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

In this episode, I want to talk about depression. And not just from a psychological and scientific perspective but also from a personal perspective, sharing parts of my story. It's not something I've talked about much on the podcast but recently I've really come to terms with my own shame and stigma and I want to discuss where I'm at now, the journey I've been on and how its impacted the life I've created for myself in my 20s. We're also going to explore some of the key principles and theories behind the origins of depression, misconceptions, the different forms of depression, historical recognition of this condition, whether exercise really is a 'cure', and the new frontier of depression research, including the proposed use of psychedelics and ketamine. 

If you or someone you know needs help, please see the below resources: 

Beyond Blue - https://www.beyondblue.org.au/

Black Dog Institute - https://www.blackdoginstitute.org.au/resources-support/depression/ 

Lifeline (for immediate over the phone support) - 13 11 14 

For further reading, please see the below articles: 

Genetic Factors in Major Depression - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6065213/ 

Childhood Trauma and Its Relationship to Chronic Depression in Adulthood - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4677006/

Depression as a disease of modernity - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3330161/ 

Effects of Naturalistic Psychedelic Use on Depression, Anxiety, and Well-Being - https://www.frontiersin.org/articles/10.3389/fpsyt.2022.831092/full

 

See omnystudio.com/listener for privacy information.

Episode Transcript

Speaker 1 (00:04):
Hello everybody, and welcome back to the Psychology of Your Twenties,
the podcast where we talk through some of the big
life changes and transitions of our twenties and what they
mean for our psychology. Hello everybody, Welcome back to the show.

(00:27):
Welcome back to the podcast. New listeners, old listeners. Wherever
you are in the world, whatever date is, I hope
you're having a great day. Welcome back for another episode.
So you've read the title, I don't think it's any
surprise that today I'm going to talk about my experience
with depression in my twenties. I have depression. I've had

(00:49):
it for many years, and I really think it's time
that we talk about it. It's taken me quite a
while to really, I would say, process what I wanted
to say in this episode. I think out of fear
maybe you know, my words could be misconstrued, my experience
could be miscontrued, but also because of you know, a
level of shame. You know, it's really it's a lot

(01:11):
to really engage with that. There are millions of people
listening to what can be very deeply intimate and vulnerable
parts of my life, and sometimes there are things that
I don't really feel prepared to share because I think
that what you make public is kind of what you
allow people to comment on and what you allow people
to have an opinion on. But I also don't think

(01:33):
it's a secret. You know. I did an episode a
while back titled why am I So Unhappy? I feel
like that's a big clue. And I've also talked about,
you know, my experience with antidepressants back in the earlier
days of the show. But for a mental health podcast,
it felt like it was time to do somewhat of
a comprehensive episode on this, So today, let's talk about it.

(01:56):
Let's talk about depression in our twenties. This episode is
going to be, I think equal parts more scientific and
more personal than most of my episodes, because I think
when we're approaching things like mental health, you can't be
coming at it with your own theories, and there's also

(02:16):
no absence of really incredible research into improving the lives
of people who have this condition. It's also a sad
reality that stigma is very much alive and well. I
think as society we are getting a lot better at
accepting certain truths about depression, but a big part of
why stigma persists is because of a lack of accurate knowledge.

(02:40):
So kind of consider this your introductory guide, your immersion
into the psychology, but also the personal experiences of someone
who is going for this. We're going to discuss why
depression is more than just a blanket term, and how
it looks different for everyone, including people who may be

(03:00):
very high functioning and visibly seem very well and very okay.
It's a huge misconception that you need to look and
behave a certain way to be depressed. That's a myth
that we are definitely aiming to bust today. We're also
going to examine the different types of depression, the origins
of depression, including some of the early historical recognition of

(03:22):
this condition, and some of the secrets and surprises that
our biology and our DNA holds, as well as the
role of things like adrenaline, like family environment, and even
positive experiences like graduating. You know, our minds are very
very cryptic, a bit of a black box at times,
and I think depression is a lot more than being

(03:44):
sad or based on what we perceive as negative events
in our lives. There's also been some really fascinating research
coming out in this space that I think deserves a
very special place in this episode, particularly around the use
of things like psychedelics and certain illicit substances to treat depression.

(04:06):
We're going to tread lightly because the research is still ongoing,
but I think we're at this kind of new frontier
of how we approach a lot of different mental health disorders,
including depression. So although we're going to talk about typical treatments,
I really want to speak about my own experience on antidepressants,

(04:26):
kind of some of the myths behind why exercise is
not the secret cure we all imagine it to be.
We're also going to leave some room for new findings
and knowledge and hopefully come out of this knowing I
would say more than about ninety five the set of
the population does know about depression. There's so much information

(04:47):
that I want to cover. Maybe we can do a
part two, but if you're looking for an overview and
also some of the more fascinating elements that we don't
see discussed very often, hopefully this is the space where
you can learn. I want to quickly put out a
brief disclaimer. This episode is for entertainment purposes only. Maybe

(05:08):
not entertainment episodes informational purposes, but please do not use
this episode for diagnostic or therapeutic advice. If you find
yourself relating to this discussion or this does make you distressed,
please please reach out to someone for professional support. I
unfortunately do not know each and every one of you,

(05:30):
and I don't know your story or your needs, and
as we'll come to see, we all have different experiences.
But there will be links in the description for further information.
And if you're someone who's maybe listening to this to
better understand the experiences of a partner or a friend,
a sibling, parent, really anyone, Firstly, thank you for joining us.

(05:52):
I think it's really beautiful that you're here to learn,
and there will also be resources on how to support
people with depression as well. Like I said before, there's
a lot to cover in this episode. I'm going to
stop rambling and we're going to dive into all this
science and the psychology and a bit of my personal
experience as well. So let's get into it, alrighty. So,

(06:20):
I don't think I can do an episode like this
without explaining why I think it's so important we have
more discussions around depression and mental health in general, particularly
in our twenties, and as a part of that, I
want to talk really frankly and openly with you about
my own experience. So I've had I guess, clinical depression

(06:41):
for like five years. It comes and goes, and I
think sometimes I feel like I've spent more years of
my twenties kind of dealing with it than I have
really enjoying this time, and that you know, the best
years of my life have somehow been been claimed by
this state of mind and by this condition. And you know,
last year in particular was really hard. It was the

(07:04):
best year of my life. Everything I'd ever wanted kind
of came true. Everything was going right. It was these
constant milestones and celebrations. And I think despite all of that,
all of that perceived external success, I felt really deeply,
deeply unhappy. I would look at my life and I
knew I should be excited, I knew I should feel

(07:26):
up on cloud nine, and I just couldn't be there.
And it was so frustrating to me to not have,
you know, I guess, access to that joy, or to
the things about myself that I valued, like my creativity
and just my kind of zest for life and I
know that that experience, having talked to listeners of the show,
having talked to friends, is not a unique one. It's

(07:49):
not one that I'm alone in experiencing. That's why talking
about this is so important to me on a really
vulnerable note, because I know it's hard to talk about.
I know that this side of me might not be
what people want to see or hear about. I know
that our knee jerk reaction is to feel shame or
embarrassment towards open discussions around mental health. But I'm hoping

(08:12):
that seeing how this has played out for me and
continues to impact me, using some of my own experiences,
but also the academic and the psychological and the scientific knowledge,
can really minimize that shame for yourself and also actors
an example that this can be your experience and you
can still have a really fulfilling and fantastic life. There's

(08:34):
good days, there's bad days. I guess that's part of
the game I'm still kind of adjusting to. There's no
doubt that we are seeing rising rates of not just depression,
but general unhappiness and alienation in this generation. We know
that young people have a higher rate of diagnosis for
these conditions. There's even some estimates that put it at

(08:55):
like thirty to thirty five percent, way more than what
we saw in in previous decades. But also in older
age groups, and it's during the ages of around sixteen
to twenty nine, early thirties that typically our first major
depressive episode, if you go on to develop a major

(09:15):
depressive disorder, normally occurs, So we really want to start
talking about it earlier. The factors I think that we
can point to for this upward trend are really endless.
You know. On a positive note, reduced stigma in society
is leading people to receive a diagnosis, and you know,
previous generations may not have received that despite experiencing all

(09:38):
the same symptoms. And also generationally, I do think there
is this kind of increasing malaise with the state of
the world, Reduced protective factors like a sense of community,
which we know has really disappeared for a lot of
people in this generation, significant pressures to perform and be exceptional,
financial uncertainty, COVID, a sense of just like general doom

(10:03):
about the future, and those are only really I think
a handful of explanations that psychologists and researchers are pointing
to for a lot more people coming to them saying,
I'm having this experience, I think I might be depressed.
We're never going to eliminate conditions like depression, but I
think the existence of depression in society is not the concern.

(10:26):
It's the rate at which so many of us are
struggling without the necessary societal and community and medical supports.
You know, this condition has always had a place within
the human experience. This is not some new illness, it's
not some bad condition. It's very very real and very
very consequential. If we look back at history, although terms

(10:49):
like clinical depression or major depressive disorder, and now, how
we would label this experience. Back in even like ancient Greece,
ancient Rome, they had a name for this. They had
a different name for what we're talking about, and it
was melancholia, meaning a feeling of deep, profound sadness, a
sadness that kind of sits in your bones. And there

(11:11):
are so many historical documents and parts of history, paintings, sculptures, folklore,
even Bible versus that show us that not only did
this condition we now know as depression exist, but there
were also efforts to treat it, it was viewed as
a medical condition, and yet we still have such a
hard time acknowledging it in our society, despite it being

(11:34):
what some are calling a literal epidemic and very historically significant.
You know, you'd think that we'd have used those thousands
of years to actually get better at integrating this condition
into our understanding and our compassion for others. But still
I think we endure it in silence. When we do
have the courage to ask for help, maybe you don't

(11:55):
receive the support that you need, or at times we're
kind of convinced that we're totally fine, it's all in
our head just to get over it, to grin and
bear it. And that fallacy that avoidance in suppression can
somehow magically cure you is so false. It's you know, it's,
without a doubt, not true. Depression is so much more

(12:15):
than just sadness. It's a medical condition, perhaps one of
the most common that we see. And it's not shameful.
That shame is societal. That shame is learned, and it
can be unlearned. I know this metaphor has been used
to death, but your brain is an organ, is a
part of your body, like any other, and sometimes it's

(12:35):
going to have a few problems. The same way that
our bones break, the same way that we get scrapes
and bruises, and our arteries clog, and our hearts beat
a little bit too fast. Sometimes our brains find themselves
in a state of chemical imbalance, or they get bumped in,
you know, symbolically metaphorically bruised by the things we experience.

(12:56):
I think what I found in my own experience was
that from the outside I looked really, really fine. I
think I didn't feel fine, but I was still going
to work, I was still interacting with my friends. I
was still getting good grades at university. All the feelings
and symptoms that I was experiencing were very solitary, and

(13:19):
because of what I thought depression looked like, I didn't
really feel like I deserved to feel this way or
to accept the diagnosis that I had to me. The
depression I saw was really dramatized in the movies, in
books and TV shows. The cases I saw that were
acknowledged by society and those around me were very visible.

(13:41):
It was someone laying in bed for hours, which you
know I did do, but it was also someone who
missed work, or school, whose kind of hair was always
a mess, who walked around like a zombie. I saw
depression as tearful, as very outward, and as causing dysfunction,
And for many of us, that is the experience, and
it's one that's extremely difficult. But from the outside, in

(14:04):
my case, I was still functioning. I wasn't crying. If anything,
I couldn't cry because I really couldn't feel anything. But
I still did all the things that people expect you
to do, and that didn't really match my perception of
what I thought depression would look like. I think our
difficulty accepting the reality of this goes deeper than just

(14:24):
the stigma that we've spoken about, and it's this larger
idea of a misrepresentation that our society likes to, you know,
make things look dramatic, likes to make things look a
lot more in you know, not intense than they are,
but likes to make it a little bit of a
spectacle out of the things that we go through. And

(14:46):
like I said before, we see that in so many
types of media that we're consuming, this idea that your
life needs to be absolutely falling apart for you to
be depressed, and that's something that needs to be needs
to be corrected. There needs to be some kind of
understanding that you can still be depressed and everything in

(15:07):
your life can be going really, really well. So that's
the first misconception I really want to talk about. Depression
is not just one condition. It's not a blanket diagnosis,
and it is going to look very different from person
to person. To understand this, we kind of need to
look closer at the DSM. And this is what we
call the Diagnostic and Statistical Manual of Mental Disorders. Essentially,

(15:32):
it's like the Bible of pretty much every mental disorder
you would experience, and it lists exactly how to diagnose
a condition and what it's going to look like. Depression
was one of the founding conditions, but previously anyone who
met the symptom cut off for depression would be diagnosed
with major depressive disorder. That is what I think our

(15:54):
society the typical image of what this condition is. But
on a clinical level, it requires two or more depressive episodes,
which is a discreete period of time, often a minimum
of two weeks. When we experience at least five of
the following things, we have a depressed mood for most
of the day, a diminished interest or kind of pleasure

(16:17):
in the activities that we used to enjoy, significant weight
gain or loss, insomnia or sleeping too much, agitation, fatigue
or loss of energy, feelings of worthlessness or excessive guilt,
a diminished ability to think or concentrate, and finally, these
recurrent thoughts of death. Like many mental health conditions, it

(16:42):
has little to do with what's actually happening around you.
You can have a loving family, you can have friends,
you can have a dream job, you can have the
kind of life that you've always wanted, and you can
still have depression. But for others, this typical definition of
a major disorder isn't going to be their experience, right,

(17:03):
And that's something that psychologists have really identified in recent decades.
They had clients coming in saying, you know, I don't
have these lows that are intense as those associated with
a major depressive disorder, but it can't shake this sadness.
And it's been years. Some days you know are better

(17:24):
than others, but there's this overtone of really deep unhappiness
and hopelessness in my life. This is what we now
call persistent depressive disorder. It's also known by other names
like high functioning depression or dysthymia. This is what I
now know, I think I had, and well I still

(17:45):
have it to this day, and the criteria are a
lot less strict, but it really points to the longevity
of this type of depression. You need to have a
depressed mood for more days than not, and he's kind
of a kicker for at least two years. But you
only need to have two of the below criteria, not five.
So the same kind of list that we talked about before.

(18:07):
Low mood, sense of hopelessness, a lack of energy, low
self esteem, and this condition is much more nuanced, like
we said, than just sadness. The same way that each
person is a really unique combination of so many factors
and experiences and stories, their minds and their brains are
also going to be this unique combination, so I think

(18:28):
it's really important that we recognize that distinction and adapt
to the diversity by which these symptoms can appear. We
also see conditions under this umbrella like seasonal effective disorder
or seasonal depression, postnatal depression, depression associated with bipolar disorder,
and then finally adjustment disorder with depressed mood that's also

(18:52):
known as situational depression. This looks like major depression in
many ways, but instead of being brought on by what
we might see of certain biological mechanisms or neurological roots,
it's brought on by a specific event or situation that's
been really really hard, like the death of a loved one,

(19:12):
or serious illness, a divorce, facing financial difficulties, even a breakup,
all of which are these events that are discreet, but
they essentially overwhelm our capacity to cope, you know, as
it's only natural and kind of expected in those situations.
Situational depression. The symptoms tend to start within three months

(19:34):
of the initial experience, and it follows a very similar
pattern to major depression, with the caveat being that often
it's quite comorbid with other conditions like anxiety or things
like substance use, you know, including alcohol. I think what
always complicates our perception of this condition isn't just the

(19:57):
variety of the ways that it can manage fest, but
also the fact that depression or feeling depressed is both
a clinical term and one that we can use to
describe a certain feeling, you know. It's both a symptom
and a condition, but one of those things is temporary.
And a question I get asked a lot is is

(20:18):
this kind of my life now? Will I ever be cured?
When's this going to end? I think when we are
in this state, we often need the security of a
timeline to give us a light at the end of
the tunnel. How can we kind of go on with
life if we think that this will never end? And
that's what depression convinces you that it won't, that it's
all pointless. And if you just get one thing from

(20:42):
this episode, one tiny, tiny piece of advice or wisdom,
it's that it's not pointless. Trust me, I know so
intimately how it feels to look at life, this thing
that we think should be precious, and feel nothing for
nothing to make us happy, to be stripped of joy.
But I also know what it feels like to kind

(21:02):
of slowly see that perspective change. It's like the first
flowers after spring. You know your brain is slowly defrosting
all those happy hormones, that it's that it's kept from you.
And I really do understand the desire for a quick
fix as well. You know soundly our brain is quite cryptic,
and the length of this condition is really going to

(21:23):
depend on a lot of factors, the primary one being
the origins and the root cause, and what about our environment,
or our context or our protective factors can be altered.
So let me set the stage and kind of dive
into the science behind why we feel this way sometimes

(21:43):
where it's coming from. You know, depression is not a
personal flaw. It's not a personal weakness. It is this
hidden system and interplay of genetic and biological and environmental interactions.
If depression, you know, was true a choice or a
personal weakness, you know, we could hypothetically be able to

(22:05):
overcome it with sheer will power and positive thinking. And
while some people would have you believe that that is possible,
those are not the kinds of people that we want
to be listening to, especially when it comes to our
mental health. We're going to approach this from the model
of the four p's. So what that means is predisposing factors, precipitating, perpetuating,

(22:28):
and protective. There's kind of not just one secret formula
to what makes a depressed person, I guess, versus someone
who is not depressed. But we can use this model
to kind of break down our innate and personal vulnerabilities,
and then also what we can use to mitigate our
symptoms if we are someone who has this condition. So

(22:48):
predisposing factors are kind of areas of vulnerability that increase
your risk. When we talk about depression, the first one
that often comes to mind is genetics. If you're looking
for something else to blame your parents for, this one
might be for you. But our genetics are inherited from
our mother and our father, and they essentially lay out

(23:10):
the blueprint for how our brains and our bodies should
develop as kind of an initial template that then kind
of interacts with our environment to create our outcomes, to
create our life. Each of us has a very unique
genetic profile, with obviously the exception of biological twins, and
our genetic profile is marked by these things called mutations.

(23:32):
So these are caused when our cells are splitting or dividing,
and when we receive a mutation on one of our genes.
This is what is often responsible for certain disorders and illnesses,
or a certain predisposition for conditions like depressions. So when
scientists started using genetic mapping to figure out why some

(23:53):
people develop certain conditions for seemingly no apparent reason, and
others don't. Eventually they turn to depression to see what
they could find in our DNA, what kind of secrets
they could unlock, And here's what they found. So they
believe that as many as forty percent of those of
us who have depression can trace a link back to

(24:16):
something in our genetics, which is most often identified by
having a close family member or a relative who also
has depression. But it's important here to note that doesn't
necessarily mean that everyone with a mutation or family history
is going to develop depression, because often that gene needs

(24:38):
to be activated by our environment, and that accounts for
the other sixty percent of our kind of risk factor
or vulnerability. And this is where the interaction between family
history and genetics can become a little bit tricky, because
a child who grows up with a parent or a
person around them who has depression, maybe they are more

(24:59):
susceptible to the condition, not because of a genetic mutation
or because they've inherited this gene, but because they've learned
to mimic their parents' behavior, or they've experienced something perhaps
uncomfortable in childhood that is related to their parents' experience.
It's hard to separate whether the trigger, I guess, or
the predisposing factor was genetics or our environment, and that's

(25:23):
kind of a puzzle that we're yet to crack. But
when they dived further into what specific gene mutation was
kind of responsible for upwards of forty percent of cases,
what they really found has truly changed how we approach
this condition. Our genes are responsible for how our brain

(25:44):
processes and releases serotonin, and serotonin is the primary candidate
for the reason we experience depressive symptoms. It's like the
core neurotransmitter that we would hear about and that is
discussed when we're talking about this condition, and there's been
several studies that have shown this. You know, serotonin is

(26:06):
definitely something you've heard about before. You probably mostly know
it in terms of like the happy drug alongside famine,
the happy chemical, And that relationship between perhaps having a
less formed serotonin system or less serotonin available in our
brain and depression makes a lot of logical sense because

(26:28):
this neurotransmitter is responsible for our mood, for our general
levels of happiness, and also things like sleep, which we
know contribute and because this mutation disrupts the release and
how our brains process serotonin. People with depression may have
less of this neurotransmitter available to them, and that is

(26:48):
what results in these symptoms that we typically associate with
this condition. At the end of the day, I think
what these findings really revealed is that this may be,
you know, nothing more than just a chemical imbalance, and
it's unfortunate, but you know, we can't go into our
brain and turn on the serotonin tap whenever we'd like,

(27:09):
but we can take medications like selective serotonin reuptake inhibitors
or basically what we know as antidepressants, and they work
by preventing our neurons from sucking up all of that
serotonin in our brain and keeping it in action for longer,
making more of it available to us. That's obviously a really,

(27:30):
really simple explanation, but the apparent effectiveness they've repeatedly shown
effectiveness of this type of antidepressants really points to depression
having a biological origin in how our brain releases and
processes serotonin, in particular hormonally as well. Studies conducted in

(27:51):
two thousand and eleven, actually a bunch of them, not
just conducted during that year across a number of years.
They also suggest that major depression may involve an overactive
hypothalamic pituitary adrenal axis. Very long word, very long term,
but essentially it's responsible for a lot of our hormones,
including estrogen, which, as you may have guessed, it also

(28:13):
impacts serotonin levels. All of it comes back to this
one little neurotransmitter. But we're going to talk on this
a little bit more later, specifically the hormonal influences. I
want to quickly return to that question, how long does
this last? How long is your depression going to last?
You know, I can't answer that for you, but I
think if it's the case that a lot of your

(28:36):
condition is coming from hereditary factors like genetics, which consequently
impact your innate biology, I think the unfortunate news is
that you know, sadly you cannot rewire your brain, so
not accounting for the protective factors we're going to discuss
later on, it's really hard to say. It may be chronic,
but it's not untreatable. SSRIs are highly reliable. They've been

(28:59):
systematic tested for their effectiveness in these situations, particularly in
response to this chemical imbalanced explanation but the fact that
they don't work for everyone points to this kind of
deeper truth that not everyone's depressive symptoms have a genetic
or even a neural origin to do with some kind

(29:21):
of serotonin dysfunction or hormonal dysfunction. Certain personality types and
people of certain temperaments may also be more susceptible, and
there's a few that we typically look at, particularly those
who are rejection sensitive, self critical, anxious, worrying, or personally reserved.

(29:43):
And then of course we have things like extraneous events
and circumstances. It's not all about temperament and personality. The
things that happen to us create the thought patterns and
the response that our brain is going to have. So trauma,
as we know, is a massive country out There is
a large consensus that indicates that childhood trauma is significantly

(30:06):
involved in the development of depression. In one study they
conducted in twenty fifteen that I found so comprehensive and
incredibly well done, researchers ask people to retrospectively recall childhood trauma,
and they also measured their rates of chronic depression, and
the relationship between these two things was really really significant.

(30:30):
Our environment particularly our early childhood environment is so powerful,
and things like neglect and abuse have the capacity to
literally change how our neural and global structure is developing
in some instances, even shrinking or delaying development. Our brains

(30:52):
are also not great at forgetting trauma. We have an
evolutionary and a survival instinct to remember the bad things
that happened to us. Yes, and even when you know
they do come through as suppressed memories, the body does
not forget, and that stress and that experience does unfortunately
stay with us. These factors, though, they all have something

(31:14):
in common the ones that we've talked about, and I
want to emphasize that commonality. Really clearly, none of these factors,
none of these predisposing determinants are within our control. None
of them. None of them could be our fault. There
is nothing in that list that we have agency over.
You know, our genetics absolutely, not our personality. Some would

(31:37):
argue maybe, but I would say not the trauma and
the things that we experience, our hormone levels. If we could,
we would definitely make it so that we did not
have this predisposition, that we did not have this experience.
Once again, that's misconception. Number two, and something that we
have to say is that you do not get to

(31:58):
control how this condition manifests. And I think that really
takes a lot of the shame away from it because
it's not something that you have decided to opt into.
It's not something that you want to be dealing with.
You know, depending on your experience, I would say most

(32:19):
of us would prefer not to be depressed the majority
of the time. Okay, I think it's time for a
quick break to gather our thoughts, grab a cup of tea,
tell your friends that you love them, and when we return,
I really want to discuss precipitating factors, protective factors, and
also some of the new treatments that we are seeing

(32:41):
for depression, including the use of psychedelics not as fun
as it sounds, actually but really interesting, and also why
some people think that things like ketamine or even nature
may be particularly healing for people with these symptoms. We've

(33:03):
done a bit of an overview of what people typically
see as the causes of depression, but what kind of
triggers a depressive episode or something like persistent depressive disorder.
This is where we turn our focus to precipitating factors.
These are things that initiate or promote the onset of

(33:24):
a condition. The main fender, I would say is stressful
or adverse life experiences. These two psychologists actually created a
scale for what these might be and which ones may
be more predictive of depression. So it's called the stress scale,
and number one is the death obviously of a spouse

(33:46):
or of your child, things like divorce and separation, imprisonment,
the death of a close family member, injury. But then
surprisingly we actually see some things that are more positive,
like marriage and retirement and the birth of a child,
can be so stressful even though we see them as

(34:07):
beautiful that they trigger this kind of emotional and deeper reaction.
Let's focus in on some of the events that particularly
pertain to our twenties, in particular significant life changes things
like grief, but also moving out of home, our first
significant breakup, and deep feelings of things like isolation and alienation.

(34:29):
There are so many other unique things, and when multiple
of these events occur in a short period of time,
this has what we would call a cumulative effect. So
the prolonged accumulation of momentary stress leads to an increase
in long term cumulative stress and just general impacts on

(34:50):
our overall health, perhaps because of the release of things
like cortiso and adrenaline. It's a biological interaction that has
the name post adrenaline blues. When we go through something
intensely shocking and life altering, our bodies respond to this
as they would respond to danger or a threat, and

(35:11):
they pump us with a nice cocktail of neuropinephrine. It's
also known as adrenaline and cort result, which is the
main stress hormone that's released from our thyroid when that
danger passes, when that event kind of fades, when the
wedding is over, when you've unpacked all your boxes in
the new city, you crash and your body is trying

(35:33):
to restore things to normal, And what that can induce
is a depressive period or a depressive episode. So yes,
one event may be enough to really trigger something like
situational depression or an adjustment disorder with depressive symptoms, but
it can also interact with some of our earlier predispositions
and create other elements or symptoms or even a depressive

(35:57):
episode because it is so shocking, because it has really
caused us to perhaps rethink life. It's made or limited
the availability of our coping mechanisms. It's really transformed how
we see the world and is naturally incredibly stressful. But
something that's kind of missing from this discussion, I think,

(36:19):
and is often missing and rarely spoken about, is protective factors.
We like to focus on the negatives. Maybe that in
itself is symptomatic, but also our society is rather pessimistic.
I think our obsession with predisposition kind of also links
to that innate stigma. If we know how depression is
created or developed, maybe we can eliminate it from society,

(36:42):
which I personally don't think is quite valuable. Maybe that's
a controversial thing to say, but for me, you know, yeah,
you have your bad days. But if someone kind of
gave me a magical button, I think I'd have some doubts.
I don't want to say there's been benefits, but there's
been definite perspectives shift and various outlooks that my depression

(37:02):
has kind of given me. You know, who could say
I would be even making this podcast now if I
didn't have this experience and didn't relate to some of
the deeper discussions happening around mental health and psychology. But
I also understand that part of that comes from the
attitude I have towards what I'm experiencing, and attitude, as

(37:24):
silly as it sounds, it's not going to cure your depression,
but there has been evidence that it does minimize your
distress and perhaps the severity of your symptom profile because
of its role as a protective factor. Things like you know,
if you're innately pessimistic versus optimistic, which we'll talk about
in a second, that is going to influence your thinking
style and also your coping mechanisms. But let's discuss a

(37:48):
few other of these protective factors that are really impactful
when we talk about depression. Like I mentioned personal attributes,
but then things like social support, networks, sense of community.
Really nobody can overstate the beauty and the importance of belonging.
It kind of quats us in a bit of a
protective shield. Also, a strong sense of identity, a sense

(38:11):
of self, even things like spirituality or your connection with
a particular religion that really encompasses a reason for being.
And then also things like depression, physical health and fitness.
I think it's valuable that we focus on that last
one because I know the opinions around it are very

(38:31):
nuanced and at times contradictory. From an evidence based perspective,
there is there are a lot of findings that exercise
as a behavioral intervention does alleviate some of the symptoms
of depression. In a few large scale studies, one in particular,
which was conducted here in Australia actually published this year

(38:52):
twenty twenty three. They found that active men and women
became depressed at much lower rates than set A two people,
even if they exercise for only a few minutes a
day or a few days a week. But the kind
of precise mechanisms by which bodily movements alter brain functions
to improve our mood really remains unclear, as do the

(39:16):
differences in people's responses. So in every study the researchers
looked at, some people's depression was alleviated while others remained unchanged.
I also think we need to be skeptical when we're
promoting things like exercise because a like we showed, it
doesn't work for everyone. B. I think when we read

(39:37):
these findings without considering the broader context and interactions between
exercise and other factors, we can sometimes reduce these conclusions
to suggest that, you know, just buying a pair of
running shoes and going for a job is the magical answer.
And see, I think it shouldn't be considered the first
line of treatment for some people. I think in many
ways that would be unethical. Also, when we think about

(39:59):
the impact depression has on our motivation, it's really hard
for your therapists to be like, oh, just go for
a run when you can't even get out of bed.
Or it also excludes people with certain disabilities. It's a
protective factor. I will say, it's not a cure, and
to sell it as anything more than that, I think
would be very misleading. You know, look at elite athletes

(40:20):
as an example. We've seen so many people like Simone
Bios and Naomi Osaka come out and talk really openly
about their mental health problems. And I'm going to bet
some pretty good money that these people are exercising for
more than forty five minutes a day. So the relationship
that has been promised between physical activity and an alleviation

(40:42):
of mental distress isn't quite there. What it seems to
be is a combination. If we have a strong support network,
particularly if people we can speak openly with that really
lessens the load, as does, like we said, a sense
of being a purpose and personality or temperament, the main
one being, like we said, the distinction between being an

(41:04):
optimist or a pessimist. You know, do you see the
world and your future is genuinely positive or are you
expecting the worst case scenario. Also, I think depression can
make us feel like we're all pessimists, the outlook carried
through though by our prior predisposition for optimism, even just
even just this slight sense, even if just that like

(41:25):
very hidden voice in our head that says, all right,
let's keep focusing. Things are going to turn out or right,
That can maybe counteract that negative thought pattern that we
associate with these symptoms. Something I've also found really effective
is active coping skills, forcing myself to journal what I
was feeling, especially as a way to look back and

(41:46):
see how far I've progressed, but also as a reminder
to myself during future hard times that this is not
the first time I've been through this. I've survived, I've
pulled through. There are beautiful things waiting for me. That
is a really important and valuable part of my approach
to managing what I'm going through having a perspective. Okay,

(42:08):
so the final thing that we've been missing from this
conversation has been discussions of treatment. If we're taking a
biomedical approach to depression, that perspective tells us that, like
any other form of illness, depression should be managed through
a series of treatments or interventions. I also want to
state that this should not be taken as advice. Like

(42:30):
I said before, I'm not in the position to give
you actual medical recommendation prescriptions because I guess I don't
know you personally. But knowledge is power, and I think
psycho education is power. So consider this just an introductory
overview or glance at what is actually out there. So
there are two main forms of treatment that we typically see,

(42:52):
that's medication and therapy. We already know the basics behind
why antidepressants were Depression involves changes in brain chemistry and
that can change how people respond to the world, and
so these kinds of medication can correct the imbalance of
chemicals in the brain, such as that a natural balance

(43:16):
is restored. I have an old episode on this's called
antidepressants literally just antidepressants, and it basically explains my own
experience on Lexipro, which I've been on since I was
around twenty, and it felt like the right option for me.
I would, you know, had been going to therapy for
a while, I'd made the lifestyle changes, and I think

(43:36):
I got to the realization that what I was dealing
with wasn't going to be fixed through my behavior, and
it really personally did change my life. And four years on, it's,
you know, its second nature to be taking this medication.
The times I have tried to go off it have
been fucking horrendous, like dizziness, irritation, nausea, and you know,

(43:57):
sometimes I do worry that I will be dep it
my whole life, but I think I'm honestly a little
bit scared of who I'll be without it. And you know,
when the time is right, I'll try it again and
I'll see what happens. But it's definitely something to be
discussed before you go on it. It's not something that
you go on to temporarily relieve your hopelessness or your sadness.

(44:19):
It's like a two year thing kind of minimum. And
it's widely believed that these medical interventions they work best
when combined with some kind of talking therapy, one that
really gets to the core of how you're processing your
reality and the nature of your thoughts. Like we always
say on the show, a problem spoken out loud is

(44:42):
half the problem. So the two types that are most prominent,
I would say are cognitive behavioral therapy CBT if you've
heard of that before, and interpersonal therapy. So we're going
to start with cognitive behavioral therapy. It is perhaps the
most widely practiced and effective form of psychotherapy, and it

(45:03):
operates on the principle that our thoughts, our beliefs, our feelings,
and therefore our behaviors are interconnected, and by identifying and
challenging negative or distorted thought patterns, we bring about positive
changes and our emotions and our actions. Interpersonal therapy is
a bit different, and it's a time limited form of psychotherapy.

(45:26):
Once again. Psychotherapy is also known as kind of talking therapy,
and it centers on improving our personal relationships and addressing
the emotional issues within that context that may be contributing
to how we're feeling. I think by exploring our past
or current relationships, even by exploring our attachment style, our communication,

(45:50):
life transitions as well, we can really gain these insights
into how these discrete aspects of our lives are actually
influenced seeing our deeper emotional wellbeing. But I want to
talk about some of the more experimental incoming treatments as well,
because treatment for depression, specifically major depressive disorder, has stayed

(46:15):
relatively the same for the last two decades, but we
are seeing a lot of new presentations and rising rates
and that's made a lot of scientists and researchers really
question whether we could be doing better. You know, back
in the day, Freud used to treat his patients with cocaine,
and it seems like we're coming back full circle with

(46:35):
the introduction of what we would typically see as illicit
substances like ketamine or LSD now being used in a
clinical medical setting. So you've probably heard about this, but
I want to clear it up. No doctor is going
to hand you over a bag of whatever drug and
sago nuts. They're not going to ask you to go

(46:56):
and source it for yourself. It is highly regulated, highly detected.
In twenty nineteen, the US actually approved ketamine based nasal
spray for the first time, but it's very much used
for specific cases. You know, when We're dealing with addictive
drugs that have been proven to be very destructive, and
now we're trying to leverage them for something productive. You've

(47:19):
really got to be cautious, you know, especially around there,
you know the propensity or the risk for substance abuse.
I want to explain why it may work though. With
most medications, like valium or even lexopo or an SSRI,
the antidepressive or anti anxiety effect is only going to

(47:43):
last when that drug is in your system. When the
valium goes away, when the SSRI goes away, you're going
to get rebound anxiety or some kind of withdrawal. But
when you take ketamine, it actually triggers reactions in your
cortex that enable brain connections to regrow. It's the reaction

(48:04):
to ketemine, not the presence of ketamine in the body,
that constitutes its effect. Most of the research has been
coming out of Yale, and the responses and the findings
have been genuinely mind blowing, especially when we think about
how stagnant some of the research on depression has been
for quite some time. They've done a number of studies,

(48:25):
as has John Hopkins as well, and in one in particular,
more than half of the participants who were administered this
nasal ketamine spray showed a significant decrease in depressive symptoms
after just twenty four hours. These are patients who felt
no meaningful improvement on other antidepressant medications or through other

(48:49):
forms of therapy. And I think that's just so life changing.
I can't even imagine how profound that would be. Then,
we also have psychedelics, particularly psilocybin, so that's more commonly
known as you know, well magic mushrooms essentially, and it's
Psilocybin is the active ingredient in this recreational drug, and

(49:11):
it's a hallucinogen. It changes the brain's response to a
chemical in our brain which you may have already guessed
it it's serotonin. And when broken down, when psilocybin is
broken down, it causes an altered state of consciousness and perception.
And what this does is cause our brains to use

(49:32):
different neural pathways as it processes this substance, essentially opening
us up to experiences, connecting us to our surroundings and
triggering an alerted or mild, you know, mild to severe
hallucinogenic state when we experience chronic depression. This can often

(49:54):
reduce neuroplasticity, and it causes us to feel very stuck.
That's where that hopelessness and that's sadness comes from. But
psychedelics do the opposite. They really encourage the growth of
new connections through this hallucinogenic effect of expanding the way
our neurons fire. Now, once again a very clear disclaimer here,

(50:17):
this is not stuff that you would buy on I
don't know, the dark web. This is medication that is
being severely and cautiously vetted and administered in a clinical setting.
And in one study, a single dose of a synthetic
version of this component of magic mushrooms it improved depression
in people with what we would call a treatment resistant

(50:40):
form of the condition. And importantly, what's really valuable when
we are studying new treatments, particularly new medical interventions, is
whether the study was double blind, so meaning neither the
participants or the researchers knew which one of the trial
patients was actually received the drug. So this helps eliminate

(51:02):
things like placebo effect, which we know can be quite common.
And I think the other interest in psychedelics is that
psilocybin or even LSD. According to some statements some opinions,
it doesn't really have the abuse potential in the same
fashion as things like cocaine or opioids, or alcohol or nicotine. However,

(51:25):
there is still so much that we don't know, so
I think for now it's best to stick to the
approved therapies that are recommended by a licensed professional talking
therapy an antidepressant. I think that it's such fascinating research.
I think that people who use these drugs recreationally before

(51:47):
they started undergoing scientific testing have regularly said that this
is an impact and an influence that they personally experience
outside of a medical setting. So I'm very excited to
see where that goes. You know, I can't speak to
this personally, but what I do kind of want to
finish on is kind of where I'm at now. Given
we've had this broader overview, I think I want to

(52:09):
take some time to reflect on, you know, where that
knowledge kind of leaves us. If you're someone who is
experiencing depression, what can you really take from that? But
what can you really take from my experience? I think
I'm at this point, I've said this before, where I'm
really seeking to manage and not to cure. It's kind
of this really stoic perspective where I'm like, you know what,

(52:31):
this is my reality, and you know, sadly, there is
not some switch that's going to change how my brain operates.
I've just got to accept it. Also, you know, a
final misconception that I really wanted to bunk is that
it's not as if my life is devoid of happiness.
You know, I have really happy moments. I have an
amazing family, incredible friends. I'm super grateful, and I do

(52:53):
get to experience a lot of joy very readily, very rapidly.
Depression is not just the absence of any feeling but sadness.
It's not just sadness. It's more complicated than that. And
I don't want people to think that that's all there
is to a person, and then it will come to
define them. You know, I'm a good friend, I have
hobbies and passions, I love, I'm productive and I do

(53:16):
things with a lot of love. I still feel incredibly deeply,
and I have dreams and goals. It's just that sometimes
those things seem less clear to me. It doesn't mean
that they're not there. I still think we face a
lot of stigma. But it's so surprising that when you
start having these conversations, you'll realize that every single one

(53:36):
of us knows someone in some capacity who is experiencing
something very very similar. And that sense of not community,
but that sense of not going at it alone, really
is quite powerful for me. Depression can make you feel
quite selfishly like you're the only person in the world,

(53:58):
like you're the only person who is this sad and
this miserable, And although you don't want other people in
the boat with you, you don't want to acknowledge that
maybe they're going through the same thing. You know you
can't change that, And sometimes having an open line of
communication and open discussions about this are so valuable. So
I really want to thank you for listening to today's episode.

(54:21):
It was definitely a vulnerable one, I know. So if
you're still with us, I hope that you're feeling very
knowledgeable and you're feeling very optimistic, and if you're here
for someone you know and someone you love, I promise
it's not as hard as you think to take care
of those who you care about. I know it can
feel like you might say the wrong thing or do
the wrong thing, but as long as you're showing up

(54:43):
and you're asking how you can help, you're sending the
occasional message just seeing how they're doing, if they need
to talk. You're really doing a lot more than most.
You're doing the right thing. I promise that even listening
to this is one step in the right direction. It's
still such an unknown I don't want to say disease,
such an unknown condition. Despite all of that historical knowledge

(55:06):
that we realistically should have, there is so much about
it that is not understood, not just from a scientific perspective,
but from a general societal perspective. But I hope that
we're taking steps in the right direction. And I'm going
to list some really fascinating studies that we talked about
in this episode in the description, as well as some

(55:28):
resources for when you can get further help, further information.
You know, it's a tough time in our twenties, and
it's a bit tougher when you've got this kind of
like we say, black cloud over our heads. But I
promise it's someone who's gone through it as well. There
is so many good things coming and hard times as well,
but you'll be able to approach them a lot better.

(55:50):
A lot better, So I want to thank you for listening.
If you enjoyed this episode, please feel free to leave
a five star review on Apple Podcasts, Spotify, wherever you're
listening right now, and maybe your friend needs to hear this,
feel free to share it with them. I would really
appreciate that as well. If you have an episode suggestion,
or you want to get in touch. If you like
this episode or have some feedback, please follow me at

(56:13):
that Psychology podcast on Instagram. I love receiving messages from
you and seeing the community grow. So I want to
thank you for listening to this episode. I hope you
learned something. I'm glad you're here, and we will be
back next week for another episode.