hey I'm so delighted to be here with you tonight and I want to tell you a little story about myself if I can I tell you what hold that thought you're gonna hear a story before you hear it I want to tell you something else which is a bit of a an interesting challenge maybe a little conundrum for us tonight and as I tell it to you I'm going to ask first for a little bit of data from you to see if it matches what the research says did you know there's research that has to do with how long the average person can keep their attention focused on a lecture and as someone who has to give many lectures every week and who also is a researcher I have to tell you I was a little bit I found it a little daunting when I got the the results of this research so but I need to ask for show of hands I need you to be completely honest with me okay you will not hurt my feelings in any way you will not make me panic in any form or fashion even though I believe we're supposed to go is it true Jessica for a till 8 o'clock tonight we have okay we have until 8:00 well you know if you ever give a college professor you know an open-ended kind of invitation like that we will have no trouble filling the time now some other folks may have other things they need to go do all right so here's a question how long can you keep your attention focused on a lecture let's say a lecture based on PowerPoint slides and you're getting the information what some of my students at Kay you affectionately refer to as an info dump right you get all this info that's dumped into your lap and I need you to further assume this is on average this is not very particularly engaging or riveting presentation just your average it's not bad it's just average okay so I need to ask for a show of hands how many of you would say your answer is over 30 minutes really be honest really Wow you you were I need you guys in my classes okay you how many of you would say between 15 and 30 for you okay looks like the majority maybe how many would say under 15 under 15 all the folks I hope yeah okay great great I'm with you your kindred your kindred spirits we're talking continuous before your ma yes see I didn't even make that completely clear before your mind starts to wander off you know I'm talking about when you're hearing somebody talk and they say something kind you know eventually they'll say something interesting right and if you put enough monkeys at enough typewriters eventually they'll type out a line of Shakespeare just at random so I mean even the most boring speaker eventually will say something interesting and then your mind is off to the races you're kind of thinking about that thought you're right about five minutes about five minutes okay now the the average adult can track it for about 20 minutes the ask the average adults it looks like we have very many above average individuals here tonight god bless you I'm so glad you came but nobody almost nobody that's been studied can actually track information continuously for two hours right I guess we do now sure we can we can we can break at the halfway point my point in raising this is not to discourage anyone but rather to raise it in order to propose a solution which is instead of saving all your questions and comments for the end why don't we make this a little more conversational okay so because let's think about it can we track can you track a good conversation longer than you can track a typical boring lecture right you can track conversation for a long time the other thing that that's been found that people can track really easily is stories stories and so as I'm going to be talking to you tonight about the story of how I came to be a psychotherapy researcher specifically devising a psychotherapy for depression that never in my wildest dreams what I thought I would be doing 15 years ago when I came to University of Kansas so we'll make this conversational and we'll also be sharing some stories now my first story I was at the University of Colorado you like to spend time in Colorado especially in the summer or when it's about a hundred degrees here and it may be you know about 20 degrees cooler there I was the University of Colorado living in Boulder went hiking times a week and loved it loved it but it was not you know it didn't strike me as the best place necessarily to raise a family and I wasn't on the tenure track and this job opened up at K U and I knew the school by reputation but I'd never been like many people probably many of your distant relatives outside of Kansas I had stereotypes about Kansas that proved to be totally false right so I I fly in to Kansas City and it's dark so I don't really get to see the the surrounding area and I get picked up at the airport and we drive back to this little Bed and Breakfast in the dark and I get up the next morning and it's glorious and sunny and I'm walking around downtown Lawrence before my first interview and it's absolutely gorgeous and I'm thinking I think I could actually live in Kansas this is amazing but here's my little story I keep hearing about Mount Oread Mount Oread do we have any K U alums here any K u alums did those of you who are not K alums do you know what I mean when I say Mount Oread well I was ignorant and coming from Colorado you know in Colorado once when they say Matt when they put Mount in front of a proper name like you know Mount Elbert Mount heart they have a Mount Harvard these are like 12,000 13,000 14,000 foot Peaks now right outside of Boulder Boulder Valley gorgeous pristine Valley there are foothills that rise 3,000 feet out of the valley they're called foothills there none of them none of them are called Mount okay none of them and so I'm hearing about this fabled Mount Oread and people talk about it like it's nearby so I'm getting really excited and now I'm really intrigued because I'm thinking back to eighth grade geography class where I should have been paying more attention wondering so is is eastern Kansas maybe it's closer to the Ozark chain than I knew you know where and as I'm walking around campus during two days of interviews every time I get a stray bullet I'm scanning The Horizon expectantly waiting to catch a glimpse of the fabled Mount Oread finally at the end of my sojourn in Lawrence I get a little free time before we're about to take the trip back to the Kansas City Airport and so I decide to go out hunting for Mount Oread the true story and I'm walking around campus and you know I think I've been able to get a pretty good glimpse of the horizon in the full 360 panorama and don't see it so I'm walking back dejected Lee to Frazier hall which is where the psych department is and as I'm getting close I stopped a young undergrad and it's it's late in the afternoon and campus has cleared out and there's this guy and he looks actually a lot like some of the folks that you see in Boulder he looked and forgive me for saying this because not that we have a lot of folks ok you like this but he looked kind of like a STONER he I mean god bless him he had on this tie-dye t-shirt and and you I think he was playing hacky sack or something and and I said excuse me but can I ask you a question his uh sure I said can you tell me where I could find Mount Oread and he says ah seriously I said yeah seriously I've been looking for it for two days he said do your stand and I apropos of absolutely nothing other than it just that was my introduction to Lawrence and once he said that I knew by God I had to come and live it I've been here fifteen and a half years no plans to leave anytime soon I'm going to be talking tonight about clinical depression I'm gonna come at it from a little bit of a different angle maybe than many of you have many of you have heard the very first thing I want to talk about of course if you if you look I've you guys see this this laser pointed by the way a lifestyle based approach to healing depression a lifestyle based approach that's not the approach that we typically think of when we think about depressive illness and I hope you're at least a little bit intrigued now I'll tell you a little bit about the story of how I came to see it this way as we move on but first things first humanity a timeline if we put the entire history of anatomically modern human beings and our immediate preceding ancestors on a timeline we go back about 1.8 million years as a genus and for the vast majority over 99.9% of that time our ancestors made their living as hunter-gatherers they hunted they gathered very much like modern Aboriginal tribes do today they've been relegated to some very marginal lands and very sparsely populated corners of the planet but at one time the entire planet was largely covered with our ancestors who made their living as hunter-gatherers about 12,000 years ago agriculture was invented and you can see can you guys see here in the front row so we had the agrarian revolution for about 12,000 years people in parts of the world began they learned the really neat trick of growing crops and hurting livestock and it changed their way of life it wasn't a very it was just a blink in geological terms in genetic evolutionary terms and then we had speaking of blinks about 200 years ago the Industrial Revolution of course which radically changed the way people live it has been suggested by modern geneticists that the overwhelming majority of the selection pressures that shaped who we are that shaped our genome that shaped the assumptions that our genes have as they build our bodies as they build our brains the overwhelming majority of that experience was as hunter-gatherers what does that mean we are largely walking around with Stone Age genes building stone age bodies and stone age brains expecting to encounter a Stone Age world largely a set of genes that have been modified a little bit by 12,000 years of experience in an agricultural setting like what anybody had a curiosity anybody know of a genetic change that's happened just in the last twelve thousand years to reflect the different environment we face in an agrarian exactly right yeah lactose tolerance the ability to digest milk and it's one of its main constituents lactose after were beyond the age of about three or four if we look at modern aboriginal groups today nobody can digest milk after about the age of three or four why because they never encounter it after they've been weaned that makes sense and yet all over the planet when you have populations that have encountered milk for about ten thousand years you've had mutations that have rippled through the population and now okay great there's a little bit of genetic change but for the most part work does that does that surprise you by the way to here that we're kind of largely walking around with a set of Stone Age genes I'll give you an example see if this makes it hit close to home how many of you have children children they could be grown okay how many of you can remember the sorts of things that your kids when they were say two three years old that they easily almost automatically almost like they were hardwired easily acquired fears of were the kinds of things that kids are just really really easily afraid of yeah scary strangers with beards and wait a minute yeah so the dark the dark how about going to bed in the dark in fact what do you remember what your children told you when they were really really really small when you tried to get them to go to bed by themselves in the dark what was what sort of fate did they fear would befall them they're monsters that are gonna do what eat them right okay now I want you to think about this if you were if you were a hunter-gatherer and by the way if you're a hunter-gatherer you're on a lifelong camping trip with 50 to 100 of your closest friends and relatives lifelong camping trip out in the wild and you take your two-year-old and you put them by themselves alone in the dark to sleep what's going to happen to them they're gonna be eaten by monsters right our children still know this they know it innately they don't really have to be taught very much they certainly find it very plausible at least the first time they hear that that idea right that makes sense the things that we innately fear spiders snakes strangers Heights electrical storms there are things that made sense to fear in the ancestral environment in the Paleolithic environment in the Stone Age environment not so much anymore you know the rate of death due to spiders and snakes in 21st century America miniscule the things we want our children to naturally fear running out in the street chasing after a ball handguns electrical sockets with you know forks that look enticing that you know will that fit and I mean we can't get the stove tops right they don't innately acquire those fears why there's a mismatch between the expectations of the environment we're going to encounter in the one we find ourselves encountering why over the past 200 years our environment has radically mutated and it leads to some bizarre juxtapositions we can make them work it's not always pretty it's not always elegant but we can make it work it'd be safe to say and I really need to ask somebody to weigh in on this is it H a fair assumption that if we could take one of the founders of our great Republic from the 1770s snap our fingers bring them into 2012 and let them see how we live today if they would be astonished that they would find our way of light and we're talking about can somebody do the math on it about two hundred and forty years two hundred and forty years which by the way is six generations six generations which is a blink of an eye in geological time six generations and our way of life is unrecognizable to them well it turns out that several key functions of our bodies and our brains are still calibrated to an ancestral environment in ways that no longer makes sense for our well-being in the 21st century I want to give you a very important example it's one it's going to have implications for depression and several other forms of illness that we may encounter in our own lives and that of our loved ones let's talk about the stress response how many of you remember back to health class back in junior high high school where you learned about the stress response the fight-or-flight response does that set ring a bell for you the fight-or-flight response when do we get it what does it do for us why do we have it under what circumstances should the fight-or-flight response go off when there's danger what kind of danger danger of some sort of actual physical danger a perceived actual physical danger so a predator another hostile human being a natural storm disaster right you ever been hiking above treeline when an electrical storm blows up that happened to me a few years ago I was very foolish set off too late and yeah you know and I was warned storms coming in said oh I'll see it in time no it didn't happen I can tell you I had a vigorous fight-or-flight response now why do we have it you know we know about it it starts in the brain when we perceive danger and it actually the message travels to our control gland the pituitary travels down to our adrenal cortex which releases adrenaline and other stress hormones you may have heard of them like cortisol why do we have it why have we been wired to have a fight-or-flight response and by the way every mammal has it yeah and in what way what are what does it prepare our bodies to do find fight or flee right to fight her vigorous physical activity vigorous physical activity now I want you to note and remember two things about the fight-or-flight response one is that it's incredibly costly to the body it's incredibly costly why because we jump all kinds of sugar glucose in the bloodstream to be available as fuel for our muscles right cost a lot of energy cortisol one of the key stress hormones prepares not only does it elevate our blood sugar but it also is a really nice steroid so it prepares us to heal injuries to tamp down inflammation right it's costly but it's worth it if it saves your life or it helps you have an adaptive response to what - the second feature of our fight-or-flight response which is it's designed for a very short-term situation that makes sense when our ancestors let's just you know go back in time 15,000 years if you had an ancestor 15,000 years ago that was having a vigorous fight-or-flight response how long would they in a typical situation how long would they have needed to have that go off what do you think anybody if you have a response raise your hand okay I'll pretend like I'm back it aku is so much easier that way if I can call on somebody yeah go ahead right here in the front 10 minutes and why do you say that I like the way you think it's gonna have yeah exactly you're gonna have a quick resolution the vast majority of the time can you imagine maybe a scenario that could go as long as an hour I mean if we have a fertile imagination we might be able to concoct a couple of scenarios that might last an hour or two we might even be able to come up with a hypothetical rare situation that might last several hours right but day after day after day in the ancestral human environment no no not gonna happen not gonna happen which is a good thing why because the stress response our fight-or-flight response is a DAF gig I see this is adaptive in the short term but it's toxic when it goes on for long chronic stress the chronic fight-or-flight response is toxic in the ancestral environment a it almost never happened and B there were lots of natural breaks built into their way of life that put the brakes on the stress response we're gonna talk in just a minute about what some of those natural brakes are and how we can reclaim them because it's really important now I'm not going to belabor this point because I'm bet I'm betting that most of you are already it'd be sort of like preaching to the choir but let's see here's my claim modern life is really stressful modern life is perversely calibrated to keep our stress response engaged all kinds of reasons why right well interacting with strangers turns out interacting with strangers is a somewhat stressful experience for most human beings if you look at modern-day aboriginal groups they don't really enjoy interacting with strangers in fact very often those interactions turn somewhat ugly they find it stressful it elevates their stress response it does for most of us today we live in a global village of over seven billion people and guess what when we hear news of tragedy or danger can I get a informal survey how many of you have heard some piece of news over the past let's go the past week of some sort of tragic tragedy or some somebody who had unfortunate happened to them in the past week every hand virtually how many of you have heard something like that in the past 48 hours how about the past 24 hours virtually every hand now here's what's interesting in the ancestral environment when your ancestors heard a piece of bad news heard about something dangerous like oh hey you know Fred in that that group right around that the ridge in the river he said when he was out hunting three days ago he was chased by a pack of hyenas okay now did your world your world just become a more dangerous place potentially you have to upgrade your level of threat assessment you do you do do you see the point it's subtle but it's really really important the point is that our brains are wired in such a way that we attend to gossip about danger gossip about tragedy gossip about bad things that are out there as if they are personally salient personally relevant why because our ancestors lived in a very small world and every bit of news was meaningful now we live in a world of seven billion neighbors and we hear about their tragedies all the time we hear about their dangers and most of us walk around thinking the world is much much more dangerous than it really is and we feel stressed every time we turn on the TV every time we listen to the radio every time we go to Google News does that does that ring true for you the other problem of course is that Brad Pitt is also your neighbor guys ladies Angelina Jolie is your neighbor what does that mean that our brains are wired in such a way that we compare ourselves to the people that we encounter that we hear about we compare ourselves we get a sense of where we rank especially with our peers same-sex peers if you were in an ancestral hunter-gatherer band the average size was about 50 or so on average 25 male 25 female how many same-sex peers would you have let's say peers would be plus or minus five years of your age might have three or four or five you with me there's your peer group imagine that's your world you've got four five people that you're comparing yourself to what do you think the odds are that you're going to be the best in your peer group at something it's it's overwhelmingly certain that you would have been think about this every person here think about this you would have been the Michael Jordan of something of finding new water sources the Michael Jordan of you know skinning a freshly killed deer the Michael Jordan of preparing some tasty yams to write you would have been the best and everybody would have known it and valued you for it why because your gifts and your abilities would have benefited everyone else in your group and yet today in a global village of seven billion it's hard to be the best at anything why because we're always thinking about oh I've heard about that famous person who does it even better does that make sense to you do you follow it so the modern world is incredibly stressful of course if you want to get a really easy sense of how stressful think about this issue of 24/7 365 connectivity have any of you had the luxury that I had this past summer of unplugging and disconnecting for several days have you had that experience of completely and and you you anybody kind of go through withdrawal for a little while where you're just like I got to check my my cell phone I got to check my email I got to check the news I got a and then after a couple days what happens it turns out it wasn't quite go ahead you yeah you just start to kind of really habituate and and all of a sudden you know what happens your stress hormones drop your blood pressure drops your resting pulse drops your level of well-being goes up why we were never designed for the pace of 21st century American life our brains were not designed for it our bodies were not designed for it and it leads to potentially toxic effects and it turns out in fact that the chronic runaway stress response is an underlying trigger not only of depressive illness which we're going to talk about in more detail in just a bit it can actually cause brain damage I'm not saying this to scare you but to inform you cortisol one of the key stress hormones actually blocks the brain's major repair hormone if you're keeping score at home it's called BDNF you can look it up brain derived neurotrophic factor BDNF we need lots of it in the brain to repair damage that's done every day by have you ever heard of free radicals these are molecules that slice and dice cellular machinery cortisol suppresses that key growth hormone and over time it can actually lead to brain damage shrinkage of the frontal cortex shrinkage of the hippocampus which is ground zero for our short term memory function in fact I'll give you a little tidbit it's kind of fun you can share this sort of family gathering sometime in the next few weeks if you want to regale your loved ones with your newfound knowledge stress actually temporarily impairs short-term memory function it does when we are stressed cortisol suppresses that that hormone I told you about BDNF well guess what BDNF does aside from repair brain damage it literally helps us grow new memories when you learn new information you literally grow new connections between neurons and key networks in your brain without that growth hormone you will not grow them stress is toxic to our memory and so if you've have you had any senior moments recently and I'm talking about you got that tip-of-the-tongue phenomenon I'm I'm only 49 and I I get those moments sometimes and it's almost invariably when I've been under very high level of acute stress now that I know how toxic it is I promise you it has changed the way I live my life in many many ways which I'll share with you as we go on anxiety of course by definition as part of chronic stress sleep disturbance both the quantity and the quality of our sleep will decline when we're chronically stressed our immune function is shot have you noticed how much more susceptible you are to illness when you're when you're chronically and acutely stressed well here's a big culprit that lots of folks are talking about can you guys see this I don't have to crane your neck I'll say it out if you can't inflammation inflammation anybody know what inflammation actually is when we talk about inflammation because it's a big big deal in medical research and many of our most important illnesses many of our biggest killers are inflammatory illnesses why do we have inflammation first of all what does implement what is it designed to do because we are designed to have inflammation under certain circumstances do you know good brilliant yeah and let me repeat this for folks who can't hear in the back what what what she just said is and maybe I can can illustrate this with an example you ever had a splinter right and it gets all inflamed how do you know it's inflamed it gets red and swollen why because blood has been rushed to the site why yeah and right so we have we have antibodies we have natural killer cells that will attack any invading pathogens and we have tissue repair factors that will grow new tissue repair the injury okay so without inflammation without that ability this is kind of interesting to think about we wouldn't survive for long can you imagine if every time you got a splinter every time you twisted an ankle it would never heal every time you got a splinter you'd be risking a life-threatening invasion of some sort of pathogens okay so we need to have inflammation and yet what happens when we have too much of it what happens if your immune system which is the source of inflammation if your immune system gets the idea that your whole body has been invaded that your whole body is sort of riddled with splinters as it were then your immune system starts attacking healthy tissue have you heard the term auto immune that's exactly what it means autoimmune illnesses are simply inflammation run amok we'll guess what the average American the average American has far too much inflammation attacking their body the average American has unhealthy frightening lis unhealthy levels of inflammation and in fact if we look at so-called diseases of civilization or diseases of modernity these are all of our biggest epidemics every single one is characterized by high inflammation it is the common denominator is the thread that runs through every illness of civilization obesity of course you've all heard the news the sad news about our epidemic their diabetes which is now affecting if you look if you count pre-diabetic syndromes as well over one in four Americans hardening of the arteries the precursor to heart disease it's an inflammatory illness in fact the single best blood marker of predicting risk of dying of heart disease based on my review of the literature which just happened last year is a marker of inflammation not a marker of blood cholesterol it's called c-reactive protein at least that's one of the best ones CRP you can talk to your your doctor your cardiologist about it it measures how much inflammation you have going on in your body heart attacks are typically preceded by an inflammatory response in the arteries that feed the heart inflammation is a killer asthma fibromyalgia of many forms of cancer if there's been one insight and innovation in my research group over the last several years it's simply been that we think depression belongs on this list depression is an inflammatory illness here's something many of you may not have walked in here knowing tonight the inflamed brain is a depressed brain inflammation is powerfully capable of triggering depression well what are we talking about with depression anyway about most of you know because you came to this talk tonight but I'll bet many of you also know somebody who has a completely wrong idea of what we mean we're talking about depressive illness we're talking about clinical depression so what's the misunderstanding what what would people misunderstand if they heard someone say oh I'm battling depression yeah many of my patients have been told exactly that get over it oh yeah this is your personality you're just a slacker this is just something under your control say that again okay but yeah I might might be you know part of your trait of personality that's even that you inherited but but not something terribly serious what does depression mean as the term is used in everyday conversation not among us clinicians not among treatment providers but in everyday if you heard somebody at Costco say sadness exactly right right how long does it last at most maybe less right in other words and and what is it in reaction to the slings and arrows of outrageous fortune in other words the human condition in other words if you live long enough we can take it to the bank at some point we will all be sad right at some point we will all be sad it's kind of a sad thought at some point we will all be happy as well hopefully before we leave tonight that sadness is not what we clinicians mean by the term depression and and unfortunately I believe and maybe some of you can help me with this I believe one of our biggest one of my biggest tasks as a depression researcher is helping the field come up with a better word for this illness because when we're talking about depressive illness we're talking about something that's debilitating that changes the functioning of the brain changes the functioning of the body changes our hormone function robs us of the most restorative phase of sleep robs us of our energy robs us of our concentration robs us of our memory robs us of our ability to experience pleasure lights up the brains pain circuits I had a patient not too long ago who told me about a good friend of his who was battling a form of cancer it was Hodgkin's lymphoma have you heard of it thank God it was curable it was curable so his friend is going through chemo for Hodgkin's and it was brutal he's going through chemo and his hair falls out have you ever known somebody going through chemo hair falls out he's nauseate he's throwing up all the time he feels like hell he feels like he's gonna die but he knows he's getting better okay now while he's going through chemo all of his friends and acquaintances and loved ones rally around him and they're all like oh you're so brave you poor guy you know this is so hard we're here for you buddy you know hang in there people are saying you know hang in there we're here for you nobody says snap out of it nobody says get over it see I'm going with this this friend who was fighting Hodgkin's lymphoma who had cancer who's going through chemo five years earlier had battled an episode of clinical depression and so he tells my patient guess what cancer is a walk in the park come to depression chemo is brutal and yet I would take it any day of the week before I would take another episode of depression does that put a face on it for you this guy said depression was about 10 times worse and yet when I was depressed nobody could see it my hair didn't fall out I didn't have involuntary episodes of projectile-vomiting which is you know hard thing to hide so nobody rallied around and people said stupid things like hey come on snap out of it as if he said as if I didn't want to snap out of it as if I wouldn't give anything to be able to feel better that's what we're talking about when we're talking about depressive illness it leads in this country to over 30,000 deaths every year due to depression linked suicide why because depression can rob a person of their will to live and as I mentioned it lights up the brains pain circuitry people who are suffering from clinical depression feel a kind of pain that they can't quite put into words they don't really know where it hurts they just know it hurts and they want as any sane person wants they want escape they want relief for some of them the desperation mounts to such a level that the ultimate tragedy ensues so I take depression really seriously I take it really personally I've known people whose lives were cut down by this illness I've had loved ones who suffered years of torment and yet it's an epidemic so when we talk about when I say depression is an epidemic believe me I'm not just throwing Lindner around in a Cavalier fashion 23% of all Americans it's estimated by a five based on our best epidemiology by 75 will get depressed that's probably an under estimate there's some evidence of at least a tenfold increase in the US since World War two we get a real sense of it if we look and I'm not going to bore you with lots of detailed charts and graphs but I just want you to get a sense of what the epidemic is like from this picture what I've got here I don't if you can see it in the back but age here on the horizontal axis lifetime risk of depression on the vertical axis is 5 percent 10 percent 15 and these different colored lines are different age groups different generations okay so what do I have here in red these are folks that were 60 and above and notice that by the time they were in middle-age five percent of them had been depressed lifetime five percent but under middle-aged and here we have the baby-boom cohort and notice by the time they're in middle age it's 15% the next generation is getting depressed at a higher level look at the next enter rate this is Generation X by the time they're in their 30s it's already almost 25% now look at the kids that I teach in their late teens and early 20s and notice that by the time they're in the early 20s their lifetime rate of depressive illness remember debilitating brain damage inducing potentially lethal illness 25 percent and if you can extrapolate that line out into their middle age by the time they're my age it's gonna be over 50 percent if we don't do something to turn around this epidemic notice by the way that this epidemic has increased over the past couple decades at the same exact time when we've seen a 300% increase in the use of antidepressant medications we've seen a 300% increase in the use of antidepressant medications one out of every nine Americans according to the Center for Disease Control is currently taking an antidepressant medication one out of every nine Americans about excuse me above the age of 12 one out of every nine the age of 12 has it eradicated the epidemic no has it at least slowed it down to the point where it's leveled off no are they game-changing not in my book and I say that not as someone who came here tonight to bash medications because they've saved many lives for those for whom they are helpful they can be a godsend but the dirty little secret among us clinical researchers is that the medications do not live up to the marketing hype if you look at the outcome data the actual data they have not lived up to the marketing hype I wish they did nothing would make me happier than if we had game-changing medication well here here's a statistic for you some of you have heard it it alarmed me when I heard it as the father of a 15 year old the average teenager right now in the u.s. is spending seven and a half hours every day interacting with a screen and oh by the way that doesn't does not include the hour and a half that they spend on average texting that doesn't even count in their screen time that counts school days by the way so nine hours a day interacting with a screen or their their thumbs on the keypad texting screen time instead of face time with our friends and loved ones right so the quality of our interaction with others is being eroded and we're going to talk about that but also the stress and we talked just a little while ago about the bizarre beauty of just unplugging and by the way I'm not you know the term Luddite let I think somebody who wants to just completely obliterate all technology I'm not a Luddite I want to keep my I want to keep my I like my iPad okay all right so what are some exceptions this is one of my favorite I love this slide this this is this is the kaluli people of Papua New Guinea they're one of the few remaining Aboriginal people groups on the planet still living as our ancestors lived hunters they're not technically hunter-gatherer they're foraging horticulturalists they hunt they gather but they can also grow the sago palm so they kind of sort of have a crop but they live basically the way our ancestors live there's small groups fifty to a hundred people so why am I so fascinated by the kaluli because they're the only hunter-gatherer group that's ever been infiltrated by a westerner an anthropologist named Edward C Pollan and carefully assessed for the presence of mental illness according to our diagnostic criteria now here's what's interesting they have really hard lives they have a high rate of infant mortality they have a high rate of death due to violence not by the way within their group but between their group and other groups within their group not so violent at all between groups pretty violent a high rate of parasitic illness they don't have any of our modern comforts they don't have any of our medical care they have tough tough lives I don't want to trade places with them but guess what they don't get clinically depressed they grieve when they lose a loved one they grieve they have ceremonies rituals a bereavement they grieve like we ought to grieve right they they really go at it they know how to grieve and they have rituals and ceremonies and they know how to say goodbye and they know how to cherish and celebrate the life of those who they leave behind and then they move on and they take their loved ones with them in their memories and in their stories they don't get clinically depressed and it fascinated the hell out of me when I first excuse me perfect is it okay if I spice it up a little salty language your name it's an adult crowd is it okay Jessica do I have the Dean's blessing is the Dean still here okay if he's not here I'm gonna spice it up it's it's shock the hell out of me and I thought what in the world is going on how could it be that this group doesn't get depressed when they have all the reasons to be depressed I'd be depressed I think if I had to give up everything and live the way they live but they don't and it fascinated me and it got me thinking wait a minute what are they doing that we're not doing that the existing research already shows us can prevent depression and can fight depression even if we happen to be depressed right now and so I started meeting with my graduate students in our research group and we found six things really really quickly that just jumped out at us we're going to talk about them over the second half of this presentation we're going to talk about them in very practical ways what can you be doing what can your loved ones be doing that the kaluli and our ancestors do all the time well our ancestors don't still do them but the kaluli still do them other aboriginal groups still do them in abundance they capture the following intuition see if it resonates with you we were never designed for the sedentary fast food laden sleep-deprived indoor socially isolated frenetic pace of modern life and there are at least six things that we can reclaim from an ancient way of life that we can bring into the present that can protect us from depressive illness and an array of other illnesses that can change brain chemistry more powerfully than any medication that can change the way our body functions and the way we feel more powerfully than any chemical we can put into our bodies okay I think we should probably pick back up where we left off if we can I know it's it's kind of like herding cats sometimes when you have a break in them in the middle of a presentation I see we have a congregation back there but yeah okay well so we left off last time talking about at least six things that we can that we can do that are part of our day-to-day lives none of them are particularly profound none of them are I mean if we if you look at the list none of them are necessarily something that requires a lot of expense a lot of Technology that necessarily requires that you hire a PhD level clinical psychologist to put into practice in your life and and yet they can have an absolutely profound impact so let's talk about them one at a time as you have questions as we go along feel free to to just raise your hand and I'll try to get to as many as I can now exercise I have to acknowledge that the very outset and see if this is true for you that for many Americans exercise despite appearances is a four-letter word many many people when they when they hear the idea of exercise are working out they start to kind of get tense they start to think about oh yeah I should I should do it I should do it I know I should and yet I don't want to right I don't want to I'm going to tell you something that might be the single most validating thing anybody has said to you in the last hour exercise is completely unnatural exercise is completely unnatural you're not designed to exercise I'm not designed to exercise we were designed to be physically active in the service of adaptive goals the average visitor to Walt Disney World devinder Walt Disney World does it look like a particularly Fitness crazed crowd typically not right I mean just average the average visitor to Walt Disney World has been found by the Disney Corporation to walk between eight and nine miles per day during their visit that is a high level of physical activity it is almost on par with the fitness level of our hunter-gatherer ancestors not quite hunter-gatherers have been studied and they engage in four plus hours of vigorous physical activity every day doing what running walking briskly while they're chasing down food while they're gathering while they're erecting dwellings or carrying water you with me but it's always in the surface of a goal so what happens when you take I mean our brains as it when it comes right down to it in most respects are not that different from say the brain of any other so let's take the lowly lab rat did you know that just like us their brains are programmed not to exercise you don't anybody sighs I mean like you're staring at a piece of equipment you know that that horrible feeling of dread you get the pit of your stomach you're looking at it you're saying I should get up there on that thing it's a treadmill it's a elliptical trainer stationary bike and there's a piece of your brain that's screaming out don't do it you're not going anywhere on that thing so you take a lab rat and you now you can take the lab rat and you can give it if you ever seen those little exercise wheels where they can kinda lollygag and stroll at their own pace they're fine with that they'll get up on the wheel every once in a while just out of sheer boredom if you don't give them like natural rat things to do because it's better than just sitting right but if you talk about like aerobic level activity like getting their heart rate up where you know where it needs to be like they're really you put them on a treadmill in a harness where they can't escape you know what they do they squat down on their haunches in protest till the treadmill starts to wear the fur and then the skin off they're off they're off their backside they they feel our pain when it comes to the difficulty of forced exercise what this means is if you think about it do hunter-gatherers ever turn to their companions and say hey you know I know that we just did for you know for our hunt but I'm going to just you know lace up my no I don't have any thing to lace I'm just going to you know go out and run a 10k just because know why not why why would our brain be wired with a program that basically says never expend calories on an activity unless it's for a purpose it makes sense to you conserve energy because our ancestors never had a reliable food surplus they would have occasional food surplus but then six months down the road they might have famine right so your savings account was the fatty tissue on your body which explains a lot and yet you would never want to squander calories on pointless activity so how can we take advantage of this knowledge well do we even want to take advantage of this knowledge hold that first question for a second let's think about the second the second question do we want to take advantage of this knowledge well it turns out that exercise fights depression as powerfully as any known medication one of my old mentors in grad school at Duke gym Blumenthal has randomly assigned in two separate studies severely depressed middle-aged patients to one of two conditions either zoloft you've heard of it the antidepressant at a fairly high dose or exercise now guess what kind of exercise how hard would you have to exercise to change brain chemistry enough to be antidepressant it was brisk walking no brisk walking walking like you're late for an airplane you know kind of brisk like you're not messing around you're walking with a purpose for hours no for 30 minutes three times a week that's it 30 minutes of brisk walking three times a week compared head-to-head with zoloft and at the end of four months both groups had an antidepressant response that beat placebo sugar pill right there was no difference between the groups but when they followed them up six months later the folks who got the Zoloft were three times more likely to have had their depression returned than the folks who were exercising how can exercise be antidepressant well it changes neural chemistry it increases activity and circuits of the brain that use a neurochemical you called dopamine which is the key neurotransmitter in the brains pleasure centers reward centers those are centers that go dormant in depression exercise increases functioning in circuits that use the neurotransmitter called serotonin which you've heard of which helps put the brakes on the brain stress response which helps turn down activity in the brain's emotion centers you've heard of some of you the amygdala which generates sadness and anxiety and fear exercise also has a really nice side effect it might interest many of you it slows down the aging process british researchers have recently shown did you know that we can look at your DNA we could just get a little a little DNA sample like a q-tip on the inside of your cheek a little swipe on the inside of your cheek get some cells look at the DNA and it's like you've got your own tree rings really did you know you have your own molecular tree rings they're called they're their protective caps on the end of each of your chromosomes are called telomeres their protective caps and as we age they shrink and you can just look at the age at the length of these telomeres and get a really really good guess at a person's chronological age but guess what British researchers found that if you took a bunch of middle-aged folks folks my age roughly 40s 50s and you looked at the telomere length of two sets of middle-aged folks Group A is the couch potatoes people that say my whole adult life I've been in that vast group of people that just really don't dig exercise I just you know I do what I have to do but I just don't exercise in any store regular basis group B people that work out and have been workout fanatics at least it was at least 45 minutes a day an average of six days a week at least okay now I don't mean to brag or anything but when I started doing this research I was not in that latter group since I started doing it I'm in that guess what they found the people who exercised regularly and had been through their adult life while they were in middle-age their biological age as evidenced by their DNA was 10 to 15 years younger on average than the couch potatoes have you ever known somebody that was in their 60s or 70s that seemed really freakishly spry now I'm talking about have you ever noticed how common it was for that person to have been really physically active through much of their adult life have you ever seen if you if you don't know how I'm talking about you need to go look it up on YouTube sometime Jack LaLanne does that name ring any bells the original TV fitness guru there's a great video of him at age 90 when he looks about 55 60 he's 90 he looks and moves holds himself like he's 55 60 years old and he's like swimming across to Alcatraz pulling a tugboat behind him or something it's crazy freakishly youthful exercise has all these benefits now here's the thing if we want to be physically active we need to remember that exercises are natural you need to remember that image of that labrat squatting down on its haunches wearing the fur off its backside you're like that lab rat and so am i in many respects so what can you do finding a partner often can provide a sense of purpose remember we are designed to be physically active in the service of a goal the goal will vary from one what is a meaningful goal for you may not be meaningful for me and vice-versa for some of us I have two very highly spirited dogs getting out and walking in fact I like to run with them and they love it they are in heaven they beg for it and I feel this warm toasty glow inside because my doggies are happy right that that works for me it might be walking to a destination might be just the company of a friend it might be a game-like activity something gate because we're you know hunting is a like activity gathering is a game like it could be so if you're doing something that's game-like that will keep you engaged my last little point on exercise really quickly is this some of you here are battling clinical depression or you have a loved one you know somebody who is when we're clinically depressed we have is special difficulty initiating activities clinical depression turns down activity in the left orbital frontal cortex it's a part of the brain that allows us to initiate things that we want to do does that make sense in other words when we're depressed we can have a thought I should do that and then we can't actually make it happen the part of the brain how about this that translates between your intentions and your actions that part of the brain goes dormant when we're depressed so some of you are hearing me right now and you're thinking oh I should do that you need someone in your life for many of us if we don't have somebody who's reliable who can give us that little nudge of initiative that we need to make it happen it can be a personal trainer to get us started when I started this research seven years ago it never dawned on me in a million years that I would be telling people hiring a personal trainer can really make a difference I've seen dozens and dozens and dozens of lives transform from that it's the best money they've ever spent if I could have five minutes with President Obama I really think I might just bend his ear on how cool it would be if we could have a tax deduction for any money spent on enhancing our fitness because I'm telling you what it would be pennies on the dollar whatever tax rebate people got for that the federal government would get on the back end multiplied tenfold one hundredfold in terms of savings with Medicare Medicaid you see it so think about spending your money that way okay let's let's talk about something else oh by the way Blumenthal and his research shows that in order to be antidepressant to change your brain chemistry the the activity needs to be robic if you don't know how to take your pulse I can show you if you want hang around afterwards there are lots of tutorials online to be aerobic you want to be somewhere between this says 60 to 85 percent that's fine you get the best results the research shows if it's between 75 and 85 percent of your maximum heart rate a good ballpark idea for what that is is 220 minus your age so for me it's about 171 is my max when I'm working out I actually wear a heart rate monitor which you can buy for about 30 bucks online I wear it when I workout and I'm looking and I'm usually somewhere between 140 and 155 I go at it hard feels great it didn't when I started it does know somebody had a question right over here brilliant question because dogs are descended from wolves which are pack animals that follow an alpha which is usually one of their parents that tell them when it's time to go on a hunt and while we're out running they are scanning looking for bunnies which they often find looking for squirrels and they look to me every single time they're like daddy can we go get can we go eat that one can we go eat that one and you know what they never they never tire of it even though we've probably run hundreds of times that we've never eaten a single bunny they to my knowledge well actually Teddy caught a dead one one time but yeah that's a great question so so for them it has a purpose and for me it has a purpose because I'm making them happy it's a great question okay um fatty acids where are we timewise Jessica you were you were teasing me that I can't I can't speak and I can't even get this content in two hours you said I couldn't do it in 20 minutes but I'm starting to believe we're gonna do it though in the next buzzer I'm just gonna hold it right here is that okay is this gonna distract you if I hold my watch right here I can see it is it distracting is it I can't see it there's a really bright oh if I do that I can see it laughs is that gonna distract you no not at all it's not distracting dr. Lurie okay fatty acids really quickly your brain is mostly made up of fat did you know that your brain is 60% fat by dry weight so somebody calls you a fat head they are they are speaking they are factually correct you are and so am i and maybe they're paying you a compliment I'm not sure probably not there are two types of fats that your body cannot make most kinds of fat that are in your brain your body can make but there are two kinds that it cannot make they're called omega-3s and omega-6s they're called essential fatty acids why essential because they have to come from your diet you can't make them they're both critical for proper brain function omega-3s and omega-6s they're both critical for regulating inflammation they play complementary roles in the body generally speaking omega sixes build inflammatory hormones omega-3s build anti inflammatory hormones in the ancestral diet people our ancestors ate omega-3s and omega-6s at a ratio somewhere between one to one and two to one the optimal ratio and put six first the optimal ratio is roughly two to one if we did a blood draw on you or I and and we wanted to know in advance what should we be looking for for an omega-6 omega-3 ratio we're gonna do a blood test about two to one in the brain it's about one to one but in the blood it's about two to one now modern American diet unfortunately can you see this if you can't I'll tell it to you 20 to 1 we need 2 to 1 it's 20 to 1 why what in the world is going by the way this is not good the 20 that's on the side of inflammation the 1 is on the side of anti-inflammation ok omega-3s are mainly found in grasses plants algae and the animals that eat them grasses plants algae and the animals that eat them well we can't eat grasses or plan we usually don't encounter algae so our best bet is eating the animals that eat them okay omega sixes come from vegetable fats they come from basically seeds and grains and the animals that eat them so hmm corn oil cottonseed oil you see it linseed oil all basically almost all the oils that are used in virtually every type of fast food in virtually every type of processed food oh but waiting it's better our meat supply if you went back in time 150 years ago or even a hundred years ago and a piece of beef what did it feed on grass grass and leafy plants that were out in the pasture oh and insects which we're eating grass and leafy plants out the pasture so they were chock-full of them oh my insects are actually a really good source of omega-3s I'm not willing to start eating them anytime soon but just you know just in case anybody's curious what do our cattle and poultry corn grains right in fact they're their stomachs are not even designed to eat corn do you know what happens if if a if a typical Garden issued garden-variety cow starts eating a bunch of corn first of all it's going to turn up its nose at it unless you pump it full of growth hormones to make it freakishly hungry now it wants to eat the corn because it's so hungry but then the corn turns its stomach so acidic that it becomes a seething cauldron of bacterial growth so we need to pump it full of antibiotics so that it won't die of the systemic bacterial infection see the issue but it grows really fast if we do all of the above and so it's really profitable to do it that way and it's not good for us it doesn't take rocket science to figure out that that's probably intuitively we sort of get that's probably not the best way that we should be taking in meat and yet that's the way we all do it and so what's the result an extraordinary imbalance this is just historic trends and fatty acid consumption in the u.s. omega-6 is omega-3s and notice that by the time we get to the year 2000 whopping imbalance well guess what we have an epidemic of inflammation as a result of this imbalance and as I mentioned earlier depression is an inflammatory illness in countries across the world where they do not have this imbalance in omega-6 omega-3 dietary intake they do not have the same epidemic of depression the rates of depression are considerably lower it gets better than that when we take depressed patients and them with omega-3 supplements found in for example fish oil it's usually the most convenient source we see a robust antidepressant effect now some of you might have how many of you have seen a news story at some point on something about omega-3s or fish oil for depression how many of you've heard about this finding ok now I got to ask and be honest how many of you have ever seen a news story that said well there's some controversy about that or maybe there was a finding or two where they didn't see the result how many of you've seen that finding okay fewer thankfully it is true there have been some some findings that did not see the effect and you know why I'm gonna explain why right now and this is a little bit of deep inside baseball but hopefully it'll it'll be useful information there are three different kinds of omega-3s there's one if you're vegetarian you might say well wait a minute they're vegetarian sources of omega-3s like flaxseed oil have you heard of that or walnuts they're a source of a very short molecule called ala this is not anti-inflammatory particularly it's a little anti-inflammatory but the one that's really the building block of anti inflammatory hormones is EPA that's a medium-sized one and then there's DHA that's the longest one that's DHA is the building block of brain tissue in the developing fetus and in a newborn in a small child kids need lots of DHA have you ever heard of infant formula supplemented with omega threes that's what they supplement with DHA unfortunately DHA is not antidepressant so when you look at research trials where they've given depressed patients DHA those are the the null find those are the findings were there like it didn't work so well when you look at the studies where they gave EPA especially in high quality supplement with sufficient antioxidants they typically avoid they typically have any president we're not going to go through this this just is a really nice way of showing that all of these hormones here are built by EPA these are anti-inflammatory these on this side are omega sixes and these are all inflammatory hormones that are built that's all I'm going to say about that now if you press on dose of omega-3s if you're gonna get omega-3s how much do you need the best research evidence suggests that it's the starting dose is 1000 milligrams of e.p.a now I'd like to see patients take DHA as well it comes along for the ride if you get it in a natural fish oil source that makes sense I want you to have it in the way it's found in nature why because it there's some evidence that it kind of it kind of freaks out the brain a little bit when it's only seeing EPA and not any DHA it taxes some of the enzymes that are involved and and it's just it's not an easy thing for the body necessarily to just get pure EPA at least that's the way I read the research evidence on this so we like our patients to get a thousand milligrams per day of EPA to start some people benefit from 2000 so if we're not seeing any sort of effect any sort of benefit on any level after a couple weeks on a thousand will often bump it up to 2,000 now actually I'm gonna shoot ahead two here we go if you look at the side of a bottle of fish oil supplement omega-3 supplement you will see something like this it says omega-3 fatty acids 500 milligrams but you have to look at the fine print how much EPA this one says 300 so notice that even though the capsule by the way it's even more complicated this because there'll be something that'll say one capsule equals it'll be a thousand milligrams per capsule of something and people say oh I'm supposed to take a thousand and this capsule has a thousand so I should take one capsule the the kind of fish oil that you would buy at a typical drugstore would have a hundred and eighty milligrams of EPA if you do the math on that if you can do it in your head that means six capsules to get an antidepressant dose actually 6 to 12 to get an anti-depressant dose I cannot tell you how many literally literally over a hundred different individuals have come up to me after talk and said doctor lardy I tried taking omega-3 and it didn't work for me I'm sorry to hear that do you mind if I ask you know what brand what dose and they'll say well just to kind of got at the drugstore and I just you know it says serving size 1 yeah I took the serving size now I'm a polite guy most of the time so my little thought bubble is is like you know congratulations you've just taken one-sixth of the ninety two president dose I'm not shocked that it didn't work but what I say is I'm afraid you didn't have any antidepressant dose it might be worth trying trying it again at a higher dose and as several individuals have then gone back taking it at a higher dose and reported that it actually is beneficial at a higher dose now potential side effects there we go potential side effects if you get a low-grade a low quality fish oil have any of you ever had indigestion or god forbid nasty fishy burps that's what we call him in the business know how many of you have ever had nasty fishy burps at some point from a that's a sign that you have just ingested a capsule of semi rancid fish oil and after your digestive juices in your stomach made their way through that outer gel coating they spilled this nasty rancid fish oil into your stomach no wonder that you're burping that back up by the way just in case you were wondering if it's semi rancid it is not psychoactive it is not able to have the anti-inflammatory benefit that your brain and body need what does that suggest you really would benefit from a higher quality grade of fish oil now the really good news is there are some very high quality supplements available for very low price now supply and demand have finally caught up on the fish oil front I love the way you think if you guys couldn't hear this question the gentleman and a few sure though if you could raise your hand but but that's still a good question question is well what about doing it naturally can we just start eating grass-fed beef absolutely if you if you're willing to double and triple your food budget which by the way I am and my family has I am but most people are not and remember when somebody's clinically depressed they're fighting an illness that's robbed them of their initiative that's robbed them of their much of their energy and willpower the last thing I'm going to ask them to do while they're acutely depressed is change the way they buy their and prepare their food does that make sense to you so what we do in our program is we start them typically with the fish oil supplement but then we talk about for the long term what are some changes what are some things we can do to cut out all those nasty omega sixes all the processed food all the fast food or much of it but I don't ask them to cut out the fast food right away it's a great question any other questions about taking fish oil supplement yeah yes oh yeah thank you the slide that I showed was actually of a high quality supplement that had 300 EPA per capsule right but the lower quality supplements the kind that you typically the most commonly consumed fish oil supplements only have 180 of epa per capsule a good one could have 300 in fact a couple supplement makers now make a capsule one capsule has 500 so it only takes two to get it potentially antidepressant dose one of them is made by now foods they know double use all capital letters it's like they're always orange bottles you ever see them at the drugstore health food store now a know double you can go online you can buy them on Amazon it's called I believe it's called ultra EPA I think I think it's called its ultra Sun I think it's alter EPA and it's 500 milligrams of EPA per capsule and you can get a month's supply at an antidepressant dose for about ten dollars or so I mean they've really come down really come down in price if you ever have the nasty fishy burps the chances are you need to upgrade your supplement what I look for are two things the phrase pharmaceutical pharmaceutical grade it's hard to say quickly pharmaceutical grade and molecularly distilled if they're going to all that trouble to produce it at that high quality they're probably also not producing it under oxygen and that's what causes it to go rancid if you've ever had ever had raw fish out in oxygen I mean Omega threes do not get along well with oxygen let's put it that way which by the way reminds me of another quick point which is you don't want your omega-3s to oxidize while they're in your body which means you will get more benefit if you take antioxidants along with it back to your point antioxidants tend to work better when we get them in Whole Foods what does that mean consider eating nine servings of fruit and vegetables every day so that your body can mount its most vigorous antioxidant response protect those omega-3s in your body give your brain and body the best possible benefit if you're not willing to do that you're not willing to do that then a daily multivitamin is a lot better than nothing a lot better than nothing yes Oh excellent question yeah I do not keep mine in the freezer but some people will have a little indigestion with it it's not that it's rancid it's just that it's just kind of a little tough on the stomach for people that that don't have a cast-iron stomach and if you keep it in the freezer then it it generally doesn't completely thaw out until I gets past your stomach and most people never notice that they're having any digestive issues any further by the way if you take super high doses of omega-3 you can have some blood thinning if you are on a blood thinner you must talk to your doctor if you're on heparin warfarin coumadin anything like that you might you they can adjust the dose so you can take care of make a three with that blood thinner but you have to talk to them about it yes yeah and this this ratio is just a guideline you know you see several that come three to two several that come two to one the reason I like two to one is the the best most rigorous research published research on omega-3s for depression used Manhattan oil which actually comes in about a two to one EPA DHA ratio and it's the best published research we have to go on that's why I like to use that ratio and we've had great results in our own clinical trials at k you with it okay let's let's shift gears did I miss somebody are we good okay look oh yeah go ahead men men hadn't meant somebody can look it up if you've got a smartphone if you want to get a little more screen time in before we finish I think it's ME Nhat en I it's some cold water Atlantic fish that's been yeah I don't anybody know we have any ecologist present yeah what are the odds that you'd ever have one of those when you meet them okay light exposure I'm going to tell you about the fastest known fastest known antidepressant response that you can get this side of ketamine which is we're not gonna talk about a whole lot anybody how many of you saw the news last year about ketamine which is a street drug that when they injected intravenously to a point where they basically had surgical anesthesia with depressed individuals they could get for some of them an antidepressant response within 24 hours I don't recommend it by the way so assuming you know we're not going that route light therapy is profoundly antidepressant and when somebody takes a medication like what are some of the best sellers right now effexor lexapro cymbalta you guys could tell me lots of others thank you very much wellbutrin I mean we could you know have a list of about 15 when you take an antidepressant medication you're typically told if you're told accurately oh this'll take three to six weeks to kick in right bright light therapy when it has an effect typically has an effect that's discernible initially within five to seven days five to seven days this is particularly interesting and important this time of the year why because one out of three Americans experience at least some symptoms of depression during the cold cloudy dark gloomy days of winter one out of three Americans experience at least some clinically significant symptoms of depression why what is it about light what is it about bright light in particular that affects our ability to function that affects our mood that affects our energy well before we answer that question I need to point out something that you may not have known which is if you look at this light meter here this is by the way the units are Lux Lu X what you'll see is that indoor light ranges down on this end of the continuum and outdoor light especially than a clear sunny day is on this side let me put it to you in the simplest possible terms as bright as it is in here with these floodlights if if I were to step outside on a sunny afternoon it would be 100 to 1000 times brighter indoor lighting at its brightest is no match for outdoor lighting and get this our ancestors for hundreds of thousands of years were outdoors all the time their brains were wired with the expectation that their eyes are going to be getting very bright light from sunup to sundown now this gets really interesting why because your body clock is not very accurate your body clock is not a Rolex it's not even a Timex it's like you know a Timex that's been left outside for a couple months and you know the body clock on average is off by about an hour a day if you're like left in a cave somewhere where you have no external cues your body clock starts to drift by an hour sometimes two hours every 24 hour period you cannot keep your biological rhythms in sync without what a daily dose of bright light how big a dose circadian keep that come back circadian q 2500 Lux the brightest indoor light 500 Lux in other words at least five times brighter than anything you're going to get inside what does that mean get outside yeah during the short cold cloudy days of winter many Americans do not get their body clock reset what does that mean their circadian rhythms start to drift their sleep starts to suffer their hormonal levels are out of balance their energy starts to sag their appetite starts to go crazy they start craving carbs they start wanting to hibernate but wait it gets better you have specialized light receptors in the back of your ID you remember the part of the eye called the retina when you were back in school and you learned the retina has two kinds of light receptors rods and cones right remember rods for light and dark and cones for color they lied you have a third type just for the brightness of light and those light receptors have a broadband connection right to the center of the brain where your body clock is but it gets even better also does circuits that regulate your energy level that use dopamine that have special connection to the reward circuits in the brain and other circuits that use serotonin bright light changes brain function it changes neuro chemistry somewhere between 70 and 80 percent of the population report they get an immediate mood elevating effect when it goes from being very gloomy and cloudy to being very sunny or when they go from a dark indoor space to going out on a bright how many of you by the way I just had a show of hands like if it's been cloudy and gloomy for several days and the Sun breaks through you just notice an immediate boost in your mood and energy level yeah yeah most of us most of us here we need bright light we need it everyday it is antidepressant it has been tested head-to-head now this is what really shocked the heck out of me not only has it been tested head-to-head against medication for the treatment of seasonal winter onset depression it's been tested head-to-head against antidepressant for non winter onset run-of-the-mill depression and it works and it works its antidepressant what kind of dose does it take 30 minutes a bright light for most of us in the morning for most of us within one hour of waking up how bright is bright 10,000 Lux that means outside on at least a partly sunny day in other words maybe cloudy but you can see clear sky or an artificial light box you can now buy an artificial light box this for less than $100 go on Amazon look for 10,000 Lux lightbox or several yes Oh excellent excellent excellent question there's one other benefit from natural sunlight so we covered the the bright light so in the winter time of course you know the holiday season is quickly upon us some of you might like as a gift a airline ticket to someplace warm and sunny you now have a wonderful rationale to give such a gift or to receive such a gift because if you happen to live in Kansas in the middle of winter your options for getting the antidepressant dose of bright light each day are probably either by a light box or take a trip someplace sunny and warm so I would opt for Hawaii or Acapulco or something yes Oh excellent questions sunglasses do regular glasses do not if you're in your car as long as you don't have Tenten yeah we don't need ultraviolet we need ultraviolet light for vitamin D which I'll talk about in just a second if you're in your car commuting when it's sunny out any of you have that you actually still get 50% of the the luminance or intensity of light so you're okay in your car if you don't wear sunglasses at least for those 30 minutes now if you want to prevent Deion's if you're not depressed right now but you want to prevent the onset of depression it only takes 15 minutes first thing in the morning let me say two other things quickly then I'll talk about the vitamin D angle number one if you have bipolar depression you know a bipolar where you know where there's mania on top of the depression at different times if you have bipolar depression it is dangerous to get bright light exposure first thing in the morning research studies have found that many individuals about half who have bipolar depression actually flip over into a very dangerous episode of mania or what we call a mixed state where they have mania and depression simultaneously where they're suicidal and have lots of energy and impulse that's not a good combination so if you're bipolar and depressed you can still benefit from bright light the best research evidence suggests that it's safest at midday midday not first thing in the morning yes within one hour within one hour of awakening within one the only accept no matter what time you get up within one hour now the only exception to this is if you have what we refer to as terminal insomnia where your body clock has been shifted in such a way that you go to sleep really really easily and you start to get drowsy super early and then you wake up like 3:00 in the morning and you can't go back to sleep or you wake up at 4:00 in the morning and you don't want to be awake until 6:00 or 6:30 anybody here have that if you have that you want to get your bright light exposure about four hours before your target bedtime and that'll help push your body clock in the right direction and this is very powerful my wife had somebody that she worked with who for ten years had been waking up at between 2:30 and 3:00 in the morning for ten years she tried multiple meds you tried everything nothing helped I said honey we need to give her our art we have our own light box at home let's give her our light box we're not using it right now get and I sent her with like you know just handwritten instructions and a month later she calls it she's like this is a miracle it's changed my freakin life I just slept until 7:00 a.m. for the first time and like it's powerful it's powerful powerful stuff now vitamin D is another benefit we get from being outside remember we're designed to be outside all the time what does vitamin D it's not a vitamin it's a hormone right why do I call it a hormone out of vitamins or nutrients that you have to get from your diet hormones or things your body can make your body can make all the vitamin D it needs it just needs a little assist from the Sun ultraviolet rays hitting your skin you know what it what the building block is you know what vitamin D is made out of cholesterol cholesterol yes your cholesterol level will go down if you have sun exposure in the summertime and you're making vitamin D now the average American is deficient in vitamin D over the winter in fact many Americans are deficient in the summer time as well because they love their dermatologist and the dermatologist says slather yourself with SPF 5000 you know all the time and by the way as we age as we get older we lose our efficiency in making vitamin D so older Americans are more likely to be deficient than younger Americans what can you do well vitamin D is anti-inflammatory huh but think the inflammatory that is probably antidepressant yes the evidence suggests that it probably is because vitamin D deficiency is a big risk factor for depression so I would suggest as we do with the patients in our protocol that you also consider talking with your doctor about supplementing with vitamin D as well great great question all right healthy sleep how much I lost my watch here okay we got eight minutes plenty time it's plenty time healthy sleep and let me just say to you really quickly the average American gets about six point seven hours of sleep per night the average adult a century and a half ago the average American adult got nine hours per night nine hours per night most of us if we were left on our own in a sleep lab away in a cave and this has been done actually at Stanford we would thrive on about eight hours per night until we got caught up because we're so sleep-deprived we'd get about nine or ten for a while and then we get caught up and then we'd get about eight per night and we would just be hitting on all cylinders our mood would improve our cognitive function would improve our physical performance would improve sleep deprivation is a huge trigger of depression if you want to depress somebody's mood you can start depriving them especially of the most restorative phase of sleep most of us have compromised quantity and quality of sleep we can benefit from from both now what's happened we picked up lots of unhealthy habits in our treatment program we trained individuals on habits of healthy sleep we have ten that we emphasize I've got a few of them here I'm not going to talk about them all first target eight hours per night by the way some of you only need seven how would you know if you're getting enough sleep you know how you know test yourself by putting yourself in a low stimulation setting you know what happens with a roomful of kindergarteners who by the way tend to usually get enough sleep roomful of kindergartners when they're in a boring assembly and they're listening to the principal drone on and on what do they do they squirm they fidget do they yawn no did they get drowsy no if you are in a boring situation and you find yourself yawning and getting drowsy that's a good sign you're sleep-deprived you know another good sign is go lay down an hour after lunch some day go lay down an hour after lunch someday in a dark quiet setting put a little sleep mask on if you want to pull the blackout curtains if you can fall asleep within 10 minutes you are sleep-deprived really really if you fall asleep within minutes of your head hitting the pillow you definitely sleep deprived now many of you should be following asleep the second your head is a pillow but the problem is you've been working or you have bright light exposure within an hour bedtime and you know what even though the light in this room is not bright enough to reset your body clock it is bright enough to tell your brain the Sun hasn't gone down when your brain sees this light it interprets it oh the Sun hasn't gone down yet which means what don't release melatonin to give you that wave of drowsiness because you don't need it the Sun hasn't gone down so you know what happens let me just ask for show of hands how many of you have been dog tired you know you're sleep-deprived and you finally at the point where you lay down in bed and you know you need sleep and you just lay there it for like 45 minutes to an hour at least before the sleep comes for many of us that is because either a we've been working within an hour bed time which keeps our stress response circuitry engaged or more more likely we have indoor lights on so what does that mean within an hour bed time turn off all the overhead lights go only for the last hour under low lamplight or candle light which is even more relaxing you will be amazed at how much easier it is to fall asleep yes sir excellent question is this autobiographical okay the TV if if it's a typical TV and you're not right on top of it it's it's probably okay if you're in a completely dark doubt blacked-out room TVs across the room it's not going to be too much light for you you know a lamp light in addition to it that starts to kind of push the envelope a little bit you want exactly or under like a little penlight oh oh or an iPad you know where it's backlit right the bed is for sleep only and vice versa we why is the bed only for oh by the way I'll make an exception no not me sleep researchers sleep insects okay sleep and sex but nothing else why why you want to train your brain and your body to associate the bed with sleep the same way Pavlov's dog associated the Bell with dinner in other words just like Pavlov's dog reflexively unconsciously started slobbering and drooling we want your body reflexively unconsciously to go boom and go right to sleep as soon as you get in the bed why because the bed has only ever been associated with sleep and vice-versa in other words you're not sleeping in the Barcalounger right or the sofa in the living room you're sleeping only in bed yes working nights is one of the worst possible things a person can do if they're prone to depression working nights is I mean it raises the rate of premature death by orders of magnitude it raises the rate of all kinds of accidents illness I mean I don't want to talk you out of it if that's what I mean but it I exactly as a clinical researcher it is one of the worst possible things we can do to our bodies it's to be avoided at all costs as soon as we can I would say yes melatonin is wonderful when it's released naturally by the pineal gland and the Sun of the brain as a supplement I'm not a huge fan and and by the way there's a very controversial position I have many colleagues whom I love and respect who do not agree with me on this my own position on it is that when we take melatonin as a supplement it weakens our own natural melatonin response and unless we have some sort of pineal gland deficiency tumor cyst something like that we can actually probably train our pineal to release melatonin in 45 minutes before our normal bedtime the best way we can do it by the way you guys are gonna want to hear this if you have exercise helps bright light helps but here's what helps even more if you have unhealthy sleep go to bed at the same time every night and even more importantly get up at the same time every morning even if you had a crappy night's sleep get up at exactly the same time set your target whatever it is 6:30 six seven eight my undergraduates 11 a.m. you know set the same time every day why what does it do it powerfully trains your circadian rhythm and it gives you a profound sleep drive when you need it gives you that big melatonin release when you need it for 45 minutes before oh by the way one quick thing about bright light flat screens such as are found in iPads laptops any flat screen gives off blue shifted light and for reasons that are still mysterious to science blue shifted light even when it's dim can fake out your photoreceptors in your retina into thinking that it's really bright let me say that again if you spend time in front of a blue shifted screen like a flat screen and I've had a laptop even if you have the the brightness on dim it's going to trick your brain into thinking you're sitting in front of bright light which means the Sun hasn't gone down which means you're not gonna get drowsy which means it's going to interfere with your sleep basically here's it in a nutshell you're not going to be able to fall asleep easily within 45 minutes of using your iPad or 45 minutes of using your laptop in most cases yeah there is a there there is an app now because this has been discovered there's an app that you can get that will cause your iPad or your laptop to shift into the red spectrum that's a great point somebody had a question yeah wait fine oh absolutely there are all kinds of yeah there are some wonderful wonderful ways of helping us get in and basically what it takes to sleep is a tired body and a quiet mind a tired body and a quiet mind so that when crawled into bed we're ready for that let me in our negative one minutes remaining let me just say one last quick thing about one more point which is rumination do you guys know that word rumination it means dwelling on brooding on the same thoughts over and over and over when we are anxious when we are depressed our negative thoughts take possession of us we can't let go of them we just chew on them it's toxic it's psychologically toxic why because it amplifies the intensity of our negative moods and it revs up the brain stress response circuits which keeps our depression going so what do we do well in our program we've got three steps for helping people stop ruminating the first step is just to notice when you're doing it learn how to get really good catching yourself in real time every time you catch yourself decide you're going to shift your focus you need to redirect your attention elsewhere what are the kinds of things that work really quickly social interaction and by the way shared activity not conversation that sounds counterintuitive when we are ruminating and we talk to somebody we very often drag them into our rumination with us what has been discovered by clinical research and certainly in our clinical practice is shared activity with somebody else is much better most of the time at breaking rumination than conversation unless you are really disciplined and your friend is disciplined so that you when you talk you are not talking about anything that you're going to ruminate about that's very hard to do by the way engaging solo activity that sounds a little bit print it's not meant to engaging that means all of us have things that we need to be able to do when we're by ourselves we don't have the luxury of social interaction that will capture our attention for some of us it's a it's a video for some of its being online for some of us it's playing them anybody play musical instrument I find that I play piano wonderfully anteroom in a tip if I'm brooding over something and I start playing something on keyboard it just takes me right out of it I wish we had time to brainstorm a little bit I'd love to hear from more of you about your best antirheumatic activities writing out your thoughts have you ever noticed when you write something down it's a lot easier to walk away from it you get it down on paper you've got things that are on your mind you can't stop thinking you write them down it's like oh it's dead on paper I don't have to keep thinking about it I don't have to burden my memory with keeping that thought afloat changing the scenery by the way most of us who ruminate have pet places that trigger our rumination again like Pavlov's dog we've been conditioned to ruminate in certain spots believe it or not when you're ruminating if you change the scenery to something novel especially getting out in nature there's something about nature that's been recently discovered to be an T ruminative and our brains crave the visual stimulation and relaxation that we get from looking at natural sceneries oh and here's the most shocking thing I'm gonna tell you tonight I think I'm gonna end on the shocking note I love this this is worth the price of admit it you didn't pay it's still worth the price of admission right for this when we're in nature when we're outside we are inhaling dust borne soil borne bacteria called Mycobacterium decay that are found all over the northern hemisphere and most of the southern hemisphere that go into our lungs these are bacteria have you heard a probiotic bacteria Probot these are probiotic bacteria we get them in our lungs they cross into our bloodstream they start interfacing with our immune system and telling our immune system to release factors that travel into our brain and start changing neural chemistry increasing growth of neurons in circuits that use dopamine and that rev up our pleasure centres being outside in nature is bizarrely antidepressant bizarrely yeah bizarrely antidepressant let me just close by saying I've written all this down if you if you felt like there's a lot of information there's more that you wanted to know I'm certainly willing to stay after and answer any questions but I do have a book it's called the depression cure that's available at most books hello there's a copy right right if here it looks like this it's blue it's kind of pretty it's got an outdoor sort of scene it has a lot of details we also have a website in our lab at kayuu that has most of this information at least in summary form if you just google our program is called TLC therapeutic lifestyle change if you google TLC and Kansas or TLC and al RT or TLC and depression you'll find it really easily so thank you guys very much it's been a pleasure to be with you
This video/talk has helped me understand a lot about depression and mental health in general, as well as doing something about it. I thought I'd share it here for others.