:31

into conscious awareness. Think about that.

26:34

You keep these things buried away. You

26:36

take this psychedelic according to Dr. Raison

26:39

and all of a sudden those things that were

26:42

inhibited, that were buried pop

26:44

into our conscious awareness. Another

26:46

key difference Dr. Raison said is that unlike

26:49

an antidepressant pill that you have to take every

26:51

day, psychedelics appear.

26:54

And I want to be careful here because this is still new

26:56

science, but psychedelics appear to

26:58

set something in motion in our brains that

27:01

somehow stays in motion. It becomes

27:03

self-sustaining so you don't have

27:05

to take them frequently, certainly not every day.

27:08

Charles referred to SSRIs,

27:10

again the selective serotonin reuptake

27:13

inhibitors, these antidepressants. He

27:15

referred to them as a gas grill that

27:17

will go out if you don't keep giving

27:19

it gas. Psychedelics

27:21

he said are more like a campfire. Once

27:24

you light it, it burns for a while.

27:26

Now look, again, these findings are promising,

27:29

but there's still a lot we don't know about how

27:31

psychedelics treat depression, just like we don't

27:34

know how antidepressants really work. There's

27:36

also the question that a lot of you are probably immediately

27:39

asking about the federal regulations.

27:43

So you know, we and everybody else in the space

27:46

working to get FDA approval is synthesizing

27:48

these agents to this insane

27:51

purity that you have to do for the Food and Drug Administration.

27:54

And we're doing the kind of studies that if they're positive,

27:57

traditionally cause the FDA to say, okay, I'm

27:59

going to do this. we're going to give you approval to

28:02

use this medicine. I

28:04

think it's very clear that because psychedelics

28:06

induce these very powerful, acute,

28:09

you know, psychedelic what are colloquially called

28:11

trips, they're never going to be agents

28:13

that you take it home on a Saturday morning, right? Almost

28:16

certainly they will be administered in a

28:19

clinical setting where there's safety. They

28:21

will be administered with people that are in

28:23

the room with you in case you really

28:25

start struggling. So these are, but

28:28

these are hurdles. You know, there's some real challenges

28:29

there.

28:32

I remember back when I was a medical student, there

28:34

was some papers that were actually written about hypothermia

28:38

and actually patients who are in acute crisis,

28:40

mental health crisis to actually

28:43

use hypothermia. What you've

28:45

written about is the effectiveness of heat therapy.

28:48

Is this something that can work? Oh, yes. Hyperthermia.

28:51

Yes. Yes. Yes.

28:54

Oh, yes. trying

28:57

to retread ancient

28:59

practices, you know, psychedelics. We're talking

29:01

about psychedelics. They've been around for thousands of years. Heat,

29:04

you know, heat has been a healing modality in almost

29:06

every culture for millennia,

29:08

you know, all of Native Americans and all

29:11

sweat lodges and the baths in Asia and, you know,

29:14

so we've known for a long time that heat has

29:16

beneficial properties.

29:19

Cold though probably does too. I've

29:22

got a colleague out in Colorado, Christopher Lowry,

29:24

who's shown that in animal models, cold

29:27

and heat have very similar signaling capacities

29:29

on the brain. And now some

29:31

of my colleagues have done studies showing that if

29:33

you're depressed, that I can put you

29:36

in a machine of one sort or other that will

29:38

elevate your body temperature. We like to get people

29:40

up to about 101.3 Fahrenheit, which is 38.5 centigrade. It's

29:44

hot. If you're pouring sweat,

29:46

it's really hot. But if I do that, if

29:50

I do that in a group of depressed people, very reliably,

29:52

their depression scores drop by about half.

29:56

Some people get much better than that, right? And

29:58

the biggest study that we've done is that we've done it in one group. done, we gave

30:00

people a single treatment, their scores dropped

30:03

considerably and they stayed improved

30:06

for six weeks. So this is another

30:08

one of these sort of more ancient ways of doing

30:10

things that I think can be

30:13

kind of spruced up and be another sort

30:15

of option for folks. But

30:18

people now, of course, they asked me about it because this is, we've

30:20

really shown there seems to be something here.

30:23

And what I tell people is, if you go to the sauna

30:26

and you feel better, if you

30:28

can stand doing it by yourself,

30:31

just a regular old rectal thermometer, put

30:33

yourself in the heat and monitor your

30:35

body temperature a couple of times, see

30:37

what it feels like to get up to about 101.3 and then try to

30:39

do it. Because

30:43

we know, we look at people in

30:45

our studies very carefully and there's a dose

30:48

response relationship. You do get

30:50

more of an antidepressant response at higher temperatures,

30:52

right? So it really is worth, frankly,

30:55

it's worth doing. I do this all the time.

30:57

I do. Oh yeah. I'm

30:59

in a

30:59

clean shower and I use it every day.

31:02

For me, it's really, it's

31:06

huge.

31:07

When you listen to Charles, another psychiatrist,

31:09

talking about the new treatments on the horizon

31:11

for depression, you can't

31:14

help but realize that what was old can

31:16

be new again. We're talking about plants.

31:19

We're talking about heat. We're talking about

31:21

ancient traditions. And in some ways,

31:23

I think that should make you feel a little

31:26

bit more hopeful. Don't get me wrong.

31:28

The statistics, the rising rates of depression

31:30

that we talked about, that is real. That

31:33

is something we have to pay attention to. And

31:35

right now, it feels like the world around

31:38

us is pretty inflamed. But

31:40

at the same time, as Charles points out,

31:43

at this point in history, there

31:45

are more treatments for depression than

31:47

ever before. And there are many more

31:50

promising treatments on the way.

31:52

But what I like about psychedelics and what I

31:54

like about hypothermia is they share something in common

31:56

that I think is a potential path forward

31:59

as we think about... novel treatments for depression,

32:01

which is this. Unlike

32:03

a pill that you take every day that the brain then accommodates

32:06

to and begins to kind of push against.

32:10

Psychedelics and hypothermia, but especially psychedelics

32:13

seem to set, they're drugs, they're very

32:15

powerful drugs. They come from

32:17

the outside, they set something in motion, but

32:20

then they're gone. And whatever they've set in

32:22

motion stays in motion and it becomes

32:25

something that becomes a sort of self-sustaining

32:27

within the mind, body, brain complex.

32:30

It requires oxygen and things from

32:32

the environment like everything does, but it has

32:34

a self-sustaining life of its own. Psychedelics

32:38

like the match, they seem to light something and

32:40

then the fire burns for a while. And

32:43

I think that metaphor is one that

32:45

we should take more seriously in terms of

32:47

trying to identify new treatments.

32:49

That makes a lot of sense. Oh, that'll stick with me for

32:51

sure. Let me just ask

32:54

you in closing, I'm

32:57

very diligent about exercise. I

32:59

know exercise can help new brain

33:01

connections, more BDNF,

33:04

it's called, brain-derived neurotrophic factor. I

33:07

meditate every day now. I know that

33:09

can help with feelings of stress and anxiety. I'm

33:12

really diligent about sleep. As busy

33:14

as you and I both are, my guess is you're

33:16

diligent about sleep as well. She

33:18

told me just now you also do steam showers

33:21

to try and raise your body temperature. But

33:23

I have a terrible history of family history

33:25

of heart disease. So I do all these things

33:28

to ward that off. To

33:31

prevent mental illness, mental

33:33

health problems later in life, what

33:36

should I be doing? What do you do? Well,

33:38

all the above. So everything you said is those

33:41

are all fantastic things, right? So if

33:43

I had a short list, you've just named a bunch of

33:45

the short list. The thing that I

33:47

do in addition to that, that I found

33:49

very, very helpful, is

33:51

to work on developing

33:55

an attitude of

33:59

thankfulness. for the fact that I

34:01

exist. Thankfulness for

34:04

the people in my life. This sort of trying

34:07

to foster a sort of, I'm looking out the window, it's

34:09

a beautiful autumn day up here in Wisconsin,

34:11

trying to foster this sense

34:13

of wonder that in this crazy amazing

34:16

universe, we're here and we're conscious.

34:18

I had this idea that there's certain mental states

34:21

that make depression impossible. The

34:23

grief is possible in those states, but not

34:25

depression. It's just, it's very hard

34:27

to get to those states. But

34:30

we talk about psychedelics, psychedelics often put people

34:32

in those states, at least briefly. So

34:35

that's the other thing I do, is I really try to foster

34:37

that sense of

34:39

kind of wonder and gratitude. That

34:43

for me helps a lot. That and the steam showers.

34:47

They help me a great deal.

34:52

Steamy showers and gratitude.

34:55

What I like about these two parting pieces

34:57

of advice from Dr. Raison is that

34:59

these are small things anyone can try.

35:02

And just a reminder, of course, that this isn't gonna help

35:04

with all kinds of depression. If you

35:07

or someone you love is seriously struggling,

35:09

there can be help available for you. You

35:11

can call the National Suicide and Crisis Lifeline

35:14

anytime, 988. Also,

35:17

we'd like to hear from you. Give us a call. What

35:20

are some tips that have helped you care for your mental

35:22

health? Give us a call, 470-396-0832. Your

35:27

message could help others, could be featured

35:29

on an upcoming episode of the podcast. Plus

35:32

next week, we're gonna dive into

35:34

the world of dating apps,

35:37

or introducing apps, as

35:39

they are now called. How have they changed

35:41

how we find love? And what

35:44

is all that swiping doing to your

35:46

brain? The answers might surprise

35:48

you. The brain

35:49

is built to love. And

35:52

all these dating sites, introducing

35:54

sites, are built for only one

35:56

thing. Introduce you to people

35:59

so that you can then.

35:59

pick up the ball

36:02

and move it down the road. That's

36:05

next time on Chasing Life. Thanks

36:07

for listening.

36:14

Chasing Life is a production of CNN

36:16

Audio. Our podcast is produced

36:18

by Erin Mathewson, Madeline Thompson,

36:21

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36:23

senior producer and showrunner is Felicia

36:26

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36:28

our medical writer and Tommy Bazarian is

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36:32

is our technical director and the executive producer

36:35

of CNN Audio is Steve Lickti.

36:37

Special thanks to Ben Tinker, Amanda Seeley

36:40

and Nadia Kunang of CNN Health.

36:49

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