Your Brain On Depression, Antidepressants, and Ketamine
In 2008 I put in many 70-hour work weeks (bleeding over weekends) in the middle of the Great Recession. Our largest clients were publicly traded. I would doomscroll their stock prices every morning to see who might be in severe trouble, trying to anticipate the impact on the business if any went under — and a few did.
Toward the end of that year, my sister was killed in a tragic and local news-making accident around the holidays, right before we were to see each other on New Year’s Eve. Not too long after the funeral, during my annual physical, my doctor, seeing the mental state I was in, recommended a temporary round of the antidepressant Wellbutrin. At the time, if you had told me drinking sheep urine would help, I would have tried it.
So I started the protocol of pills.
Handrails — not crutches
Some initial side effects were weird; I felt off balance when I tried to play tennis, but that went away. While It didn’t make me perpetually positive or invulnerable to sadness, it did help. I remember feeling more normal; however low my emotional floor was, it was raised a bit. Staircase handrails come to mind; having something to hold on to while getting my emotional feet back under me.
I share all that for two reasons. The first is to address any stigma any might have about seeking this type of help. This is NOT a recommendation for medications; it’s a recommendation for consideration IF a qualified Doctor (not a friend) has recommended it for your specific situation. The second is for equal time or balance. Let me explain.
Brain ecology
In many previous podcasts, I talk about cognitive tools that help with thinking and cognitive distortions. These are evidence-based skill sets that can be learned, but to this point, I haven’t given attention to the actual neurobiology of negative feelings or the pro-cons of pharmaceutical interventions. Saying I lean toward the thinking work needed for such states (which I do) leaves out the fact that thinking and emotion arise in an embodied ecosystem. Just deprive yourself of needed sleep and tell me your mood. The Lombardi quote, “fatigue makes cowards of us all,” comes to mind.
Thinking and emotion arise in an embodied ecosystem.
To say a lot has changed in the field of psychopathology and pharmacology since I took that round of medication is a huge understatement. New treatments include transcranial stimulation (TMS), and some psychedelics are showing amazing results in suicide prevention, PTSD, and treatment-resistant depression.
Many people end up struggling with depression for long periods of time; even with psychotherapy there are still people who continue to suffer, which was one of the reasons that we continue to probe the biology to both better understand the disorder and to try to develop new treatments — Dr. John Krystal
So, this podcast focuses on brain chemistry, specifically, what happens in our brains when we are severely depressed or anxious. And for those stuck in that state, how do antidepressants and new psychedelic treatments help someone get unstuck?
For the episode, I interviewed the distinguished Dr. John Krystal, MD. Dr. Krystal is the Professor of Psychiatry, Neuroscience, and Psychology; Chair of the Department of Psychiatry at Yale University; and Chief of Psychiatry and Behavioral Health at Yale-New Haven Hospital. He is best known for leading the discovery of the rapid antidepressant effects of ketamine in depressed patients.
We discuss everything from the neurobiology of depression to how antidepressants work on that neurobiology and how psychedelics — specifically ketamine — rewires the brain’s circuitry.
We also cover …
- The relationship between thought and brain chemistry
- Anxiety and its connection to depression
- The varieties of medications for treating depression
- How antidepressants were discovered
- How ketamine works in the treating severe depression and PTSD
I learned a lot talking with Dr. Krysal, and you will too.
Or check it out on iTunes, Google, Spotify, or any pod player.
