welcome to the radically
genuine podcast dr roger mcfillin here with my

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[sean]: brother shawn kelly is on vacation good
morning shawn we're aloud vacations only kelly okay

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[sean]: well we kind of want to get
in the studio and address some recent events

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[sean]: within the field of psychiatry psychology that
has certainly kind of taken the world by

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[sean]: storm because is hit you international news
media and it's ironic because the very first

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[sean]: podcast that we recorded was on this
very subject we thought it was that valuable

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[sean]: in that important it was the around
the chemical and balance myth and when we

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[sean]: first recorded that podcast many people would
have been surprised to hear these ideas that

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[sean]: depression for example is not related to
low saratonian in the brain and therefore everything

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[sean]: that we believe anti depressant to do
as far as correcting that low seratone in

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[sean]: the brain is inaccurate and we've been
led to believe through very sis matic and

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[sean]: targeted pharmasutical marketing campaigns to have us
believe that what we experience what we feel

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[sean]: is related to an underlying brain abnormality
or an illness and in a recent review

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[sean]: article in molecular psychiatry june july twentieth
came out very recent uh dr joanna moncrief

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[sean]: and colleagues published this systematic review the
seratonan theory of depression a systematic umbrella review

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[sean]: of the evidence anyone who wants to
get into the nitygrity details of such review

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[sean]: feel free to i think for our
purposes today we just want to go over

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[sean]: the highlights um very simply you know
the idea that depression is a result of

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[sean]: abnormalities and brain chemicals in particular sarah
toning has been influential for decades and provides

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[sean]: important justification for the use of anti
depressant what has the actual literature revealed and

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[sean]: so when shan when we were recording
this podcast back in twenty twenty one june

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[sean]: twenty twenty well probably fourteen months ago
fourteen months ago i just got finished with

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[sean]: my own review and was surprised not
necessarily surprised but i was certainly shocked about

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[sean]: how there was really no evidence at
all and we're all kind of subjected to

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[sean]: media manipulation of idea yes and when
i knew very clearly that this was a

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[sean]: you know a theory that was never
supported by evidence it became very important for

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[sean]: us to be able to just start
communicating that that message and for me what

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[sean]: was most concerning and forget about the
efficacy of anti depressence or any of the

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[sean]: other effects the withdraw effects the the
side effects the long term impairment that exists

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[sean]: from prolonged use i was most concerned
about was the psychological aspect of believing that

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[sean]: there is something wrong with your brain
yes because of everything i know about the

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[sean]: field of psychology and attempting to cope
and live well really reflect some core principles

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[sean]: in how to you approach the the
experiences just being human and one of them

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[sean]: is the idea that there are emotions
are there to serve us and when we

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[sean]: feel something and we're experiencing something it
is something to be paid attention to because

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[sean]: it is our body reacting to events
that occur in our life now those events

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[sean]: could be outside of us or they
could be internal just our own thoughts our

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[sean]: own our own memories and using those
emotions to our benefit is part of a

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[sean]: very important adaptation process so i was
very concerned and always have been concerned about

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[sean]: what happens then when you are led
to believe that what you are thinking or

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[sean]: feeling is different than somebody else that
there's something you're broken in some way that

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[sean]: that it's an illness and you'll never
know it was ever fixed or could be

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[sean]: fixed yeah that's i would imagine that's
extremely challenging and difficult for someone to be

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[sean]: in that position when you're told you're
broken and you have to do this for

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[sean]: the rest of your life not only
that you have to really put trust into

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[sean]: a physician who might only sit down
with you for thirty minutes forty minutes you

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[sean]: know if that and just accept that
these are these are scientific advancements and you

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[sean]: know there's clear validity to some of
the recommendations that are that are being made

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[sean]: and so that's a lot of trust
right here take this farm a cuticle take

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[sean]: this pill and you're going to feel
better over thirty plus years we've learned that

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[sean]: you know most people don't feel better
and a lot get much much worse so

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[sean]: where do things go from here and
what are our next steps when it's clear

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[sean]: now that this has been disputed scientifically
i feel like it had been disputed scientifically

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[sean]: for quite some time in a very
small niche of the psychiatry and psychological community

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[sean]: of those that we're understanding the science
and it took this paper to take all

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[sean]: of the research that existed compile it
into one concise statement that would finally say

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[sean]: that that hypothesis for which ant depressant
were originally marketed under is not true therefore

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[sean]: we need to investigate further it's basically
for me it was an if then statement

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[sean]: right that's how i interpreted it so
i don't know if we actually said what

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[sean]: the results were we just kind of
were going through the history of it can

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[sean]: you can you reveal what the study
um what the final statement was for this

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[sean]: umbrella review sure basically the main areas
of sara tone and research provide no consistent

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[sean]: evidence of there being an association between
saratonian and depression no support for the hypothesis

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[sean]: that depression is caused by lower carton
an activity or concentration some evidence was consistent

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[sean]: with the possibility that long term anti
depression use actually reduces sara toning concentration and

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[sean]: i don't think anyone argues or we'll
support the idea that depression is related to

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[sean]: one nero chemical like sarah tone but
i think we'd all be concerned about what

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[sean]: would happen for long term use if
you're unable to produce sarah tone so this

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[sean]: this adaptation process of the brain when
you impact its own ability to produce a

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[sean]: neuro chemical so we're certainly experimenting with
such a complex organ the brain what does

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[sean]: then happen for prolonged ice so we're
at a point now where even though the

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[sean]: majority these studies were very short term
definitely under twenty four weeks most eight to

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[sean]: sixteen weeks we now have people on
the inside a presence for ten fifteen years

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[sean]: or more multiple meditations which the combination
of has never been studied never studied so

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[sean]: a lot of this is going to
be shocking to many people i remember when

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[sean]: we recorded the first episode in here
this was all new to me i believed

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[sean]: it to be true i thought you
were crazy and my approach in this room

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[sean]: was to try and balance out many
of the conversations and make sure what was

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[sean]: being said was was factual at least
debate with you a little bit so i

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[sean]: could continue to learn and there by
others that were listening could learn as well

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[sean]: and i look back now fourteen months
ago and i realize that m right it

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[sean]: was it was a marketing campaign well
there's very good reason that you would have

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[sean]: believed that and thought i was the
crazy one because of directed consumer marketing it

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[sean]: really started in the nineteen nineties if
we we had this we played one of

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[sean]: the commercials so i pulled it up
so we can we can listen to it

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[sean]: again because of the language in there
and i always like to listen to the

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[sean]: words that they used specifically right because
people hear what they want to hear and

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[sean]: they believe it to be true but
i worked in advertising and we chose words

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[sean]: very carefully so that we would never
ever get into legal trouble you know or

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[sean]: i'm going to play this let's take
a listen about a minute long you know

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[sean]: when you feel the weight of sadness
you may feel exhausted hopeless and anxious whatever

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[sean]: you do you feel lonely and don't
enjoy the things you once love things just

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[sean]: don't feel like they used to these
are some symptoms of depression a serious medical

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[sean]: commission affecting over twenty million americans while
the cause is unknown depression may be related

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[sean]: to an balance of natural chemicals between
nerve cells and the brain prescription zola works

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[sean]: to correct this in balance you just
shouldn't have to feel this way any more

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[sean]: only your doctor can diagnose depression so
loft is not for everyone people taking m

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[sean]: s where pemiside shouldn't take solo side
effects may include dry mouth insomnia sexual side

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[sean]: affects diario nausea and sleepiness zolofis not
having for talk to your doctor about zola

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[sean]: the number one prescribed brand of its
kind zoloft when you know more what's wrong

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[sean]: you can help make it right you
know when you okay there's the reason right

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[sean]: and so what i started doing over
this past i guess year and a half

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[sean]: as i wanted to ask people would
you have taken an anti depressing drug if

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[sean]: you were told there is no such
thing as a chemical and balance have no

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[sean]: evidence depression is associated with diminished sarah
to nan we have no evidence you have

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[sean]: lower sarah to nan and we have
no idea what is going to happen to

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[sean]: you long term would i absolutely not
so now so i ask questions like that

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[sean]: to people i know impose those questions
on twitter one hundred per cent people come

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[sean]: back no i would not have taken
this drug p questions always were you communicated

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[sean]: to by doctor that this drug corrects
and underlying chemical or in balance or was

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[sean]: it communicated to you in some way
that you may have a chemical balance the

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[sean]: question is for a large the answer
was for a large majority absolutely so even

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[sean]: though we didn't have the evidence shown
yeah doctors were still communicating this to patients

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[sean]: because of a very very targeted marketing
campaign to physicians themselves with farmasutical sales people

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[sean]: in the offices doctors were led to
believe that this drug does correct a underlying

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[sean]: chemical abnormality and many to this day
are still communicating the same message if they

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[sean]: are not in this field primary care
of physicians looking at close to eighty per

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[sean]: cent of these drugs being prescribed by
primary care physicians certainly not reading the literature

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[sean]: in sochiatry on depression probably not listening
to the radically genuine podcast they don't have

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[sean]: patients in their office every day they
are just following protocols and they also have

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[sean]: a broad knowledge base so take everything
in the medical field if you're a primary

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[sean]: care physician or like a pediatrician you
have to understand what's happening in so many

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[sean]: areas so you rely upon the expertise
of those that are providing literature to you

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[sean]: in summary form so you can clearly
read digest understand repeat so you probably got

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[sean]: an email from me this week and
actually send it out to the entire staff

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[sean]: twelve email today was what this weekend
was a weekend where i was obsessively for

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[sean]: gest on this subject because i have
plans you know i have i have ideas

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[sean]: i think we have to actually i
think i have a responsibility to contribute more

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[sean]: and one of those areas that i
think i need to contribute more is providing

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[sean]: people informed consent and i have to
have a very extensive then knowledge of the

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[sean]: literature base if i'm going to construct
something to be able to make an impact

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[sean]: in this area so i'm going to
have to say i went through fifty plus

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[sean]: papers on antidepressence for both adolescence and
an adult's teams adolescence and adults for the

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[sean]: most part there there in the and
the past decade but when you read a

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[sean]: scientific paper you kind of you can
go down the rabbit hole because you know

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[sean]: each scientific paper might have fifty citations
so then you might just check out the

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[sean]: citations in there yes and boy did
i have a headache i mean it was

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[sean]: it was rough because you want to
know how did we get to this point

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[sean]: because prescriptions are on the rise it's
not like they're declining they're actually the rise

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[sean]: each year pharmasutical industry is going to
improve their customer base for psychiatric drugs especially

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[sean]: when they tell people they don't have
they can't go off of them so then

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[sean]: you like got that one moving on
to the next group that's a really good

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[sean]: point because i didn't want to make
sure that i i miss this because it's

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[sean]: really important especially from a safety perspective
this evidence has been widely distributed and is

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[sean]: part of now the main stream to
hear in the united states which will get

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[sean]: to in a second but it is
critically important to know that if you are

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[sean]: taking anti de presence and you are
listening to this podcast or you read this

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[sean]: study or you watched it on some
news channel do not abruptly stop your medication

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[sean]: it could be deadly and we now
know that there is dependent c once you

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[sean]: start these drugs if you abruptly start
stop them be a withdrawal reaction and for

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[sean]: some people the withdrawal reactions are very
severe including increase suicideality um agitation sleep insomnia

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[sean]: a number of things it's just a
very very dangerous process so consult your prescriber

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[sean]: and if you are interested in starting
taper off these drugs you're going to want

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[sean]: to do it in a very safe
science based way so don't just stop it

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[sean]: especially for these people who have to
have been on this drug for quite some

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[sean]: time because this umbrella review did not
look into anti depressant it was only looking

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[sean]: at the causality effect of sarahtonan levels
and depression it's that needs to be like

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[sean]: really clearly communicated because in the media
is getting misinterpreted and of course everybody s

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[sean]: run in different directions with what the
interpretation yeah i think it's simply this a

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[sean]: lot of people went on anti depressant
because it's influential because of the chemical and

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[sean]: balance theory that's what they were led
to believe so once people learn that there

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[sean]: is no ceratonan deficiency in fact some
people have more the level can be up

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[sean]: and down and it depends on when
you're etting the test exactly you know like

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[sean]: my guesses may be you did some
of the things that we were talking about

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[sean]: like you're in the morning and you
do you you do your walk in the

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[sean]: sun maybe you exercise then you meditate
and then you get a know some form

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[sean]: of test to try to measure saratonanlevels
they might pay high right so it's yeah

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[sean]: it's a it's very you want to
be very skeptical of the entire idea around

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[sean]: saratonan or certain brain chemicals or even
thinking about depression as a brain disorder like

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[sean]: just eliminate that thinking right now we're
talking about high levels of complexity when you're

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[sean]: talking about the human experience a biological
psychological social spiritual nutritional perspective and we are

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[sean]: a mystery in so many ways the
human experience is a mystery we haven't even

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[sean]: begun to evolve the stage where we
can understand the complexity of such an experience

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[sean]: that being said um this did bring
about some national recognition and as you would

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[sean]: expect it became politicized unfortunately you're the
one who turned me onto the initial article

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[sean]: article tell me about like how you
found that i was having my morning breakfast

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[sean]: coffee over that weekend and apple news
and it got served to me probably because

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[sean]: of my my search in recent history
has been focused on this industory so they

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[sean]: probably saw this as a relevant story
for me and they kind of get bumped

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[sean]: up and promoted and i was interested
why would the rolling stone be covering this

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[sean]: topic and when i was reading the
rolling stone article it made me start to

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[sean]: identify some key words that i was
interpreting as an attempt to mis credit the

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[sean]: authors of the paper their position on
things in the past and um and ultimately

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[sean]: what they were communicating in that rolling
stone actually in the in the umbrella report

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[sean]: so what was being communicated in the
report was being misinterpreted and they were looking

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[sean]: for others things that these authors had
said to almost align them with a very

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[sean]: here in the united states a very
conservative right wing movement and trying to tie

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[sean]: it to gun violence and that i
thought was an attempt to get people to

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[sean]: ignore what this was trying to communicate
in the first place yeah it was in

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[sean]: very poor taste not surprising because we've
we've broached topics such as this on our

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[sean]: podcast previously especially how scientific ideas have
been high jacked play sized um but this

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[sean]: is really disappointing because although i don't
know dr moncrief personally she's from the u

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[sean]: k i'm very familiar with her work
and she is high le respected and she

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[sean]: is in no way the type of
professional who is provocative she's quite measured and

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[sean]: scientific certainly presents as as very compassionate
i believe she lives by that guiding principle

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[sean]: of first do no harm there is
no doubt that she is a principled individual

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[sean]: the highest ethical order and

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[sean]: she did we'll get into this in
a second here if you if you look

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[sean]: at any of her work she's a
she's a physician she's actually a psychiatrist right

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[sean]: and she speaks about this know this
drug centered model u versus like a brain

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[sean]: diseased model and she talks about realistically
and scientifically what the drugs actually do and

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[sean]: why some people may report a benefit
but she unfortunately had to respond to that

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[sean]: rolling stone article and we'll include that
in our show summary um and i'm bringing

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[sean]: up the article right now she's pretty
much associated in the article some right wing

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[sean]: ideology right so i'll just read the
the title of the article who is the

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[sean]: psychiatrist behind the anti depress and study
taking over right wing meet and listen i've

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[sean]: been looking at the various articles around
the world and there's certainly not limited to

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[sean]: any political political perspective no not at
all so it says juandanna moncrefe has spent

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[sean]: two decades questioning the efiqofefficacy of s
r s recently she's gone after covid nineteen

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[sean]: vaccine mandates why connect this study to
covid nineteen vaccine mandates well it's been politicized

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[sean]: politicized and trying you use the words
o misinformation high jack the word science among

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[sean]: other things and so like trying to
communicate a message to people that if you

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[sean]: question whatever the narrative that's that's presented
then you're a science denier and ultimately that's

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[sean]: they're trying to discredit people um in
some ways as if they're you no conspiracy

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[sean]: theorists um the truth of the matter
is r moncrief has always been clear about

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[sean]: just presenting data as it exists and
then trying to inform people of what that

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[sean]: data means and concern about this article
is they misrepresented a lot of her ideas

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00:22:53,534 --> 00:23:00,389
[sean]: and in some situations they were just
flat out lies and rolling stone magazine is

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00:23:00,449 --> 00:23:07,800
[sean]: a pretty influential cultural magazine in the
united states and there's there's no doubt that

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[sean]: this comes across as a farm hit
piece i'm going to try to find a

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[sean]: i'm going to try to get some
quotes from psychiatrist that they tried to support

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[sean]: the previous narrative um m

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[sean]: this paper is not coming in a
vacuum says as tab a clinical assistant professor

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[sean]: of psychiatry at case western university who
previously interviewed moncrief in twenty twenty psychiatric times

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[sean]: article it's coming with two decades of
work in which moncrief has consistently challenged the

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[sean]: character ization of depression as a mental
illness that's a lie r moncrief very much

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[sean]: communicates that being severely depressed is a
condition that requires intervention so they're shifting the

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[sean]: language and correctly interpreting the thing she
said she actually does use medications in a

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[sean]: very controlled way to in crises situations
when appropriate yeah and she's going to it's

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[sean]: a she believes it's a decision that
needs to be made between a doctor and

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00:24:24,506 --> 00:24:29,454
[sean]: a patient best on best best avail
but evidence in which they're provided the potential

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[sean]: risks and the potential benefits and it's
carefully monitored and so she's very clear about

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00:24:35,865 --> 00:24:41,685
[sean]: the potential benefits they tend to be
too thin s one when you take an

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[sean]: anti depressant there is m you're inducing
a chemical in balance so you're inducing a

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[sean]: physiological reaction so your body is going
to react to it the most notable one

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[sean]: is blunting of emotion numbing numbing blunting
numbing and that includes both positive emotions and

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[sean]: negative emotions so for a for a
small percentage of people especially if someone's feeling

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00:25:10,254 --> 00:25:18,143
[sean]: intensity of negative emotions that might be
initially interpreted as relief so we have to

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00:25:18,203 --> 00:25:24,113
[sean]: communicate that this could numb emotions much
like other drugs for some people if you

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[sean]: smoke mariana or you drink alcohol they
can have similar effects everyone is different i

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00:25:30,869 --> 00:25:38,327
[sean]: was actually watch listening to a podcast
joe rogan podcast this this particular weekend where

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00:25:38,627 --> 00:25:44,955
[sean]: a someone that we've um you know
we've listened to previously and quoted on this

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00:25:45,055 --> 00:25:50,745
[sean]: podcast um m i'm forgetting his name
it's okay what was the message the message

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00:25:50,845 --> 00:25:58,598
[sean]: was that for some people for alcohol
it impacts their dopamenreceptors to differently and so

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00:25:58,879 --> 00:26:04,468
[sean]: they become highly elated and can continue
to drink for long periods of time with

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00:26:04,628 --> 00:26:09,196
[sean]: real elevated mood while other people it's
a sedative you know so for me i

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00:26:09,256 --> 00:26:14,307
[sean]: can have a couple of drinks and
it's relaxing yeah but if i have too

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00:26:14,427 --> 00:26:20,724
[sean]: many get tired the same way i'll
have you know at most two drinks now

250
00:26:21,164 --> 00:26:25,812
[sean]: that's that's what two is my you
know it's my magic my comfort so everyone

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00:26:25,832 --> 00:26:30,039
[sean]: is different and we know that right
so there might be some people who take

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00:26:30,079 --> 00:26:33,372
[sean]: it in and to press it might
be in a high agitated state in a

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[sean]: lot of emotional pain some emotional blunting
initially could have some potential positive interpreted improvement

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00:26:42,984 --> 00:26:48,180
[sean]: and improvement the other thing that she's
very clear of is they provide some people

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00:26:48,341 --> 00:26:56,586
[sean]: hope so it is the the placebo
response the belief that that i've found something

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00:26:56,967 --> 00:27:02,977
[sean]: to help me it's an exhale i'm
finally doing something about this and she recognizes

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00:27:03,137 --> 00:27:11,443
[sean]: how powerful that is the thing that
makes her really separate from many of her

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00:27:11,584 --> 00:27:17,533
[sean]: colleagues in the greater field and the
medical establishment she is very clear about what

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00:27:17,573 --> 00:27:24,204
[sean]: the risks are you know she'll be
open that with this drug centered model that

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00:27:24,504 --> 00:27:29,463
[sean]: in time the brain is going to
adapt and it will have an effect on

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00:27:29,543 --> 00:27:35,793
[sean]: the body right whether it's effect on
your metabolic health or your gutmicroiato or your

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00:27:36,114 --> 00:27:42,344
[sean]: brain a mysterious organ that we're still
learning about in time it certainly does increase

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00:27:42,424 --> 00:27:50,643
[sean]: to susceptibility and potentially a greater chance
of relapsing into further depressive episodes it does

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00:27:50,724 --> 00:27:59,505
[sean]: increase suicideality as we had on previous
podcasts we're learning about evidence regarding specific um

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00:28:00,159 --> 00:28:05,806
[sean]: m you know like genetic components and
like how how drugs are metabolized differently so

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00:28:06,226 --> 00:28:14,552
[sean]: bottom line as they affect people differently
and the overall research really it doesn't distinguish

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00:28:14,632 --> 00:28:19,220
[sean]: it much from a placebo response maybe
some short term response so bottom line is

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00:28:19,300 --> 00:28:25,558
[sean]: this is that she's she is not
the person that was presented in this article

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[sean]: and it brings up a lot of
concern for me because um that that tells

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[sean]: me that who's ever influencing this article
who's ever driving it certainly has an agenda

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[sean]: and that agenda isn't science based that
agenda isn't looking out for the well being

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[sean]: the health and the well being of
the populace i agree i agree if anything

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[sean]: it just it separates you know we've
talked about putting people in the two camps

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00:29:01,423 --> 00:29:05,333
[sean]: it was establishing what camp are you
a part of that's that was how i

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00:29:05,473 --> 00:29:11,911
[sean]: was responding to reading that piece and
she's responded to it also because it was

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00:29:11,951 --> 00:29:15,577
[sean]: getting so many eyeballs she felt like
she really had it to or had to

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00:29:16,058 --> 00:29:22,529
[sean]: and this particular research study right now
is like the most downloaded research study it's

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00:29:22,569 --> 00:29:25,835
[sean]: been but like two or three weeks
and there's been millions of down loads so

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00:29:25,895 --> 00:29:30,863
[sean]: of course it's getting lots of attraction
as it should and she has taken a

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00:29:30,923 --> 00:29:37,681
[sean]: very appropriate path towards how to community
what it means i don't know where you

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00:29:37,701 --> 00:29:41,127
[sean]: want to continue to go in this
discussion but i read a couple of the

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[sean]: other articles and i wrote down a
couple statements and i don't know a few

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00:29:46,155 --> 00:29:50,526
[sean]: i could read through them and you
can either say true false or we can

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00:29:50,606 --> 00:29:54,970
[sean]: comment on them or what are your
thoughts on to do it okay so i've

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00:29:54,990 --> 00:29:59,077
[sean]: already said that you know i interpreted
this entire study as an if then statement

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00:29:59,458 --> 00:30:07,811
[sean]: you know if the drugs were developed
to improve sara toni deficiency that's been proven

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00:30:08,411 --> 00:30:13,936
[sean]: not to be true then you know
what do the drugs do that was how

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00:30:14,036 --> 00:30:21,616
[sean]: she left it so number one is
that the research doesn't show that drugs aren't

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00:30:21,716 --> 00:30:26,628
[sean]: effective they only rule out one possible
way the drugs might work

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00:30:30,290 --> 00:30:36,300
[sean]: well i think we have decades of
studies shown that that show the drugs are

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00:30:36,340 --> 00:30:44,001
[sean]: not effective okay so too many physicians
are unwilling to take that leap because so

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00:30:44,061 --> 00:30:50,627
[sean]: many people are on them and the
moment you really proclaim that and you were

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00:30:50,747 --> 00:30:57,580
[sean]: somebody who wrote prescriptions and have been
part of that treatment for decades i think

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00:30:57,620 --> 00:31:03,510
[sean]: you're putting yourself in a precarious position
so i'm willing to say that because i've

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00:31:03,570 --> 00:31:12,866
[sean]: evaluated the research i don't believe the
drugs are anti depressence i don't think they

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00:31:13,006 --> 00:31:19,797
[sean]: have an effect on anti depressant something
that's really on anti depression something that's really

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00:31:19,837 --> 00:31:27,828
[sean]: interesting i got into an old article
um regarding what untreated depressive episodes look like

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00:31:28,740 --> 00:31:38,754
[sean]: okay and it's fascinating because what it
informs us is that depression has always been

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00:31:39,416 --> 00:31:47,655
[sean]: episodic so there is usually a time
limit to them and in particular it's when

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00:31:47,936 --> 00:31:53,744
[sean]: certain conditions resolve in your life right
could be loss of a job break up

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00:31:54,580 --> 00:32:02,644
[sean]: um a down period that exists you're
adapting when the conditions resolve themselves and your

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00:32:02,744 --> 00:32:09,055
[sean]: natural coping abilities allow you to overcome
them it's time limited so i think something

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00:32:09,135 --> 00:32:17,905
[sean]: like in his research eighty five percent
of all depressive episodes resolve themselves within twelve

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00:32:17,965 --> 00:32:26,238
[sean]: months most of them within three to
six so that means according to his research

305
00:32:26,278 --> 00:32:29,063
[sean]: and i'll get that to you to
put in the show summer because i don't

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00:32:29,123 --> 00:32:32,809
[sean]: have the title with right now i
did post it on my twitter account this

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00:32:33,431 --> 00:32:40,585
[sean]: this weekend what that means is that
people are just inherently resilienthey're going to overcome

308
00:32:40,625 --> 00:32:45,733
[sean]: those challenges on their own and if
you did not intervene they're going to improve

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00:32:46,334 --> 00:32:50,502
[sean]: i believe that to be true also
just based on this this you know people

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00:32:50,602 --> 00:32:53,728
[sean]: call we're not able to get to
everybody right away they go on the waiting

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00:32:53,788 --> 00:32:59,701
[sean]: list for people that get past ninety
days when we start calling them they say

312
00:33:00,101 --> 00:33:03,866
[sean]: i no longer need your services ye
that's absolutely if they get an appointment elsewhere

313
00:33:03,966 --> 00:33:11,221
[sean]: now i'm just i'm okay now good
and therefore this concept of wait fur watching

314
00:33:11,481 --> 00:33:15,708
[sean]: is so important we've talked about that
before also so about there's going to be

315
00:33:15,889 --> 00:33:22,520
[sean]: it just doesn't deny the fact that
depression in itself can be impairing and health

316
00:33:22,640 --> 00:33:27,368
[sean]: condition to take seriously so there's about
fifteen per cent of people who are it's

317
00:33:27,428 --> 00:33:31,335
[sean]: not gonna be episodic right it's going
to be prolonged there's probably various reasons for

318
00:33:31,415 --> 00:33:36,870
[sean]: that and it's our responsibility in this
to identify how to intervene with them in

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00:33:36,930 --> 00:33:46,453
[sean]: a way that is most effective also
respects their autonomy and provides them the information

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00:33:46,534 --> 00:33:52,764
[sean]: because they're vulnerable right they're vulnerable for
for help so soon i don't believe that

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00:33:53,846 --> 00:33:59,944
[sean]: anti depressant work per se but i
am willing to say for a small percentage

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00:34:00,004 --> 00:34:05,866
[sean]: of people they interpret them for a
period of time as benefits that leads to

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00:34:05,926 --> 00:34:12,878
[sean]: my statement number two okay research suggests
anti depressant work only a bit better than

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00:34:12,958 --> 00:34:13,398
[sean]: placebo

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00:34:18,412 --> 00:34:21,817
[sean]: i'm gonna say that's false okay now
i want to expand upon that because in

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00:34:21,917 --> 00:34:25,824
[sean]: a in a study where it shows
a little bit better than placebo it's the

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00:34:25,884 --> 00:34:30,752
[sean]: law of averages within those that are
a little bit better than placebo there are

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00:34:30,832 --> 00:34:34,378
[sean]: some that are greater and some that
are less than you put them together the

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00:34:34,438 --> 00:34:39,407
[sean]: combined shows a little bit better than
very lowly so when you're talking about that

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00:34:39,567 --> 00:34:43,714
[sean]: in terms of it helps some people
the small percentage of those that it truly

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00:34:43,854 --> 00:34:49,203
[sean]: has helped would be into that group
that is a little that is better than

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00:34:49,303 --> 00:34:56,675
[sean]: placebo but most are at the placebo
level ye let me address that number one

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00:34:56,976 --> 00:35:04,609
[sean]: we're talking about better is a statistical
difference and interpretation it's a statistical difference on

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00:35:04,909 --> 00:35:12,684
[sean]: a a symptom check list yes the
best available evidence will say that statistical diff

335
00:35:13,185 --> 00:35:21,075
[sean]: difference is not significant enough to have
any clinically relevant improvement in quality of life

336
00:35:21,536 --> 00:35:24,861
[sean]: and i've taken the check list and
i know some of it is subjective based

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00:35:24,901 --> 00:35:27,646
[sean]: on how you're feeling at that moment
based on how tired you are did you

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00:35:27,706 --> 00:35:31,393
[sean]: get a good night sleep all that
stuff is factor into that so the other

339
00:35:31,434 --> 00:35:39,543
[sean]: thing that's important to note is that
the this is fact that's the drug companies

340
00:35:39,803 --> 00:35:46,757
[sean]: buried the studies that didn't demonstrate an
effect meaning they didn't publish them and that's

341
00:35:46,817 --> 00:35:54,239
[sean]: called publication bias that you you publish
the studies that demonstrate in the fact and

342
00:35:54,280 --> 00:35:59,027
[sean]: you don't in the ones that did
not support your intervention you put it all

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00:35:59,208 --> 00:36:05,852
[sean]: together my belief and this is from
my examination of the literature that they are

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00:36:05,932 --> 00:36:13,190
[sean]: a plus bo effect with side effects
got it statement number three there are many

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00:36:13,410 --> 00:36:19,435
[sean]: different expressions of depression that come from
a wide array of causal factors and present

346
00:36:19,475 --> 00:36:27,705
[sean]: themselves differently from person to person absolutely
true absolutely in fact the idea of depression

347
00:36:27,785 --> 00:36:34,515
[sean]: is just some social construct and an
umbrella term right so what one person might

348
00:36:34,595 --> 00:36:39,063
[sean]: communicate as depression is just a use
of language and it's our limitations of language

349
00:36:39,824 --> 00:36:44,972
[sean]: and while another person may deny that
exact same experience its depression at all it's

350
00:36:45,032 --> 00:36:51,713
[sean]: a label it's trying to communicate something
that we are unable to investigate through direct

351
00:36:51,854 --> 00:36:57,466
[sean]: observation so that leads to my next
statement there is no single treatment approach that

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00:36:57,526 --> 00:37:06,622
[sean]: works for everyone with depression absolutely true
okay so i was encouraged because as i

353
00:37:06,763 --> 00:37:10,008
[sean]: was i stumbled upon something that's happening
in the u k and it may have

354
00:37:10,048 --> 00:37:13,574
[sean]: just been in the last year or
so u k doctors have been told they

355
00:37:13,614 --> 00:37:20,371
[sean]: should offer therapy exercise mindful this or
meditation to people with less severe cases of

356
00:37:20,431 --> 00:37:22,758
[sean]: depression before trying medication

357
00:37:25,890 --> 00:37:29,676
[sean]: i mean i think for for you
who's not been involved in this field um

358
00:37:30,117 --> 00:37:35,947
[sean]: that sounds encouraging but i'm it goes
back to the language again less severe depression

359
00:37:36,027 --> 00:37:41,780
[sean]: and how does one even define that
would be a doctor and a client understanding

360
00:37:42,181 --> 00:37:46,545
[sean]: the circumstances and working closely kind of
like what joanna mon crave thoughts we're gonna

361
00:37:46,585 --> 00:37:50,029
[sean]: have a small percentage that she feels
could truly benefit in a short period of

362
00:37:50,089 --> 00:37:59,256
[sean]: time it's a huge challenge because there
is probably a very very small minute percentage

363
00:37:59,296 --> 00:38:04,654
[sean]: of people who've been assigned the label
of depression who are impaired in ways that

364
00:38:04,794 --> 00:38:14,621
[sean]: many of our listeners do not understand
could be catatonic states um just not leaving

365
00:38:14,721 --> 00:38:21,714
[sean]: their home crying all the time and
each day as a fight to get through

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00:38:21,814 --> 00:38:30,805
[sean]: without ending their life to me that
is severe right and i think those people

367
00:38:31,950 --> 00:38:37,665
[sean]: who are struggling to that extent and
have not been helped by other means should

368
00:38:37,725 --> 00:38:45,736
[sean]: have every right go through any treatments
that are available including anti to presents or

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00:38:46,597 --> 00:38:55,416
[sean]: innovative drug treatments or nutritional diets or
whatever it takes right like you only got

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00:38:55,536 --> 00:39:00,144
[sean]: one life to live maybe and so
therefore yeah whatever it takes and i think

371
00:39:00,705 --> 00:39:05,681
[sean]: in order to ease the suffering of
people should be you know creative and work

372
00:39:05,762 --> 00:39:10,544
[sean]: with them collaboratively but i also it's
really important for me to communicate that that

373
00:39:10,945 --> 00:39:17,325
[sean]: is not the percentage of people most
people who are receiving anti depressance and mental

374
00:39:17,345 --> 00:39:22,053
[sean]: health treatment don't even meet that criteria
i think we have a distorted idea of

375
00:39:22,313 --> 00:39:28,243
[sean]: what is actually severe depression the mag
ority of therapists out there who are working

376
00:39:28,544 --> 00:39:33,131
[sean]: in community based settings are dealing with
mile to moderate even some of the more

377
00:39:33,191 --> 00:39:39,583
[sean]: challenging or difficult cases still don't reach
that threshold so it's just been an expansion

378
00:39:40,464 --> 00:39:49,538
[sean]: of the diagnostic h severity range that
you know too many people are being identified

379
00:39:49,598 --> 00:39:56,149
[sean]: as having severe depression when in fact
m that's not what others are experiencing but

380
00:39:56,189 --> 00:40:00,657
[sean]: it's jane because then you don't want
to ever invalidate someone's you can be you

381
00:40:00,697 --> 00:40:06,226
[sean]: can be in a lot of emotional
pain and not be severely depressed and those

382
00:40:06,346 --> 00:40:11,906
[sean]: lines have been blurred um in our
society and then you'll just see a lot

383
00:40:11,986 --> 00:40:18,291
[sean]: of nonsense out there that say who
are you to determine what is severe depression

384
00:40:18,832 --> 00:40:24,657
[sean]: or people are hiding it and u
and they're doing a really good job of

385
00:40:24,998 --> 00:40:31,681
[sean]: hiding their emotional experience well how do
we study it and how do we have

386
00:40:31,701 --> 00:40:38,071
[sean]: a science base around it if professionals
aren't able to distinguish between what is most

387
00:40:38,151 --> 00:40:43,461
[sean]: impairing versus what might be a range
that exist and many of us might face

388
00:40:43,541 --> 00:40:48,374
[sean]: and at one point in our in
our lives i agree i would imagine there's

389
00:40:48,414 --> 00:40:54,146
[sean]: a number of individuals that are severely
depressed and fail to recognize and admit it

390
00:40:54,326 --> 00:41:02,444
[sean]: and go about their lives just numb
to that fact yeah that goes into coping

391
00:41:02,765 --> 00:41:09,075
[sean]: right so there are wide range of
coping styles and one one coping style is

392
00:41:09,155 --> 00:41:14,765
[sean]: avoidance um and another coping style is
you know reflects around a denial of the

393
00:41:14,825 --> 00:41:18,872
[sean]: experience not everyone is so connected and
in touch to what they're feeling and their

394
00:41:18,912 --> 00:41:24,421
[sean]: experiencing and don't even have that concept
of depression in their their view point like

395
00:41:24,782 --> 00:41:29,289
[sean]: their perspective doesn't even allow them to
understand what they're experiencing in that way so

396
00:41:29,369 --> 00:41:34,297
[sean]: that's that there are many different forms
of expression that is one where others are

397
00:41:34,357 --> 00:41:38,942
[sean]: very expressive yeah can i read a
quote i was looking for this quote earlier

398
00:41:39,062 --> 00:41:44,467
[sean]: from this i've been stalling so yes
i'm glad you and this is what's disingenuous

399
00:41:44,587 --> 00:41:50,645
[sean]: and this is what's concerning i'm going
to read the paragraph within the medical community

400
00:41:50,825 --> 00:41:57,256
[sean]: the papers conclusions were nothing new david
hellerstein professor of clinical psychiatry at columbia university

401
00:41:57,356 --> 00:42:03,711
[sean]: medical center and director of columbia pression
evaluation service explains that the ceratoneand hypothesis the

402
00:42:03,791 --> 00:42:10,027
[sean]: idea that depression is caused by lowsrtoneand
levels a quaint and over simplified shorthand that

403
00:42:10,067 --> 00:42:15,770
[sean]: has been superseded by other explanations and
clinical practice for decades now he said to

404
00:42:16,191 --> 00:42:21,299
[sean]: the review was largely met with yawns
from the psychiatric community and reading it i

405
00:42:21,360 --> 00:42:27,330
[sean]: was kind of thinking wow next she'll
tackle the discrediting of the black bile theory

406
00:42:27,891 --> 00:42:38,640
[sean]: of depression he tells rolling stones you
smug i read you smug clown i right

407
00:42:38,761 --> 00:42:43,408
[sean]: now and i want you to come
on to this podcast david hallerston i will

408
00:42:43,468 --> 00:42:50,941
[sean]: reach out to you because that is
such an offensive comment because still on major

409
00:42:51,021 --> 00:42:55,629
[sean]: websites around your profession they'll still talk
about it in the possibility of a chemical

410
00:42:55,689 --> 00:43:01,495
[sean]: de balance chemical and balance most people
who have depression and are seeking out psychiatric

411
00:43:01,575 --> 00:43:09,508
[sean]: medications still believe that to be true
our physicians in community based settings are talking

412
00:43:09,889 --> 00:43:18,560
[sean]: to ants about sarah toning and depression
and that's how it's being treated in the

413
00:43:18,960 --> 00:43:27,585
[sean]: in the psychiatric community you're still treating
it with s s r is selective sarah

414
00:43:27,665 --> 00:43:35,675
[sean]: to nan up take inhibitors you are
talking about and associating the chemical and balance

415
00:43:35,715 --> 00:43:41,162
[sean]: theory with the screading of the black
bile theory of depression how can you put

416
00:43:41,262 --> 00:43:47,987
[sean]: yourself out there in a major news
outlet like rolling stone with such a stupid

417
00:43:48,108 --> 00:43:55,266
[sean]: statement that's embarrassing and that is why
i have such a challenge working in this

418
00:43:55,406 --> 00:44:03,460
[sean]: field when you make a statement like
that r a professor of clinical psychiatry a

419
00:44:03,520 --> 00:44:05,887
[sean]: renowned university at columbia

420
00:44:10,137 --> 00:44:17,633
[sean]: um hm so here's the one thing
that i like about joanna moncreave is the

421
00:44:17,733 --> 00:44:23,314
[sean]: published paper came out on the twentieth
and she wrote a piece that she was

422
00:44:23,394 --> 00:44:29,464
[sean]: directing everybody to where she takes it
basically step by step and she says basically

423
00:44:29,524 --> 00:44:33,791
[sean]: was a title of her article actually
did a social media and it's how to

424
00:44:33,912 --> 00:44:38,159
[sean]: take the news that depression has not
been shown to be caused by a chemical

425
00:44:38,319 --> 00:44:44,509
[sean]: balance uh that to me is a
very responsible way of handling this and not

426
00:44:44,930 --> 00:44:52,122
[sean]: attacking anyone but purely just to help
those who may misinterpret um so i think

427
00:44:52,142 --> 00:44:55,407
[sean]: this is a good way to end
it not reading her thing but we've already

428
00:44:55,488 --> 00:45:03,341
[sean]: touched on the important of informed consent
people reading the literature for themselves understanding what

429
00:45:03,401 --> 00:45:08,449
[sean]: is communicated and then recognizing that the
next steps are not to independently make any

430
00:45:08,509 --> 00:45:13,738
[sean]: decisions but to consult with physicians in
a responsible way to determine what their next

431
00:45:13,798 --> 00:45:20,346
[sean]: steps may be because everybody's pressive situation
is unique and everyone is an individual their

432
00:45:20,407 --> 00:45:26,336
[sean]: situations very drastically so how how can
we responsibly communicate what the next steps are

433
00:45:26,657 --> 00:45:30,632
[sean]: for anyone who may be listening to
this tell you what it's you're using the

434
00:45:30,672 --> 00:45:39,507
[sean]: right word being responsible and that's the
difference between someone of dr joanna moncrete's stature

435
00:45:39,547 --> 00:45:47,676
[sean]: and character versus the gentleman from olumbia
is that she is going to continue this

436
00:45:47,756 --> 00:45:52,424
[sean]: process on how to communicate it responsibly
to clients she also understand and i think

437
00:45:52,464 --> 00:45:58,364
[sean]: through empathy that a lot of people
are going to hurt and feel a lot

438
00:45:58,424 --> 00:46:05,876
[sean]: of resentment and distrust towards the greater
mental health field which i'm a part of

439
00:46:06,758 --> 00:46:12,753
[sean]: and so she recognize is it with
compassion and she helps people to better understand

440
00:46:12,813 --> 00:46:17,917
[sean]: the complexity of what might be happening
to them and gives them a more thorough

441
00:46:19,312 --> 00:46:27,924
[sean]: clear directive on what these drugs actually
do and what are the potential risks ultimately

442
00:46:27,964 --> 00:46:34,655
[sean]: that's what we're asking for we're just
asking for honesty we're asking to be able

443
00:46:34,735 --> 00:46:39,731
[sean]: to communicate to people hey if you're
going to put something into your body you're

444
00:46:39,751 --> 00:46:45,053
[sean]: going to start any form of treatment
or medical intervention that you're aware of what

445
00:46:45,334 --> 00:46:51,004
[sean]: the potential negative outcomes exist might choose
to do it with those risks just based

446
00:46:51,064 --> 00:46:55,231
[sean]: on how you're feeling right now but
it is your choice i'm here with you

447
00:46:56,300 --> 00:47:02,730
[sean]: and that's just that's not the way
it's been in psychiatry psychiatry has has made

448
00:47:02,810 --> 00:47:07,658
[sean]: statements that are you know really what
are ridiculous come at this point there you

449
00:47:07,699 --> 00:47:13,305
[sean]: know they're going to be flected on
is absolutely ridiculous such as like considering what

450
00:47:13,365 --> 00:47:19,751
[sean]: you're experiencing or feeling to be similar
to insolent for diabetes associating these drugs as

451
00:47:20,032 --> 00:47:24,817
[sean]: as if they're life saving there's so
many messages that we've been exposed to over

452
00:47:24,857 --> 00:47:33,229
[sean]: the last thirty years that are just
inaccurate they're harmful and they're certainly not standing

453
00:47:33,289 --> 00:47:38,498
[sean]: the test of scientific scrutiny so we
have that responsibility and i like that word

454
00:47:39,359 --> 00:47:44,124
[sean]: this cast has to be responsible i'm
certainly aware that people are listening and they've

455
00:47:44,184 --> 00:47:48,728
[sean]: been on these sores for potentially decades
they might even prescribe them to their own

456
00:47:48,929 --> 00:47:56,720
[sean]: children yeah the goal of this is
to get you to become more educated and

457
00:47:56,760 --> 00:48:01,367
[sean]: to wear and then to make do
your own research and then to take the

458
00:48:01,407 --> 00:48:07,477
[sean]: appropriate steps that are the best interest
of yourself or your loved ones it's important