115. Let's talk about depression in our 20s

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Speaker 1: Hello everybody, and welcome back to the Psychology of Your Twenties, the podcast where we talk through some of the big life changes and transitions of our twenties and what they mean for our psychology. Hello everybody, Welcome back to the show. Welcome back to the podcast. New listeners, old listeners. Wherever you are in the world, whatever date is, I hope you're having a great day. Welcome back for another episode. So you've read the title, I don't think it's any surprise that today I'm going to talk about my experience with depression in my twenties. I have depression. I've had it for many years, and I really think it's time that we talk about it. It's taken me quite a while to really, I would say, process what I wanted to say in this episode. I think out of fear maybe you know, my words could be misconstrued, my experience could be miscontrued, but also because of you know, a level of shame. You know, it's really it's a lot to really engage with that. There are millions of people listening to what can be very deeply intimate and vulnerable parts of my life, and sometimes there are things that I don't really feel prepared to share because I think that what you make public is kind of what you allow people to comment on and what you allow people to have an opinion on. But I also don't think it's a secret. You know. I did an episode a while back titled why am I So Unhappy? I feel like that's a big clue. And I've also talked about, you know, my experience with antidepressants back in the earlier days of the show. But for a mental health podcast, it felt like it was time to do somewhat of a comprehensive episode on this, So today, let's talk about it. Let's talk about depression in our twenties. This episode is going to be, I think equal parts more scientific and more personal than most of my episodes, because I think when we're approaching things like mental health, you can't be coming at it with your own theories, and there's also no absence of really incredible research into improving the lives of people who have this condition. It's also a sad reality that stigma is very much alive and well. I think as society we are getting a lot better at accepting certain truths about depression, but a big part of why stigma persists is because of a lack of accurate knowledge. So kind of consider this your introductory guide, your immersion into the psychology, but also the personal experiences of someone who is going for this. We're going to discuss why depression is more than just a blanket term, and how it looks different for everyone, including people who may be very high functioning and visibly seem very well and very okay. It's a huge misconception that you need to look and behave a certain way to be depressed. That's a myth that we are definitely aiming to bust today. We're also going to examine the different types of depression, the origins of depression, including some of the early historical recognition of this condition, and some of the secrets and surprises that our biology and our DNA holds, as well as the role of things like adrenaline, like family environment, and even positive experiences like graduating. You know, our minds are very very cryptic, a bit of a black box at times, and I think depression is a lot more than being sad or based on what we perceive as negative events in our lives. There's also been some really fascinating research coming out in this space that I think deserves a very special place in this episode, particularly around the use of things like psychedelics and certain illicit substances to treat depression. We're going to tread lightly because the research is still ongoing, but I think we're at this kind of new frontier of how we approach a lot of different mental health disorders, including depression. So although we're going to talk about typical treatments, I really want to speak about my own experience on antidepressants, kind of some of the myths behind why exercise is not the secret cure we all imagine it to be. We're also going to leave some room for new findings and knowledge and hopefully come out of this knowing I would say more than about ninety five the set of the population does know about depression. There's so much information that I want to cover. Maybe we can do a part two, but if you're looking for an overview and also some of the more fascinating elements that we don't see discussed very often, hopefully this is the space where you can learn. I want to quickly put out a brief disclaimer. This episode is for entertainment purposes only. Maybe not entertainment episodes informational purposes, but please do not use this episode for diagnostic or therapeutic advice. If you find yourself relating to this discussion or this does make you distressed, please please reach out to someone for professional support. I unfortunately do not know each and every one of you, and I don't know your story or your needs, and as we'll come to see, we all have different experiences. But there will be links in the description for further information. And if you're someone who's maybe listening to this to better understand the experiences of a partner or a friend, a sibling, parent, really anyone, Firstly, thank you for joining us. I think it's really beautiful that you're here to learn, and there will also be resources on how to support people with depression as well. Like I said before, there's a lot to cover in this episode. I'm going to stop rambling and we're going to dive into all this science and the psychology and a bit of my personal experience as well. So let's get into it, alrighty. So, I don't think I can do an episode like this without explaining why I think it's so important we have more discussions around depression and mental health in general, particularly in our twenties, and as a part of that, I want to talk really frankly and openly with you about my own experience. So I've had I guess, clinical depression for like five years. It comes and goes, and I think sometimes I feel like I've spent more years of my twenties kind of dealing with it than I have really enjoying this time, and that you know, the best years of my life have somehow been been claimed by this state of mind and by this condition. And you know, last year in particular was really hard. It was the best year of my life. Everything I'd ever wanted kind of came true. Everything was going right. It was these constant milestones and celebrations. And I think despite all of that, all of that perceived external success, I felt really deeply, deeply unhappy. I would look at my life and I knew I should be excited, I knew I should feel up on cloud nine, and I just couldn't be there. And it was so frustrating to me to not have, you know, I guess, access to that joy, or to the things about myself that I valued, like my creativity and just my kind of zest for life and I know that that experience, having talked to listeners of the show, having talked to friends, is not a unique one. It's not one that I'm alone in experiencing. That's why talking about this is so important to me on a really vulnerable note, because I know it's hard to talk about. I know that this side of me might not be what people want to see or hear about. I know that our knee jerk reaction is to feel shame or embarrassment towards open discussions around mental health. But I'm hoping that seeing how this has played out for me and continues to impact me, using some of my own experiences, but also the academic and the psychological and the scientific knowledge, can really minimize that shame for yourself and also actors an example that this can be your experience and you can still have a really fulfilling and fantastic life. There's good days, there's bad days. I guess that's part of the game I'm still kind of adjusting to. There's no doubt that we are seeing rising rates of not just depression, but general unhappiness and alienation in this generation. We know that young people have a higher rate of diagnosis for these conditions. There's even some estimates that put it at like thirty to thirty five percent, way more than what we saw in in previous decades. But also in older age groups, and it's during the ages of around sixteen to twenty nine, early thirties that typically our first major depressive episode, if you go on to develop a major depressive disorder, normally occurs, So we really want to start talking about it earlier. The factors I think that we can point to for this upward trend are really endless. You know. On a positive note, reduced stigma in society is leading people to receive a diagnosis, and you know, previous generations may not have received that despite experiencing all the same symptoms. And also generationally, I do think there is this kind of increasing malaise with the state of the world, Reduced protective factors like a sense of community, which we know has really disappeared for a lot of people in this generation, significant pressures to perform and be exceptional, financial uncertainty, COVID, a sense of just like general doom about the future, and those are only really I think a handful of explanations that psychologists and researchers are pointing to for a lot more people coming to them saying, I'm having this experience, I think I might be depressed. We're never going to eliminate conditions like depression, but I think the existence of depression in society is not the concern. It's the rate at which so many of us are struggling without the necessary societal and community and medical supports. You know, this condition has always had a place within the human experience. This is not some new illness, it's not some bad condition. It's very very real and very very consequential. If we look back at history, although terms like clinical depression or major depressive disorder, and now, how we would label this experience. Back in even like ancient Greece, ancient Rome, they had a name for this. They had a different name for what we're talking about, and it was melancholia, meaning a feeling of deep, profound sadness, a sadness that kind of sits in your bones. And there are so many historical documents and parts of history, paintings, sculptures, folklore, even Bible versus that show us that not only did this condition we now know as depression exist, but there were also efforts to treat it, it was viewed as a medical condition, and yet we still have such a hard time acknowledging it in our society, despite it being what some are calling a literal epidemic and very historically significant. You know, you'd think that we'd have used those thousands of years to actually get better at integrating this condition into our understanding and our compassion for others. But still I think we endure it in silence. When we do have the courage to ask for help, maybe you don't receive the support that you need, or at times we're kind of convinced that we're totally fine, it's all in our head just to get over it, to grin and bear it. And that fallacy that avoidance in suppression can somehow magically cure you is so false. It's you know, it's, without a doubt, not true. Depression is so much more than just sadness. It's a medical condition, perhaps one of the most common that we see. And it's not shameful. That shame is societal. That shame is learned, and it can be unlearned. I know this metaphor has been used to death, but your brain is an organ, is a part of your body, like any other, and sometimes it's going to have a few problems. The same way that our bones break, the same way that we get scrapes and bruises, and our arteries clog, and our hearts beat a little bit too fast. Sometimes our brains find themselves in a state of chemical imbalance, or they get bumped in, you know, symbolically metaphorically bruised by the things we experience. I think what I found in my own experience was that from the outside I looked really, really fine. I think I didn't feel fine, but I was still going to work, I was still interacting with my friends. I was still getting good grades at university. All the feelings and symptoms that I was experiencing were very solitary, and because of what I thought depression looked like, I didn't really feel like I deserved to feel this way or to accept the diagnosis that I had to me. The depression I saw was really dramatized in the movies, in books and TV shows. The cases I saw that were acknowledged by society and those around me were very visible. It was someone laying in bed for hours, which you know I did do, but it was also someone who missed work, or school, whose kind of hair was always a mess, who walked around like a zombie. I saw depression as tearful, as very outward, and as causing dysfunction, And for many of us, that is the experience, and it's one that's extremely difficult. But from the outside, in my case, I was still functioning. I wasn't crying. If anything, I couldn't cry because I really couldn't feel anything. But I still did all the things that people expect you to do, and that didn't really match my perception of what I thought depression would look like. I think our difficulty accepting the reality of this goes deeper than just the stigma that we've spoken about, and it's this larger idea of a misrepresentation that our society likes to, you know, make things look dramatic, likes to make things look a lot more in you know, not intense than they are, but likes to make it a little bit of a spectacle out of the things that we go through. And like I said before, we see that in so many types of media that we're consuming, this idea that your life needs to be absolutely falling apart for you to be depressed, and that's something that needs to be needs to be corrected. There needs to be some kind of understanding that you can still be depressed and everything in your life can be going really, really well. So that's the first misconception I really want to talk about. Depression is not just one condition. It's not a blanket diagnosis, and it is going to look very different from person to person. To understand this, we kind of need to look closer at the DSM. And this is what we call the Diagnostic and Statistical Manual of Mental Disorders. Essentially, it's like the Bible of pretty much every mental disorder you would experience, and it lists exactly how to diagnose a condition and what it's going to look like. Depression was one of the founding conditions, but previously anyone who met the symptom cut off for depression would be diagnosed with major depressive disorder. That is what I think our society the typical image of what this condition is. But on a clinical level, it requires two or more depressive episodes, which is a discreete period of time, often a minimum of two weeks. When we experience at least five of the following things, we have a depressed mood for most of the day, a diminished interest or kind of pleasure in the activities that we used to enjoy, significant weight gain or loss, insomnia or sleeping too much, agitation, fatigue or loss of energy, feelings of worthlessness or excessive guilt, a diminished ability to think or concentrate, and finally, these recurrent thoughts of death. Like many mental health conditions, it has little to do with what's actually happening around you. You can have a loving family, you can have friends, you can have a dream job, you can have the kind of life that you've always wanted, and you can still have depression. But for others, this typical definition of a major disorder isn't going to be their experience, right, And that's something that psychologists have really identified in recent decades. They had clients coming in saying, you know, I don't have these lows that are intense as those associated with a major depressive disorder, but it can't shake this sadness. And it's been years. Some days you know are better than others, but there's this overtone of really deep unhappiness and hopelessness in my life. This is what we now call persistent depressive disorder. It's also known by other names like high functioning depression or dysthymia. This is what I now know, I think I had, and well I still have it to this day, and the criteria are a lot less strict, but it really points to the longevity of this type of depression. You need to have a depressed mood for more days than not, and he's kind of a kicker for at least two years. But you only need to have two of the below criteria, not five. So the same kind of list that we talked about before. Low mood, sense of hopelessness, a lack of energy, low self esteem, and this condition is much more nuanced, like we said, than just sadness. The same way that each person is a really unique combination of so many factors and experiences and stories, their minds and their brains are also going to be this unique combination, so I think it's really important that we recognize that distinction and adapt to the diversity by which these symptoms can appear. We also see conditions under this umbrella like seasonal effective disorder or seasonal depression, postnatal depression, depression associated with bipolar disorder, and then finally adjustment disorder with depressed mood that's also known as situational depression. This looks like major depression in many ways, but instead of being brought on by what we might see of certain biological mechanisms or neurological roots, it's brought on by a specific event or situation that's been really really hard, like the death of a loved one, or serious illness, a divorce, facing financial difficulties, even a breakup, all of which are these events that are discreet, but they essentially overwhelm our capacity to cope, you know, as it's only natural and kind of expected in those situations. Situational depression. The symptoms tend to start within three months of the initial experience, and it follows a very similar pattern to major depression, with the caveat being that often it's quite comorbid with other conditions like anxiety or things like substance use, you know, including alcohol. I think what always complicates our perception of this condition isn't just the variety of the ways that it can manage fest, but also the fact that depression or feeling depressed is both a clinical term and one that we can use to describe a certain feeling, you know. It's both a symptom and a condition, but one of those things is temporary. And a question I get asked a lot is is this kind of my life now? Will I ever be cured? When's this going to end? I think when we are in this state, we often need the security of a timeline to give us a light at the end of the tunnel. How can we kind of go on with life if we think that this will never end? And that's what depression convinces you that it won't, that it's all pointless. And if you just get one thing from this episode, one tiny, tiny piece of advice or wisdom, it's that it's not pointless. Trust me, I know so intimately how it feels to look at life, this thing that we think should be precious, and feel nothing for nothing to make us happy, to be stripped of joy. But I also know what it feels like to kind of slowly see that perspective change. It's like the first flowers after spring. You know your brain is slowly defrosting all those happy hormones, that it's that it's kept from you. And I really do understand the desire for a quick fix as well. You know soundly our brain is quite cryptic, and the length of this condition is really going to depend on a lot of factors, the primary one being the origins and the root cause, and what about our environment, or our context or our protective factors can be altered. So let me set the stage and kind of dive into the science behind why we feel this way sometimes where it's coming from. You know, depression is not a personal flaw. It's not a personal weakness. It is this hidden system and interplay of genetic and biological and environmental interactions. If depression, you know, was true a choice or a personal weakness, you know, we could hypothetically be able to overcome it with sheer will power and positive thinking. And while some people would have you believe that that is possible, those are not the kinds of people that we want to be listening to, especially when it comes to our mental health. We're going to approach this from the model of the four p's. So what that means is predisposing factors, precipitating, perpetuating, and protective. There's kind of not just one secret formula to what makes a depressed person, I guess, versus someone who is not depressed. But we can use this model to kind of break down our innate and personal vulnerabilities, and then also what we can use to mitigate our symptoms if we are someone who has this condition. So predisposing factors are kind of areas of vulnerability that increase your risk. When we talk about depression, the first one that often comes to mind is genetics. If you're looking for something else to blame your parents for, this one might be for you. But our genetics are inherited from our mother and our father, and they essentially lay out the blueprint for how our brains and our bodies should develop as kind of an initial template that then kind of interacts with our environment to create our outcomes, to create our life. Each of us has a very unique genetic profile, with obviously the exception of biological twins, and our genetic profile is marked by these things called mutations. So these are caused when our cells are splitting or dividing, and when we receive a mutation on one of our genes. This is what is often responsible for certain disorders and illnesses, or a certain predisposition for conditions like depressions. So when scientists started using genetic mapping to figure out why some people develop certain conditions for seemingly no apparent reason, and others don't. Eventually they turn to depression to see what they could find in our DNA, what kind of secrets they could unlock, And here's what they found. So they believe that as many as forty percent of those of us who have depression can trace a link back to something in our genetics, which is most often identified by having a close family member or a relative who also has depression. But it's important here to note that doesn't necessarily mean that everyone with a mutation or family history is going to develop depression, because often that gene needs to be activated by our environment, and that accounts for the other sixty percent of our kind of risk factor or vulnerability. And this is where the interaction between family history and genetics can become a little bit tricky, because a child who grows up with a parent or a person around them who has depression, maybe they are more susceptible to the condition, not because of a genetic mutation or because they've inherited this gene, but because they've learned to mimic their parents' behavior, or they've experienced something perhaps uncomfortable in childhood that is related to their parents' experience. It's hard to separate whether the trigger, I guess, or the predisposing factor was genetics or our environment, and that's kind of a puzzle that we're yet to crack. But when they dived further into what specific gene mutation was kind of responsible for upwards of forty percent of cases, what they really found has truly changed how we approach this condition. Our genes are responsible for how our brain processes and releases serotonin, and serotonin is the primary candidate for the reason we experience depressive symptoms. It's like the core neurotransmitter that we would hear about and that is discussed when we're talking about this condition, and there's been several studies that have shown this. You know, serotonin is definitely something you've heard about before. You probably mostly know it in terms of like the happy drug alongside famine, the happy chemical, And that relationship between perhaps having a less formed serotonin system or less serotonin available in our brain and depression makes a lot of logical sense because this neurotransmitter is responsible for our mood, for our general levels of happiness, and also things like sleep, which we know contribute and because this mutation disrupts the release and how our brains process serotonin. People with depression may have less of this neurotransmitter available to them, and that is what results in these symptoms that we typically associate with this condition. At the end of the day, I think what these findings really revealed is that this may be, you know, nothing more than just a chemical imbalance, and it's unfortunate, but you know, we can't go into our brain and turn on the serotonin tap whenever we'd like, but we can take medications like selective serotonin reuptake inhibitors or basically what we know as antidepressants, and they work by preventing our neurons from sucking up all of that serotonin in our brain and keeping it in action for longer, making more of it available to us. That's obviously a really, really simple explanation, but the apparent effectiveness they've repeatedly shown effectiveness of this type of antidepressants really points to depression having a biological origin in how our brain releases and processes serotonin, in particular hormonally as well. Studies conducted in two thousand and eleven, actually a bunch of them, not just conducted during that year across a number of years. They also suggest that major depression may involve an overactive hypothalamic pituitary adrenal axis. Very long word, very long term, but essentially it's responsible for a lot of our hormones, including estrogen, which, as you may have guessed, it also impacts serotonin levels. All of it comes back to this one little neurotransmitter. But we're going to talk on this a little bit more later, specifically the hormonal influences. I want to quickly return to that question, how long does this last? How long is your depression going to last? You know, I can't answer that for you, but I think if it's the case that a lot of your condition is coming from hereditary factors like genetics, which consequently impact your innate biology, I think the unfortunate news is that you know, sadly you cannot rewire your brain, so not accounting for the protective factors we're going to discuss later on, it's really hard to say. It may be chronic, but it's not untreatable. SSRIs are highly reliable. They've been systematic tested for their effectiveness in these situations, particularly in response to this chemical imbalanced explanation but the fact that they don't work for everyone points to this kind of deeper truth that not everyone's depressive symptoms have a genetic or even a neural origin to do with some kind of serotonin dysfunction or hormonal dysfunction. Certain personality types and people of certain temperaments may also be more susceptible, and there's a few that we typically look at, particularly those who are rejection sensitive, self critical, anxious, worrying, or personally reserved. And then of course we have things like extraneous events and circumstances. It's not all about temperament and personality. The things that happen to us create the thought patterns and the response that our brain is going to have. So trauma, as we know, is a massive country out There is a large consensus that indicates that childhood trauma is significantly involved in the development of depression. In one study they conducted in twenty fifteen that I found so comprehensive and incredibly well done, researchers ask people to retrospectively recall childhood trauma, and they also measured their rates of chronic depression, and the relationship between these two things was really really significant. Our environment particularly our early childhood environment is so powerful, and things like neglect and abuse have the capacity to literally change how our neural and global structure is developing in some instances, even shrinking or delaying development. Our brains are also not great at forgetting trauma. We have an evolutionary and a survival instinct to remember the bad things that happened to us. Yes, and even when you know they do come through as suppressed memories, the body does not forget, and that stress and that experience does unfortunately stay with us. These factors, though, they all have something in common the ones that we've talked about, and I want to emphasize that commonality. Really clearly, none of these factors, none of these predisposing determinants are within our control. None of them. None of them could be our fault. There is nothing in that list that we have agency over. You know, our genetics absolutely, not our personality. Some would argue maybe, but I would say not the trauma and the things that we experience, our hormone levels. If we could, we would definitely make it so that we did not have this predisposition, that we did not have this experience. Once again, that's misconception. Number two, and something that we have to say is that you do not get to control how this condition manifests. And I think that really takes a lot of the shame away from it because it's not something that you have decided to opt into. It's not something that you want to be dealing with. You know, depending on your experience, I would say most of us would prefer not to be depressed the majority of the time. Okay, I think it's time for a quick break to gather our thoughts, grab a cup of tea, tell your friends that you love them, and when we return, I really want to discuss precipitating factors, protective factors, and also some of the new treatments that we are seeing for depression, including the use of psychedelics not as fun as it sounds, actually but really interesting, and also why some people think that things like ketamine or even nature may be particularly healing for people with these symptoms. We've done a bit of an overview of what people typically see as the causes of depression, but what kind of triggers a depressive episode or something like persistent depressive disorder. This is where we turn our focus to precipitating factors. These are things that initiate or promote the onset of a condition. The main fender, I would say is stressful or adverse life experiences. These two psychologists actually created a scale for what these might be and which ones may be more predictive of depression. So it's called the stress scale, and number one is the death obviously of a spouse or of your child, things like divorce and separation, imprisonment, the death of a close family member, injury. But then surprisingly we actually see some things that are more positive, like marriage and retirement and the birth of a child, can be so stressful even though we see them as beautiful that they trigger this kind of emotional and deeper reaction. Let's focus in on some of the events that particularly pertain to our twenties, in particular significant life changes things like grief, but also moving out of home, our first significant breakup, and deep feelings of things like isolation and alienation. There are so many other unique things, and when multiple of these events occur in a short period of time, this has what we would call a cumulative effect. So the prolonged accumulation of momentary stress leads to an increase in long term cumulative stress and just general impacts on our overall health, perhaps because of the release of things like cortiso and adrenaline. It's a biological interaction that has the name post adrenaline blues. When we go through something intensely shocking and life altering, our bodies respond to this as they would respond to danger or a threat, and they pump us with a nice cocktail of neuropinephrine. It's also known as adrenaline and cort result, which is the main stress hormone that's released from our thyroid when that danger passes, when that event kind of fades, when the wedding is over, when you've unpacked all your boxes in the new city, you crash and your body is trying to restore things to normal, And what that can induce is a depressive period or a depressive episode. So yes, one event may be enough to really trigger something like situational depression or an adjustment disorder with depressive symptoms, but it can also interact with some of our earlier predispositions and create other elements or symptoms or even a depressive episode because it is so shocking, because it has really caused us to perhaps rethink life. It's made or limited the availability of our coping mechanisms. It's really transformed how we see the world and is naturally incredibly stressful. But something that's kind of missing from this discussion, I think, and is often missing and rarely spoken about, is protective factors. We like to focus on the negatives. Maybe that in itself is symptomatic, but also our society is rather pessimistic. I think our obsession with predisposition kind of also links to that innate stigma. If we know how depression is created or developed, maybe we can eliminate it from society, which I personally don't think is quite valuable. Maybe that's a controversial thing to say, but for me, you know, yeah, you have your bad days. But if someone kind of gave me a magical button, I think I'd have some doubts. I don't want to say there's been benefits, but there's been definite perspectives shift and various outlooks that my depression has kind of given me. You know, who could say I would be even making this podcast now if I didn't have this experience and didn't relate to some of the deeper discussions happening around mental health and psychology. But I also understand that part of that comes from the attitude I have towards what I'm experiencing, and attitude, as silly as it sounds, it's not going to cure your depression, but there has been evidence that it does minimize your distress and perhaps the severity of your symptom profile because of its role as a protective factor. Things like you know, if you're innately pessimistic versus optimistic, which we'll talk about in a second, that is going to influence your thinking style and also your coping mechanisms. But let's discuss a few other of these protective factors that are really impactful when we talk about depression. Like I mentioned personal attributes, but then things like social support, networks, sense of community. Really nobody can overstate the beauty and the importance of belonging. It kind of quats us in a bit of a protective shield. Also, a strong sense of identity, a sense of self, even things like spirituality or your connection with a particular religion that really encompasses a reason for being. And then also things like depression, physical health and fitness. I think it's valuable that we focus on that last one because I know the opinions around it are very nuanced and at times contradictory. From an evidence based perspective, there is there are a lot of findings that exercise as a behavioral intervention does alleviate some of the symptoms of depression. In a few large scale studies, one in particular, which was conducted here in Australia actually published this year twenty twenty three. They found that active men and women became depressed at much lower rates than set A two people, even if they exercise for only a few minutes a day or a few days a week. But the kind of precise mechanisms by which bodily movements alter brain functions to improve our mood really remains unclear, as do the differences in people's responses. So in every study the researchers looked at, some people's depression was alleviated while others remained unchanged. I also think we need to be skeptical when we're promoting things like exercise because a like we showed, it doesn't work for everyone. B. I think when we read these findings without considering the broader context and interactions between exercise and other factors, we can sometimes reduce these conclusions to suggest that, you know, just buying a pair of running shoes and going for a job is the magical answer. And see, I think it shouldn't be considered the first line of treatment for some people. I think in many ways that would be unethical. Also, when we think about the impact depression has on our motivation, it's really hard for your therapists to be like, oh, just go for a run when you can't even get out of bed. Or it also excludes people with certain disabilities. It's a protective factor. I will say, it's not a cure, and to sell it as anything more than that, I think would be very misleading. You know, look at elite athletes as an example. We've seen so many people like Simone Bios and Naomi Osaka come out and talk really openly about their mental health problems. And I'm going to bet some pretty good money that these people are exercising for more than forty five minutes a day. So the relationship that has been promised between physical activity and an alleviation of mental distress isn't quite there. What it seems to be is a combination. If we have a strong support network, particularly if people we can speak openly with that really lessens the load, as does, like we said, a sense of being a purpose and personality or temperament, the main one being, like we said, the distinction between being an optimist or a pessimist. You know, do you see the world and your future is genuinely positive or are you expecting the worst case scenario. Also, I think depression can make us feel like we're all pessimists, the outlook carried through though by our prior predisposition for optimism, even just even just this slight sense, even if just that like very hidden voice in our head that says, all right, let's keep focusing. Things are going to turn out or right, That can maybe counteract that negative thought pattern that we associate with these symptoms. Something I've also found really effective is active coping skills, forcing myself to journal what I was feeling, especially as a way to look back and see how far I've progressed, but also as a reminder to myself during future hard times that this is not the first time I've been through this. I've survived, I've pulled through. There are beautiful things waiting for me. That is a really important and valuable part of my approach to managing what I'm going through having a perspective. Okay, so the final thing that we've been missing from this conversation has been discussions of treatment. If we're taking a biomedical approach to depression, that perspective tells us that, like any other form of illness, depression should be managed through a series of treatments or interventions. I also want to state that this should not be taken as advice. Like I said before, I'm not in the position to give you actual medical recommendation prescriptions because I guess I don't know you personally. But knowledge is power, and I think psycho education is power. So consider this just an introductory overview or glance at what is actually out there. So there are two main forms of treatment that we typically see, that's medication and therapy. We already know the basics behind why antidepressants were Depression involves changes in brain chemistry and that can change how people respond to the world, and so these kinds of medication can correct the imbalance of chemicals in the brain, such as that a natural balance is restored. I have an old episode on this's called antidepressants literally just antidepressants, and it basically explains my own experience on Lexipro, which I've been on since I was around twenty, and it felt like the right option for me. I would, you know, had been going to therapy for a while, I'd made the lifestyle changes, and I think I got to the realization that what I was dealing with wasn't going to be fixed through my behavior, and it really personally did change my life. And four years on, it's, you know, its second nature to be taking this medication. The times I have tried to go off it have been fucking horrendous, like dizziness, irritation, nausea, and you know, sometimes I do worry that I will be dep it my whole life, but I think I'm honestly a little bit scared of who I'll be without it. And you know, when the time is right, I'll try it again and I'll see what happens. But it's definitely something to be discussed before you go on it. It's not something that you go on to temporarily relieve your hopelessness or your sadness. It's like a two year thing kind of minimum. And it's widely believed that these medical interventions they work best when combined with some kind of talking therapy, one that really gets to the core of how you're processing your reality and the nature of your thoughts. Like we always say on the show, a problem spoken out loud is half the problem. So the two types that are most prominent, I would say are cognitive behavioral therapy CBT if you've heard of that before, and interpersonal therapy. So we're going to start with cognitive behavioral therapy. It is perhaps the most widely practiced and effective form of psychotherapy, and it operates on the principle that our thoughts, our beliefs, our feelings, and therefore our behaviors are interconnected, and by identifying and challenging negative or distorted thought patterns, we bring about positive changes and our emotions and our actions. Interpersonal therapy is a bit different, and it's a time limited form of psychotherapy. Once again. Psychotherapy is also known as kind of talking therapy, and it centers on improving our personal relationships and addressing the emotional issues within that context that may be contributing to how we're feeling. I think by exploring our past or current relationships, even by exploring our attachment style, our communication, life transitions as well, we can really gain these insights into how these discrete aspects of our lives are actually influenced seeing our deeper emotional wellbeing. But I want to talk about some of the more experimental incoming treatments as well, because treatment for depression, specifically major depressive disorder, has stayed relatively the same for the last two decades, but we are seeing a lot of new presentations and rising rates and that's made a lot of scientists and researchers really question whether we could be doing better. You know, back in the day, Freud used to treat his patients with cocaine, and it seems like we're coming back full circle with the introduction of what we would typically see as illicit substances like ketamine or LSD now being used in a clinical medical setting. So you've probably heard about this, but I want to clear it up. No doctor is going to hand you over a bag of whatever drug and sago nuts. They're not going to ask you to go and source it for yourself. It is highly regulated, highly detected. In twenty nineteen, the US actually approved ketamine based nasal spray for the first time, but it's very much used for specific cases. You know, when We're dealing with addictive drugs that have been proven to be very destructive, and now we're trying to leverage them for something productive. You've really got to be cautious, you know, especially around there, you know the propensity or the risk for substance abuse. I want to explain why it may work though. With most medications, like valium or even lexopo or an SSRI, the antidepressive or anti anxiety effect is only going to last when that drug is in your system. When the valium goes away, when the SSRI goes away, you're going to get rebound anxiety or some kind of withdrawal. But when you take ketamine, it actually triggers reactions in your cortex that enable brain connections to regrow. It's the reaction to ketemine, not the presence of ketamine in the body, that constitutes its effect. Most of the research has been coming out of Yale, and the responses and the findings have been genuinely mind blowing, especially when we think about how stagnant some of the research on depression has been for quite some time. They've done a number of studies, as has John Hopkins as well, and in one in particular, more than half of the participants who were administered this nasal ketamine spray showed a significant decrease in depressive symptoms after just twenty four hours. These are patients who felt no meaningful improvement on other antidepressant medications or through other forms of therapy. And I think that's just so life changing. I can't even imagine how profound that would be. Then, we also have psychedelics, particularly psilocybin, so that's more commonly known as you know, well magic mushrooms essentially, and it's Psilocybin is the active ingredient in this recreational drug, and it's a hallucinogen. It changes the brain's response to a chemical in our brain which you may have already guessed it it's serotonin. And when broken down, when psilocybin is broken down, it causes an altered state of consciousness and perception. And what this does is cause our brains to use different neural pathways as it processes this substance, essentially opening us up to experiences, connecting us to our surroundings and triggering an alerted or mild, you know, mild to severe hallucinogenic state when we experience chronic depression. This can often reduce neuroplasticity, and it causes us to feel very stuck. That's where that hopelessness and that's sadness comes from. But psychedelics do the opposite. They really encourage the growth of new connections through this hallucinogenic effect of expanding the way our neurons fire. Now, once again a very clear disclaimer here, this is not stuff that you would buy on I don't know, the dark web. This is medication that is being severely and cautiously vetted and administered in a clinical setting. And in one study, a single dose of a synthetic version of this component of magic mushrooms it improved depression in people with what we would call a treatment resistant form of the condition. And importantly, what's really valuable when we are studying new treatments, particularly new medical interventions, is whether the study was double blind, so meaning neither the participants or the researchers knew which one of the trial patients was actually received the drug. So this helps eliminate things like placebo effect, which we know can be quite common. And I think the other interest in psychedelics is that psilocybin or even LSD. According to some statements some opinions, it doesn't really have the abuse potential in the same fashion as things like cocaine or opioids, or alcohol or nicotine. However, there is still so much that we don't know, so I think for now it's best to stick to the approved therapies that are recommended by a licensed professional talking therapy an antidepressant. I think that it's such fascinating research. I think that people who use these drugs recreationally before they started undergoing scientific testing have regularly said that this is an impact and an influence that they personally experience outside of a medical setting. So I'm very excited to see where that goes. You know, I can't speak to this personally, but what I do kind of want to finish on is kind of where I'm at now. Given we've had this broader overview, I think I want to take some time to reflect on, you know, where that knowledge kind of leaves us. If you're someone who is experiencing depression, what can you really take from that? But what can you really take from my experience? I think I'm at this point, I've said this before, where I'm really seeking to manage and not to cure. It's kind of this really stoic perspective where I'm like, you know what, this is my reality, and you know, sadly, there is not some switch that's going to change how my brain operates. I've just got to accept it. Also, you know, a final misconception that I really wanted to bunk is that it's not as if my life is devoid of happiness. You know, I have really happy moments. I have an amazing family, incredible friends. I'm super grateful, and I do get to experience a lot of joy very readily, very rapidly. Depression is not just the absence of any feeling but sadness. It's not just sadness. It's more complicated than that. And I don't want people to think that that's all there is to a person, and then it will come to define them. You know, I'm a good friend, I have hobbies and passions, I love, I'm productive and I do things with a lot of love. I still feel incredibly deeply, and I have dreams and goals. It's just that sometimes those things seem less clear to me. It doesn't mean that they're not there. I still think we face a lot of stigma. But it's so surprising that when you start having these conversations, you'll realize that every single one of us knows someone in some capacity who is experiencing something very very similar. And that sense of not community, but that sense of not going at it alone, really is quite powerful for me. Depression can make you feel quite selfishly like you're the only person in the world, like you're the only person who is this sad and this miserable, And although you don't want other people in the boat with you, you don't want to acknowledge that maybe they're going through the same thing. You know you can't change that, And sometimes having an open line of communication and open discussions about this are so valuable. So I really want to thank you for listening to today's episode. It was definitely a vulnerable one, I know. So if you're still with us, I hope that you're feeling very knowledgeable and you're feeling very optimistic, and if you're here for someone you know and someone you love, I promise it's not as hard as you think to take care of those who you care about. I know it can feel like you might say the wrong thing or do the wrong thing, but as long as you're showing up and you're asking how you can help, you're sending the occasional message just seeing how they're doing, if they need to talk. You're really doing a lot more than most. You're doing the right thing. I promise that even listening to this is one step in the right direction. It's still such an unknown I don't want to say disease, such an unknown condition. Despite all of that historical knowledge that we realistically should have, there is so much about it that is not understood, not just from a scientific perspective, but from a general societal perspective. But I hope that we're taking steps in the right direction. And I'm going to list some really fascinating studies that we talked about in this episode in the description, as well as some resources for when you can get further help, further information. You know, it's a tough time in our twenties, and it's a bit tougher when you've got this kind of like we say, black cloud over our heads. But I promise it's someone who's gone through it as well. There is so many good things coming and hard times as well, but you'll be able to approach them a lot better. A lot better, So I want to thank you for listening. If you enjoyed this episode, please feel free to leave a five star review on Apple Podcasts, Spotify, wherever you're listening right now, and maybe your friend needs to hear this, feel free to share it with them. I would really appreciate that as well. If you have an episode suggestion, or you want to get in touch. If you like this episode or have some feedback, please follow me at that Psychology podcast on Instagram. I love receiving messages from you and seeing the community grow. So I want to thank you for listening to this episode. I hope you learned something. I'm glad you're here, and we will be back next week for another episode.