SIO338: Is Depression 'Just a Chemical Imbalance?' with Dr. Dean Burnett

Transcript

This transcript was generated automatically and may contain errors — the audio is the record.

0:00:13 Thomas: Hello and welcome to Serious Inquiries Only. This is episode 338. I'm Thomas. With me, as always, is Dr. Lindsey Osterman. And before we get to it, I just wanna say thanks everyone so much for pledging at patreon.com/seriouspod in the wake of the recent announcement we made. It's been super exciting and if you haven't done so yet, definitely go to patreon.com/seriouspod, pledge, and listen to the What is a Woman takedown that we did, Matt Walsh's hateful, transphobic, quote-unquote documentary. We break down why it's nonsense and why Matt Walsh should feel bad about himself. Those two things. All right, that said, we've got a guest today. Lindsay, why don't you go ahead and introduce our guest for today's show?

0:01:01 Lindsey: Joining us today is Dr. Dean Burnett. So Dr. Burnett is a neuroscientist and the author of several best-selling books exploring topics in psychology and neuroscience and mental health, including The Idiot Brain and The Happy Brain. Apparently

0:01:14 Thomas: First one was a biography of me. And I, I, uh, it feels a little weird to invite my biographer on the show, but that's okay. I think we'll, you

0:01:21 Lindsey: We'll learn a lot. Um

0:01:22 Dean: To make a lot of it up, to be honest, this is the first time we've met, so we're very, very ad -libbed, of

0:01:24 Lindsey: Yeah All so those titles were apparently shortened simply to Idiot Brain and Happy Brain in the U.S. releases. I'm not sure why we're allergic to definite articles, but yeah, I

0:01:36 Dean: Guys are busy, you haven't got time to read extra syllables,

0:01:38 Thomas: It is now when I butt in and bring up something no one cares about, which is Bluey just came to Disney Plus in the U.S. And on the topic of weird American edits, they have edited it. Disney has done the most mind blowing. People are posting comparisons and they edit out stuff that makes no sense. Like it's not even offensive. They just change it in confusing ways. There must be somebody who thinks that Americans need a good edit. But it's just baffling. Maybe they're pranking us.

0:02:03 Dean: It Odd, I remember remember seeing that happen when, um, the British release of, uh, things like Shrek 2, that was one, and they had, you know, obviously there's lots of celebrity voices in the, some of the, some of the peripheral characters, but they changed some of those, so rather than one of your celebrities, is one of our celebrities, but because they make such a good effort to make the character look like the celebrity, it made absolutely no sense. It's like Captain Hook was like a chacha hoax, called Jonathan Ross, he's like a foppish guy with a bit of a lisp, so like, this This is weird. What have you done? Also, that's Jonathan Ross. Why is he here? We know that's not him.

0:02:36 Thomas: Are already my favorite guest ever because of your ability to go with the nonsense that I'm spouting, which I I just have to say I love. So thank you so much. And

0:02:44 Lindsey: In addition, and, uh, most relevant for the discussion we're going to have today, in 2021 Dr. Burnett published Psychological, Psychological, it's psycho-logical, why mental health goes wrong and how to make sense of it, which I am currently reading and strongly recommend to our listeners. It's excellent, very accessible exploration of current scientific understanding of mental health and illness. Received his PhD in neuroscience from Cardiff University in Cardiff, Wales, and he was a psychiatry tutor and lecturer or professor for our US listeners at Cardiff University Center for Medical Education and is currently an honorary research associate at Cardiff Psychology School. So Dr. Burnett, thank you so much for agreeing to talk to us about this today.

0:02:58 Dean: You.

0:03:20 Dean: Thank you for having me. I just got promoted, so I'm happy. Which is nice.

0:03:23 Thomas: Wait, you did?

0:03:24 Dean: Well, professors are a different thing here. So, yeah, cool. Yeah, I'm unhappy with that. I just suddenly got promoted to five steps. That's marvellous. So, straight

0:03:26 Thomas: Oh, oh. OK.

0:03:26 Lindsey: Yeah. Yeah, I had to learn that for like five minutes when I was applying for jobs. I applied to some places in the UK, had no idea what I was playing for.

0:03:37 Dean: Different, uh, system. It's very odd, but uh, but yes, thank you. I, I appreciate the promotion, and uh, now, but now I, I should be paid for this because I'm too far too important to do it. So, good, good night, everyone. Self.

0:03:39 Lindsey: Yes.

0:03:50 Thomas: I will send a letter to whoever your employer is, you know, letting them know that we officially promoted you. I think it should go through. It should

0:03:57 Dean: At the moment, so that could work. I'll accept it. So, yeah.

0:04:02 Thomas: Yeah, this came up because, I, you know, we get lots of good listeners submitted stuff. And the best thing is when I've already sent Lindsay a science thing that, that also the audience sends, and everybody said that's a good indication that people are very curious about it. And this was, I think I saw your tweet thread, Dean, about this article that's making the rounds that like actually depression is not a chemical imbalance. Balance. And then it seems like there was some like version of that that made sense. And then there was like a right wing version that maybe didn't make sense. So I'm thoroughly confused. And I'm very much hoping that that you're going to enlighten us on what's going on here.

0:04:35 Dean: Well. I'll be happy to. This is something I've delved into quite a lot in various high profile ways in the UK and beyond, not with my intention, it's just happened that way, which is always nice. So, what, But I like to start by saying, so, what your understanding of what's being reported, essentially? What would you take from it as a, not a lay person, but someone who's not part

0:04:54 Thomas: I'm happy to be called a layperson anytime. Well, I'll answer and Lindsay as well, but I think she's too smart. So she probably knows the right answer. So I'll give you the wrong answer so you can correct me. It's more fun.

0:04:56 Dean: Okay.

0:05:05 Lindsey: Well, I read the review, view papers, so I feel like I've got the answer key, I don't know, uh,

0:05:08 Dean: Insight on this. Yes.

0:05:06 Thomas: Yeah, exactly. As somebody I should mention too, like as somebody who takes, I guess not these kind of antidepressants. I'm on a different thing. I've told you. I arresting you for violating my HIPAA rights. You just violated my hippo rights for revealing my confidentialness.

0:05:19 Lindsey: There. You go. Oh, man. Yeah, because that one's like, uh, it's a, it's not serotonin, it's like dopamine and norepinephrine or something. Oh.

0:05:25 Thomas: No. Yeah. Yeah, and like it's worked pretty well, Well, but I guess this is about a different, like an SSRI or something. And from the coverage I've seen at first, I saw a kind of a reasonable take of, yeah, no, it's like breaks and you put on a jacket to get warmer, it is not as though the jacket or lack of the jacket was the cause of you getting cold. And that was like the analogy to the thing. And then I saw some other right wing information. I think it's misinformation, rather, that was like, no, actually, SSRIs, just none of it works. It's so that's kind of what I've seen in terms of coverage.

0:06:06 Dean: That's pretty much the gist that a lot of people have, uh, from it, and approached me with. So, yes, all that's on the same page, so it's, that's good to clarify. So, basically, the study which, uh, this is all stems from, uh, with it's not new information, it's not a new research, it's a systematic review. So it's taken all the relevant papers that look at this area, looks like, what are the effects of antidepressants on serotonin levels in the brain, or variations on that.

So, all in a certain set of parameters, and it's crunched all the numbers, like, you combine all the, this relative papers together, all the ones which have compatible data, so you have more data, a bigger pool of data, which obviously means your, your, pardon power, like the correctness or the impact of your data is more valid because, and it's put it all together.

And the conclusion you've come up with is that it, all the existing data, that serotonin levels don't really have that much of an effect or change in serotoner levels doesn't really have much a role in the treatment of depression, and therefore the claim that, uh, is a chemical imbalance, is wrong and incorrect, and, you know, shouldn't be used anymore, though that isn't in and of itself isn't an unreasonable claim. So unreasonable, is it not?

That most scientists I've know of, I've been under this impression for like 20 odd years, because it's not a new thing from the scientific field, it's very much like, yeah, we know that's

0:07:20 Thomas: Can I pause you there and ask, why why didn't I know that? Why doesn't anybody, you Know, as someone who's gone through some of these struggles and You know, pays a little bit of attention, I think I would have still casually referred to it like, yeah, no. Some people just have a chemical imbalance and that's why they need their yummy me pills. Yeah.

0:07:22 Dean: Of course. Well. Yes.

0:07:37 Dean: And that, that's a very, that's the whole interesting question itself when I try to unpack, but doing Twitter is not the most, uh, format when it comes to nuance, along with the explanations, although I do try my best. If anyone just follows me, and what, still follows me, they go, oh, god, this guy's off on one again, I'll check back in tomorrow when he's finished his thread, I suppose.

Um, a lot of reasons why, why the chemical imbalance theory is so prevalent and so accepted, especially in the mainstream, rather than the, you know, the, the area of mental health science. And first off, it's straightforward, it's easy, it offers an explanation for something which still is the most people, a scary thing, an uncertain thing, and an unnerving thing.

The idea that mental illness in general, the ideathat your mind isn't working right, mental disorders, the mind, your mind can go, quote unquote, wrong, and I'm sort of doing the scare quotes there, because, you know, don't like to assign value judgments to people's mental expression, because a lot of times it can be totally fine, just different, and, you know, so I always couched in safe language where I can.

But still, it's the idea that your mind, like your body, starts doing unhelpful, unhealthy things, more unsettling, because your mind is intangible. It's more you than your body is, really. When body starts going wrong, it's like you've got a broken leg, upset, you're in pain, it's bad, but you're still you. You think, oh, my leg's broken.

0:08:53 Thomas: Yeah.

0:08:53 Dean: That, of course, you do. You have full insight there. You don't think there's anything wrong with your ability to perceive the leg. You know you're walking is going to struggle and you're going to need physio, but you're still mentally intact. You're so, you, when that your mind goes wrong, is more unsettling because you can't measure it. You can feel it, you know, and you don't know what's happening, you lack the insight, and until it gets to a certain point.

So by and large, that's one of the reasons why mental health problems have had so much more stigma and so suspicion around them, and so also doubt and denial, because you can say to someone, I broke my leg, and look down. So yeah, it's facing in the wrong direction, that it shouldn't be at that angle, that's that's definitely a broken leg, fibres do not bend that way, that's clearly wrong.

And someone says, yeah, I don't feel very well, it's weird, you've got black stuff coming out of all your pores, that's that's atypical for a human body to be doing that. And so we can recognize physical ailments a lot better and relate to them and empathize with them, you can't redo that with a mental health problem.

So someone says to you, I'm depressed, uh, 50 years ago, when awareness of depression really wasn't so much a thing, you said, oh yeah, I'm impressed, I've been depressed, we're all sad sometimes, get over it. You a very, it's very different thing, it's really hard to convey. And I think one of the reasons why the chemical imbalance became so entrenched is because it offered tangibility to something which didn't have it before. It's that emotions, your your mind is going wrong, is unsettling.

If you can say, no, no, it's just the chemicals in your brain, they right, they've been knocked out of whack by whatever it is that's caused this, it, it, a biological basis.

And a lot of mental health treatments sort of revolve around the basic fundamental, um, of trying to make things more tangible, trying to assign, like, look, this is the problem here, like, when you've got even like cognitive behavioral therapy, saying, right, you think about things in this way, we want you to stop doing that and think in a different way, or, or, you know, it's always, a it's, it's always some sort of way to give yourself a better grasp of the issues you're dealing with.

When you say to someone, as people did, it's a chemical imbalance, then, oh, I see, there's, there's no fault of mine. I'm not to blame here. I haven't done something wrong. I'm not flawed. It's just I don't, like with, you got a cold, you've got too many viral particles in your lungs, or if you're got a tumor, you've got too many cells in this one place.

You can extract it from yourself and pin it on something fundamentally biological, logical, which is more reassuring, so certainty and boundaries to it, so alone would have been and probably still is quite, um, to an extent, so say, like, oh, I know where it is now, I can, I can deal with that. So it, do, it catches on that way.

And you know, when antidepressants were first discovered, uh, were discovered by accident, they were like meant to be medications for other things, like surgical shock, or, uh, sorts of, um, you know, blood thinning things, but they found out that people in these medical, in the 60s, were unhappy with their illness and suddenly started being less unhappy, that's not right, it's not even working, but they, that's how antidepressants were discovered essentially.

And then they go, oh, so if you give people this stuff, they, mood improves, that's worth knowing because, well, what these chemicals do, they raise certain levels of monoamine neurotransmitters. So, oh, that makes sense. So obviously depression, is it must be when people don't have enough of these chemicals. These drugs increase the levels of chemicals, and antidepressants, therefore, they become less depressed. So therefore, it's a chemical imbalance. A logic to that. It hangs together as sort of A to B to C sort of process.

But it's far, far too simple, the brain never does anything so directly and so bluntly. But you know, when you try to convey the wider world that depression is a real thing, and someone comes in and said, I've got room, like, or my, my sibling, my partner, my spouse, that has this serious mood issue, they're not, they're not really going to be receptive to a 20 minute explanation about what we think is the root cause of depression.

You tell them chemical imbalance, oh okay, well, we can do something about that. So it becomes sort of self -sustaining that people want an explanation and they want to know something to be done about it, and chemical imbalance fits really neatly into that.

And also, been the problem with the medical practice, and it comes to mental health care, there's been a big problem for many years with the what they call the disease model or the medical model of mental illness or mental health, where you treat a mental health problem just like you would a physical one.

There's a certain logic to it, but it's not always the best approach, because whereas you know someone's got, like I say, a broken leg, you say, there's your leg, it's broken, here's what you're gonna do to fix it, okay, I'll do that, you know, I'll do the physio, I'll wear the cast.

Whereas you can't really do that, mental health problems, see someone, your mind's not working right, take these pills and see me in a month, well, I've got to use my mind between now and then, what do I do? Is no, shut

0:13:01 Dean: Up and do as I told you, that's, no, it's, you can't do that, you

0:13:01 Thomas: Stay off it, yeah, stay off that mind, don't, don't put, don't put any weight on it

0:13:09 Dean: Bed rest, that's what it needs, is what, okay. Head rest, is that the, yeah, that uh. You That becomes a reassuring thing to know that, yes, you can have this medication and get better. But because of how people work, the patient needs to be a more active participant in their own mental health improvement because they're the only ones with access to the disorder. A doctor can't take an x -ray. You can't weigh someone's ennui. You their input and insight, and that's become more of a thing.

Thing, it's become very common, entrenched, as a result of that, but the reason it's kind of unhelpful, the chemical imbalance series, because it's huge, very oversimplification. It's tantamount to, you know, say if you say to someone, what's, tell me the cause of depression, and they say a chemical imbalance, that's like if you're doing history in university and they write an essay on the Cuban Revolution and they hand in a poster of Che Che Guevara, and that's it. And I see what you're doing.

There's a connection here, but I don't think you've understood or supplied any of the context or any ofthe nuance behind this. So yeah, it's become a thing, a pop culture thing, where you can say, ah, chemical imbalance, that's where it is, isn't it? It's not. There's so much more to it than that. There's that, it's now, this paper has been brought out, which says, ah, it's not all to do with chemical imbalances.

Is It's one of those things that people in the world of science, it be, it can be very, very insular, because scientists spend most of their time talking and arguing with each other, and science communication is not really valued as much as it could, slash, should be. Particularly, therefore, like the scientists, the don't deal with this sort of side of thing very much, and it's more my area, and it is unhelpful.

It's happened to me a few times, I've accidentally gone viral by explaining something because I didn't know other people didn't no. In my book I just did a brief explanation of why travel sickness happens, because of the imbalance, the incompatibility between the vestibular system, which is what measures balance, you know, where you move, how you're moving, and your visual system, which if you're on a ship, which is the worst offender, there's no landmarks, and it's very big.

Eyes are saying, all is still, all is well, and your civil system has gone up and down, sloshing left, right, because you're literally on the sea, and those two things hit, hit your thalamus, your hypothalamus, to say, okay, I got one part of the brain saying we're still, one part saying we'm moving. Those are incompatible, so like you've got the fundamental parts of your brain going, we've got conflicting data from the senses.

The only way that can happen, according to evolution, because obviously vehicles are a very recent addition to the human history, is a hallucination, and the only reason that happens, if we've been poisoned. So throw up, purge, and we

0:15:21 Dean: Just start vomiting. So obviously you didn't know that either, so I thought that was common knowledge.

0:15:22 Lindsey: Interesting. I Didn't Know that.

0:15:25 Dean: When I an article somewhere, and it hit like 50 different sites for the next day, is, oh, I guess that wasn't, uh

0:15:25 Lindsey: No, well

0:15:29 Thomas: I Don't want this to be a criticism of you, but I guess in science in general, a good sign that something's wrong is if a news story comes out talking about a basic truth that you all know about and it's news, and all of us are like, whoa, that's a, that maybe work needs to be done, I suppose,

0:15:47 Lindsey: I clarify something though, because saying that, like, yeah, we've known for a, a long time that it's not a chemical imbalance, but like, I want to be clear about what's being said here. So it's not that there's not an neurochemical underpinning of things like depression, right? Or that serotonin levels are unrelated to depression in any way.

0:16:01 Dean: It's more like the chemical imbalance, the chemical thing is there, but it's not the whole story, it's Like, like one facet of it, like you say, the whole thing about, you know, if you just see the tail, you think an elephant's really skinny, and it's not, it's, it's obviously gargantuan. It's just one part of the whole story, and there are lots of different, um, neurological mechanisms for, or potential mechanisms for depression, because it is really hard to pin down, uh, in particular because it off, like, what is a mood, how do you define the mood.

It's an, an emotional state, but it's sustained, it's not an emotion, it's an general umbrella state of emotions, and emotions are incredibly infused throughout the brain, so all the parts of the brain which handle emotions, they're not like one big lump in the middle, like a lot of people seem to think. It's almost like they're spread throughout your brain, like the mortar in a brick house, it's like there's everywhere.

So, so it's really hard to our current technology to even say, like, oh, that's a mood, we're looking at mood here, and this is a bad mood, and a high mood, and is quite chronic as well, because I've seen quite a few things on Facebook with like two scans, two brain scans side by side, that, this is the brain, this is normal brain, or bright and yellow, this is brain on depression, or like so little subdued blobs, but that brain scans, they're not still images, that's not how they work at all, like, those be the exact same brain two seconds apart, it's

0:16:07 Lindsey: Sure.

0:17:07 Dean: Like, it's, it's a really misleading portrayal of, yeah, exactly.

0:17:07 Thomas: Or you just spilled mustard on one of them, could oh

0:17:11 Dean: That's just as valid as what they're saying, I'll be honest. So it's not they're seeing that there's no chemical imbalance at all. It's just that isn't the be -all and end -all of it, Which is another thing I think, that's where the, want to cast aspersions to anyone's character, but some people have taken the leap to say like, oh, isn't about chemical imbalances. It's not just about that at all, that's not something most people would deny, most involved in the research around it. But then to say and therefore antidepressants don't work and are a con, that's that's the inevitable conclusion from that, far from it.

It's just that the, like, jacket and the heating thing, or what are you saying, if you take paracetamol and it gets rid of your headache, your headache wasn't caused by lack of paraceton.

It's these interventions, these chemical interventions are changing something which, but evidence shows that they do definitely have a effect on most depressive cases, but not, you know, not reliably, not brilliantly, um, know, effectively, I think, are the default, you know, your Prozac and phylloxetines, those are the default antidepressants in most cases, those arethe first ones people try, not because they are the best ones, but the data shows that actually were some of the most feeble ones in terms of therapeutic effects, but because they're so sort of mild, they, the fewer side effects, the to cause actual harm from, you what you're doing is you're changing the underlying chemistry of your brain, which is a big thing to do, you know, it's not something you should ever be taking lightly, and blunt tool, but they're what we've got for the time being.

And but to say that, well, depression isn't just a chemical imbalance and therefore the drugs don't work, is an inaccuracy. And I think when motivated by forces other than scientific integrity.

0:17:18 Lindsey: Right.

0:18:39 Lindsey: Do you think was being gotten wrong in the reporting about this? And do you, you think that there was anything wrong in terms of the conclusion that the the actual review paper was putting forward? Sure.

0:18:48 Dean: Quite a few things, which, which I'd hesitate to blame people because it's more maybe a consequence of the wider media ecosystem we find ourselves in, was a big part of it. For many years I wrote for the Guardian, the UK newspaper, their website, so I saw, like, I proposed some personal, just how frantic the modern media industry is.

Obviously, when back in the days when you had, back in my day, when I was youth travel across town for two months and a bit, if you're not British, that makes absolutely no sense, and if you are British, it makes even less, weird, not my best ad lib, but it. When you had just like three, four news buildings a day, or one newspaper, you had to be far more careful about what news you put in.

You had only a limited space to work with, and only important stuff got through. And that had its downsides as well, people had to strangle a load of information. But now, when there are so many media sources and so much accessibility, like rolling 24-hour news, all the different social media channels, and less time than there was to really consider a story. If something hits the news, it's got to be reported and copied and churned out there as fast as possible.

Is good for breaking news stories, when dramatic is happening in politics or natural disasters, that's helpful then. But when it comes to science, that's really not the best way to go about it. So I can imagine what happened is this paper was published and it had a sort of a relatable hook, like I say, most people just assume that depression caused by chemical imbalance.

Balance, this paper says what we all think is wrong, that's interesting, people want to read about that, and by press release seems to be a common problem, that people put a press release, and because most news providers don't have like a dedicated staff of science reporters, uh, no one there to give it the critical analysis which it needs to say, well, hang on, slow down, is this right? Um, even if they could do that, I mean, would they necessarily carry the day, would they listened to?

Well, don't become a thing, especially even with politics, economics reporting of press releases as if they are gospel. Uh, they sound like they know what they're talking about, just take it out there and let's move on with our lives. I think Kim Kardashian just burped, so let's

0:20:38 Dean: Dedicate five hours to that. So that's one part of it. But there are people who are involved, people who're scientists who aren't the most scrupulous, so I, in hock to certain influences or funders, will exploit this, who will say like, well, we have an agenda here, we want prove this point, we will, you can just cherry pick things which back up your argument, and you can modify your research methods to results that you want. There are systems in place to stop that happening, but when we're dealing with such complex and nuanced and uncertain data as to what's going on in the brain and mind, it's very hard to really enforce that, or to make sure it doesn't work that way. And the whole publish or perish thing, people want, even in in the scientific publishing field, they want interesting papers, they want things which are controversial, to say, ah, see what you thought is wrong, that'll

0:20:38 Thomas: My

0:21:23 Lindsey: Yeah.

0:21:23 Dean: Get us attention, that'll give us clicks. Just publishing has been doing the whole, we need clicks more beyond anyone, long before the news, news went online. So it's, it does happen, it happens a lot, and sometimes you get this perfect storm of scientists who have other agendas and perhaps other desires that they want to make happen, who are willing to provide data to the sort of outcome they want. Uh, the media, media ecosystem, which, um, you doesn't really check it, you know, just like here it is, press release, okay fine, type That seems to be the case here, like this, this stuff was reported just verbatim, it wasn't questioned, it wasn't, you, one was interrogated about this, it was just, oh, this is a new study which shows that depression isn't caused by chemical imbalance. Right, because, you know, when someone seems credible and you don't have the vocabulary to question it, you, easier and safer to assume that they know what they're talking about and just don't get involved. There are lots of uh issues to be had with this particular uh reports, but not ones that are unusual.

0:22:10 Lindsey: Yeah, we break down stuff like this on the show sometimes, um, the issue that needs to be clarified is like, you know, this paper comes out and it seems like it's making this really counterintuitive claim, and then when you look at, it's like, the the paper didn't actually make that claim, right? And so when I first heard this headline, I, assumption was like, the paper is probably not giving the oversimplified version that I'm seeing in the media outlet. So I thought that's where the problem was initially. Looking into this more, it, of seems like, like, Joanna Moncrief is head, the author. It seems like she is sort backing what I, my is that it's a misinterpretation of what we mean when we say depression is not a chemical imbalance. Do I have that right? And can you explain, like, sure.

0:22:50 Dean: It's, um, I, that depression is not caused by chemical imbalance is a valid statement, you know, the chemical imbalance does happen, but that's not the beyond end all, it's like one facet of a much more complex picture. So to say it's all to do with chemical imbalances is definitely an incorrect statement, and known that for quite a while, like it's decades now, especially the common thing is that antidepressants take two to three weeks to actually kick in to have any therapeutic effects, but they raise the chemical levels in your brain, the ones which are supposedly diminished, they raise those pretty much immediately, they're like 10 minutes of being consumed. So if, there were, you know, if depression was just only to do with insufficient neurochemicals in your brain, antidepressants should work right away, because they're fixing the underlying problem. The fact they don't, the fact that it takes two to two weeks for anything to happen, shows that that's not the underlying problem. It's

0:23:36 Thomas: Gosh, that is so interesting, because I have this, again, I am not on these specific antidepressants, but I the old with the stuff I'm taking. I got The Old, yeah, give it two, three weeks, could even take a month to kick in. Meanwhile, if I forgot to take them in the morning, by about three o'clock, I pass out. Like I just can't, I've just been like, what is happening? And then my body shuts down. And every time I'm like, oh shit. And then I go check and without fail, I have forgotten to take the stuff. And my body just quits the weirdest thing. So they take forever to work. But if you forget one dose for I pass out and can't even function. Really weird. I don't understand how that works.

0:23:38 Lindsey: Yeah.

0:23:48 Dean: Hmm. Yep.

0:24:14 Dean: Effects take two or three weeks to kick in, and the key with this therapeutic, the effects, that effects of altering your brain chemical levels by your external means, those kick in pretty quickly.

0:24:23 Thomas: That is very helpful. I That wish the doctor had told me that.

0:24:26 Dean: Well, again, it's not something doctors think to tell you, because it's one of those things whereby you have to assess the risks. And if you tell patients that, yes, you're going to feel better in two to three weeks, you'll feel shitty for that whole time, like they might be less inclined to take them because someone's already in a sort of depressed state or in a vulnerable state, you putting them at more risk by telling them the full story, they might just be inclined to the medication, which would ultimately harm them more in the long run. So, you know, it's a very um, it's narrow tightrope to walk when you're dealing with this sort of stuff, but it also gives, you know, gives light to the whole idea, well, antidepressants don't do anything, they're just like a placebo, just a calm, if that was the case, you wouldn't be having side effects, if they don't doing anything, you would have no ill effects on them, but everyone does, everyone doesn't like them, they can't be both unpleasant and cause bad effects and a placebo, that's that's impossible, there's either an active agent or there's not, if

0:25:03 Lindsey: Yeah.

0:25:11 Thomas: Be weird to have a pill that's just side effects. It's a side effects pill. Yeah, no, it's all just side effect. No main effects.

0:25:17 Dean: I believe that's called alcohol, if I'm not mistaken, that's um, is

0:25:21 Thomas: No, that has main effect. That is great. Yeah.

0:25:23 Lindsey: Yeah. That definitely has me.

0:25:25 Dean: Does that have any good effects, though? It's fun, don't be wrong, but it's not, uh, it's Yeah, yeah, I'm sure that, I'm trying, so, back to the original question, that yes, so this is all idea that, um, you know, um, uh, is caused by a chemical imbalance, and this study showed that it's not necessarily that, yes, like if you alter the levels of serotonin, you don't get immediate or essential recovery in depression, and serotonine levels can be, you, linked to depressive system and stuff, so that's, that's a totally valid point to make, but that, that doesn't therefore mean that antidepressants do not work, don't do anything, and don't cure depression, there's ample data, more than enough data, to show that they do, not for everyone, not reliably, but they do definitely have therapeutic effects. Yes, I, the article in The Conversation by the authors of the paper, and if it was them who wrote it, if actively themselves made the leap saying this calls the whole area, antidepressants, into question, it throws doubt into whether or not they

0:25:28 Thomas: Topic for another show.

0:26:18 Lindsey: Right.

0:26:18 Dean: Are valid and not necessarily in, like, the more sort of, um, forthright language you'd get in more ideologically driven media platforms, but it was very much a clear, clear sort of take -home message of, yeah, antideressants are rubbish, aren't they, you know, so this proves it, as someone who's read a lot about this, I'd say it doesn't. I think that was... can't see how you do that by accident.

0:26:37 Lindsey: Yeah.

0:26:37 Thomas: I'm happy to question people's motives here, I'll be the bad guy of the show, isn't the Moncrief person funded or part of Scientology or something, wasn't that, didn't because I mean, they very much have a preconceived bias that they, method of, of Tom Cruise telling you to feel better is going to be what actually works

0:26:46 Dean: I come up a lot, hasn't it? Yeah. Yeah. As someone who has actually read Battlefield Earth cover to cover, I find that I thought, wow, this became a religion. Wow, that's really quite something. I'm almost impressed. But not not for the reason they're thinking of, yeah, think, yeah, that's the, um, another unfortunate aspect of science, because scientists don't spend a lot of time communicating with the public and sharing their research face to face or with the wider world, because anything, being a good scientist, you develop and learn skills which actually work against that, you spend all your time arguing your case and reinforcing your data with other like-minded scientists, you learn to speak in the most meticulous jargon, you learn to be as technical as possible to show that you thought through your arguments, is great when you're talking to other scientists at conferences, but it makes you very difficult to get your point across to someone who doesn't have that vocabulary

0:27:01 Thomas: Yeah yeah well

0:27:26 Lindsey: Yeah.

0:27:41 Thomas: But I, I think the most dangerous type of villain that we've seen on this show is, is So, or whatever, wrote the end of gender, it's people who have that scientific background but are also that to kind of spread misinformation, or spread their agenda because yeah yeah, that's the most dangerous kind, because, like, well, they have the doctor in front of their name and it's in a relevant field, and yet they're, they're, uh, they're spouting misinformation, it's hard to debunk, right?

0:27:47 Lindsey: Oh, yeah. Yeah. Using their powers for evil.

0:27:52 Dean: Oh yeah Yes, it's like the whole sphere of credibility thing, so, someone, this person's, like, say, they've got a PhD in this, they do this study, so, going to assume they know what they're talking about because it's not my world, I don't have the, the perception, the relevant cognitive tools to critique it, to debunk it, you know, you know, we tend to defer to authority when we're uncertain, because that's, that's the whole point, really, my expertise, and, think I make this point wherever I can, but it's this idea that scientists are these sort of emotionless robots who just, only all live for, for the love of data, and, to try, humans too. Scientists, scientists are very human people, and a lot of them aren't very nice, or aren't very moral, or have the scruples that can't promise that, but that thing about Travel Cyclists, totally made that up, for my own pure amusement, cause

0:28:13 Thomas: Well

0:28:37 Lindsey: Company excluded, of course. Yeah.

0:28:45 Thomas: I'm a data loving robot, but not a scientist, so that, I'm kind of the opposite

0:28:48 Dean: Yes, you know what we call an anomaly. But it's a thing. It's like this idea that scientists aren't, They're bad with people. They don't socialize well. They just love information. That then someone could be just motivated by greed or personal agendas doesn't sit right. You don't think that's something scientists do all the time, but it happen. By and large, scientists might have been a good person or at least had the heart in the right place, But because there's millions of them, you will get the occasional arsehole who will happily use their credibility for personal gain at the expense of others.

0:29:08 Lindsey: Yeah, yeah.

0:29:23 Lindsey: Yeah and I want to talk about the- because, like, okay, so we're saying that it's not a chemical imbalance, but antidepressants still work. How like when I when I read this initially, I was thinking that the press was just sort of misunderstanding what a routine claim was being made in the paper. But that doesn't seem to be what Joanna Moncrief and colleagues are saying. Right. They really are making a claim that that like antidepressants don't work, essentially.

0:29:45 Dean: Seems to be what I'm reading from it, yes.

0:29:47 Lindsey: Like some of the basic claims about the relationship between serotonin and depression seem to be valid. They just don't lead to that claim about antidepressants. Why don't they lead tothat claim?

0:29:55 Dean: Lots of different potential explanations for why depression happens at all. Uh, think one thing people sort of, again, still a lot of people still think that depression is sadness, you know, you are just, you're really sad, you're upset, you can't, you wandering in your filthy, your bad mood and your, you hate yourself and stuff. So this idea it's just negative, intense negative moods, um, that's you often use to sort of like argue, argue against depression.

Yeah, well, everyone gets really bad mood, like someone dies or you have a breakup, then yeah, it's all the same thing in it, which I, you can argue, yes, and people can be in a very, very, very bad low mood without having any clinical disorders, that's entirely possible. The more prominent feature of depression is that you can't change your mood, but you enter this very low mood state and you can't get out to it, you stay in it for two weeks minimum, that's like the diagnostic criteria, and that's not normal. People do not stay in the same mood and changing for weeks at a time, because mood is basically an emotion, it can be influenced by what happens around you, like you, you can go into work in a bad mood because you got cut off in traffic and you didn't have enough change for the parking meter and got a ticket, you walk in, your boss says, by the way, you promoted, you're suddenly in a good mood and you know, sort of, start

0:30:32 Lindsey: Yeah.

0:30:55 Dean: Skipping around a lot and kiss the traffic warden or maybe some Yeah.

0:30:59 Lindsey: Depends on the. Yeah.

0:31:00 Dean: Depends on the traffic one, I suppose. So sort, your mood is flexible, it's changeable because it's to do with your but what's going on around you. Being stuck in a certain mood state is not normal, you know, it's it's atypical and that's where, you know, manic phases too, like that's being a extremely good mood for a long period, which is again not really typical, it's not normal, it'snot really healthy because your brain needs to have some downtime, it needs to take a more critical outlook on things.

So you the idea that it's established, it's sustained low or negative mood, doesn't even flat affect, you have no emotional state, it's not like your mood system just frozen this off.

And one of the sort of more compelling explanations for this, that I, because this, but I'm a neuroscientist, so like it's all to do with neuroscience, so obviously, you know, when you're, when you know a scientist, every hammer looks like a brain or whatever, that whatever that phrase is, I don't know, something like that, it works that effect.

Don't, don't have a brain's kids, that's really a bad, a bad, bad approach, as I, I found out my first year, um, so yeah, so look, it's basically it argues that because of sustained unhelpful activity, stress, uh, could be like one sharp of stress, like from a high traumatic experience, or could be low, constant, prolonged stress, chronic stress, which is something the brain hasn't really evolved to deal with well, it's um, I'll get that later on, but, you is a physiological experience, it releases all these, you know, cortisol chemicals, it goes through the brain and causes all this heightened activity in the fear systems and things like that.

So it's an active process which our brain is constantly dealing with. One argument is that as a result of constantly having to deal with this stress, which we shouldn't have to be dealing with because, you, you know know, we haven't really evolved to do that, parts of your brain which control mood and allow it to change, they become exhausted, they become sort of spent, so they can't change, they can't undergo an alteration, and therefore you, you get stuck in a low mood state.

So like those, those neurons which are responsible for changing your mood cannot do that, they're essentially on standby, they're not dead, but they're not doing anything, and therefore you become stuck in this state. And one argument then is that, well, antidepressants, they elevate activity in, in this case, the serotonin system, and via various means, that sort of gradually stimulates the exhausted neurons to sort of coax them back to life.

Sort like blowing out of the embers of a campfire, you know, just gently coax it, try and bring it back up, and try and, um, you know, spark some life back into these neurons. And it's not a direct system, it doesn't happen quickly, you know, this, it's almost like more like fertilizing a plant than flicking a switch, so you, you see a few weeks before the leaves are back and it starts to grow again.

Therefore, that's why the argument is, that's why you have, uh, two to three weeks before they actually kick in, because it takes that long to coax these sluggish neurons back into life.

No, so that's, that's one way, which, yes, so the depression itself isn't really to do with the chemicals, or it is, but not, not those ones, or those are far more downstream or upstream, whichever way you're looking at it, but by adding, but by changing these chemical levels, you therefore bring about, no, after step A, B, C, D, E, F, these bring about this change which is helpful, therapeutic, and therefore you can still, do you lose some serotonin in your system, or have, have too much serotonin, and it won't really have much of an effect on depression, but if you keep it at these levels and cause those particular cells to be active, more wanted to stimulate the ones next to them and pass that along, you will sort of coax your mood system back into a more normal state, and therefore you can have like a depression which doesn't rely on just instantly changing chemical levels, so you can have both, you know, it's like the brain is far more complex than simple explanation would allow for. This idea that it's not a chemical imbalance, therefore antidepressants can't work, that's such a ridiculous oversimplification, you

0:30:54 Thomas: I'm

0:31:01 Lindsey: Yeah, that's Yeah.

0:34:24 Dean: Know, it's sort of like almost disturbing that an actual scientist would say that, but you know, we live in interesting times. Yeah.

0:34:30 Lindsey: You you want to talk about neural plasticity at all in this story as

0:34:33 Dean: Main power of the brain, like the one thing which it does, which gives it its incredible clout and, uh, range and abilities, and you know, makes it as good as it is at doing what it does, that it can change. You, experiences, know, things, information comes in and it goes, okay, that's new, also I'll save that.

And that change is brought about by changing connections between neurons, that's like the basic substrate of information in our brain, our brain's ability to do anything, it's sort of like the, you know, the letters in a book, it's likethe connections in ourbrain are everything that we are, what all the things we're capable of.

And as a result of the stress and everything I mentioned, that parts of the brain which are sort of responsible for changing mood and regulating mood, they lose plasticity, they can no longer change, and that's why you get stuck in a mood state, uh, so therefore they have lost neuroplasticity, and antidepressants therefore reinsert or resurrect neuroplasticity, or like increase just it, by some complex means, uh, so you know, it's not what chemicals, it's what cells, and that's the one argument there, but there are, are other arguments, it's some arguments to do with inflammation, stress, and common response cause, and sort of an immune response to the brain, which, uh, and suppresses those parts of the brain that regulate mood, uh, even some, some arguments that depression is natural, it's an evolved response to stressful situations because otherwise we wouldn't sit down and think through them, I mean, that's one of the less mainstream theories, but it's interesting one in its own right, I think, but um, yeah, so there's lots of different out there, but no, I tend to go for the one which is about brains because that means I can talk about it.

0:35:55 Thomas: I'm surprised, there it seems like a very common feature is the stress element, and that's not in any part of my experience, but I don't know, maybe I'm just different. But weird. Is that common to all of them, or is, do you think it's necessary to this depression explanation, or just a feature of some of them?

0:36:06 Dean: Yeah. Seems to be a common factor in a lot of the more, uh, common mental health disorders. So that's one thing I've covered in the psychological book. It's, uh, depression and anxiety seem to have a stress mechanism which, uh, sort of leads to both in many, many cases, because you get, I think, I think it's something like, um, 30 percent of cases are diagnosis, you can have, you get depression and anxiety in like 30 percent of patients or, um, often makes you more vulnerable to the other, and antidepressants are often the go-to treatment for anxiety because anxiolytics are quite powerful and quite addictive. Valium, that's one of theirs. So they don't tend to give that up like sweets anymore, like they did in the old days, for

0:36:32 Thomas: Right.

0:36:47 Thomas: Don't actually have the anxiety. I'm not part of that 30%, I guess. So that could be.

0:36:52 Dean: Yeah, it's not the underlying, like the stress thing is, that like human brain, well, it hasn't evolved to do anything specific. It doesn't have a long-term plan in mind. Just, do you see yourself in 10 million years? Uh, well, I thought, I thought, I thought I developed telepathy. That's

0:36:52 Thomas: Yeah.

0:37:03 Thomas: I see myself climate change to death. Okay, cool. Keep

0:37:06 Dean: Thanks, brain. A human brain is almost like a victim of its own success, because most macroscopic creatures have some sort of stress response whereby they get scared of something, something looks dangerous, they have the fight or flight reaction and the body sort of changes, all these chemicals are squirted in to make them more alert, to make the more anxious, make them more focused and more afraid. Uh, in nature, you know, something that stresses you out, it either goes away or it kills you, those are the two choices. Uh, it's very tangible, the threat's very real, lack of food, predators, all that sort of stuff. The human brain's got the point where we can be stressed out by theoretical concepts and possibilities. Now, so good at that, we love that sort of stuff, don't we? We can be stressed out by, you know, like I said, climate change. Now, it's bad, it's caused a lot of anxiety, don't get me wrong, but I imagine most rabbits aren't really worried about it because they, they don't have the ability to comprehend such a thing.

0:37:51 Thomas: And why they're responsible for the bulk of greenhouse gas emissions in our on

0:37:55 Dean: Go, yes. It's always the rabbits. It can be stressed out. But, you Know, even like sort of everyday things, like what performance review coming up, like I said, and what if that goes badly? I could lose my job. Or what if I lose if my chosen sports team loses? I'll be miserable for weeks. Or what if my significant other has been but quiet lately? What if they've got bad news for me? These things stress us out. Now, they might never happen. Need not happen, and they don't cause any physical danger, we become stressed by them. There's even a thing called counterfactual thinking where we become stretched by things which we know cannot happen. So if you're crossing a road and a car comes around quickly and almost hits you, didn't hit you. You're fine, but you'll be stressed out by that for several days. It's like, oh, that could have killed me. It could have. It didn't. It's in the past. We cannot change it now. But nonetheless, because know, we can be stressed by things which aren't

0:37:56 Lindsey: Yeah

0:37:57 Thomas: Damn rabbits.

0:38:39 Dean: Happening.

0:38:39 Thomas: I feel like I'm fine with that particular mechanism because it really makes me not want to do that again in the future.

0:38:44 Dean: Well, that's what it's for exactly. Yes, that is why it is.

0:38:46 Thomas: That one's good. Yeah.

0:38:48 Dean: To the point where our brains regularly experience stress by things that are not happening. And if they are not happen, they can't stop happening. So you can't think, oh, what if the economy is going badly? I might lose my job. Well, economy is not going to go badly ever again. You can't ever say that.

So we have chronic stresses things just cause constant stress because those parts of the brain receive a stress they don't know the difference between there's a tiger next to me and my boss is in a bad mood, I get, I get sacked. They just go, they've only got one stress response, okay.

You know, it can be low level, it can be sort of small stress response but accumulates and over time the room, the chemical systems we have, the neurological systems to regulate the hypothalamic pituitary adrenal axis, which is responsible regulating the amount of stress chemicals in our body, they in that part of the brain where the brain stem really can be quickly overwhelmed because like, well, I can't keep doing this.

It's like revving an engine for too long when you're in park, you know, it just eventually will burn out. And then we have a constant stress chemicals on our body and these have tangible impacts on our brains and it can sort of exhaust the the regulating parts of our brain and cause depression, or they can can overstimulate the amygdala, the fear response, and therefore we have an overactive amygdale which responds to things which make no sense, and therefore you have anxiety.

And these things, the same stress response causes these two very tangibly different mental health disorders. And it might not be that you have any particular trigger incident, but that if you have some sort of genetic vulnerability whereby there's a certain protein in your cells, in the brain cells, which handle mood regulation, which makes them more vulnerable to these stress chemicals, then you can become more prone it without having any particular incident which causes it.

And you might get to the point where you become anxious before you get depressed, and therefore you don't have then the other, or vice versa. So it's a lot of complex interaction going on, but stress does seem to be an underlying mechanism in a lot mental health disorders.

0:38:45 Lindsey: I

0:40:32 Thomas: As we're winding down here, I want to make sure that, you know, we're kind of all on the same page as to what should we take from these studies and from the from the discussion. Step one, nobody stopped taking their pills as a result of this podcast. I think that a number one.

0:40:46 Dean: Yes. Absolutely. Not. Yes, that's really bad idea, please don't do that. Appalling that I've had to say that to so many people over the past, like, four years, but it's becoming a thing. Please don't just stop your medication. That's gonna end well for anybody. Hmm.

0:40:46 Thomas: Right.

0:40:57 Thomas: Also, let's see what else. So, I mean, the fact that it's depression can't be completely reduced down to a chemical imbalance doesn't mean that treating the chemicals of the different ways, different antidepressants and such doesn't work. Right. There's a lot of negatives in there.

0:41:05 Dean: Yeah. Totally. Yeah. There's, like, it's just because depression isn't necessarily all about a chemical imbalance, it doesn't then automatically follow that antidepressants don't work. Those two things aren't same, and one doesn't automatically lead the other

0:41:23 Thomas: Is that synonymous with the serotonin discussion? Basically, is that like the chemical that typically people think is in imbalanced in depression?

0:41:32 Dean: Serotonin has a lot of, uh, according to evidence, has a lof of, uh, in the mood regulation system, but you know, it's for one thing, it doesn't make you happier, or the evidence and suggests that certain parts of the brain, at least serotonin, improves your ability to change your mood. It helps you regulate and alter your mood.

0:41:47 Thomas: Right.

0:41:47 Dean: And makes your mood more responsive, which is obviously a very good thing when you've got depression. Again, that's why you don't get SSRIs or chronic depressants as recreational drugs. They don't make you happy. They

0:41:48 Thomas: Right. Right. Well, I think that's important to say, because I remember in one of the articles and Lindsay, maybe you'll refresh us all on what it was. I think one as proof that, you know, antidepressants don't work, quote unquote, is, well, we gave these people serotonin. They didn't feel any better. It's like, well that seems to be entirely, am I remembering that right, Lindsay? And that seems entirely compatible with what you're suggesting is already the prevalent view about depression to begin with. With.

0:42:23 Dean: Yeah, Totally. Let's say they give them serotonin neat, that's a whole other system. And that's a very, haven't seen that study, but if that's what they did, like we just gave them serotonina directly, that's dubious in its own right because medication doesn't do that, it sort of triggers the innate serotonin producing parts of the brain, it doesn't just stick it in and hope for the best. I mean 90% of the body's serotonin is in the stomach or the intestines, which is why antidepressants have such a, should we say, a gastric effect for so many people. They have a unfortunate consequences for the lower half of your body sometimes, because they are heavily influenced in the serotonin systems there, which are a whole whole other set of roles to do, all of which are probably not polite in the type of discussion, um.

0:42:23 Lindsey: Yeah.

0:43:01 Thomas: Right. Well, do you think there's anything else that you would like the average listener to take away from all this?

0:43:07 Dean: I say the discussion on depression has improved, uh, since I started, like just dabbling in science writing, talking, like 15, close to 20 years ago now. Perhaps I've seen the discussion move on. Like when I started, uh, it was still very common to see people in mainstream articles saying that depression is not a thing, it's people attention seeking, people being lazy, those sort of things.

And obviously you still find them somewhere, but they're far less common, they're far less prevalent in the sort of the general mainstream ecosphere now. They are, that's a fringe view, and you know, now it's those, but people who are quite happy to bash and stigmatize mental health problems now have in back on the antidepressant route. You say, well, well, depression might be real, but antidepressants aren't the thing, easy target. They're easy to vilify. Big pharma involvement helps that as well.

There's a whole lot of ideology out there which argues that pill shaming and things like that. And there's nothing wrong with taking antideressants. Like there's Nothing Wrong With Taking Insulin If You've Diabetic Got Diabetes. And had a long long one in barney with the author Johann Hari for his book Lost Connections, which was, um, severely damaging for the reputation of antidepressants, uh, I mean if you look at my Twitter threads, like, you thought the one you saw recently was a big one, Christ.

0:44:12 Thomas: Right.

0:44:13 Dean: Yeah, uh, that's why I first started having people tell me, should I just stop my meds then? So please don't, for the love of god, please don't, that's going to potentially harm you seriously, if not not fatally, but someone who writes a compelling yarn and has clearly an agenda to had there, and I'll happily go on the record of that, had a lot of beefs, a lot toot-a-toots, and I seem to be, I was sort of named, in the UK at least, the face of the resistance against him, to my confusion and surprise, because that wasn't what I was going for, but someone's got to do it, and I thought I would. But um, yeah, so it's a very common whipping boy, antidepressants. There's a lot of ideology and hidden agendas when it comes to vilifying antidegressants, and a lot, it's so easy to think these people are like standing up for the little guy, whereas if anything it's the opposite. No, are a vital tool for so many, and.

0:44:59 Thomas: It does get framed as like, well, the pharmaceutical companies have been making money off of this fake medication.

0:45:05 Dean: And the people who vilify antidepresants, they're rarely ever doing it for free. I noticed just that out.

0:45:10 Thomas: That's excellent. This was very helpful. And Dean Burnett, thank you so much for coming on on the show. That was an absolute joy.

0:45:16 Lindsey: Yeah, Yeah, thank you. This is great.

0:45:16 Dean: Thank you you much for having me. I had a great time. Cheers.

0:45:19 Thomas: You've your referenced Twitter account and such, but just to make sure I want to put out any plugs, any, any place people should go to find you in your work.

0:45:25 Dean: Yeah, my website is demonet.com. Very straightforward. But I'm on Twitter as atgarowboy, G-A-R-W-B-O-Y. That's the Garw Valley, that's where I'm from. And I set up my Twitter account before I thought anyone would care, so uh, it's a bit late to change it now, but so that's why it's so obscure. So yeah, thanks guys.

0:45:42 Thomas: Excellent. Thank you so much. All

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