0:00

What up

0:02

team? It's

0:05

episode 479

0:09

of The

0:12

Genius Live.

0:16

Let's go.

0:22

What's going on everybody? I'm your

0:24

host Max Lugovir and welcome back to

0:26

The Genius Life a show where we

0:28

try to make sense of this messy

0:30

beautiful human experience one conversation at a

0:32

time Here's a stat that'll stop you

0:34

in your tracks depression is now the

0:36

leading cause of disability worldwide And yet,

0:38

what if we've been missing a huge

0:40

part of the picture? What if millions

0:42

of people, maybe even you, are suffering

0:44

from a hidden variant of depression that

0:47

doesn't show up the way we've been

0:49

taught to recognize it? Well, my guess

0:51

today is Dr. Judith Joseph, a board-certified

0:53

psychiatrist, clinical researcher, and one of the

0:55

leading voices making mental health more human

0:57

and more relatable. Her viral video on

0:59

high functioning depression has been viewed over

1:01

20 million times and for good reason.

1:03

It put a name to what so

1:06

many people are quietly going through. The

1:08

folks who are showing up, getting it

1:10

done, overperforming even all while silently struggling.

1:12

In today's episode we explore what high

1:14

functioning depression really is, how it hides,

1:16

why so many people miss it, and

1:19

what you can do about it. We

1:21

talk about the difference between clinical depression

1:23

and subclinical symptoms like anhedonia, the loss

1:25

of joy, and how numbing out with

1:27

productivity can actually be a sign of

1:30

deeper emotional avoidance. We also dive into

1:32

the science of your happiness, burnout versus

1:34

depression, gender differences, and hormonal factors, the

1:36

role of trauma and environment, and whether

1:39

we're actually overpresribing SSRIs. just under delivering

1:41

on support and access. Now before we

1:43

get started, just a quick heads up.

1:45

This weekend I'll be in Austin to

1:48

keynote the Health Optimization Summit. It's shaping

1:50

up to be an incredible gathering of

1:52

2,000 like-minded people passionate about wellness, ancient

1:54

wisdom, and high-tech tools for better health. If you're

1:56

in the area, I'd love to see you there.

1:58

You can grab tickets at USA. Health optimization.com

2:00

and use code Max for 10% off.

2:03

Now listen all the way through to

2:05

the end. You're not going to want

2:07

to miss a beat. And don't forget

2:09

to share this episode with someone you

2:11

love. Leave a rating and review on

2:13

your podcast app of choice and subscribe

2:15

wherever you're listening. And of course on

2:17

YouTube. And now with all that out

2:19

of the way, here is my eye-opening

2:22

conversation with Dr Judith Joseph. Here we

2:24

go. Dr. Judith Joseph, welcome to the

2:26

show. How you doing? Good. Thank you

2:28

for having me. I'm excited to be

2:30

here. I'm excited to have you. How

2:32

do we know if we have hidden

2:34

depression? I've never heard of such a

2:36

thing. People are walking around with a

2:38

latent hidden depression, not even knowing it.

2:40

It's a good question. And so I

2:43

was recently on another podcast where they

2:45

were talking about depression versus symptoms of

2:47

depression. And technically, there's only one clinical

2:49

depression. In my lab, I have a

2:51

research lab where when I'm diagnosing someone,

2:53

I pull out the Bible of psychiatry,

2:55

the DSM-5, and I flip through it

2:57

and I go through the symptoms of

2:59

depression. Now if you don't, if you

3:01

have symptoms of depression, but you don't

3:04

meet criteria for losing functioning or having

3:06

significant distress, technically according to the Bible

3:08

psychiatry, you don't have clinical depression. But

3:10

that being said, after 2020, I was

3:12

getting a lot of people in my

3:14

lab coming in with symptoms of depression,

3:16

but they were overfunctioning. So they were

3:18

the mom showing up. They were the

3:20

entrepreneurs showing up. They were the doctor

3:22

showing up, the nurse showing up. So

3:25

they had these symptoms of depression, but

3:27

they were actually over-functioning. And because they

3:29

were so deep in their work, they

3:31

weren't really identifying with having distress because

3:33

they weren't feeling. They were numbing. They

3:35

had anhedonia. And I thought, well, if

3:37

there are people like this that I'm

3:39

seeing in my practice and my research

3:41

lab, then how many out there are

3:43

experiencing this? And because I'm a scientist,

3:46

I did a little experiment, and I

3:48

put out a social media reel describing

3:50

the symptoms of depression in a given

3:52

day of someone who's overfunctioning, very busy,

3:54

showing up, and that reel got over

3:56

20 million views. So I thought, okay,

3:58

I have to be onto something. So

4:00

I decided to do the first clinical

4:02

study in the world on high functioning

4:04

depression, and it was just published in

4:07

a peer-reviewed journal article. Oh my God,

4:09

congrats. Thank you. So you really touched

4:11

a nerve, I guess, with that real.

4:13

There are people for whom life looks

4:16

perfectly normal on the outside, but are,

4:18

I guess, silently suffering. They are, and

4:20

you know, I was one of those people,

4:22

to be honest. sitting at my desk in

4:24

April 2020 giving a talk to these health

4:26

care workers and the questions coming through I

4:29

mean they didn't know what was going to

4:31

happen they were asking questions like should I

4:33

even go home what if I infect my

4:35

family how am I going to do this

4:37

people are dying like and I was at

4:40

this on this zoom call given this talk

4:42

and I was feeling depressed and I was

4:44

like wait a second I'm a board

4:46

certified psychiatrist and researcher and I was

4:48

struck by my own depression that was

4:51

hidden and you know I told you I kept

4:53

seeing people in my lab, in my practice, I

4:55

was experiencing it. So I just felt like it

4:57

was something I needed to talk about. When I

4:59

first started to talk about it with

5:01

my colleagues, They were like, oh, high

5:04

function depression isn't real. And I was

5:06

like, you know, this doesn't have to

5:08

be a competition. You know, there can

5:10

be people who break down, who are

5:12

classically crying, but there can also be

5:14

people who are showing up, they're wearing

5:16

this mask of productivity, they're pathologically productive.

5:18

And in my research with PTSD, one

5:20

of the symptoms of PTSD is avoidance,

5:22

right? So you avoid things that bother you,

5:25

that trigger you, that trigger you, like

5:27

people placed in situations. But busying yourself

5:29

is also avoidance because you are

5:31

not thinking about the thing that's

5:33

painful. You're not processing your pain.

5:35

And I think many of us,

5:37

you know, people who are listening right now,

5:39

they busy themselves to avoid dealing with pain,

5:41

to avoid dealing with trauma. I know I

5:44

was one of them. And when I started

5:46

doing the research, I was hearing more and

5:48

more of this. So we have to think

5:50

about depression differently. You know, like the DSM

5:53

is great. It's a wonderful guideline, you know,

5:55

but... The depression of your grandma isn't going

5:57

to be the depression today. We have way

5:59

different. things we're dealing with. We have

6:01

social media. We have constant access to

6:04

bad news. We have this pandemic that

6:06

we don't know how it's impacted us.

6:08

The numbers show that maybe 75% of

6:11

people were infected. We don't know what

6:13

the long-term data is on that. So

6:15

we have different factors to deal with.

6:18

We have to think about depression differently

6:20

because people express it differently. I know

6:22

I did. How much of this subclinical

6:25

depression would you say is environmentally mediated?

6:27

I mean like, you're from, you're out

6:29

from New York City, right? Like that's

6:32

a pretty depressing place to live. I

6:34

mean, said with all love to New

6:36

York, I'm born and raised in New

6:39

York City, but like, the buildings crowd

6:41

out the sun, you're not experiencing nature

6:43

in any meaningful capacity. Most of the

6:46

time, it's a stressful city. So like,

6:48

how much of this is just like,

6:50

we're living in the wrong environment in

6:53

the wrong environment? I get these comments

6:55

and DMs all the time, like, well,

6:57

that's just capitalism, right? And I'm like,

7:00

yeah, you're right. There's something called the

7:02

bio-psychosocial model. All medical students have this.

7:04

And I wanted to make this available

7:07

to everyone. I wanted to democratize mental

7:09

health because in some parts of our

7:11

wonderful country, there is only one of

7:14

me, one psychiatrist, one psychiatrist. If I

7:16

have 30 patients, I feel overwhelmed. So

7:18

30,000, right? So I wanted to make

7:21

this information available to everyone because not

7:23

everyone has access to a psychiatrist. The

7:25

biosyco social model is basically the makeup

7:28

of your happiness. The model of my

7:30

lab is understand the science of your

7:32

happiness because your happiness is different than

7:35

mine. Your background is different than mine.

7:37

all human beings have a biosycosocial, but

7:39

the composites of that are going to

7:42

be different. So biologically, I'll use myself

7:44

as an example, I have low thyroid.

7:46

So biologically, having this low thyroid, which

7:49

is this organ that sits here on

7:51

my neck, that fuels the other organs,

7:53

having that low thyroid puts me at

7:56

risk for depression and anxiety and problems

7:58

with sleep and metabolism issues. Psychologically, I

8:00

have my own history of trauma, so

8:03

I came to this country when I

8:05

was small, we didn't have much, sometimes

8:07

we didn't have food, that scarcity trauma

8:09

is a driving factor in how hard

8:12

I work, right? And then. Other people

8:14

have different factors in their trauma, so

8:16

there are attachment styles. You know, I

8:19

don't know your attachment style, but it's

8:21

probably different from mine. We'll get into

8:23

that as a way. But attachment style,

8:26

resiliency factors, IQ, right? That's all psychological.

8:28

And then social factors, right? You're living

8:30

in LA. I'm living in New York,

8:33

right? You identify that our environments are

8:35

very different. our behaviors every day may

8:37

be different, like whether or not you

8:40

move, the foods that you eat, if

8:42

they're processed, whether or not you're in

8:44

a toxic work environment, you know, the

8:47

quality of your relationships, the work that

8:49

you do, those are all social factors,

8:51

whether or not you drink a lot

8:54

or smoke. So we all have different

8:56

bio-psychosocials, and I wanted this to be

8:58

available to everyone because I didn't understand

9:01

why we weren't sharing this with our

9:03

patients. You know, when when doctors sit

9:05

with you, you better believe they're writing

9:08

up a biosecosocial. But I think everyone

9:10

needs access to this so they understand

9:12

what makes them unique as a human.

9:15

So you understand the science of your

9:17

happiness, because many people are using tools

9:19

that they see online. or they read

9:22

a buck and they're like, why am

9:24

I not happy? Well, it's because you're

9:26

using these tools and you don't know

9:29

how they apply to you. Understand the

9:31

science of your happiness first and then

9:33

use the tools. Some of the tools

9:36

are not made for you. If you're

9:38

using tools that help someone who, let's

9:40

say they're neuro divergent, and they have

9:43

ADHD. Well, if you have trauma, then

9:45

you're just, you don't understand the science

9:47

of your happiness. You need to understand

9:50

what's supposed to you. That makes perfect

9:52

sense. So thyroid, I mean there's so

9:54

much to unpack there, but are there

9:57

any biomarkers or blood tests? I mean,

9:59

I guess thyroid function would be potentially

10:01

one of them that might reveal hidden

10:04

depression. Well, there are risk factors for

10:06

depression. Right now, we don't, unfortunately, have

10:08

the science to say, come into my

10:11

lab and let's take some blood and

10:13

let's image your brain and you definitely

10:15

have depression. Why? There are so, again,

10:18

the biosecosocial model is so different. So

10:20

someone, one person with thyroid disease may

10:22

not have symptoms of depression where another

10:24

person will. And it's important to understand

10:27

all of these biological factors. For example,

10:29

I do research with postpartum depression. The

10:31

depression symptoms in a postpartum mother are

10:34

going to look very similar to the

10:36

depression in another patient, let's say a

10:38

man who has depression, right, because symptoms

10:41

of depression are like low energy, poor

10:43

sleep, poor concentration, anhedonia, which is a

10:45

lack of joy, a lack of pleasure,

10:48

people saying, eh, meh, you know, blah,

10:50

but the driving factors behind, let's say

10:52

this postpartum mother's depression and this man's

10:55

depression are going to be different. The

10:57

postpartum mother is going to experience a

10:59

drop in progesterone in her brain shortly

11:02

after giving birth or even in the

11:04

third trimester of birth. Whereas the man,

11:06

I mean, he doesn't have that. But

11:09

there are other factors involved in that

11:11

person's depression. That's why I want people

11:13

to understand how unique they are. There's

11:16

only going to be one you. right?

11:18

And there will only ever be one

11:20

of you. So why are you not

11:23

understanding what makes you so unique and

11:25

special? Understand your science, your bio psychosocial,

11:27

you know, your risk factors, and then

11:30

do the work from there. I love that

11:32

so much. Yeah. Do you think, do

11:34

you feel like in some ways we

11:36

might though run the risk of pathologizing

11:38

like normal, a normal aspect of human

11:40

emotion? Like this sort of subclinical, like

11:42

I get depressed sometimes, like, does that

11:44

mean I need to book an appointment

11:46

to see you or the equivalent of

11:48

you here in Los Angeles? There is so

11:50

much power in naming things. As human beings,

11:53

the uncertain freaks us out. We're scared when

11:55

we don't know it, right? Think back to

11:57

2020, right? The uncertain is not good for

11:59

humans. the naming of things and identifying

12:01

things is important because it takes away

12:04

the shame, it takes away the stigma,

12:06

and I use a term in psychology

12:08

called affect labeling, I don't know if

12:10

you heard of it, but it's when

12:12

you are able to name an emotion,

12:15

you're less afraid. So I liken it

12:17

to if you were to, you know,

12:19

being in a room and the light

12:21

turns off. and then something falls. Some

12:24

people will swing, right? Some people will

12:26

panic, others will try to escape. But

12:28

if you turn that light on in

12:30

that room and you see it's a

12:32

book that fell, you're like, oh, it's

12:35

just a book, I'm just put it

12:37

back on the bookshelf, you're not freaking

12:39

out because you know what you're dealing

12:41

with. The same happens when you are

12:44

able to name an emotion, name a

12:46

feeling. So when people like myself are

12:48

pushing through life, overworking, they have symptoms.

12:50

there's this uncertainty, like what's wrong with

12:52

me? Why am I like this? But

12:55

then when you put a name to

12:57

it and you say, actually, you're over

12:59

functioning to compensate for your depressive symptoms,

13:01

that's high functioning AF, that's what I

13:04

call it. Then people are like, oh

13:06

my gosh, sorry, that's my post nasal

13:08

drip. Then people are like, oh my

13:10

gosh, like I know what I'm dealing

13:13

with, right? I can name this, I'm

13:15

over functioning. to compensate for my symptoms

13:17

of depression, I have anhedonia, which is

13:19

a lack of joy and pleasure in

13:21

things, blah, empty, then I can do

13:24

something about it. So the naming is

13:26

actually quite powerful in psychology, not to

13:28

pathologize, not to give people labels, but

13:30

so that people know what they're dealing

13:33

with, so then they can apply the

13:35

correct tools. I told you that people

13:37

don't understand the signs of their happiness.

13:39

When I talk about high function depression,

13:41

people are like, I finally have a

13:44

name for what I'm dealing with, you

13:46

know, it's so powerful. And there will

13:48

be pundits, there will be people who

13:50

criticize and say, oh, we're just nameling

13:53

normal things. Well, you know, you had

13:55

to name clinical depression first, right? So

13:57

there's this double standard. And it's not

13:59

a competition. We're not saying that one

14:01

is more important than the other. But

14:04

I think there's a problem in mental

14:06

health where we will. for people to

14:08

break down, right, to check that box,

14:10

no longer functioning, in crisis, in distress,

14:13

and then we act. Well, the numbers

14:15

are showing that the amount of mental

14:17

health conditions, anxiety depression, substance abuse, that's

14:19

increasing. So if the people who are

14:22

technically breaking down, losing functioning, if that

14:24

number is going up, then there's a

14:26

cue. Because right before you break down,

14:28

you have symptoms and then you break

14:30

down. Why are we waiting? It is

14:33

a broken model. And there's this renaissance

14:35

in physical health where you see longevity

14:37

scientists, you know, we're doing great work

14:39

in menopause in longevity science to prevent

14:42

breakdown, right? There's that renaissance and everyone's

14:44

behind it. We need the same for

14:46

mental health because there's less of us.

14:48

There are less psychiatrists. There are less

14:50

child psychologists. And we're seeing this boom

14:53

in people breaking down because of mental

14:55

health. Let's Give them the signs, let's

14:57

give them the tools to understand how

14:59

to maintain joy, how to prevent a

15:02

clinical depression, so that we're not dealing

15:04

with the problems later on when we

15:06

don't have enough providers. This

16:06

All lowercase. Again, that's shopify.com/genius

16:09

to take your retail business

16:11

or that dream you've been

16:14

sitting on to the next

16:16

level today. That's shopify.com/genius. Let's

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make something great together. Enjoy.

16:30

as a box and more as

16:32

like a handle of

16:34

sorts so that you

16:36

can handle better handle what

16:39

it is that you're

16:41

that you're struggling with.

16:43

I sometimes think that

16:45

I'm a high functioning

16:47

depressive. I mean, I've

16:49

never been diagnosed with

16:52

depression, but I've

16:54

struggled with nihilism,

16:56

like feelings that you know, what

16:58

does any of this matter, life

17:00

has no inherent meaning, sometimes, you

17:02

know, occasionally it's been difficult to

17:05

like get out of bed, you

17:07

feel like you're just sort of

17:09

running this perpetual hamster wheel to

17:11

the grave, and then you look around, you

17:13

see so much suffering in the world, and

17:15

it's, I mean... Especially if you're an

17:18

empathetic person and a compassionate person, I

17:20

mean, it can wear on you, it

17:22

can definitely take a toll. How does

17:24

one know if they have high functioning

17:26

depression? I mean, is there like a

17:29

checklist or, you know, like, how do you, what

17:31

sort of like a self inventory that

17:33

you might do? Because I mean, I

17:35

sometimes feel like I'm a, I mean,

17:37

I hadn't had the vernacular prior to

17:39

being introduced to your work. But I

17:41

feel like I meet some of this

17:44

criteria. Like what if I'm a high

17:46

functioning depressive? Well, that's something that

17:48

actually crashed my website. So when

17:50

I first started talking about Anadonia,

17:52

people had never heard of it.

17:55

And for me, who's like I'm

17:57

in research, I've been using Anadonia

17:59

ratings. for the past 10 years.

18:01

So I thought it was like boring

18:03

and not interesting, but people, they wanted

18:05

more information on it. And the first

18:08

time I talked about it on a

18:10

major podcast, 10,000 people filled out my

18:12

Anhedonia rating scale like that day. So

18:14

it overwhelmed my website wasn't made for

18:16

that. I've upgraded since then, but you

18:19

know, there's a rating scale on my

18:21

website where you can fill out Anhedonia

18:23

symptoms. So if you think about the

18:25

word Anhedonia, A is lack of, hedonism

18:28

like pleasure and the Nia is like

18:30

the condition or the symptom. So when

18:32

you have joy, what is happiness to

18:34

you, right? Many people don't know what

18:36

it is. They think it's this idea

18:39

of they achieve a career or they

18:41

have a home or a partner, but

18:43

that's not what happiness is in science.

18:45

In my lab, when we look at

18:47

happiness, you will rarely find the word

18:50

happy on any of the rating scales.

18:52

So there's a disconnect between what researchers

18:54

think and what we study and what

18:56

the general population thinks, because when a

18:58

patient comes in, they're like, I just

19:01

want to be happy. But in academia

19:03

and in research, we're just trying to

19:05

eradicate depression. But what happiness is, is

19:07

just a plethora of these sensations that

19:09

make being a human worth living. So

19:12

when you eat, you savor and enjoy

19:14

your food. When you're with a loved

19:16

one, you feel connected. You don't feel

19:18

lonely. when you're watching something beautiful, like

19:21

a beautiful movie or scenery, you're in

19:23

a state of awe, that's what joy

19:25

is. But we have it wrong. We

19:27

have this image of happiness being like

19:29

the perfect family on Instagram, right? or

19:32

the being a boss lady having all

19:34

the things right but that is not

19:36

what happiness is in terms of the

19:38

human condition in terms of the science

19:40

of your happiness it's a plethora of

19:43

sensations so when you fill out the

19:45

antonia rating scale and you look at

19:47

things like when you're sleeping and when

19:49

you wake up are you rested no

19:51

right when you have a cup of

19:54

coffee is it enjoyable to you I

19:56

just chug my coffee when you're intimate

19:58

with your loved one are you just

20:00

trying get it over with or are

20:02

you in the moment? A lot of

20:05

people are just trying to get through

20:07

it, you know. Those are all the

20:09

points of joy, right? That make up

20:11

being like life is worth living, right?

20:13

Like you were describing when you wake

20:16

up like what's the point? If you're

20:18

not having those points of joy, then

20:20

you may have anhedonia and an anedonia

20:22

is a symptom of depression, but it's

20:25

the silent. symptom of depression that people

20:27

overlooked, right? So when I think about

20:29

depression, I think of twin sisters, right?

20:31

There's depression and there's anhedonia. There's depressed

20:33

mood and there's anedonia. Depressed mood looks

20:36

like a crying person who's not getting

20:38

out of bed. Anhedonia is not crying.

20:40

They're blunted. They're muh. So they're silent.

20:42

So your doctor doesn't look for symptoms

20:44

of anedonia. They look for depression. They

20:47

wait for you to break down to

20:49

no longer want to live to live.

20:51

Not, is your life worth living, is

20:53

your life worth living. Right? That's the

20:55

nuance. And I wanted people to understand

20:58

that because then they'll realize, wait, there's

21:00

nothing wrong with me. Other people feel

21:02

this way. Anadonia is a real thing.

21:04

And it's robbing me of joy in

21:06

life. And when you think about being

21:09

a human, we're built with the DNA

21:11

for dopamine for a reason. But many

21:13

of us are on our phones. We're

21:15

just like getting that dopamine hit. We're

21:17

feeling blah, meh, because we're overwhelming our

21:20

brain with things that are not enriching

21:22

our lives. So put the phone down

21:24

and start walking through grass, you know,

21:26

start looking at a sunset. The parts

21:29

of your brain that light up when

21:31

you look at a sunset in real

21:33

time are different than if you look

21:35

at a sunset on your screen, right?

21:37

So we need to actually become humans

21:40

again, right? Instead of a human doing,

21:42

you're a human being, and then tap

21:44

into that. But yeah, that was a

21:46

long-witted way of answering a question. You

21:48

know, how do I know? We'll fill

21:51

out the an anadonia scale. Again, the

21:53

symptoms of depression are well known. Low

21:55

energy, low concentration, low mood, feelings of

21:57

hopelessness and guilt. If you have those

21:59

symptoms, because I have a scale for

22:02

that too, I'm a researcher. But you're

22:04

still functioning. In fact, you're over functioning.

22:06

You have symptoms, and your doctor's

22:08

going to wait for you

22:10

to break down. I'm telling

22:12

you don't wait. Do something

22:15

about it now. Prevent the

22:17

breakdown, right? So you can

22:19

still do the things that you

22:21

want to love, that you do

22:23

love in life, that you want

22:25

to be doing. I love that. who

22:28

you are, like at your core. I mean,

22:30

I, for as long as I can remember

22:32

as a child, I would get

22:34

bored really easily. Like my parents

22:36

would take me on vacation. I

22:39

would just remember I would always

22:41

be bored. I would constantly be

22:44

just unimpressed. So there hasn't really

22:46

been much of a change as far

22:48

as my own personal level

22:50

of anhedonia goes. But I guess

22:52

for some, maybe... you know, if there's

22:54

a change, is that something that might

22:56

be more worrying? If there's a change

22:59

and also, is it impacting your

23:01

relationships? Usually I don't have someone

23:03

coming to my office and saying,

23:05

doc, I'm anhedonic. It's, you know,

23:07

I'm not doing as well at

23:09

work and my or my partner,

23:11

you know, we're just not getting

23:13

along. There's something happening. There's this

23:15

shift that's occurring. Or, you know,

23:17

they just feel as if Life

23:19

is not where they thought it

23:21

was going to be. There's usually

23:24

a turning point because people are

23:26

on this anhedonic road for quite some

23:28

time until something changes, you know, and

23:30

I always say that, you know, listen

23:32

to your body, you know, like what's happening

23:34

in your body. Sometimes I get people

23:36

coming to my office who are referred

23:39

from a medical doctor, like, you know,

23:41

like a physician for medical health. and

23:43

they're having, they're experiencing some pain or

23:45

some discomfort. Back pain is one thing

23:47

that I see a lot of, and

23:49

they're going through all these workups, they're

23:51

in physical therapy, they're taking meds, and

23:54

they're still having back pain, there's no

23:56

root to it, or, you know, it's

23:58

not as bad as the... but it's

24:00

because they're they're just having so

24:02

much angst right they don't they're

24:04

not sleeping properly or when they're

24:06

sleeping they're turning their bodies right

24:08

and we get down to the

24:10

root of it and it's it's

24:12

really a lot of it isn't

24:14

what's happening in their head interesting

24:16

so you see a lot of

24:18

patients that have back pain with

24:20

a psychosomatic origin I do wow

24:22

I suffered with back pain for

24:24

a really long time and I

24:26

just had back surgery a month

24:28

surgery a month and I was

24:30

sort of aware of some of

24:32

that literature linking back pain to

24:34

emotions and things like that. And

24:36

for me it was definitely not

24:38

emotional. It was like completely structural,

24:40

but that's very interesting that you

24:42

like see this. People, the mind-body

24:44

connection is real. I used to

24:46

be an anesthesiologist, so before I

24:49

switched to psychiatry, but people carry

24:51

a lot in their backs and

24:53

their necks. So some of it

24:55

is, again, look at the biosecical

24:57

social, some of it is what

24:59

they do for a living, so

25:01

people who tend to overwork work.

25:03

there are like this in front

25:05

of their screens and if you

25:07

do that for long enough you're

25:09

going to get back pain you

25:11

know yeah and if you're not

25:13

getting the right nutrition because food

25:15

and the nutrients in food replenish

25:17

your body and if you're not

25:19

getting enough of a well-rounded diet

25:21

you're not getting good nutrients so

25:23

vitamin B deficiencies can lead to

25:25

a lot of pain odd and

25:27

neurological symptoms. And I've seen this

25:29

so many times where people who

25:31

aren't eating properly are coming in

25:33

with all these pains and they're

25:35

like, you have to see a

25:37

psychiatrist because there's something going on

25:39

with you. Well, it's because they're

25:41

not taking care of themselves, right?

25:43

They're humans doing, not humans being.

25:45

And so they're not eating foods

25:47

that really enrich them and they're

25:49

experiencing neurological issues. And then people

25:51

who are not getting good sleep.

25:53

They have a lot of stress

25:55

in their body and they have

25:57

unresolved trauma and their body is

25:59

just really like fighting it. You

26:01

know, they're in fight or flight,

26:03

they're tense all the time, so

26:05

they have a lot of pain.

26:07

So absolutely, back pain is tied

26:09

to a lot of mental health

26:11

issues. That's crazy. And I don't

26:13

doubt it. Are there gender differences

26:15

in terms of the prevalence of

26:17

high functioning depression? Well, women are

26:19

twice as likely to have depression

26:21

and anxiety than men. Twice. I

26:23

mean, whenever I hear that, and

26:25

I've heard this many times, I'm

26:27

just always in awe, even though

26:29

I know that women have different

26:31

hormones, they are more prone to

26:33

these vulnerable pockets in life. Like,

26:35

think about the teenage girl who's

26:37

going through her first period and

26:39

she's moody. Think about the postpart

26:41

of mother. who is told to

26:43

be happy when 80% of women

26:45

experience sadness, when they give birth,

26:47

80%, right? And then think about

26:49

perimenopause and menopause. Those are emotional

26:51

rollercoasters in terms of what the

26:53

hormones do. So it's no wonder,

26:55

right? And that's why I want

26:57

people to understand the science of

26:59

their happiness because biologically being a

27:01

woman puts you at risk. Then

27:03

you don't feel crazy. You don't

27:05

feel that there's something wrong with

27:07

you. You know that your hormones

27:09

are tied to it. And it's

27:12

not to say that women are

27:14

crazy and they can't be trusted,

27:16

but if we know what we're

27:18

dealing with them, we're not going

27:20

to overwhelm ourselves at certain parts

27:22

in life. We're going to get

27:24

more support. And others will support

27:26

us. But if we don't know,

27:28

then what do we do? We

27:30

feel guilty because we're moody. We

27:32

say, oh, I wish I was

27:34

different. Or I used to not

27:36

be like this. We turn on

27:38

ourselves. We blame ourselves. There's a

27:40

lot of shame. There's a lot

27:42

of shame. There's a lot of

27:44

shame. There's a lot of shame.

27:46

There's a lot of shame. And

27:48

this is me, like, before I

27:50

get my period, I'm like, oh,

27:52

like, I know I'm not going

27:54

to schedule myself too much, right

27:56

before my period, right? I'm going

27:58

to take care of myself. I'm

28:00

going to get better sleep. I'm

28:02

going to eat better. I'm going

28:04

to not, you know, overwork myself

28:06

at the gym. I'm going to

28:08

probably do like more walking. Then

28:10

my outcome is better. Then I

28:12

don't blow up. That I'm not

28:14

moody, right. Shaping your life and

28:16

your support around that science is

28:18

so empowering. As a psychiatrist, do

28:20

you think we have a, does

28:22

a field, does the field in

28:24

your purview have an overprescription problem?

28:26

I mean, we've... There's being a

28:28

lot of focus now being placed

28:30

on, you know, the prevalence of

28:32

SSRI use in this country and

28:34

particularly for certain populations. I mean,

28:36

what comes to mind for me

28:38

is women over 40, one in

28:40

four are on some kind of

28:42

anti-deperson drug. Do you believe we

28:44

have an over-prescription problem? I don't.

28:46

I think that there may be

28:48

under diagnosis. I think that people

28:50

don't have access to care. So

28:52

if there are, let's say, over-presribing,

28:54

then it's probably like... over prescribing

28:56

without therapy, because a lot of

28:58

the prescriptions are probably coming from

29:00

people who are not therapists, because

29:02

there just aren't enough of us.

29:04

There aren't enough psychiatrists. And psychiatrists

29:06

are trained to prescribe and to

29:08

provide therapy. But there aren't enough

29:10

of us, so people are getting

29:12

their medications from primary care doctors,

29:14

from obese, and there's nothing wrong

29:16

with that. But I do think

29:18

that having that added support of

29:20

therapy is beneficial. If antidepressants cured

29:22

everything, we'd all be on them.

29:24

It'd be in the water. But

29:26

they're not, right? And there's great

29:28

supports. Remember I mentioned that women

29:30

are twice as likely to have

29:32

depression anxiety. We need supports. I

29:34

don't think there are enough interventions

29:37

in terms of therapy in terms

29:39

of processing trauma because women are

29:41

also at high risk for trauma.

29:43

When people think trauma, they think

29:45

combat veterans. No. Women are unfortunately

29:47

survivors of sexual assault, right, a

29:49

physical battery. And so I don't

29:51

think there are enough supports in

29:53

addition to the medication therapies. Yeah,

29:55

but there, I mean, there have

29:57

been studies that have found that,

29:59

you know, for example, certain SSRI

30:01

drugs in certain depressed populations, like

30:03

people with mild depression, don't seem

30:05

to derive an effect from these

30:07

drugs more significant than they would.

30:09

exercise for example, right? Like, at

30:11

least from my vantage point, it

30:13

does seem that there are people

30:15

that are being prescribed these drugs

30:17

that are not necessarily driving benefit

30:19

from them, but are likely deriving,

30:21

you know, the side effects and

30:23

whatever from these drugs, like the

30:25

impaired libido, waking, all that stuff.

30:27

Well, what I will tell you

30:29

is that not everyone is ready

30:31

to change their lives. Not everyone

30:33

wants to do the work. Think

30:35

about the practical aspects of therapy.

30:37

You have to find a therapist.

30:39

Then you have to find a

30:41

therapist that you can afford. Then

30:43

you have to find a therapist

30:45

who fits into your schedule. Then

30:47

you have to actually do the

30:49

work, right? So for many people,

30:51

that is not an option. And

30:53

I think that's probably one of

30:55

the factors getting in the way

30:57

of maybe getting the most out

30:59

of a medication management. I do

31:01

medication prescriptions, and I also do

31:03

therapy. But not everyone has access

31:05

to someone like me. and that's

31:07

why I want people to be

31:09

very careful when they make statements

31:11

like this because as someone who

31:13

sees patients every day in my

31:15

practice I've seen how having the

31:17

support of an antidepressant it may

31:19

not eradicate your depression but it'll

31:21

get you better sleep it'll mitigate

31:23

anxiety it may take you from

31:25

like feeling depressed and wanting to

31:27

end your life to actually being

31:29

depressed but not wanting to end

31:31

your life, you know? And so

31:33

I want people to be very

31:35

careful about that because anti-depressant use

31:37

is very, very like rampant in

31:39

this country. And there are many

31:41

causes towards depression, right? We talk

31:43

about the biosecocosocial. For many people,

31:45

they can't even like afford to

31:47

get by, right? And their circumstances

31:49

are depressing for them. What are

31:51

we going to do? Take away

31:53

the support of it. gentle when

31:55

we approach people who are taking

31:57

antidepressants because you would never say

31:59

to someone who's using an inhaler

32:02

for their asthma, well don't you

32:04

think you need to just like

32:06

move to a place where you

32:08

can breathe clearer? Like that would

32:10

just sound so out of touch

32:12

or someone who was on diabetes

32:14

medicines like. Well, you should just

32:16

eat less doughnuts. Well, not everyone

32:18

has that self-control, right? Some of

32:20

us have different factors driving the

32:22

way that we eat. Some of

32:24

us can't access healthy foods. We

32:26

would never shame someone. But there's

32:28

that shame with depression when we

32:30

don't even realize the brain, the

32:32

brain is a part of our

32:34

bodies. Why are we telling people

32:36

like, you're using too many antidepressants?

32:38

That's a part of your body.

32:40

And some people are more prone

32:42

to depression than others. So I

32:44

want us to be very careful

32:46

when we talk about mental health

32:48

conditions. The brain is a part

32:50

of our bodies and people do

32:52

need support. And when we have

32:54

these like blanket statements, then you

32:56

know, some people are very impressionable

32:58

and they're saying things like, well,

33:00

maybe I should stop it. Maybe

33:02

I need to do this differently.

33:04

Two things can be true, right?

33:06

Yes, like, antidepressant use is common

33:08

and we should also be implementing

33:10

behavioral methods, therapies, other supports, right.

33:12

They're not. different truths. They're the

33:14

same. No, I totally appreciate that.

33:16

It doesn't help anybody to take

33:18

a black or white stance, you

33:20

know, on something so complicated and

33:22

nuanced and particularly, you know, when

33:24

addressing such a diverse population as

33:26

the United States population, where access

33:28

is so different, I couldn't agree

33:30

more. It's super important. We don't

33:32

place a stigma on drugs or

33:34

anything like that, but I think

33:36

it's... It relates to the like

33:38

the conversation now that many people

33:40

are having regarding these G.L.P. one

33:42

agonist drugs like these weight loss

33:44

drugs like I'm super glad that

33:46

we now have them on the

33:48

market as a fail safe for

33:50

people for whom lifestyle change is

33:52

difficult if not impossible and have

33:54

just experienced lifetimes of yo-yo dieting

33:56

and maybe they live in food

33:58

deserts where they don't have access

34:00

to healthy food or what have

34:02

you. I mean there are many

34:04

reasons that might push one towards

34:06

you know the the use of

34:08

one of these drugs. But I

34:10

always think that it's best used

34:12

as a fail safe like as

34:14

a last. line defense. The first

34:16

line should always be, you know,

34:18

safe and healthy and effective lifestyle

34:20

modifications, you know. And if those

34:22

don't work, then, like I have

34:24

a family member taking one of

34:27

these, the G.L.P. one drugs, and

34:29

he's lost a lot of weight

34:31

with it, thus lowering his risk

34:33

for cardiovascular disease, Alzheimer's disease, and,

34:35

you know, all of the other

34:37

conditions that it's now being linked

34:39

to, but But then you hear

34:41

some that suggest almost as though

34:43

we should be putting semagletide in

34:45

the water in the water supply

34:47

I Haven't heard that but I

34:49

have you know I've done several

34:51

studies in my lab based on

34:53

binge eating And I can tell

34:55

you that for some people Their

34:57

metabolic picture is so challenging that

34:59

I Think they need that support

35:01

and sorry And, you know, with

35:03

these people, like with these studies

35:05

that I've done, there's usually a

35:07

food journal, and there's also the

35:09

medication intervention, right? So one is

35:11

a therapy, and one is a

35:13

medication intervention. I could tell you,

35:15

many people, they struggle. They can

35:17

be the most disciplined, the most

35:19

intelligent. have a great family support,

35:21

but they're metabolically challenged. So they're

35:23

going to need that support. Should

35:25

it be in the water? No.

35:27

Nothing should be in the water,

35:29

but water. Some would argue lithium,

35:31

but no. But I think we

35:33

have to be careful with this

35:35

messaging because there's a huge assumption,

35:37

right? Because you see all these

35:39

influencers and they're ripped and they're

35:41

in their mansions and they're like,

35:43

it's just like a matter of

35:45

not having discipline. Easy for you

35:47

to say. I've worked with so

35:49

many patients, like I see children,

35:51

adolescents, adults, and geriatric patients, like

35:53

being compassionate and empathic is so

35:55

important and understand that not everyone

35:57

has your access and not everyone

35:59

has your history, right? the science

36:01

of your happiness. So try and

36:03

like, take it with a grain

36:05

of salt and don't assume people

36:07

have things that you have because

36:09

everyone has different struggles. And that metabolic

36:12

challenge, that's something, it's really

36:14

difficult. They get judged, you

36:16

know, people are viewed as being

36:18

lazy, you know, and it's really,

36:20

really challenging for them to walk

36:22

through life, being judged for something

36:25

that they can't control. Yeah,

36:27

certainly nobody should be judged.

36:29

comparing yourself to influencers on

36:31

social media, who are all

36:34

using filters, performance enhancing drugs,

36:36

have obsessive, you know, probably

36:38

likely even unhealthy relationships with

36:40

food and or their bodies.

36:42

And yeah, that's important. That's

36:44

an important disclosure. It's not

36:47

often made. It's not. And like,

36:49

I see a lot of my adolescent

36:51

male patients will come in and they're

36:53

like, I want to look just like

36:56

this guy and there's just. They just

36:58

have this image that it's so easy

37:00

to be perfect. And there are so

37:02

many patients that struggle with that physical

37:05

embarrassment and that shame. Like, why can't

37:07

I just be like this other person?

37:09

And these are real challenges for them.

37:11

And some people are abusing it, right?

37:13

There's always like, oh, there are people

37:15

who are just using it when they

37:18

shouldn't be. But I believe that the

37:20

majority of people who are

37:22

on these medications, they really

37:24

have a hard time controlling.

37:26

their metabolic issues and they're

37:28

getting the appropriate care.

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So what do we do then?

39:01

I mean, so many people today

39:03

are struggling with issues related to

39:05

mental health. We live in stressful

39:07

times, social media is pervasive, and

39:09

it is a double-edged sword in

39:12

the sense that most of us

39:14

do need it to stay connected

39:16

these days to our friends and

39:18

loved ones. and many of us

39:20

have businesses that require the use

39:22

of social media myself included, but

39:24

on the other hand, it's not

39:26

doing our mental health any favors,

39:28

and then you look at the

39:31

larger, you zoom out and you

39:33

look at the larger socio-cultural political

39:35

environment where everybody's at each other's

39:37

throats 24-7, and it seems almost

39:39

as if we are living in

39:41

a perfect storm for mental distress.

39:43

the perfect storm. Absolutely. And like

39:45

anything, we need to think about

39:48

how it's impacting our lives. Social

39:50

media impacts us. I truly believe

39:52

that there's going to be a

39:54

section in the Bible Psychiatry one

39:56

day talking specifically about how the

39:58

use of social media and technology

40:00

impacts us. And I know that

40:02

people are studying this even today

40:05

as we speak. There's a whole

40:07

Stanford Zoom study center, right, where

40:09

they're looking at the impacts of

40:11

zoom meetings on people's well-being. Why?

40:13

Because it's a natural to be

40:15

looking at yourself when you're talking

40:17

to others, right? That puts this

40:19

level of self-scriny on us and

40:21

that performance and that anxiety that

40:24

we never had before. And being

40:26

sedentary, you know, sitting at a

40:28

desk. For that many meetings, that's

40:30

not how human beings were designed.

40:32

We were designed to move You

40:34

know being on platforms where we

40:36

see 10 faces at once like

40:38

come on There's nothing human about

40:41

that. So yes technology impacts us

40:43

and I do believe that we

40:45

will have more data There's already

40:47

emerging data about children and how

40:49

it impacts their self-esteem their acceptance,

40:51

you know, the rejection that they

40:53

feel And we're looking at humans.

40:55

There was a recent study looking

40:58

at adults, adult humans who were

41:00

being deprived of phones that were

41:02

seamlessly connected to the internet. That's

41:04

different than like the phones growing

41:06

up, like those phones. So basically

41:08

smart phones and they removed these

41:10

adults from the smartphone access for

41:12

two weeks. And they experienced something

41:14

of an antidepressant effect. Now not

41:17

clinical depression, but like the symptoms

41:19

of depression like poor concentration, low

41:21

mood, poor sleep, anhedonia improved when

41:23

they were removed from having access

41:25

to these smartphones for just two

41:27

weeks. Right? So we do need

41:29

to think about how that plays

41:31

into anhedonia. This numbing. And when

41:34

you look at a phone, it's

41:36

so immersive. There's easy access. The

41:38

drugs that are most addictive are

41:40

immersive. with easy access. So you

41:42

have, they just feel as if

41:44

they fit neatly into your life.

41:46

But then we can become dependent

41:48

on those drugs, right? The phone.

41:50

We get dependent. not with it,

41:53

we feel anxious. That's a form

41:55

of withdrawal. Not the same, clearly

41:57

as a substance, but very similar

41:59

in terms of the pathways of

42:01

reward in our brain. And so

42:03

we have to realize whether or

42:05

not we get anxious when our

42:07

phones are not near us. That's

42:10

a good indicator that maybe we're

42:12

spending too much time on our

42:14

phones. Something called fummel, right? pulled

42:16

adults away from this immersive technology

42:18

and they actually felt better. So

42:20

you can do an experiment with

42:22

yourself. You can say, okay, I'm

42:24

gonna limit my smartphone used to

42:27

X amount of hours a day

42:29

or during these pockets of time

42:31

a day. Or when I'm with

42:33

my family, I'm not gonna have

42:35

it in the room. And you

42:37

can see whether or not your

42:39

anhedonia improves, right? Does your sleep

42:41

get better? Are you paying attention

42:43

to your loved ones more? Is

42:46

your focusing better? These are all

42:48

symptoms of depression. So the study

42:50

looked at people's, you know, these

42:52

symptoms of depression that improved. So

42:54

it was almost like an antidepressant

42:56

effect. Wow. I feel better when

42:58

my phone is not on me.

43:00

Sometimes I'll go to the gym

43:03

and I'll put my phone, I'll

43:05

lock my phone in the locker

43:07

just so I get, you know,

43:09

an hour of uninterrupted me time.

43:11

Yeah, I think that's great advice.

43:13

What's... If you can name one,

43:15

a simple habit shift that somebody

43:17

could make today to start feeling

43:20

more joy, even if they don't

43:22

feel like it's possible. I think

43:24

to feel more joy, first, and

43:26

I'm going to say it again,

43:28

understand the science of your happiness,

43:30

right? So if you're someone who

43:32

has unprocessed trauma, it's hard to

43:34

be happy when you're in fighter

43:36

flight. So if you're someone with

43:39

unprocessed trauma and you're in fighter

43:41

flight, Do something that's grounding so

43:43

you're present. And that could be

43:45

as simple as drinking tea and

43:47

letting all your emotions be there

43:49

when you drink that tea. So

43:51

that's like feeling the warmth in

43:53

your hands. at the color of

43:56

the tea, smelling it, listening to

43:58

how it sounds as you feel

44:00

it going down your throat, right?

44:02

So that very present act can

44:04

ground you. If you're someone who's

44:06

neuro divergent, right, and it's hard

44:08

to focus and be present, and

44:10

that's what's blocking your happiness, then

44:13

simplify your life, declutter, you know,

44:15

like make it easier in the

44:17

morning to get up, get your

44:19

bag and out, so you're not

44:21

flustering look for your keys and...

44:23

trying to figure out your schedule,

44:25

simplify your life. If you're someone

44:27

who has anhedonia and it's hard

44:29

to enjoy things, maybe focus on

44:32

one thing that day. You know,

44:34

like, I'm going to eat my

44:36

meal without looking at a screen

44:38

and I'm going to describe all

44:40

the flavors of my salad. I'm

44:42

going to crunch the almonds. I'm

44:44

going to taste the zest in

44:46

the Caesar dressing. You know, like,

44:49

those small interventions are increasing your

44:51

points of joy. I mentioned that

44:53

in my lab we measure happiness

44:55

based on points. It's not about

44:57

becoming happy, the state that is

44:59

static, that many of us strive

45:01

for and we fail. It's about

45:03

becoming happier. That nuance is so

45:06

important because when you think about

45:08

becoming happier, it's okay, how many

45:10

points of joy can it get

45:12

today? So that one point could

45:14

be better sleep. That number two

45:16

point could be more connection. It's

45:18

about increasing the points every day

45:20

to becoming happier. And then you're

45:22

like, okay, well, today I'm two

45:25

points happier than I was yesterday.

45:27

And then you feel as if,

45:29

okay, there's hope. But when you're,

45:31

like, working towards this idea of

45:33

happy, right, I will be happy

45:35

when I have a partner, a

45:37

career, a home, you know, the

45:39

perfect dog, then you may never

45:42

be happy. And you may never

45:44

be happy. And the research shows

45:46

that people who delay happiness until

45:48

they get a goal. every day.

45:50

Tomorrow is not promised. We have

45:52

today. So increase the points today.

45:54

It's also happiness is an inside

45:56

job. something that you can just

45:58

acquire with a new car or

46:01

a better house or I mean

46:03

it's it's something that yeah you

46:05

have to you have to cultivate

46:07

and it's like a practice is

46:09

it is it worth making the

46:11

distinction between items things activities that

46:13

bring you pleasure versus enduring happiness

46:15

like is there a difference between

46:18

pleasure and happiness there is so

46:20

sorry pleasure are these sensations, the

46:22

dopamine bumps that you get from

46:24

engaging in these human activities. Happiness

46:26

tends to be this idea, right,

46:28

that like this is a state,

46:30

this is what happiness looks like,

46:32

versus experiences, experiences versus idea. Different

46:35

shift, but it could be a

46:37

game changer for people who have

46:39

been struggling with depression. with becoming

46:41

happy all their lives, right? And

46:43

I have patients who come in

46:45

every day and they're like, when

46:47

I thought about it differently, when

46:49

I thought about getting these points

46:51

by engaging in these human experiences

46:54

that bring me pleasure and joy,

46:56

that feels so much more doable.

46:58

That feels so much more attainable.

47:00

But when I was chasing happy,

47:02

this idea, this ideal, I was

47:04

coming up short. I felt like

47:06

it was hopeless. And that very

47:08

simple shift is so important. Because

47:11

a lot of us are in

47:13

our in our heads. I was

47:15

the existential kid. I was the

47:17

broody teenager who were like the

47:19

Wednesday outfits, right? Totally like, emu.

47:21

And I used to think about

47:23

like, what's the point of life,

47:25

blah, blah, blah, blah. And then

47:28

when I shifted that, you know,

47:30

as a researcher, like, how do

47:32

I get points every day? It

47:34

was, it was eye opening for

47:36

me. And I started sitting with

47:38

my daughter more and like, you

47:40

know, playing with her and being

47:42

present. or said that pleasure is

47:44

dope. where is happiness is serotonin

47:47

mediated? Is there any truth to

47:49

that? That's really scientific. There is

47:51

some truth to that because it's

47:53

very similar to what I was

47:55

saying, right? Like the dopamine is

47:57

the engaging in the activities that

47:59

give you those hits, whereas serotonin.

48:01

We like getting dirty. It's like,

48:04

you know, the antidepressant that floods

48:06

your brain, right, to give you

48:08

that state, but I don't think

48:10

you can really prove that, right?

48:12

We're not there yet. The science

48:14

isn't there yet. Well, MDMA floods

48:16

your brain, serotonin, right? Well, MDMA

48:18

floods your brain with serotonin, right?

48:21

MDMA floods your brain, serotonin, serotonin,

48:23

and other neurotransmitters, Gabba. So it's

48:25

not clean and cut. correlation is

48:27

not the same as causation. It's,

48:29

you know, like that's great that

48:31

we're getting there, we're not there

48:33

yet, or else everybody would be

48:35

getting their brain scanned and getting

48:37

diagnosed and then we wouldn't need

48:40

psychiatrists. But again, the science of

48:42

our happiness is so different. You

48:44

know, when your brain goes through

48:46

the postpartum phase and your progesterone,

48:48

that's not the same as serotonin,

48:50

but there's interactions with Gaba, right?

48:52

That's why a lot of... postpartum

48:54

mothers are anxious and they have

48:57

OCD-like symptoms where they're constantly checking

48:59

to see their babies, okay? Because

49:01

that progesterone interacts with the gabba.

49:03

And so there's, that's a link

49:05

between anxiety and depression in the

49:07

postpart brain. So it's so, we're

49:09

just such incredible humans. And it's

49:11

so complicated. So complex. Yeah, I

49:14

mean, I guess that is a

49:16

very overly simplistic way of thinking

49:18

about it, because also there was

49:20

that. That long-standing myth about depression

49:22

being a chemical imbalance, I mean

49:24

that was sort of overturned fairly

49:26

recently, wasn't it? Yes, it's just

49:28

it's not that simple and we

49:30

we have to think about the

49:33

factors that play into the happiness,

49:35

the science of your happiness, right?

49:37

If we're that simple, again, everybody

49:39

would be on a pill, we'd

49:41

all be like serotonin and happy.

49:43

But it's not that simple. There

49:45

are factors involved. Someone who is

49:47

highly traumatized, who is having flashbacks

49:50

every day, they're not going to

49:52

be happy. Given them like a

49:54

dopamine hit isn't going to change

49:56

their trauma. And that's why it's

49:58

so important for us to understand

50:00

our own happiness, the signs of

50:02

our own happiness. Have you done

50:04

any research with regards to psychedelic

50:06

assisted psychotherapy? I mean, we recently

50:09

had Dr. Robin Carhart Harris on

50:11

the show, who's one of the

50:13

preeminent researchers in the space using

50:15

like silosibin and treatment resistant depression,

50:17

stuff like that. Has that sort

50:19

of crossed your purview at all?

50:21

Well, I am doing a city

50:23

right now with the post-partum woman,

50:26

with a silosibin-like medication. There's a

50:28

tweak on it. It is interesting,

50:30

I can't talk about the results,

50:32

but I think that, you know,

50:34

working with these agents is so

50:36

important. There's a lot of restrictions,

50:38

you know, certain states, I think,

50:40

I believe only Oregon allows you

50:43

to use silicone without like getting

50:45

arrested, but if you're not in

50:47

a research facility, like my lab,

50:49

you don't have access to it.

50:51

But I do think that that

50:53

is a part. of the future

50:55

that gives me hope in terms

50:57

of, you know, treatment resistant depression,

50:59

things like PTSD where people have

51:02

tried everything and, you know, they're

51:04

still feeling stuck. But I do

51:06

think that that is a part

51:08

of the future. And I'm very

51:10

fortunate to be a part of

51:12

it. Yeah, I know. I'm so

51:14

grateful that you're on the front

51:16

lines like working on this stuff

51:19

because, I mean, what's so exciting

51:21

to me about that research is

51:23

that it's a natural substance where

51:25

one... or just a handful of

51:27

doses in the right setting leads

51:29

to enduring like symptom improvement to

51:31

the point of remission for patients

51:33

with treatment resistant depression that would

51:36

otherwise need to be on these

51:38

drugs for life and you know

51:40

these drugs are not without there

51:42

like there's no free life. when

51:44

it comes to synthetic pharmaceuticals, like

51:46

they're not without their unintended effects.

51:48

But these these these these psychedelic

51:50

drugs don't seem to have any

51:52

enduring negative like effects and the

51:55

the risk in the appropriate setting

51:57

the risk of adverse effects seems

51:59

to be really low. The issue

52:01

is that there aren't enough people

52:03

to assist the therapies, you know,

52:05

like with these interventions you have

52:07

to have someone with the person

52:09

to guide them through it. They're

52:12

just aren't enough of of these

52:14

people out there. And so that's

52:16

the limitation. But I do hope

52:18

that more professionals will get trained,

52:20

that they're not gonna be afraid

52:22

of using these interventions, and that

52:24

they realize it's worth it to

52:26

at least have this added skill

52:29

set so that when the time

52:31

comes, and hopefully if it is

52:33

available, they can assist their patients

52:35

through the guided therapy. Yeah. So

52:37

if someone is feeling off, but

52:39

can't. pinpoint why? What's the first

52:41

step you'd tell them to take

52:43

today? You are not alone. validate.

52:45

I say that happiness is within

52:48

a reach and if you look

52:50

at your hand, most of us

52:52

have five fingers, and I have

52:54

this system called the five v's.

52:56

So the first step is validate

52:58

how you feel. Accept it and

53:00

acknowledge it. Many of us, you

53:02

ask, how are you doing? And

53:05

we'll say, I'm fine, say it.

53:07

or like at least accept it

53:09

in your mind. Self validation is

53:11

important. Number two, express it. If

53:13

you don't have someone to talk

53:15

to, not everyone has access to

53:17

therapist or a loved one, you

53:19

know, many are lonely, write it

53:22

down. Or sing it out if

53:24

you're a singer or performer. Express

53:26

it, that's called venting. And number

53:28

three is values. Tap into what

53:30

brings your life meaning and purpose.

53:32

It doesn't have to be great,

53:34

you don't have to go out

53:36

and like change the whole world,

53:38

but if you value nature, take

53:41

a walk in nature as much

53:43

as you can every day. or

53:45

by a plant, do something that

53:47

taps into your values. Number four

53:49

is vitals. You only get one

53:51

body. I tell my daughter every

53:53

day, how many bodies did I

53:55

give you? And she goes, one,

53:58

what do you gotta do? Take

54:00

care of it. Take care of

54:02

your body. That could be a

54:04

small intervention. It's drinking water or

54:06

resting or taking a break to

54:08

breathe. Honor your body, you only

54:10

get one. And then the fifth

54:12

is vision. We often get stuck

54:14

in the past. Start planning joy.

54:17

It doesn't have to be grand.

54:19

It could be, you got your

54:21

kit to school on time, sit

54:23

down and enjoy a cup of

54:25

coffee and say, wow, I did

54:27

that. You know, like, plan joy.

54:29

Put it in your schedule. What

54:31

am I going to plan for

54:34

myself? If you're someone who takes

54:36

care of everyone else, plan something

54:38

for yourself, even if it's small.

54:40

But that vision, that moving forward

54:42

will keep you from getting stuck

54:44

in the past. And usually when

54:46

I give this talk in front

54:48

of people, I hold my hand

54:51

up and it reminds me of

54:53

him of that as a pastor.

54:55

So I have this like very

54:57

evangelical way of expressing when I

54:59

feel passionate about something, but you

55:01

know, look at your hand. Joy

55:03

is within reason. You just forgot

55:05

how to access it. But if

55:07

you can tap into one of

55:10

these five v's every day, you

55:12

will be happier. So valuable. It

55:14

was really pithy, but I thought

55:16

there was some there was a

55:18

profound truth to it. I'm curious

55:20

what your take on it might

55:22

be It was essentially that if

55:24

you Go on vacation and your

55:27

depression lifts You weren't depressed. You

55:29

were just living a shitty life

55:31

Something to that effect. I mean,

55:33

maybe I you know the way

55:35

that I said it was a

55:37

little bit more crude than the

55:39

way that it was presented or

55:41

at least the way that I

55:44

saw it. But yeah, like if

55:46

you go on vacation and you're,

55:48

you know, suddenly not depressed anymore,

55:50

well then maybe you weren't depressed

55:52

to begin with. You were just

55:54

living in an environment that was,

55:56

that wasn't appropriate for you. I

55:58

saw that. It was like, it

56:00

was repeated several times. Yeah. Yeah.

56:03

And I make that distinction, you

56:05

know, in my, in one of my

56:07

newsletters I wrote, are you depressed or

56:09

is it burnout, right? So burnout was

56:11

only recently included in

56:14

the ICD code, which is

56:16

the international code for medicine,

56:18

only very recently. Does that

56:20

mean that burnout didn't exist

56:22

before then? Is that the medical name?

56:24

Yeah, burnout is an actual term that

56:27

was added to the ICD, which is

56:29

like the. you know, we have the

56:31

DSM-5 here, but the ICD is the

56:33

world's classification. But it was only recently

56:35

added, and by definition, burnout is related

56:38

to your occupational exposure. So if

56:40

you're at work and you're like

56:42

not inspired, you can't focus, you

56:44

just can't wait to get out

56:46

of there, you're irritable and moody,

56:48

and then you are removed from

56:50

that work setting, your burnout should

56:52

lift if it's true burnout. And

56:54

that's a difference between burnout and

56:56

depression. Depression doesn't matter where you

56:58

are. You still feel those symptoms.

57:01

You still feel antonia, even if

57:03

you're in a beautiful Bali beach,

57:05

you know. You still feel poor

57:07

concentration. You still feel low energy.

57:09

You still feel moody and sad

57:11

at times or irritable. That doesn't

57:14

lift, right? And that's a difference

57:16

between a burnout, which is occupational

57:18

hazard and depression, which is, you

57:20

know, what's happening within you, right?

57:22

So I think that it's important

57:24

to listen to how you feel, listen to

57:27

your body. If you go on vacation

57:29

and you're like happy and refreshed and

57:31

you're like excited and then you come

57:33

back to this situation, then that situation

57:35

may not be for you. You know, I'm

57:37

not saying quit your job, but you

57:40

know, start saving. Yeah. Well, there's truth

57:42

to it. So it's like you're probably

57:44

burnt out. You're probably burnt out. Yes.

57:46

But burnout can develop into a

57:48

clinical depression, right. So like. Again,

57:51

the biosecicosocial is important

57:53

because social stressors can

57:55

impact everything else. When you

57:58

look at the biosecosocial... Venn

58:00

diagram, you see overlap between social, psychological,

58:02

and biological factors because you're not this

58:04

like isolated human. You're in an environment.

58:07

So your environment does impact your psychological

58:09

and your biological. But conversely, if you

58:11

do go on vacation and you are

58:14

still depressed, then you're depressed. And yeah,

58:16

you need to think about that. It's

58:18

an overgeneralization because you may be on

58:21

vacation with the person who's causing you

58:23

to be depressed, right? I always say

58:25

you could eat as much kale as

58:28

you want, but if you're with a

58:30

toxic partner, you're kind of screwed, right?

58:32

So like, think about what's, again, what's

58:35

the science of your happiness. being in

58:37

a toxic relationship will drain you. So

58:39

if you go on vacation with this

58:42

person who was toxic, you're not going

58:44

to be rested so that it's not

58:46

as simple. So your relationships are what

58:49

the number one predictor of your long

58:51

term like health outcomes or? Yeah, so

58:53

like there was a recent I can't

58:56

remember which study it was, but they

58:58

looked at the quality of people's relationships.

59:00

And I believe it was at Harvard.

59:02

Oh, the Harvard study on human flourishing.

59:05

Yeah, that's, yeah, yeah, you know of

59:07

it. Yes. So your relationships, if they're

59:09

healthy and supportive and you look forward

59:12

to them, you have better health outcomes,

59:14

you know, and when you look at

59:16

Alzheimer's dementia, and you look at risk

59:19

factors for having, you know, worsened dementia,

59:21

your relationships are really important. Super important.

59:23

And I believe there was a recent

59:26

loneliness study where I showed that being

59:28

alone and not having good connections is

59:30

almost as dangerous or more dangerous than

59:33

smoking a pack of cigarettes or something

59:35

like that. So pay attention to the

59:37

people in your life. It's not like

59:40

a matter of, okay, I'm going to

59:42

stay with this person just because it's

59:44

easy and, you know, like, I don't

59:47

have to deal with going out and

59:49

dating. Think about whether or not you

59:51

want to part with them long term

59:54

because that could be the source of

59:56

your source of your health outcome. You're

59:58

a longevity science. Don't discount it. Don't

1:00:01

say, oh, like, I'll just wait until

1:00:03

I find someone better. Think really think

1:00:05

hard about who you want to be

1:00:08

with, who you're spending time with, who

1:00:10

your friendships are, who your coworkers are,

1:00:12

who your bosses. Those relationships matter. Yeah,

1:00:14

great advice. So true. Well, high functioning,

1:00:17

who would you write this book for?

1:00:19

I'm so excited for this to get

1:00:21

out into the world. I think it's

1:00:24

so important. Yeah, definitely something that I

1:00:26

think many more people than you might

1:00:28

think are struggling with. So who is

1:00:31

best? Yeah, who's your target audience? If

1:00:33

you're pathologically productive and you are busying

1:00:35

yourself, this book is for you. This

1:00:38

book is for the single mom who

1:00:40

is just taking care of everyone else

1:00:42

but herself for the entrepreneur who doesn't

1:00:45

ever want to fail again. For the

1:00:47

immigrant kid who can't let... the people

1:00:49

back home down who just pushes through

1:00:52

pain for that doctor that health care

1:00:54

worker who's taking care of everyone but

1:00:56

themselves this book is for the rock

1:00:59

the person who everyone depends on but

1:01:01

really no one else is looking out

1:01:03

for them you know this is book

1:01:06

is for that person and for people

1:01:08

who have anhedonia who are just going

1:01:10

through the motions in life and they

1:01:13

want more joy they want to feel

1:01:15

as if there's more purpose this book

1:01:17

is for them Well, thanks for coming

1:01:19

out. I've got one last question for

1:01:22

you before we get to that. Where

1:01:24

can listeners connect with you on social

1:01:26

media and where can they pick up

1:01:29

the book? Well, thank you for having

1:01:31

me. This was so much fun. You

1:01:33

can follow me at Dr. Judith Joseph

1:01:36

on all the socials and Dr. Judith

1:01:38

joseph.com and check out my high functioning

1:01:40

book. Dope. And the book is available

1:01:43

everywhere, Amazon, local bookstore. Yes, yeah, we

1:01:45

love that. So cool. And is your

1:01:47

first book. It is. It's like my

1:01:50

book baby, I love it. Oh my

1:01:52

God, no, congrats, congrats. And when did

1:01:54

it come out or does it come

1:01:57

out? Like, what's the release date? April

1:01:59

8th, 2025. Amazing. So fun. Well, thanks

1:02:01

again for writing it and for advancing

1:02:04

this topic. I think it's super important

1:02:06

stuff. And mental health, I mean, it's

1:02:08

a big thing. It's super important. We

1:02:11

talk a lot about physical health. We

1:02:13

talk a lot about emotional health. We

1:02:15

talk a lot about environmental health, super

1:02:18

important. But mental health, I mean, if

1:02:20

you're, I mean, depression is so difficult.

1:02:22

So and I know a lot of

1:02:24

people today are struggling with it. clinically

1:02:27

and this sort of hidden variant that

1:02:29

you so eloquently describe. So again, just

1:02:31

really important. The last question that gets

1:02:34

asked everybody on the show is, what

1:02:36

does living a genius life mean to

1:02:38

you? Oh, living a genius life is

1:02:41

understanding the science of your happiness. I'm

1:02:43

going to say it over and over

1:02:45

again. Hey, I mean, you got to

1:02:48

understand you. I mean, people come to

1:02:50

me and they're like, I want you

1:02:52

to fix me. You know, I'm like,

1:02:55

but do you know who you know

1:02:57

who you are? Do you really know

1:02:59

who you are? Have you validated the

1:03:02

pain you've gone through? You are one

1:03:04

in a gazillion, gazillion, whatever the number

1:03:06

is. There will never be another you.

1:03:09

Ever. So you're here for a reason.

1:03:11

So get to know who you are,

1:03:13

understand your science, understand the science of

1:03:16

your happiness. There's nothing better than that.

1:03:18

Here, here. Thank you, Doc. Hey guys,

1:03:20

thanks so much for listening to this

1:03:23

episode of the show. If you enjoyed

1:03:25

it, hit subscribe and leave a rating

1:03:27

and review. It really does help. And

1:03:30

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1:03:32

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1:03:34

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1:03:36

just good stuff. Catch you next time.