SPEAKER_1: Everything was a problem, everything seemed so hard, and I just pushed through it because I grew up at a time where that's what you were supposed to do.
SPEAKER_2: Suck it up.
SPEAKER_1: Yeah, suck it up, man, suck it up.
SPEAKER_1: And so, I got to a place where it was literally killing me.
SPEAKER_1: And I went and saw a professional and they were like, yeah, we can help you with that, man.
SPEAKER_1: And as a result, now when I feel happy and I'm in a social setting, I'm not faking it anymore, you know?
SPEAKER_1: And some people were like, I wish you would go back to faking it because you're a little much.
SPEAKER_2: Welcome to StarTalk, your place in the universe where science and pop culture collide.
SPEAKER_2: StarTalk begins right now.
SPEAKER_2: This is StarTalk Special Edition.
SPEAKER_2: Neil deGrasse Tyson here.
SPEAKER_2: You're a personal astrophysicist.
SPEAKER_2: And as you know, for a special edition, we have Gary O'Reilly.
SPEAKER_2: Gary, how you doing, man?
SPEAKER_3: Hey, Neil.
SPEAKER_3: I'm good, man.
SPEAKER_3: Thanks.
SPEAKER_2: All right.
SPEAKER_2: And of course, we got Chuck.
SPEAKER_2: Chuck, how you doing, man?
SPEAKER_1: Hey, I'm doing well, man.
SPEAKER_1: Thanks for asking.
SPEAKER_2: All right.
SPEAKER_2: We love you, Chuck.
SPEAKER_2: Today, we're going to talk about something I don't think we've talked about before.
SPEAKER_2: We're going to talk about depression, something that we all know about.
SPEAKER_2: It afflicts so many of us.
SPEAKER_2: And Gary, how did you put this show together?
SPEAKER_3: Well, we started off thinking about seasonal depression because we're recording this, it's January, and it just makes everybody feel less vibrant.
SPEAKER_3: And then we realized that there's more to this and we have to go way deeper than the winter blues.
SPEAKER_2: Oh, wait a minute.
SPEAKER_2: So that seasonal depression, they made that into an acronym for the Seasonal Affected Disorder.
SPEAKER_2: Which is?
SPEAKER_2: Yeah.
SPEAKER_3: So there you go.
SPEAKER_3: We asked ourselves, what's the difference between anxiety and depression?
SPEAKER_3: Is it all about your serotonin levels?
SPEAKER_3: How do other cultures cope with seasonal depression?
SPEAKER_3: Do we need to be sad to actually learn to feel good?
SPEAKER_3: How much low-level depression in society actually goes undiagnosed and unnoticed?
SPEAKER_3: We have the questions, but we didn't have the answers, which is why we needed an expert.
SPEAKER_2: Oh, I know what expert we get for this.
SPEAKER_2: Oh, yeah, we're the cheerings and the crap.
SPEAKER_1: Our returning champion.
SPEAKER_2: Our returning...
SPEAKER_2: Our returning neuro champion, Heather Berlin.
SPEAKER_2: Heather, welcome back to StarTalk.
SPEAKER_4: Hey, thanks for having me.
SPEAKER_4: It's always a pleasure.
SPEAKER_2: So, you're not only a good friend of StarTalk, you are also a neuroscientist.
SPEAKER_2: We've done so many shows on the brain.
SPEAKER_2: You're also a clinical psychologist, importantly for this episode.
SPEAKER_2: Which means you see patients, right?
SPEAKER_2: And you're also associate professor of psychiatry and neuroscience at the Icahn School of Medicine, Mount Sinai, New York.
SPEAKER_2: So, welcome back to StarTalk on this very important subject.
SPEAKER_4: Thank you.
SPEAKER_2: So, we just got to start at the bottom.
SPEAKER_2: Or start at the front door.
SPEAKER_2: What is depression?
SPEAKER_4: What is depression?
SPEAKER_4: Well, depression can be many things, and there are various sort of configurations.
SPEAKER_4: But when I think most people are talking about depression, they're talking about what we would call major depressive disorder, or often if somebody has what's called a major depressive episode.
SPEAKER_4: And we define that as it's lasting at least two weeks.
SPEAKER_4: You have to have significant depressed mood, loss of interest and pleasurable things.
SPEAKER_4: You sometimes end up eating more or eating less.
SPEAKER_4: So change in your eating pattern, change in your sleeping pattern.
SPEAKER_4: You might be sleeping more or sleeping less.
SPEAKER_4: And there's various other symptoms, but usually it's just having this very pervasive sense of sort of hopelessness.
SPEAKER_4: Maybe you lose energy, you're less motivated.
SPEAKER_4: And the things that used to make you feel good or happy or bring you pleasure don't bring you pleasure anymore.
SPEAKER_2: So Heather, why two weeks that feels so arbitrary?
SPEAKER_4: Well, you know, we all have various fluctuations in our mood.
SPEAKER_4: And we sometimes have depressed days, days where you don't feel like getting out of bed, you don't feel motivated.
SPEAKER_4: You just, again, feel this pervasive feeling of maybe sadness, loneliness, isolation.
SPEAKER_2: You would call that normal.
SPEAKER_4: Yeah, I mean, everybody has fluctuations in mood, and that's normal.
SPEAKER_4: It's okay to feel sadness.
SPEAKER_4: I mean, sadness is a feeling that evolved over time.
SPEAKER_4: And there are reasons to be sad in life, right?
SPEAKER_4: And you might have something really tragic happen or a really bad day at work.
SPEAKER_4: And sometimes you get to what people will call a bad mood, right?
SPEAKER_4: But it becomes clinical when you can't seem to shake it.
SPEAKER_4: It's just day after day after day.
SPEAKER_4: And sometimes you can feel sad for a number of days, but then it kind of clears up and you get back on your feet again.
SPEAKER_4: But so that's why it's, again, it's kind of arbitrary the length of time.
SPEAKER_4: You know, it's give or take.
SPEAKER_4: And it's not like there's this clear mark where, okay, as soon as it's two weeks, it's definitely, you know, you have a chemical imbalance.
SPEAKER_4: But on average, it tends to be if it lasts that length of time, there's probably some sort of underlying, maybe neurochemical dysfunction or it's hormonal, but there's some sort of biological imbalance and nothing can get you out of it, and then you need a little bit more help.
SPEAKER_1: It also helps when it's not coinciding with an event or like if you have a death of somebody close to you, you are in what we call a period of mourning.
SPEAKER_1: That can actually last for a couple of years, but running parallel to that, you feel normal at times, and then you slip into depression because of that event.
SPEAKER_1: So even if it lasted for two years, it's still natural because it's mourning, but when nothing happens and you feel that way, there's something really wrong.
SPEAKER_2: Thank you, Dr.
SPEAKER_2: Chuck Nice.
SPEAKER_1: That's right.
SPEAKER_4: We call it the, there's actually a bereavement exclusion.
SPEAKER_4: So if there's been a death or maybe even just a significant, you know, a breakup, a divorce, then it's sort of allowed, you can have depressive symptoms for up to two months after, say, the death of a loved one.
SPEAKER_4: But then if it's, you can't sort of get out of it and it starts to, it's almost like thinking about it like long COVID.
SPEAKER_4: You know, you have these post-COVID symptoms after a certain amount of time, you get diagnosed as long COVID.
SPEAKER_4: And there's no real cutoff time.
SPEAKER_4: So we have this exclusion criteria for bereavement.
SPEAKER_4: The problem is that when people start— There's a whole pass for bereavement.
SPEAKER_4: Yes, exactly.
SPEAKER_4: But the problem is when people feel depressed and it's biological, but sometimes they try to tie it to events that are happening in their life.
SPEAKER_4: Oh, I'm only feeling this way because of X or Y.
SPEAKER_4: It must be because of this.
SPEAKER_4: And it becomes more clear to a person when things in their life are going well and they still feel depressed that, okay, maybe there's something in my neurochemistry that needs to be treated maybe with medication.
SPEAKER_4: But sometimes it's not clear because there's a correlation between negative things that are happening in your life.
SPEAKER_4: So that's what we're trying to differentiate as a clinician.
SPEAKER_4: Is it biological?
SPEAKER_4: What's their history?
SPEAKER_4: What's their genetic history, family history?
SPEAKER_4: Have they had this before in their life?
SPEAKER_1: Are you a parent?
SPEAKER_2: I'm a parent.
SPEAKER_4: Yes.
SPEAKER_3: So where do we go, doctor, with anxiety and depression?
SPEAKER_3: Do they come as a partnership?
SPEAKER_2: I've always heard, I hear them so often together as a diagnosis.
SPEAKER_4: They're really highly co-morbid, meaning they tend to co-occur with one another.
SPEAKER_4: They co-occur together.
SPEAKER_2: They co-exist.
SPEAKER_4: They co-exist.
SPEAKER_4: They tend to, you know, occur together, but not always.
SPEAKER_4: And they are two different things.
SPEAKER_4: So anxiety is more...
SPEAKER_4: It's a different neural system.
SPEAKER_4: It's that kind of fight-or-flight response that we have.
SPEAKER_4: It's the anticipation of a future threat.
SPEAKER_4: It's imagining something bad is going to happen, and then you have these physiologic reactions to that imagined threat, even though there's something bad happening in the moment.
SPEAKER_4: So some people have chronic anxiety or specific phobias that they're anxious about a specific thing.
SPEAKER_4: Whereas depression is different.
SPEAKER_4: It's more to do with this sadness, the lack of motivation.
SPEAKER_4: It's more the serotonin system seems to be involved, but it's not just serotonin.
SPEAKER_4: And we can get into that, too.
SPEAKER_4: This is in the right...
SPEAKER_4: But it's different neurotransmitters are involved in depression, but there is some overlap in that they both involve things like serotonin and dopamine and norepinephrine.
SPEAKER_4: So there's some overlap between the two.
SPEAKER_2: So, Heather, I collect old science books, and some of them are medical textbooks and medical, you know, what people thought was going on with human physiology in the day.
SPEAKER_2: And a common term back then was melancholy.
SPEAKER_2: Did that term like predate the word depression?
SPEAKER_2: Did it mean something else?
SPEAKER_2: Clearly, it existed as a condition long before our modern ailments started affecting us.
SPEAKER_4: Yeah, it started...
SPEAKER_4: I mean, really, when you go far back, we thought that, well, scientists thought that all of these psychological disorders had to do with an imbalance of certain fluids in our body.
SPEAKER_4: And so, melancholia was actually too much black bile, which I think is like too much poo, basically.
SPEAKER_2: Wow, so that's how the word comes in.
SPEAKER_4: So, that was the sort of, you know, the dark sadness.
SPEAKER_2: Wasn't there also, like, your uterus was, of course, making you depressed?
SPEAKER_4: Hysteria was, they thought, hysterical women, was the uterus was detached and it was kind of floating around the body and causing us to be hysterical.
SPEAKER_4: That's where...
SPEAKER_4: Oh my God, I'm freaking out.
SPEAKER_2: Damn, people were hitting us.
SPEAKER_4: Makes me wonder, what are we going to think 200 years from now?
SPEAKER_4: But I mean, for as long as humans existed, we called it different things.
SPEAKER_4: We thought there were different causes.
SPEAKER_4: But there's this, what we call now dysthymia or persistent depressive disorder is a little bit different than what we'd call major depressive disorder.
SPEAKER_4: Dysthymia is having that low level sadness.
SPEAKER_4: It's not as intense as a depressive episode, but it lasts longer.
SPEAKER_4: So it could be like two years of just a kind of down mood.
SPEAKER_4: And so there are different like gradations of what people used to categorize as different things in the past.
SPEAKER_4: Now we're trying to differentiate it and correlate it to underlying brain dysfunction.
SPEAKER_3: So if you've got a persistent state of depression, you're most likely going to get prescribed antidepressants.
SPEAKER_3: Now are they the cure or are they now seen as part of, what is it, a serotonin hypothesis and the sort of yes, no, maybe scenario that plays out there?
SPEAKER_2: Yeah, what's a quick primer on the chemicals of happiness and sadness?
SPEAKER_4: Okay, so for many years we had this kind of hypothesis.
SPEAKER_4: The monoamine neurotransmitters, which are serotonin.
SPEAKER_4: Dopamine, the idea is that there was too little serotonin in the receptors, and this is what was causing depression.
SPEAKER_4: And so the treatments that developed over the last, say, 50 years were, how do we increase serotonin in the receptors?
SPEAKER_4: And that's what's called SSRIs, selective serotonin reuptake inhibitors, meaning you inhibit the neurons from sort of cleaning up the serotonin out of the synapses, so it stays there longer and it can activate the neurons for longer.
SPEAKER_4: And that is part of it, but what we've learned is that there are many other things that are contributing to depression.
SPEAKER_4: It's not just serotonin.
SPEAKER_2: But just to understand what you're saying, so this medicine, it doesn't add more serotonin to your system, it prevents your system from getting rid of it.
SPEAKER_4: Yes, or it prevents it from being...
SPEAKER_4: So the neurons will get activated and then they'll release serotonin into the synapse.
SPEAKER_4: And then it will affect the neuron next to it as long as it's in that synapse, right?
SPEAKER_2: So why would it be better than just taking a serotonin pill?
SPEAKER_4: Well, there are...
SPEAKER_1: Because that pill is called Molly.
SPEAKER_4: There are actually other ways.
SPEAKER_4: So there are other ways to increase serotonin in the receptor...
SPEAKER_4: In between neurons, you want to have more serotonin.
SPEAKER_4: So there are ways that you can get to that.
SPEAKER_4: There used to be other drugs, older drugs called monoamine...
SPEAKER_4: Monoamine oxidase inhibitors, or MOAs.
SPEAKER_4: But they weren't as effective as the SSRIs or just much more selective.
SPEAKER_4: And there are different receptor sites for the serotonin.
SPEAKER_4: So you can actually be selective in those receptor sites, one A and one B.
SPEAKER_4: So we're getting more and more honing in on exactly where we want to target.
SPEAKER_4: And there are different serotonin receptor sites in different parts of the brain.
SPEAKER_4: So again, instead of coding the whole brain with serotonin, you can be more targeted with where you're trying to activate the serotonin.
SPEAKER_4: You can target it more toward the prefrontal cortex if there's more serotonin receptor A1 in the prefrontal cortex.
SPEAKER_4: This is getting into the weeds, I'm sure, but it is more selective.
SPEAKER_4: That's why they're, you know, selective serotonin reuptake inhibitors.
SPEAKER_3: Okay, have we gone down the route successfully of alternate treatments outside of this is chemical, we'll deal with it with another chemical?
SPEAKER_2: And you see these ads, I've read somewhere where a walk in nature has some chemical value to your brain through the woods.
SPEAKER_4: Absolutely.
SPEAKER_4: You can increase your, you know, your, say your dopamine and your serotonin through just, you know, interacting in the world.
SPEAKER_4: I mean, that's a lot of what talk therapy is doing and just social being, social being around friends can make you feel good.
SPEAKER_4: Walking in nature changes your brain, right?
SPEAKER_4: When you change your environment and the stimulation.
SPEAKER_4: So it doesn't have to be just with drugs.
SPEAKER_4: But when you have, let's say, genetic predisposition, where you might produce less of this neurotransmitter, then that's where the kind of drugs come in that you need an extra little boost on top of these other strategies.
SPEAKER_4: But the other aspect is that not everybody is, it doesn't work for everybody.
SPEAKER_4: So SSRIs are the first line treatment.
SPEAKER_4: But sometimes you need, some people have SNRIs, which affects also the norepinephrine system.
SPEAKER_4: And even those don't work for some people.
SPEAKER_4: And then we get into what we call treatment-resistant depression.
SPEAKER_4: And then we get into these alternative treatments that we have now.
SPEAKER_1: Like what?
SPEAKER_3: Exactly, yeah.
SPEAKER_3: What are we doing?
SPEAKER_1: Shock therapies.
SPEAKER_3: A good talking to.
SPEAKER_3: You know, which is what used to happen, and now we've hopefully progressed.
SPEAKER_1: I am Olicon Hemraj, and I support StarTalk on Patreon.
SPEAKER_1: This is StarTalk with Neil deGrasse Tyson.
SPEAKER_1: Thanks watching.
SPEAKER_1: Before we go into this subtopic, let me just say that if you're a person who is experiencing what Heather just talked about, the telltale sign is other people may not know you're depressed because you learn how to mimic what it is to be a happy, normal person.
SPEAKER_1: So if you find yourself kind of empty and feeling like, wow, all these people seem really happy and I'm just acting that way, you might be a good candidate to talk to a doctor about something that's good, baby.
SPEAKER_1: Something that can help you out is what I'm saying.
SPEAKER_2: Dr.
SPEAKER_2: is shaking a bottle of prescription pills that we cannot read because the resolution is not high.
SPEAKER_1: So she was talking about SSRIs.
SPEAKER_1: That is, this is a dopamine reuptake inhibitor.
SPEAKER_1: Because I don't make enough dopamine.
SPEAKER_1: My brain does not make enough dopamine.
SPEAKER_1: And so as a result, without this, I found myself faking it through life for a very long time, dragging myself out of bed.
SPEAKER_1: Everything was a problem.
SPEAKER_1: Everything seems so hard.
SPEAKER_1: And I just pushed through it because I grew up at a time where that's what you were supposed to do.
SPEAKER_1: Suck it up, man.
SPEAKER_1: Suck it up.
SPEAKER_1: And so I got to a place where it was literally killing me.
SPEAKER_1: And I went and saw a professional and they were like, yeah, we can help you with that, man.
SPEAKER_1: And as a result, now when I feel happy and I'm in a social setting, I'm not faking it anymore.
SPEAKER_1: And some people were like, I wish you would go back to faking it because you're a little much.
SPEAKER_2: You're a little much.
SPEAKER_2: You were funny back then.
SPEAKER_2: Chuck, I worry if you keep talking that Heather's going to have to charge us for a session.
SPEAKER_4: I was going to say he's a great example of, in that case, it's affecting the dopaminergic system.
SPEAKER_4: It's not just about serotonin.
SPEAKER_4: Some people have too little dopamine or too little norepinephrine.
SPEAKER_4: There is the glutamatergic theory of depression now, which is really interesting and I think is really helping us make the most significant advance in treatment that's been for as long as I've been studying the brain, which is a couple of decades, is that glutamate is involved and that's an excitatory neurotransmitter.
SPEAKER_4: So let's say there's too little excitation and ketamine is this alternative treatment that is now FDA approved.
SPEAKER_4: You can do it intravenously, intranasally.
SPEAKER_4: You have to do it in the office with the physician.
SPEAKER_4: And it seemed to be really helping people where the SSRIs don't work and nothing else has worked.
SPEAKER_4: Ketamine is an alternative treatment.
SPEAKER_4: There's also ECT, which is electric shock therapy, which has some side effects.
SPEAKER_4: And but a more-
SPEAKER_2: I see why you abbreviate it.
SPEAKER_1: One of the side effects includes having an afro where you didn't have one before the treatment.
SPEAKER_4: But that, it can affect your memory, but it's not as dramatic as it's portrayed in like films.
SPEAKER_4: They're not, people aren't like kind of all things and you know, you're sort of sedated.
SPEAKER_4: But an alternative to that is transcranial magnetic stimulation, which is whereas ECT is more like you're turning a computer off and on if it doesn't work and just something happens, like you reboot the system and it works again.
SPEAKER_4: But transcranial magnetic stimulation is you're having just a magnet and you're sort of stimulating certain parts of the brain very specifically.
SPEAKER_4: And you do that daily for a couple of weeks.
SPEAKER_4: And that seems to have a significant impact as well.
SPEAKER_2: So Heather, when we talk about triggers, one of the more common ones we heard about is, as we mentioned earlier, seasonal affected disorder or SAD, where the sun stays low in the sky in the winter months.
SPEAKER_2: And if you go above the Arctic Circle, the sun doesn't rise at all.
SPEAKER_2: My wife grew up in Alaska, where the sun would rise at like 11 in the morning and set at two in the afternoon, something like that, or one and two in the afternoon.
SPEAKER_2: So she grew up in that and didn't know anything different than that.
SPEAKER_2: It's just dark.
SPEAKER_2: It's not nighttime, it's just dark.
SPEAKER_2: And if that is your life, then how could it be a trigger for something if that's all you've known?
SPEAKER_2: And so therefore, is seasonal affected disorder something only for people who are totally into the summer months?
SPEAKER_2: And then it just ends upon them as November, December arrive.
SPEAKER_1: Yeah, like if his wife had moved there from Jamaica, I'm sure that would have really messed her up.
SPEAKER_1: You know, just like, what now, man, where is the sun?
SPEAKER_1: What did you do with the sun, man?
SPEAKER_4: Yeah, so there's, with depression, we have, it's called the stress diathesis model, meaning that certain people might be born with a kind of predisposition toward depression, but they might never develop it unless there's some sort of environmental stressor.
SPEAKER_4: So like, why is it that, you know, only certain people, it's similar to PTSD, like a lot of people can go to war and only certain of them, a percentage of them develop PTSD, and others have this sort of resilience?
SPEAKER_4: Why is it that when the winter months come, a certain percentage of people go on and get seasonal affective disorder, and others are fine?
SPEAKER_4: And it might be that they have this genetic predisposition toward depression and the lack of light and the darkness is the trigger for it.
SPEAKER_4: So sort of, you know, it has this kind of cascade effect, and then the symptoms come on.
SPEAKER_2: I would have guessed naively that when you walk into your home, you turn on the lights, right?
SPEAKER_2: And all the lights are on anytime you are indoors.
SPEAKER_2: When there was a day where if you came in at night, you'd light a candle and work your way around the home or light the oil lamp.
SPEAKER_2: And so dark sunset was a major shift in your exposure to light, not anymore.
SPEAKER_2: I walk through Times Square, midtown Manhattan.
SPEAKER_2: I don't even know if it's nighttime.
SPEAKER_1: You can't even tell if it's nighttime.
SPEAKER_2: You can't even tell.
SPEAKER_4: But there's a certain type of light, right?
SPEAKER_4: So it's also, you know, we're also thinking about these hormones as well as neurotransmitters, but like melatonin.
SPEAKER_4: So for example, when you're just looking at your computer light or a certain indoor lighting, blue light, that is different than natural light, which is more in the yellow spectrum of light.
SPEAKER_4: And different kinds of light can affect your melatonin system in different ways.
SPEAKER_4: So for treatment for seasonal affective disorder, there is special light that are within the spectrum of natural light that you sit in front of to actually help, help release the kind of neurotransmitters and the hormones that you want from natural light.
SPEAKER_4: But artificial light doesn't necessarily get you there because of the different wavelength.
SPEAKER_2: In principle, that's a knowable problem, right?
SPEAKER_2: I mean, I could create exactly the wave.
SPEAKER_2: Now with LEDs, I can create the wavelength of light that I want.
SPEAKER_3: They do this on aircraft now, on long-haul flights.
SPEAKER_3: They will change the lighting in the cabin.
SPEAKER_1: For the reason that Neil just said, because they now have LEDs in the aircraft.
SPEAKER_4: Yeah, so it is a controllable problem.
SPEAKER_4: We can start to figure out what's the best setting and the timing to help people that are pro-insect get this kind of depression during the winter months.
SPEAKER_4: But I also would suggest, and this is something that I'd actually want to look into, because I think it is interesting that if you grow up in one of these places like Alaska or Iceland or Norway, you might just adapt to it over time, that your brain adapts and adjusts to it.
SPEAKER_4: Whereas if you move there from somewhere else, it might really be a shock to your system and enough to trigger a depression, if you have that predisposition toward it.
SPEAKER_2: And what about social-cultural causes like poverty?
SPEAKER_2: In fact, let me say it both ways.
SPEAKER_2: I can imagine poverty where you don't know where your next meal is coming from, that can bring a level of depression to you.
SPEAKER_2: But so too, if you're fabulously wealthy, there's an expectation of how every day would go.
SPEAKER_2: And if one little thing goes wrong, that really stands out as a force of sadness in your life.
SPEAKER_2: And is this, might that be an explanation for why suicide rates are not higher in those who suffer abject poverty than those who are fabulously wealthy?
SPEAKER_2: What is the latest numbers on the suicide rates?
SPEAKER_2: Do we know?
SPEAKER_4: Well, this is the thing.
SPEAKER_4: This is what research has found, is that there tends to be this, as I said, this underlying biological predisposition, let's say it's genetic, that regardless of whether you're in the worst poverty circumstances or in the best whatever, you're super fabulously wealthy, that it doesn't have that huge of an impact.
SPEAKER_4: People have done this research where they go to India and people are living in poverty, dirt floors, whatever, and they're just happy and enjoying life.
SPEAKER_4: And it's like, what's going on here?
SPEAKER_4: And then you get some guy who has everything in the world and is horribly miserable and commits suicide.
SPEAKER_2: On his yacht.
SPEAKER_4: On his yacht, exactly, jumps off the yacht.
SPEAKER_4: And they also found that when something really good happens to someone, like they win the lottery, you get this little blip of happiness and then they go back to whatever their baseline is.
SPEAKER_4: So if they're generally a miserable person, they'll end up going right back to being miserable.
SPEAKER_4: Being a miserable person with money.
SPEAKER_4: With money, exactly.
SPEAKER_4: And then if you take somebody who has resilience, they might get in a horrible car accident, become paralyzed, they'll have a little blip of sadness, and then they recover and go right back to being this wonderful, happy person.
SPEAKER_4: So it's almost a little bit independent of environmental circumstances, whether you have this kind of resilience or not.
SPEAKER_4: But there is this idea of inoculation.
SPEAKER_4: We need to have little disappointments to inoculate us against bigger ones that happen later in life.
SPEAKER_4: And you're not building up that resilience in people and having what we would call exposure therapy.
SPEAKER_4: Meaning you have to sit with something that makes you uncomfortable for a while.
SPEAKER_4: You can't just avoid everything.
SPEAKER_4: Because then it becomes, you start ending up in these anxiety disorders.
SPEAKER_4: I can't be around anything that makes me feel uncomfortable and you can't tolerate any distress.
SPEAKER_4: So it's actually not healthy.
SPEAKER_1: And you quit everything that you do.
SPEAKER_4: Yeah, because any time there's a little bit of distress, it's like, okay, I'm not going to do this anymore.
SPEAKER_4: I can't, you know.
SPEAKER_4: So that's kind of the thing with if you grow up with hardship.
SPEAKER_4: I mean, I'm not saying this is a great way to grow up, but there is this sense of building up a resilience, that you're not this, you know, I guess they call it snowflakes or whatever, like any little thing will disturb you.
SPEAKER_4: You kind of get this toughness.
SPEAKER_4: That being said, however, there is, when you have chronic stressors over periods of time, you know, you can, a low level stressor, which could be living in poverty, not knowing when your next meal is going to come, you know, it can lead to things like PTSD.
SPEAKER_4: It can lead to intergenerational trauma.
SPEAKER_4: And that's, you know, what I think is prevalent in a lot of these cultures where, like, if you think about Native American Indians living on reservations, they have a high rate of alcoholism.
SPEAKER_4: And, you know, we haven't really talked about all of the things that people do to try to self-medicate themselves, you know, when they're having these negative feelings that everyone can afford or has access to going to, like, you know, the best psychiatrists and psychologists, a lot of people in rural areas.
SPEAKER_4: So you get alcoholism and, you know, impulsive behaviors, you know, pathological gambling and shopping and drug addiction and all of that that are often trying to treat these negative feelings that they're having.
SPEAKER_2: People don't, they're not actively thinking that they're treating it.
SPEAKER_2: They just know they feel better for doing it.
SPEAKER_2: But in fact, in total, it doesn't.
SPEAKER_4: Yeah, it's a numbing and a trait of escapism.
SPEAKER_4: Yeah, it's a numbing of the feelings.
SPEAKER_4: And that's why a lot of people come to me and if they've never been on medication before, they're hesitant, right?
SPEAKER_4: They're kind of afraid and what is this going to do to me and whatnot.
SPEAKER_4: But the larger question is what is it going to do to you if you don't get treated, right?
SPEAKER_4: What kind of self-soothing behaviors are you doing that are really detrimental?
SPEAKER_4: And I don't think medication is for everyone.
SPEAKER_4: And I'm very conservative when I would recommend to a patient to see a psychiatrist for medication.
SPEAKER_4: But when it is needed, and when there is a neurochemical imbalance, it can really make a difference in a person's life, as Chuck may testify to.
SPEAKER_3: Yes.
SPEAKER_3: So in society, Dr.
SPEAKER_3: just how much of this low-level depression, mind you, some of the things you've just described aren't quite low-level, but how much in society is undiagnosed?
SPEAKER_4: We don't really know, right?
SPEAKER_4: It's hard to say.
SPEAKER_4: There are cultural differences, but sometimes it's just not...
SPEAKER_4: It's not socially acceptable to have a mental health issue, right?
SPEAKER_4: It's becoming more so, especially in the younger generation in the United States, to like, it's acceptable to say, I have depression.
SPEAKER_1: I would still say there's a big stigma attached to it.
SPEAKER_1: There's like...
SPEAKER_1: Even people who talk about it freely, such as myself, you'd be surprised how many people, when you tell them that you suffer from this, you know, I have friends who are just like, not you.
SPEAKER_1: Or, oh, come on, man, you don't need that.
SPEAKER_1: Or, you know, they straight up just feel like this is not necessary.
SPEAKER_1: There are other ways that you can get your brain to do what you want it to do.
SPEAKER_2: Wait, wait, but Chuck, there's also, why are you using dandruff shampoo?
SPEAKER_2: You don't have dandruff.
SPEAKER_4: Right.
SPEAKER_1: And then the answer is, exactly.
SPEAKER_4: There are people, you know, exactly, when you start taking medication and then they start feeling better and then they say, well, I don't really, do I really need this medication?
SPEAKER_4: And you get into this conundrum, right?
SPEAKER_4: And then I'll say, okay, well, you can go through a trial period and get off it and see how you feel.
SPEAKER_4: Because it's like once you're on it and you're feeling better, you're saying, well, I really need to get on medication for.
SPEAKER_4: So sometimes patients cycle through this a couple of times where they go on and off the medication just to sort of prove to themselves that that actually it is doing something and that they need it.
SPEAKER_4: But the stigma really, it's so frustrating.
SPEAKER_4: I mean, I do think it's even getting better compared to where it was in terms of the acceptance.
SPEAKER_4: But the brain is like any other organ.
SPEAKER_4: It's like it's okay to say, oh, I'm taking this antibiotic because I have this infection.
SPEAKER_1: That's what we're calling it now.
SPEAKER_1: Oh, thank God.
SPEAKER_2: But when he's about to go to make a film, you have to go through a medical examination, especially if the film is very expensive because there's an investment being made in you.
SPEAKER_2: And they had issues with his depression diagnosis.
SPEAKER_2: And he said, first time I heard it, put it this way.
SPEAKER_2: I'm just echoing what the two of you just said from a real life situation.
SPEAKER_2: He said, I'm medically treated for my depression.
SPEAKER_2: And so, therefore, I can work.
SPEAKER_2: You shouldn't think of that as different from anybody else being treated for any other ailment that might interfere with their work, provided the medicine brings you back to where you need to be.
SPEAKER_2: And it was so sensible and so clear that the brain is just another organ that's being treated.
SPEAKER_4: Yeah, and for some reason, we think that it's like if someone had MS and they said, okay, sometimes I have flare-ups, but I have this medication that helps me with that, right?
SPEAKER_4: They wouldn't be a liability.
SPEAKER_4: And it's the same thing when you have a neurochemical imbalance and it's being treated.
SPEAKER_4: I mean, there are some stipulations where they say, for example, in child custody cases and things like that, well, it's predicated on the fact that they have to be on their medication.
SPEAKER_4: They have to stay on their medication, right?
SPEAKER_4: Because that is what's keeping them in balance.
SPEAKER_4: But this idea of like, oh, just suck it up, you know, like that you can make, just be happy, right?
SPEAKER_4: Make your sadness go away.
SPEAKER_1: It's like, don't worry.
SPEAKER_4: Right.
SPEAKER_3: We need that.
SPEAKER_1: It's stupid.
SPEAKER_2: I bet a lot of people are out of depression.
SPEAKER_1: The Bobby McFerrin treatment.
SPEAKER_2: Right.
SPEAKER_4: Like you don't think I'm trying?
SPEAKER_3: Dr.
SPEAKER_3: How do our hormonal differences affect the depressions within us?
SPEAKER_4: Well, for example, estrogen or progesterone, which you see more in women, can actually affect our serotonin levels in the brain, which then go on to affect our emotions.
SPEAKER_4: And depending on the balance, whether it's too much or too little, it can make you more irritable, or it can make you feel depressed or sad, and so there's this delicate balance between these hormones and their impact on the neurotransmitters, which then go on to affect us emotionally.
SPEAKER_2: But if I, as a man, take those hormones, will I start having those same effects, or will it be fighting my testosterone and it'll have a whole other effect?
SPEAKER_4: Yeah, and women have testosterone too, right?
SPEAKER_4: And there's all these differences, right?
SPEAKER_4: But testosterone tends to lead to more aggressive behavior.
SPEAKER_4: But if we were to give you some progesterone or estrogen, it might just help modulate the effects that the serotonin is having and just kind of make you less aggressive, but not necessarily make you feel depressed.
SPEAKER_1: There you go.
SPEAKER_1: Instead of saying, take a chill pill, we should be saying, take some estrogen, man.
SPEAKER_4: No, what you really need is oxytocin.
SPEAKER_4: So oxytocin is the sort of love.
SPEAKER_4: Oxytocin is also a hormone that acts as a neurotransmitter as well, but that's the sort of bonding, love.
SPEAKER_1: The hugging, the hugging.
SPEAKER_4: If you hug, it gets, a colleague of mine, Paul Zak, did a lot of research on this.
SPEAKER_4: Hugging can release it, but it's a release during breastfeeding, during sex, these times when you're really bonding.
SPEAKER_4: So if we give everyone a little bit of oxytocin, we had discussions in the psychiatry department about this.
SPEAKER_4: We just put a little oxytocin in the water, and maybe everyone would just chill out.
SPEAKER_2: The war would end.
SPEAKER_4: Like fluoride.
SPEAKER_4: That's the answer.
SPEAKER_4: That's the answer to everything.
SPEAKER_2: Is postnatal the same as postpartum depression?
SPEAKER_2: Is that the same thing?
SPEAKER_4: Postpartum, yeah.
SPEAKER_4: Postpartum depression, yes, yes.
SPEAKER_4: Postpartum depression, there's menopause when there's lots of hormonal changes.
SPEAKER_4: And there's something called PMDD, which is premenstrual disorder, I believe, where you get severe changes in mood around your time of month when there's these hormonal changes, but it's so severe that you actually need medication for it.
SPEAKER_4: And people take SSRIs to treat this PMDD.
SPEAKER_4: And so, just like if somebody says I have a kidney stone or a kidney infection, whatever, that's okay, but not to say my brain is out of balance.
SPEAKER_4: Somehow that doesn't seem real to people.
SPEAKER_4: And that always really bothers me.
SPEAKER_2: Can you think of any evolutionary value for postpartum depression?
SPEAKER_1: Children.
SPEAKER_4: That's a good question.
SPEAKER_1: I think children are the evolution.
SPEAKER_4: Well, there is a book on...
SPEAKER_2: It's like what half I wrought here.
SPEAKER_1: Exactly.
SPEAKER_1: It's just like that is your body and the universe saying don't do this again.
SPEAKER_1: Don't do this again.
SPEAKER_2: Let you go this one time.
SPEAKER_1: Everybody gets one.
SPEAKER_1: Yeah, after that.
SPEAKER_4: So there is a book.
SPEAKER_4: It's called Good Reasons for Bad Feelings by an evolutionary psychologist named Randy Nessie.
SPEAKER_4: And it really goes through...
SPEAKER_4: It goes through all the different evolutionary reasons about why we have these emotions.
SPEAKER_4: One theory about depression is that it actually helps elicit health when you need it.
SPEAKER_4: So all the outward sides of depression, like you're huddled up in a ball, you can't get out of bed, you're crying, whatever, that actually will elicit health in your community.
SPEAKER_4: So people will come to you, okay, let me help you take care of your child.
SPEAKER_4: You're not in a good way, right?
SPEAKER_4: And so that might have been one adaptive reason, evolutionary reason for depression.
SPEAKER_4: But not only does it show those outward signs, like Chuck was saying, I mean, there's this great commercial.
SPEAKER_4: I can't believe that they have these commercials on television by the way for psychiatric treatment.
SPEAKER_4: Because then you have patients coming to you like, oh, I saw this commercial, can I take this product?
SPEAKER_4: But there's this wonderful commercial where they have these people holding up these happy masks, and they're walking around with a happy face on.
SPEAKER_2: The fake person, the fake...
SPEAKER_4: Yeah, and they're really underneath.
SPEAKER_4: And I find that actually comedian, all the comedians I've met, and I've met quite a few, they all have come to me and said some level of depression or anxiety, they're all in therapy.
SPEAKER_1: All the therapy, and they all have the happy mask.
SPEAKER_4: Right, and it's like this really, they're like, I never feel as good as I do when I'm on stage and when I'm making people laugh, and then it's almost like therapeutic in a way.
SPEAKER_4: So I think that, I don't know if there's been study done, but again, anecdotally, there's a higher prevalence of like depression and anxiety in comedians.
SPEAKER_4: At least, I mean, again, this is my small sample size, but it's quite a few.
SPEAKER_4: So there's this idea of masking, but if you get away...
SPEAKER_2: We have a sample size of one here, and it's 100% of what you want.
SPEAKER_2: Yeah, this is our experiment.
SPEAKER_3: So, Dr.
SPEAKER_3: go back to the woman who's crunched up in a ball and is suffering severely, and an elder woman comes along and says, it's okay, I'll take care of the child for you right now.
SPEAKER_3: That's fine if you live in a small tribe, a small village and everybody.
SPEAKER_3: Does this work in the 21st century when everyone is disconnected and there's concrete walls between everybody?
SPEAKER_4: That's a really great question.
SPEAKER_4: So one of the concepts in evolutionary psychology is that all of these feelings evolved for a specific reason, but then they're butting up against modern society where it no longer is useful, right?
SPEAKER_4: So let's say it makes sense for us to be afraid of heights so you don't fall off a cliff, right?
SPEAKER_4: And there's experiments where there are these babies and it's this cliff experiment where it's like there's actually a clear plexiglass, but it looks as if there's a big drop and the mom's on the other side of it.
SPEAKER_4: And she's going, come here, come here.
SPEAKER_4: And the baby will just like be frozen.
SPEAKER_4: Like you won't crawl across this clear plexiglass because it...
SPEAKER_2: That's a f***ed up experiment.
SPEAKER_1: Thank you.
SPEAKER_1: That is actually...
SPEAKER_2: Do I have to be the one to say that?
SPEAKER_4: I'm sorry.
SPEAKER_3: But you know about your...
SPEAKER_1: I can't believe my mother is trying to kill me.
SPEAKER_1: I cannot believe my mother is trying to kill me.
SPEAKER_4: It's true.
SPEAKER_4: It's pretty...
SPEAKER_4: There are these videos, the poor baby like doesn't know what to do.
SPEAKER_4: It's like mom, come on, come on.
SPEAKER_4: It's just like frozen.
SPEAKER_4: But it's instinctive, right?
SPEAKER_4: But now for someone to be afraid when they're just on the 33rd floor of a building, because that same old evolutionary program, which was adaptive, is no longer adaptive in modern society.
SPEAKER_4: And so a lot of disorders are sort of things that were normally adapted, that become either maladaptive because they're sort of so extreme or because there's a mismatch, it's this mismatch theory between what was purposeful and what was useful before, no longer useful in modern society.
SPEAKER_4: But the other thing is this, there's no line that we're suddenly, something is clinical.
SPEAKER_4: It's just how much distress is it causing you?
SPEAKER_4: How much distress is it causing other people or your ability to function?
SPEAKER_4: Some people don't think that, like narcissists, don't think they have a problem, but everybody else does, but they think they're just fine, right?
SPEAKER_4: But often it's subjective.
SPEAKER_4: How much distress is it causing you?
SPEAKER_4: And then we sort of get to these clinical areas where a treatment is required.
SPEAKER_2: But Heather, I've got time for one more question.
SPEAKER_2: I want to sort of take the liberty of asking it.
SPEAKER_2: If someone comes into your practice, and how do you decide if, well, they just need to come see me three hours a week for two years, or you just, and that'll change them chemically or emotionally or psychometrically, whatever, or you just give them a pill and say, you know, call me back in a week.
SPEAKER_2: In other words, your profession, you come to psychiatry as a neuroscientist, and these are two different approaches to solving the problem.
SPEAKER_2: One of the persons laying down on the couch.
SPEAKER_2: The other one is they're taking medicine.
SPEAKER_2: Of course, you can do both, but I foresee a day, am I along here, where you don't have to keep shelling out cash to a psychiatrist or a therapist, so we know exactly what the problem is, and this is the exact medical cocktail to fix it.
SPEAKER_2: And it's a one-stop shopping.
SPEAKER_1: I see.
SPEAKER_1: I disagree.
SPEAKER_1: That day is very, very unlikely because the human brain is so different from person to person.
SPEAKER_1: And the one thing that, in my experience, is you take a medication and your doctor tells you, listen, we're going to try this.
SPEAKER_1: They don't tell you, take this, and this is what's going to happen.
SPEAKER_1: They say, we're going to try this and keep an eye on it.
SPEAKER_2: But Chuck, before Newton, people said, oh, these planets are all moving differently from each other.
SPEAKER_2: Well, this is very complicated.
SPEAKER_2: They all have their own movement.
SPEAKER_2: They're all doing their own thing.
SPEAKER_2: And Newton says, here's one equation, it's got it all.
SPEAKER_2: So what I'm asking is, not is the brain complex, but are we just not there yet and will neuroscientists come and save the day?
SPEAKER_4: Okay, the brain is more than just the physical matter, right?
SPEAKER_4: It's the mind as well.
SPEAKER_4: So the brain is this really wonderful organ and it's physical and it has neurochemicals and neurons, but it also has this subjectivity.
SPEAKER_4: So it's both.
SPEAKER_4: Now research shows that medication alone can have a significant impact.
SPEAKER_4: Therapy alone can have a significant impact.
SPEAKER_4: When you get them together and it's the right medication, because it is individualized, not one medication fits all.
SPEAKER_4: When you get the right drug with the right therapy, you get this synergistic effect that combined, it's much greater than the sum of its parts.
SPEAKER_4: So they need to work in conjunction.
SPEAKER_4: If it was only enough to give a person a pill and be done with it, great.
SPEAKER_4: And I can just be out of business, at least in my clinical psych business, and go straight back to neuroscience.
SPEAKER_4: But the issue is that not everything is just neurochemical.
SPEAKER_4: There's also the way your brain is wired.
SPEAKER_4: And that's why it is actually unique, because we all have different experiences throughout our lives, and our brain gets wired up.
SPEAKER_4: It's like a piece of clay that gets molded throughout our lives, and each brain is slightly different.
SPEAKER_4: So things that might trigger you don't trigger me and vice versa.
SPEAKER_4: And so it is complex.
SPEAKER_4: And it's more than just changing the underlying.
SPEAKER_4: So I'll give you just one example.
SPEAKER_4: Two people can have a lesion, like brain damage, in the same part of the brain.
SPEAKER_4: And one person has this severe neurocognitive deficit or some psychiatric illness due to it, and the other person doesn't.
SPEAKER_4: And that's because they're wired slightly differently, or their neurochemistry is slightly different.
SPEAKER_4: So it's just not one size fits all.
SPEAKER_2: You would have known that decades ago if you could just open up people's skulls just in a laboratory and just do that routinely.
SPEAKER_2: But you're stuck with the two people who happen to have the same accident and brain lesion, right?
SPEAKER_2: You have to wait for people with brain issues to come to you, right?
SPEAKER_4: Yes, but now just as like, go to the alternative treatments, when the SNSRIs or other kinds of chemical treatments don't work, the ECT doesn't work, the TMS doesn't work, the ketamine doesn't work, right?
SPEAKER_4: What do you have left?
SPEAKER_4: There's what we call deep brain stimulation where we actually can implant electrodes in part of the brain called the anterior cingulate.
SPEAKER_4: And Helen Mayberg, who's at Mount Sinai, was one of the founders of doing this work to treat depression.
SPEAKER_4: For this now, you can actually implant electrode.
SPEAKER_4: It's being stimulated, connected to a battery pack and plants in your chest.
SPEAKER_4: And you can control it.
SPEAKER_4: You can turn it up.
SPEAKER_4: You can turn it down.
SPEAKER_4: And you can literally change people's emotions in the operating room where you're like, they don't know whether it's turned on or off.
SPEAKER_4: And suddenly you turn it on and they're like, whoa, suddenly I feel great.
SPEAKER_4: I feel like I just won the lottery.
SPEAKER_4: And it's this level of control.
SPEAKER_4: And maybe that's where we're headed toward these neural implants that can actually...
SPEAKER_2: And that comes from neuroscientists, not from psychiatrists.
SPEAKER_1: And when they put this in you, when the operation is complete, do they go, it's alive.
SPEAKER_4: But there are...
SPEAKER_2: Now, Heather, you're worrying me.
SPEAKER_2: I don't want to ever like take a nap while you're anywhere within a mile radius.
SPEAKER_1: Wake up with a chip in your head and a bunch of magnets around you talking about why do I want to kill the president?
SPEAKER_2: All right, we got to end it there.
SPEAKER_2: Heather, it's been a delight having you once again as our guest on this subject that I'm disappointed we haven't treated before.
SPEAKER_2: And perhaps we can pick it up again when you see new developments on the horizon.
SPEAKER_2: You could bring it straight to us.
SPEAKER_2: And we'll put it right on StarTalk's special edition.
SPEAKER_2: Heather, where can we find you in social media?
SPEAKER_2: And weren't you doing some TV right now?
SPEAKER_4: Yeah, well, my Nova series is now out.
SPEAKER_4: You can find it online.
SPEAKER_4: It's called Your Brain on Nova.
SPEAKER_4: I'm on Instagram and Twitter at Heather underscore Berlin.
SPEAKER_4: There is a book in the works that's to be continued.
SPEAKER_4: I'll talk more about it, but keep a lookout.
SPEAKER_4: And yeah, that's it for now.
SPEAKER_2: Hi, Gary.
SPEAKER_2: Good to see you, man.
SPEAKER_3: Likewise, my friend.
SPEAKER_2: All right.
SPEAKER_2: And Chuck, stay healthy.
SPEAKER_2: Rattling your pills around in front of us.
SPEAKER_1: This is why I'm healthy.
SPEAKER_2: Stay healthy.
SPEAKER_1: All right.
SPEAKER_2: This has been StarTalk Special Edition.
SPEAKER_2: Neil deGrasse Tyson, your personal astrophysicist.