Postpartum Depression Affects Men, Mood Disorders & Trauma: Dr. Ishrat Husain | Ep.113 - Gent's Talk

[00:00:00] Depression, either for men or for women. What exactly is happening to the mind? It could be a very severe illness. Sometimes it can be so severe that one's perceptions of reality can change. They can become psychotic.

[00:00:13] Dr. Ishrat Husain is a professor and the scientific head of the Clinical Trials Unit at the Center for Addiction and Mental Health. He also serves as the lead of the CAMH Mood Disorders Service.

[00:00:24] Dr. Ishrat Husain, Mood Disorders

[00:00:25] What are things to look out for to go, oh, something is happening? If you're getting to the point where you're having really dark thoughts, where you're feeling like you don't want to be around, then you need to go out and seek help.

[00:00:39] Dr. I want to talk about the mood disorders. What you're seeing that can potentially help people self-regulate a little bit more.

[00:00:45] Dr. Anybody who is experiencing some of these intense fluctuations in their emotions or in their mood, the development of healthy coping skills is really important.

[00:00:54] Dr. Ishrat Husain is really important. The first step comes with actually recognizing.

[00:01:20] Dr. Ishrat, welcome to Jen's talk.

[00:01:23] Jen's talk. Thanks for having me.

[00:01:24] Dr. You and I met at Carol, shout out to Carol, who's just an incredible individual who just always seems to be connecting people together.

[00:01:33] But you and I met at a book launch event that Carol and yourself co-authored.

[00:01:41] It's called The Right Not to Remain Silent.

[00:01:45] Did I get the title right?

[00:01:46] That's right.

[00:01:47] Yeah, perfect.

[00:01:48] I'm proud of myself for that.

[00:01:51] And we started talking and you made a very, very interesting observation to me from your line of work.

[00:02:02] And I'm going to jump to your bio in a moment just so that everybody understands, you know, what you do and your area of expertise.

[00:02:08] But you made a very interesting comment to me where you said in the same, maybe not the same, but similarly to how women go through postpartum depression after giving birth, there is something that happens to men after the birth of their first child.

[00:02:24] And when you said that to me, I was kind of like, what?

[00:02:29] I couldn't even fathom what that could look like.

[00:02:32] I mean, I had heard of dads talking about not feeling a connection to their child and then feeling like, you know, like, I don't know who this being is type of thing.

[00:02:41] But before we go any further, I wrote down your bio because there's a lot of really interesting things and you do a lot of incredible work.

[00:02:47] So you're the scientific head of the clinical trials unit at the Center for Addiction and Mental Health, CAMH.

[00:02:54] You serve as the lead of the CAMH Mood Disorders Service.

[00:02:58] And you're an associate professor at the University of Toronto, where you also hold the Cameron Wilson Chair in Depression Studies and a Canada Research Chair in Treatment Innovation in Mood Disorders.

[00:03:11] Your research program focuses on advancing the understanding and treatment of mood disorders across populations through clinical trials of emerging treatments.

[00:03:21] That's a pretty lengthy bio.

[00:03:22] Yeah.

[00:03:22] I don't know how you do all that time.

[00:03:24] And you also look like a very young man.

[00:03:26] So, like, did you start when you were 12?

[00:03:28] No, I did not.

[00:03:29] No, it's just healthy living, I think.

[00:03:31] Okay.

[00:03:32] Well, you said that you had a workout this morning at Perry's.

[00:03:34] Yeah, it's really important.

[00:03:36] How long was the workout?

[00:03:37] 50 minutes.

[00:03:38] Okay.

[00:03:39] How many calories burned?

[00:03:40] I think probably 600.

[00:03:42] Wow.

[00:03:43] I really gotta try this, Berries.

[00:03:44] I've heard good things.

[00:03:45] It's a great workout.

[00:03:46] I've heard really good things.

[00:03:47] I've heard people go in and then just come out and they're like, my ass just got kicked, but it was incredible.

[00:03:51] It was down the road from you.

[00:03:52] You should check it out on the way to work here one day.

[00:03:55] Where?

[00:03:55] On Richmond.

[00:03:56] Oh, okay.

[00:03:57] Oh, so close.

[00:03:58] I could do that right before and then come in a sweaty mess.

[00:04:01] Exactly.

[00:04:03] Okay, so I'm really excited to have this conversation.

[00:04:05] To jump back to the point I had made earlier.

[00:04:08] What exactly is it that's happening to men after the birth?

[00:04:12] Is it after the birth of their first child or after the birth of any child?

[00:04:15] It could be after the birth of any child.

[00:04:17] Okay.

[00:04:17] So, look, you know, with the sort of transition into parenthood, whether it's a man or a woman, you've got lots of change.

[00:04:27] Change in your identity.

[00:04:29] Change in sort of who you, you know, see yourself as.

[00:04:33] As you may be somebody who's, you know, very involved in their work or social life, but all of a sudden got changing and competing demands.

[00:04:44] And so everybody has to adjust to this change in role.

[00:04:49] The adjustment can really affect an individual in different ways.

[00:04:54] So, there are some parents, whether that's again a mom or a dad, that can go on to develop a more severe form of an adjustment to that, you know, change in role.

[00:05:06] So, for women, you may have heard of the term postnatal depression or postpartum depression.

[00:05:13] And that's a very severe form of a reaction to that adjustment when they actually go on to develop a depressive illness in response to that changing role.

[00:05:23] Not necessarily just in response to that changing role, but then also you've got to remember with women, they've been going through biological changes as well, hormonal changes.

[00:05:33] And that compounded with the change in role, the change in sleep cycle can lead to the onset of a depressive illness.

[00:05:39] But at the same time, we know now over years of research and study that actually men also can go through very severe reactions to that adjustment to the new role as a father.

[00:05:52] And that can be as severe as leading to a depressive illness in dads as well.

[00:05:57] And that's a condition called male postpartum depression.

[00:06:02] So, so it's understudied.

[00:06:04] You know, you yourself when we met, you hadn't even heard of it.

[00:06:07] No.

[00:06:07] And it's underrecognized.

[00:06:09] But actually, it can affect up to 10% of fathers with their first child.

[00:06:16] And then it can also go and affect them with subsequent births of their next children as well.

[00:06:23] So, it's underrecognized.

[00:06:26] I think generally, you're aware with what you do on this platform that men's health and men's mental health in particular is, I think, an understudied and under discussed subject matter.

[00:06:42] A lot of self-stigma that men hold towards what they can talk about and express.

[00:06:48] And I think that has led to this sort of neglect of this particular area when it comes to dads as well.

[00:06:55] So, maybe we can backtrack a second.

[00:06:58] Postpartum depression in general, either for men or for women, what exactly is it?

[00:07:03] How does it happen?

[00:07:05] What triggers it?

[00:07:06] You talked about the hormonal changes, the change of the role of suddenly becoming a parent.

[00:07:11] But what exactly is happening to the body or to the mind?

[00:07:15] So, we don't know necessarily what's happening biologically.

[00:07:19] There have been some sort of studies that have implicated changes in the neurochemicals in the brain that may be contributing to the onset of depression in that phase.

[00:07:32] It may be due to the hormone changes, for example.

[00:07:36] In women, they have massive shifts in the levels of estrogen and progesterone, which are the main sort of female hormones.

[00:07:46] And it's thought that that might be implicated as well.

[00:07:49] But to be honest, we don't know what the actual biological cause in our body is for the onset of depression, whether it's around childbirth or even in general.

[00:07:59] I see.

[00:08:00] So, it's difficult to say exactly what's implicated.

[00:08:05] But how it presents is that individuals following the birth or around the birth of their child may be sort of feeling very down, very low in their mood, not as interested in the things that they would usually be interested in.

[00:08:22] Physically, they may not be able to eat.

[00:08:24] They may not have an appetite.

[00:08:26] They may not be sleeping.

[00:08:28] When they want to sleep, their child may need them.

[00:08:31] So, they're unable to sleep.

[00:08:33] And then the most worrying and concerning thing for parents is that sort of lack of attachment to their child that can really present itself, which is very distressing.

[00:08:43] I could only imagine.

[00:08:45] I mean, I'm not a parent, but I've had friends talk to me about that.

[00:08:48] Yeah.

[00:08:48] And it sounds terrifying.

[00:08:49] Yeah.

[00:08:50] And then, you know, people with depression already have feelings of guilt.

[00:08:53] Yeah.

[00:08:53] And then that compounded by this sort of lack of attachment that they feel with their new child can even make that worse.

[00:09:01] So, it can be, you know, it can be a very severe illness.

[00:09:05] Sometimes it can be so severe that one's perceptions of reality can change.

[00:09:10] You know, they can become psychotic and feel that, you know, they may harm their child or do something to their child.

[00:09:16] And that's really worrying.

[00:09:18] So, it's something that requires immediate attention and treatment.

[00:09:22] What does treatment look like in something like that?

[00:09:25] You know, generally with what we do in mental health and psychiatry is that we look at the severity of one's illness.

[00:09:34] So, if somebody, you know, is able to go about their functioning, they're able to serve in their role as mom, they're able to sort of look after themselves.

[00:09:43] We may use sort of less assertive approaches like talk therapies, cognitive behavior therapies, a type of structured psychotherapy that's very effective and evidence-based for the treatment of depression.

[00:09:56] So, that's something that could be used.

[00:09:58] If it's more moderate to severe and it's impacting one's functioning, impacting things like sleep, appetite, ability to look after themselves, then we may recommend some medication.

[00:10:09] So, antidepressant medications are very effective for depression, whether it's in the postpartum phase or otherwise.

[00:10:17] So, we would, you know, use a medication that we know would be safe in women that may be breastfeeding as well.

[00:10:23] So, that's generally the types of treatments that we would use.

[00:10:28] So, now I want to go back.

[00:10:29] At some point, I want to ask you, and if I forget, please remind me, but I want to ask you about how men can show up for their partners if they're going through postpartum depression, what they can do.

[00:10:43] You know, I'm not asking you like, hey, what are the tricks of the trade for them to become their therapist?

[00:10:47] But more so, how can they support them in these moments?

[00:10:50] Because I imagine if your partner, your closest person who, you know, you just had a child with is suddenly going through this, you don't really know what to do.

[00:10:59] So, I'm curious about what would happen in that scenario.

[00:11:02] But I want to go back a moment to when you talk about men going through their version.

[00:11:08] Is there a difference in the, I mean, I imagine there would be to some degree a difference between how, like between a woman's postpartum depression and a man's postpartum depression?

[00:11:18] Or are there similarities?

[00:11:19] I think there's actually quite a lot of overlap.

[00:11:25] So, depression can present in so many different ways, though, for any individual.

[00:11:29] Even two moms may have a very different presentation of how their depression can sort of manifest itself.

[00:11:37] But generally, there can be quite a lot of overlap.

[00:11:40] In men, we see less of that sort of severe end of the spectrum of postpartum depression where it can become that psychotic type picture.

[00:11:48] How come?

[00:11:50] We don't know, actually.

[00:11:51] That's a really good question and something to look into.

[00:11:55] But I would assume it's probably to do with some of the biological changes that men don't experience during the postpartum phase.

[00:12:04] True.

[00:12:05] So, some of those hormonal or neurochemical changes that men may not experience.

[00:12:10] Also, you know, I think men aren't as in close contact with their child as the mother in the first couple of weeks following the birth.

[00:12:21] So, I think when moms are so in contact with their child and they're having those feelings of guilt, that can really exacerbate very quickly.

[00:12:30] Whereas men are less involved, generally speaking, in the sort of early care of the child.

[00:12:39] So, maybe that's contributing too.

[00:12:41] But overall, men present very similarly with depression, right?

[00:12:46] Lack of interest.

[00:12:47] Lack of joy.

[00:12:49] Lack of sort of feeling close to their partner or to their child.

[00:12:54] With men, you know, it can also come out sometimes with irritability and outbursts of anger.

[00:13:06] that's we know that that's how depression can present in men because they don't know how to

[00:13:10] sometimes express negative emotions in any other way and that's kind of concerning because

[00:13:18] we do know that men with you know a depressive illness can be more likely at times to engage in

[00:13:27] intimate partner violence so so that can be you know a concern and another reason why we need to

[00:13:33] recognize it uh you know very quickly and try and address it that's a that's a concerning bit of

[00:13:40] information there like that's a a part of that process you know i'm wondering as you were talking

[00:13:49] i ask most of my guests if not all of them how we can better support men opening up having these

[00:13:57] conversations i have in front of me a gentleman who is trained in almost everything by the sounds of

[00:14:06] your biography um but you work for one of the greatest um most empowering mental health facilities

[00:14:16] what would you say what's your response to it you know i i really do think that the way that we're going to

[00:14:26] reduce the stigma around mental health and the self-stigma by the way there's two concepts there's

[00:14:33] like sort of the public stigma and then there's what the concept of self-stigma the the that one who's

[00:14:41] experiencing issues with their mental health may have their own biases against themselves right

[00:14:46] i think the the way that we're going to address that to improve the conversation is through education

[00:14:53] uh that is the first and foremost thing like even plat like what you're doing is amazing the platform

[00:14:59] like this uh you know that you know lots of men are probably tuning into and hearing about

[00:15:05] i think would allow them to open up learn a little bit about what's going on with them

[00:15:10] um and then talk to people around them uh i think that's the first step educating uh individuals about

[00:15:18] you know what are common you know experiences for anybody and then that education i think leads to a

[00:15:25] reduction in stigma and i think we at our organization at cam h have tried to do a really good job

[00:15:31] of around that messaging um you know trying to get send out the message that mental health

[00:15:37] is health in fact it's not a separate entity altogether it's just part of your overall health

[00:15:42] um and i think that that's the way that we're going to be to be able to demystify some of the

[00:15:49] issues around it you know as a researcher and scientist i also do believe that doing research

[00:15:54] and and sort of trying to um to sort of uh unlock some of the mystery around mental illness by

[00:16:05] understanding the causes uh the treatments uh will then reduce the stigma because you over the last

[00:16:13] sort of five decades you know not even that long ago but even now in still some cultures people feel

[00:16:19] that it's some sort of mystic or you know uh spiritual thing that's happening to individuals

[00:16:27] right um i do a lot of work in patriarchal societies like i'm originally from pakistan my family's from

[00:16:34] pakistan um which is traditionally a patriarchal society and we do a lot of actually do a lot of

[00:16:40] research in that setting as well um what are you finding and i've done a lot of work with men's

[00:16:46] mental health in that area because it's such a patriarchal society where sort of you know the dad

[00:16:51] the man is the main breadwinner uh you know they don't go and talk about illness they don't cry uh

[00:16:57] no emotions no love nothing yeah um and so you know but we found from our work there that the

[00:17:05] rates of depression are so much higher than here even uh like rates of depression in men almost 42

[00:17:14] percent of men in pakistan in that population would would experience a depressive illness and so we you

[00:17:21] know we've tried to do some work around that some education around that um and we the way that we've

[00:17:27] sort of intervened so you know we've we framed our approaches to managing depression in those folks

[00:17:35] as a training program and not a therapy because i think the word in itself scares people off exactly

[00:17:42] comes with its own baggage and when we have framed it as a training that it was you know people like

[00:17:50] that they were able to engage in it um and we found that actually through that engagement that education

[00:17:58] uh really broke down barriers improves people's uh mental health outcomes uh as well so so i think it

[00:18:07] is really about tailoring and and personalizing our approach we're we're living in toronto you know

[00:18:13] western society where it's becoming more acceptable to speak about mental health conditions

[00:18:20] but i i don't think that's applicable to all cultures even in toronto i agree with that right yeah if

[00:18:26] we go to thorncliffe park i don't think everybody else would be talking about men's mental health the

[00:18:31] way absolutely yeah if you go to you know celebration square in mississauga same thing yeah and the

[00:18:37] so i'm from lebanon and um in my own community i get criticized for having these conversations under the

[00:18:44] guys of that's uh weak western ideology right men don't show these things you have to be strong you can't show

[00:18:53] your woman anything you can't show your kids anything that's between you and god that's this that's that

[00:18:58] and um so when you talk about i mean 42 is such a massive number yeah and it's not a small population

[00:19:06] either no 250 million people geez yeah i mean you could take lebanon as a very sort of similar

[00:19:15] culture setting right like they've got all of these psychosocial stressors geopolitical issues

[00:19:21] you know exposure to so many uh different stressors that the people in that population are exposed to

[00:19:29] you can imagine why the rates of depression would be high now you know sometimes i i take the view of

[00:19:35] you know how you you described depression or mental health issues as a western construct i can take

[00:19:40] that from some folks in those settings um and i think we have to frame it to them in a in a different

[00:19:47] way right like the term depression perhaps is is not is not the most culturally acceptable to them

[00:19:55] um i know for example people from south asian cultures when they're in mental distress they will

[00:20:01] express it as a physical issue oh like my head really really hurts but actually there there's

[00:20:08] something going on emotionally yeah um and that's okay as long as you sort of get to the bottom and

[00:20:13] get to to sort of engage with them to ask them about other aspects of their life uh and frame it in

[00:20:18] a way to explain to them that sometimes when something's going on emotionally it can present

[00:20:23] uh in physical ways as well um we do have to we do have to the physical i'm laughing sorry about the

[00:20:29] you know like all my head hurts yeah that's that's because i've heard that before and i think i've

[00:20:34] used that yeah growing up like all my head hurts when i know that i was in a really bad spot yeah and

[00:20:40] i didn't know how else to articulate it because if i said something is wrong you know like anyone

[00:20:46] around me would freak out like what are you talking about something's wrong like what does that mean

[00:20:50] yeah so it's it's it's fascinating to me how we still struggle and how there's so many men out

[00:20:57] there that just don't even have the ability to articulate the words they don't have the tools

[00:21:01] they don't even know what words to use yeah um you know i i think i think it's it's extremely common

[00:21:11] across cultures across populations um i think others have more stigma uh than some western ones to be

[00:21:21] frank uh but i do even think within western populations even if you take your general sort

[00:21:27] of white canadian male i don't think they'd feel as comfortable talking about their mental health

[00:21:31] issues to their peers um as uh as you know women might um but i uh you know i like i said i think

[00:21:41] education um is really important i think um shedding a light on some issues that are understudied and then

[00:21:52] and as i mentioned to you trying to explain to people that you know there it's not a mystical

[00:21:58] it's not this sort of mystery thing there's actually something going on um whether that's

[00:22:04] psychologically emotionally biologically it's often a combination of all three and i think

[00:22:09] that's what people need to understand with mental illness as well or mental ill health that it's not

[00:22:15] often just the chemical imbalance that's that's causing it there's so many other factors the human

[00:22:21] mind is the most complex organ in the body so how do you i mean you talked about talk therapy you

[00:22:28] talked about cognitive therapy um someone comes and sees you sees another another doctor i think part of

[00:22:40] de-stigmatizing it is not knowing when you walk into a room with a therapist or someone a professional

[00:22:46] what what's going to happen to you and maybe that's something that we can at least help by it's like this

[00:22:52] is what this looks like this is what happens when you walk into cam age and you see a professional

[00:22:57] this is what the process looks like so someone if i came to you and i said you know what my head hurts

[00:23:04] and you can tell that i've either got some early on like early signs of depression or i'm really

[00:23:11] going through something what are you doing with me so you know the reason i got into psychiatry is

[00:23:18] because my whole job is about getting to know people and getting to hear people's stories so what we do

[00:23:26] when you come to us for an assessment or you come for an intake or you're going out and seeking

[00:23:33] help the first thing somebody's going to do is just like listen to your story we want to know

[00:23:39] we want to know who you are we want to know um you know what's brought you to the point of

[00:23:47] of you know the experience or the crisis or what's going on with you um and i think listening to one's

[00:23:55] story or journey or experiences in life are really really key because it allows us to gain an

[00:24:02] understanding of what's going on with somebody in their sort of current emotional state at that

[00:24:09] time you know we don't we don't really do immediately you know blood tests or brain scans

[00:24:16] and things like that to try and understand because we don't have a reliable sort of biological

[00:24:23] investigation to tell us what's going on with somebody we listen to people's stories we listen we hear

[00:24:27] you out uh that's why you'll probably have a much longer appointment with a therapist or a psychiatrist

[00:24:34] than you would with a regular physician right because we need the time to hear one story and once

[00:24:40] we hear a narrative we use you know our experience in our training to to to sort of come to a provisional

[00:24:48] diagnosis of what's going on and then we explain that to you we we try and give you some education

[00:24:54] around what you're going through so you understand and empower yourself with the knowledge of of what

[00:24:59] you're what you're experiencing because i think that's really important once somebody figures out

[00:25:04] like or can name the feelings that they're going through you know people can then also try and take

[00:25:10] steps to address some of that you know through changes in their own life it doesn't always have to be

[00:25:17] that you know a doctor gives you a diagnosis writes you a prescription and off you go yeah um and i think that's really

[00:25:23] important that's at least our approach uh where i work uh and what i do and what i train my uh my

[00:25:30] trainees to do in terms of the management of people with with any sort of uh mental distress

[00:25:37] i want to go back to the postpartum piece um what are some early early signs of it if

[00:25:48] i have a really good friend who's about to become a father

[00:25:52] and he's listening to this episode he's watching this episode and he's now thinking consciously about

[00:25:59] this this you know in x number of months time i could very well potentially find myself in this

[00:26:05] position or his wife could be in this position you know knock on wood nobody but what are things to

[00:26:13] look out for in order to improve the self-awareness level to go oh something is happening to try and catch it

[00:26:20] early on yeah so look there's certain things that are going to be disrupted by the birth of a child

[00:26:26] right like your sleep is going to be disrupted uh and that's so that's not always the first indicator

[00:26:31] to say hey something's going wrong because everybody in the home is going to be on the schedule of what

[00:26:37] the baby needs at the the current time but i do think that it's really firstly as uh you know the male

[00:26:45] partner or the dad uh in the situation you got to keep a close eye on on mom because they're still at higher risk

[00:26:56] of developing uh postpartum mental health issues so it's really important to be there and be supportive

[00:27:03] and uh you know keep an eye on their emotional state it's totally normal for women in the first sort of seven to ten days

[00:27:11] following the birth of the baby to be more emotional to be more tearful to be more irritable it's called the

[00:27:16] the the the baby blues uh so just keep an eye on that but when it extends to beyond that or if you find

[00:27:23] that your partner or mom is not eating is not connecting with you or the baby um is more withdrawn

[00:27:33] is not able to look after herself those are warning signs that you need to get help for her uh try and get

[00:27:40] in loved ones family members uh you know uh to come in and provide support uh and to also

[00:27:50] help the family unit really to try and get through and if that if they are concerned they're worried

[00:27:55] then that's the time to seek professional help of course at any time if you're worried about somebody's

[00:28:01] safety the baby's safety mom's safety she's saying things that she doesn't want to be around anymore

[00:28:06] things like that that's really worrying and means that you should get some emergency help for your own

[00:28:13] sort of well-being you've got to look out for for similar aspects right you've got to make sure that

[00:28:18] you're able to look after yourself you know you're still showering every day you're eating meals every

[00:28:25] day um like i said the sleep piece it's going to be impacted but other aspects you've got to keep an eye out

[00:28:33] if you find that you're getting irritable in the first little you know first week or two that's

[00:28:37] totally normal as well you're not sleeping as well you've got all of these changes going on

[00:28:41] that's fine but if you're getting angry and you're not able to control those emotions then there's an

[00:28:47] issue there and you may need to seek help uh speak to friends loved ones about what you're going through

[00:28:53] if you're getting to the point where you're having really sort of dark thoughts where you're feeling

[00:28:59] like you don't want to be a dad you don't want to to be in this situation you don't want to be around

[00:29:06] all overwhelming yeah you know then you need to go out and seek help um and seeking help doesn't mean

[00:29:13] necessarily like i said to you that it's going to be that's you know somebody's going to pull out

[00:29:18] a prescription pad and write something up for you that you have to start and take for the rest of your

[00:29:22] life i think it it just sort of allows you to communicate what you're going through with a

[00:29:28] professional and that might give you reassurance to be like hey you know you're okay keep going for a

[00:29:33] little bit longer come back to see us if things aren't going well in a couple of weeks or if it is

[00:29:39] something serious they'll be able to intervene sooner yeah our antidepressants you know there's a taboo

[00:29:46] around them and i don't know enough about them where i think there's a general worry where if you end up

[00:29:54] having to take antidepressants it'll mess you up in other ways for a long time is there any truth to

[00:30:00] that so there's a lot of you know there's been a lot of controversy around the use of antidepressants

[00:30:06] the overuse of antidepressants coming off antidepressants it's been all over like mainstream

[00:30:11] media for the last couple of years you see it in movies and shows yeah yeah and and honestly i think

[00:30:16] a lot of the stigma around the use of antidepressants is connected to overall stigma around the mental

[00:30:23] health um i i think you know things weren't helped by you know the sort of expansion of big pharma and

[00:30:33] the sort of uh uh sort of assertive push uh of big pharma to to prescribe antidepressants in the mid

[00:30:41] to late 90s but really what we do know over decades of research is that uh at least for individuals with

[00:30:50] moderate to severe depression antidepressants are very effective like you know 60 of people will

[00:30:56] will get better with an antidepressant you know so they can be game changers for for individuals

[00:31:04] um and it doesn't mean that if you're on an antidepressant that you have to be on it for the rest of your

[00:31:08] life uh for some individuals perhaps uh but that's only because their life is much worse when they're not on

[00:31:15] the antidepressant their depression comes back uh well how do you how do you well i guess the

[00:31:20] question then is if you were on antidepressants and you come off of it

[00:31:25] isn't the antidepressant just a masking agent essentially just sort of layering putting a cover

[00:31:31] on you to say all right everything is fine and then the minute it's gone you're just like whoa no not

[00:31:37] doing it i need more no so i think that uh for the way that we we we sort of in rough estimates

[00:31:45] about a third of people who start an antidepressants they'll take it for let's say six to 12 months and

[00:31:51] they won't ever need it again because they've recovered from their depression or anxiety and

[00:31:55] they move on with life they'll use other types of treatments whether that's talk therapy whether it's

[00:32:00] like healthy diet exercise and they'll be fine yeah um and then there's a third of people that they'll

[00:32:07] have recurrent episodes of depression when they stop their antidepressant so those are the folks that need

[00:32:13] to be on it and i don't think it's masking anything i think it's actually treating an underlying like

[00:32:21] pathology like imagine somebody with diabetes right they're taking something to control their insulin

[00:32:30] and they need it for the rest of their life because if they're not on it that pathology of the sort of

[00:32:36] insulin metabolism will come back and their diabetes will be out of control yeah so i think that for some

[00:32:43] individuals depression can be a chronic illness that needs that sort of disease management approach of

[00:32:48] of ongoing treatment this might be a stupid question but if we don't know to your point earlier

[00:32:57] what true like if we don't know enough about the human mind we don't know what exactly is happening

[00:33:03] biologically speaking that'll trigger depression like we're there's we're in the dark with so many things

[00:33:09] how have we developed drugs to treat the thing that we don't really understand fully

[00:33:15] you know it's it's such a fantastic question i think that when i say that we don't know

[00:33:22] exactly what causes depression i think i mean for all individuals because we have a over the last sort

[00:33:31] of three or four decades we have through research develop an understanding that in certain groups of

[00:33:36] people with depression we know what's contributing so we know that for example in some individuals there's

[00:33:43] perhaps disruptions in uh neurochemical metabolism particularly a chemical you may have heard of

[00:33:50] often talked about serotonin which is like the happy uh chemical we know that that can sort of

[00:33:59] disruptions in the serotonin metabolism are implicated in depression for a group of individuals

[00:34:04] yeah we know that in a group of individuals changes in the stress hormones uh like uh corticosteroids

[00:34:13] can be implicated in depression we know that in certain individuals changes in inflammation in the body

[00:34:19] can be implicated in depression and you know these drugs that have been that have sort of been

[00:34:26] developed many of them by the way purely through serendipity right there wasn't exact science when

[00:34:33] developing a lot of these drugs um trying to cure one thing and figure it out it cures another well

[00:34:38] exactly um and that that's how they a lot of the antidepressants were discovered um so i think for

[00:34:46] some individuals in which you know the antidepressants have certain effects so we know for example

[00:34:51] antidepressants although they uh in a way stabilize serotonin metabolism but they also have lots of other

[00:34:58] effects they act on other neurochemicals not just serotonin they actually have anti-inflammatory

[00:35:02] effects in some folks as well so they're kind of multi-modal in their action um and i think that's

[00:35:10] why they go and uh help some people why they help some and don't help others is a really important

[00:35:17] question and that's work that we're still trying to to understand it may be for example that they

[00:35:24] don't work in some individuals because the inflammation component is really high in those folks

[00:35:28] and maybe adding in something that if improves inflammation will improve their depression

[00:35:33] um and that's some of the work that that i started my career uh looking at um and you know we're trying

[00:35:41] to move the needle on that is genetics contributing to sort of persistent depression in some folks is it

[00:35:49] um it may be yeah yeah uh you know we we're doing some work trying to look at genetic markers of

[00:35:54] treatment response we're looking at like the gut microbiome and how that might be contributing to

[00:36:01] sort of you know we know that the gut and the mind are are closely connected as well and we're trying

[00:36:07] to figure out in some folks that don't get better or that persistent depression is that contributing

[00:36:11] um so there's lots of you know lots of areas so much yeah yeah how do i have um people in my life who

[00:36:23] have lived through war and seen the traumas of war seen people get murdered

[00:36:32] seeing family members get murdered seeing the trauma of explosions and escape and

[00:36:41] going to new countries and figuring a language out and all those things good kind human beings

[00:36:50] who've been kicked down by life who are now older and with just my own understanding of

[00:37:00] mental health can see that there's a challenge there a blockade

[00:37:05] pretty much can probably tell that these individuals suffer from some form of depression yeah but there's

[00:37:13] a resistance to doing anything about it how can we actually support our friends our family members

[00:37:21] who've gone through something traumatic like that when you can see it it's not part of their vocabulary they

[00:37:27] won't if you were ever to like hint hey you should talk to someone no what can what could i do what can

[00:37:36] people do when they know someone go through something like that i'll come to answer that in a second but i do want to touch on the really important point you raised here which we haven't discussed yet which is the role of trauma

[00:37:49] um

[00:37:51] adversity in life and that how that can contribute to mental health issues particularly depression

[00:37:56] um so we know that early life experience

[00:38:01] um

[00:38:01] uh

[00:38:03] early life adversity childhood trauma

[00:38:05] unfortunately is associated with lots of adverse

[00:38:08] uh you know health outcomes whether that's physical or mental

[00:38:11] mental health

[00:38:12] but we also know that it's also associated with more

[00:38:16] resistant or chronic depression

[00:38:17] um and even trauma

[00:38:20] in early adulthood adulthood

[00:38:23] is associated with mental health

[00:38:26] issues and you may have heard of the term

[00:38:28] ptsd post-traumatic stress disorder

[00:38:31] there's also

[00:38:33] a

[00:38:34] term called complex ptsd which is sort of folks that have been through repeated

[00:38:38] and severe traumas in their life and exposed to that and how that can present with mental health issues

[00:38:44] which can be very challenging to treat

[00:38:47] we know that trauma is associated with depression

[00:38:49] so you know like those in your circle

[00:38:53] that you just alluded to that may be going through something

[00:38:57] you know they may be experiencing

[00:39:00] health issues mental health issues

[00:39:03] um

[00:39:04] and

[00:39:05] i guess the question is is that do we

[00:39:09] approach them because we can see that it's impacting their functioning and it's causing distress

[00:39:14] or are they able to go on and live

[00:39:17] a personally satisfying life

[00:39:19] because i have people in my circle

[00:39:23] of a certain generation who have been through traumatic experiences

[00:39:27] but they

[00:39:28] go on they live life they function

[00:39:31] and when i have tried to

[00:39:34] sort of touch on

[00:39:36] some of the things that they've experienced

[00:39:38] they said that they don't need to talk about it

[00:39:41] they're absolutely fine

[00:39:43] and they're getting

[00:39:44] what they need out of life

[00:39:46] and i think in those situations it's really hard

[00:39:49] to push somebody out of their shell and get them to seek help because as far as they're

[00:39:54] concerned they're living the life that they think is

[00:39:58] giving them satisfaction

[00:39:59] there are some individuals who go through those traumatic experiences by the way who do not get

[00:40:05] the satisfaction that they need out of life they cannot function and those are the individuals that i think

[00:40:11] you know we should

[00:40:13] you know try and approach and ask them for i think it's very

[00:40:16] yeah yeah i think it's very challenging though

[00:40:19] i'm sure everybody that you've met

[00:40:22] who's been through trauma not everybody has a mental health issue

[00:40:25] correct yeah right yeah

[00:40:27] there's some folks that are for some reason which

[00:40:29] we don't understand

[00:40:29] yeah

[00:40:30] are way more resilient

[00:40:31] yeah

[00:40:31] and that is the fascinating thing

[00:40:33] i

[00:40:33] resilience a great word

[00:40:35] yeah you know the resilience piece

[00:40:37] is something that i really would like to spend some time in my

[00:40:40] sort of career over the next little while trying to explore

[00:40:43] why are some folks

[00:40:44] more resilient than others in the face of adversity

[00:40:50] maybe we should be trying to look at those individuals and try and

[00:40:54] understand what it is

[00:40:56] from their experience their background their biology that leads to that

[00:41:01] and why are there some that don't we don't know

[00:41:03] can you replicate that somehow as a treatment for others

[00:41:06] well exactly yeah

[00:41:07] the resilience piece i think is is absolutely fascinating

[00:41:10] i'd love to see that get flushed out more because

[00:41:15] you know i like to think of myself as a resilient guy

[00:41:18] because of whatever has happened in my life that i've looked at and could have

[00:41:23] easily said all right hang in my hat

[00:41:27] this happened to me

[00:41:28] what was me i'm done

[00:41:30] and instead i took that and said okay how do i actually learn from that growth

[00:41:35] through the pain

[00:41:36] and then become a better version of myself

[00:41:40] and i've had conversations to your point with others who are

[00:41:44] to this day something could have happened 10 years ago have never been able to

[00:41:49] let go of it move on from it learn from it grow through it type of thing so i'm very

[00:41:54] fascinated about the concept of resilience and what and how it works for some people and not others

[00:41:59] so for those individuals that i think that you mentioned there that are holding on to something

[00:42:05] and not able to let go and it's still impacting them now i think those are the folks that need a lot of work

[00:42:12] that we should you know what they need is honestly they need attentive

[00:42:18] trusting psychological support to help them process that adverse experience

[00:42:24] to build resilience through that psychological support and then move forward with their life they

[00:42:29] may never forget that experience but they can sort of develop skills to sort of allow them

[00:42:38] to move forward with the knowledge that yes that was a really terrible life-changing experience

[00:42:45] but i'm not going to let it impact the rest of my life yeah and i do think that's psychological support

[00:42:50] that's what it needs it's like with somebody that they trust

[00:42:54] that can develop a relationship and alliance with uh seeing that individual to work through that in a

[00:43:01] trauma sort of informed way yeah and it's a group effort yeah and i think that's the other piece too is

[00:43:08] sometimes we try to in our friends circle our families will say hey you should go talk to someone

[00:43:15] but not want to actually be there to say hey if you wanted to talk to me i'm obviously not a professional

[00:43:21] and i can't really support you the way a professional can but i'm also willing to just sit here with you

[00:43:27] and listen if you want to vent or just get something off your chest where you can feel like i'm a safe space

[00:43:32] for you type of thing and i think it there's a need to remind people that you can still support your

[00:43:39] friends your families your loved ones by just being there absolutely yeah i mean look i am a professional

[00:43:48] in this area but i'm also a friend to people i have a lot of sort of male friends that i grew up with went

[00:43:56] to high school with and you know some of them are professionals in the sort of related areas but they

[00:44:02] still feel uncomfortable within our group speaking about what they're going through but like

[00:44:08] individually with me they can talk about some of the things and i speak to them as a friend not as

[00:44:14] a professional i i speak to them uh sort of to just sort of have that give them the space to be able

[00:44:22] to talk about what they're experiencing and of course when there are times when i feel that they

[00:44:25] need that professional help i'll guide them to it and that's what we can all do for for each other

[00:44:31] i want to talk about the mood disorders so um my partner mila will often say that when i'm stressed

[00:44:40] out i get very moody i could be the highs can be high the lows can be lows i and the the self beating

[00:44:50] can essentially make me very sort of like um i can get into this state where i'm just like focused on

[00:44:57] nothing but the negatives and that changes my entire mood and it shifts how i think about things how i

[00:45:03] see things my reactions to my puppy all those things not severely but enough that it's noticeable and i

[00:45:10] notice it too and so i'm constantly trying to be trying to self-regulate be more self-aware of what's

[00:45:16] happening that triggers us that i wake up this morning and have a you know see a really frustrating

[00:45:22] email and i've haven't even gotten to the gym yet so i haven't had the ability to like really get the

[00:45:28] blood flowing or anything like that um i'm curious from your line of work in mood disorders you know

[00:45:36] what you're seeing in this space that can potentially help people self-regulate a little bit more because

[00:45:43] it seems like these days a lot of people are just very moody and it's easy to just be like that's a

[00:45:48] very moody person without understanding what's happening there firstly you need to stop checking

[00:45:52] your emails before you go to the gym i know that's the first i know i know it's like go to the gym first

[00:45:58] yeah but yeah no i think that uh i think that you you know you you really spoke quite eloquently about a

[00:46:06] good way to be able to regulate manage monitor uh your mood i think that it's not an easy thing though

[00:46:18] it's not something that comes naturally to most people you know most people including myself we

[00:46:24] we you know you go on with life you don't think about sometimes what's going on with yourself

[00:46:29] internally all the time because life is just so busy yeah and uh you don't take the moment to sort of

[00:46:36] check in with yourself to see what's going on with you internally or mood wise um you know i i deal

[00:46:46] with the sort of severe end of the spectrum of mood issues so i will see people with what are disorders

[00:46:53] which are where the mood changes are so severe that it impacts one's ability to sustain an occupation or

[00:47:01] relationships things like bipolar disorder or major depressive disorder so those those individuals the

[00:47:09] advice i give would be very different from somebody who has you know daily fluctuations in their mood which

[00:47:16] is the within the normal sort of range of human emotions which we all go through and i think that

[00:47:20] it's important not to pathologize all the time i agree i think it's like really important that people

[00:47:27] know that you're allowed to experience irritability once in a while sometimes you just got to feel it

[00:47:32] yeah you gotta feel frustrated it's okay if you got a crappy email you're allowed to feel frustrated

[00:47:38] with that now how you express that frustration is is important that's the key part right how you cope

[00:47:44] with negative feelings and emotions is is a key part if you're taking it out on your puppy or your

[00:47:51] girlfriend that's not which i don't yeah but that's that's it's one of those like i notice it and i go

[00:47:57] i'm feeling like very irritated right now and how do you manage it though what do you do with it i struggle

[00:48:04] sometimes if it's so i'll use this morning actually it's a perfect example that email i woke up this

[00:48:11] morning 5 a.m saw my you know went to turn off my alarm and again that's on me i should get an actual

[00:48:18] old school alarm yeah but as i turned off the alarm i saw an email that i'd been waiting for and i and i

[00:48:25] looked at it and it was not what i had wanted to see and immediately my mind started racing i started

[00:48:31] thinking about all the different impacts that this email now has right this bit of information now means

[00:48:38] i have to do a b and c it also means you know d and e and f can't happen anymore and they're

[00:48:45] they're delayed and all of these different things and i'm running through all these scenarios

[00:48:49] and now i'm just angry right i've worked myself up to anger at this point and i know i'm doing it to

[00:48:54] myself but it's just my mind has run wild with this one single email i was by the time i got up

[00:49:03] and said okay you know what i need to get to the gym i went to the gym and it was probably the first

[00:49:10] time i've gone to a gym where i hadn't have headphones on because i was so in my head right that i didn't

[00:49:18] even need the you know i didn't need to watch a show listen to music a podcast nothing i was just

[00:49:23] thinking about it and i found myself doing like 45 minutes on an elliptical just thinking about this

[00:49:28] thing not realizing the time um funny though the blood flow the exercise actually allowed me to just

[00:49:36] sort of calm down a little bit so exercise for me is a big part of it yeah um and by the time i got

[00:49:41] back to to the house and showered and all these things i was like okay i'm starting to to calm down

[00:49:48] but i made it intentional to not immediately just like i'm not going to the gym i gotta go solve this

[00:49:55] now it's like hold on take a breath go do what you know works have whatever that is for you for

[00:50:02] me it's going to the gym and then dealing with it so here i am now a handful of hours later it's

[00:50:08] still in my mind nothing has really technically been resolved yet and i know that logically but

[00:50:15] emotionally i feel a little better yeah so you just gave a great example of what's called an adaptive

[00:50:23] or healthy coping mechanism right um exercise in your situation uh so for anybody who is experiencing

[00:50:33] some of these uh i think intense fluctuations in their emotions or in their mood the development of

[00:50:40] healthy coping skills is really really important and i think that that can include anything from

[00:50:46] distraction uh to with something healthy don't go and distract yourself and you know pick up a

[00:50:52] a joint and start smoking that that's that's not necessarily going to improve outcomes but if you

[00:50:58] you know go for a walk go talk to a friend go do some exercise even you know honestly even like

[00:51:06] putting on something on tv if you feel that that works for you and distracts you and helps you

[00:51:11] get through a stressful moment and prevents you from taking up making out an irritable outburst on

[00:51:17] somebody who's near or could have like negative consequences then that's that's what you should

[00:51:23] do um and i think that you know the first the first step comes with actually recognizing what's going

[00:51:29] on with yourself internally um like that comes with like honestly that comes with a lot of work for

[00:51:37] people that aren't used to it it gets down to the basics of when we actually do the the sort of

[00:51:43] treatment around it we actually get people to sit down and do what's called like a thought and mood

[00:51:48] diary where they have to sit down with a pen and pencil pencil and paper and write down what they're

[00:51:55] going through it can seem really prescriptive and really really annoying but for folks that aren't used

[00:52:01] to identifying what's going on with them internally it's a really really helpful tool it's why there's a

[00:52:06] rise in journaling yeah these days yeah it works it's just getting that but it's like the physical

[00:52:11] act of just writing because when you can't write as fast as you can think you might be able to type

[00:52:16] close enough but you can't write and so it slows everything down for you yeah yeah uh and first

[00:52:22] honestly for some people it can be really tedious when they first started but for those that you

[00:52:28] know aren't used to it or aren't used to sort of recognizing what's going on with them internally

[00:52:32] it's really important um for anybody who's by the way going through any difficulties in mood one of

[00:52:39] the the best books that i would recommend which is kind of like a workbook that we have based cognitive

[00:52:47] behavior therapy on for the management of mood is something called mind over mood uh it's it's like

[00:52:53] it's available on amazon most outlets it's like 20 bucks and it's like a really easy to read workbook

[00:53:00] on managing these emotions like mood anxiety fear things like that um like it's an actual a workbook

[00:53:10] as in like you're actually interacting yeah so it's kind of like guided okay self-work yeah um and it's

[00:53:17] something that i i sort of tell everybody as a life skill yeah not not necessarily as a treatment but

[00:53:22] just as a life skill um really useful what are you most scared about in the space that you're working in

[00:53:29] right now what you're seeing whether it's a rise in something or something that just has gone untreated

[00:53:34] for too long that you're seeing worrying trends with is there something that stands out to you as

[00:53:39] hey we need to be really concerned and we should really focus in on this so i which we haven't touched

[00:53:47] on one of the areas that i uh work on is sort of uh the potential role of psychedelic therapies

[00:53:54] um like psilocybin therapy and um uh and its potential and what i'm concerned about in that

[00:54:03] particular space i'm concerned of a lot of things but like the main we'll have an episode of just

[00:54:08] things you're concerned about the main thing i'm concerned about is particularly where we are in

[00:54:14] toronto the sort of proliferation of these you know cannabis dispensaries cannabis stores and also

[00:54:22] these now mushroom dispensaries and um you know these these sort of these agents being

[00:54:32] already sort of bandied about as this sort of self-help treatment that we should all be doing

[00:54:37] yeah and i'm very concerned about that because i think our young people uh those under the age of 28

[00:54:43] their neural connections are still developing and i think that by increasing access to these

[00:54:50] to be quite frank psychoactive mind-altering substances in early life is not is not a good

[00:54:58] outlook for our youth um interesting and i know that most mental health issues 80 of mental health

[00:55:04] problems start before the age of 18 yeah and if our young people are having easier access to

[00:55:11] um things that can alter their minds then i think that that's that's problematic um i think that's hugely

[00:55:20] problematic um i'm also really really uh concerned about um the fact that you know more of our young

[00:55:32] people are going through like traumatic experiences they're going through a lot of stuff online

[00:55:40] um and i think that there is this sort of epidemic of of mental health issues in in our in in the youth

[00:55:50] population worldwide and i think our mental health services i think our society is not equipped to deal

[00:55:58] with a lot of that and i think that um we got to make sure that young people are aware of what's going

[00:56:05] on with their internal space as well like we've talked about men and other people being aware of

[00:56:10] what's going on internally but i do think that it really should form part of our school curriculum

[00:56:15] and i think it is in some schools and in some but just not enough yeah not enough like people

[00:56:20] kids should be should be able to speak about what they're going through emotionally and name their

[00:56:25] emotions that's all you just touched on like two big topics and i'm like man i want to have another

[00:56:32] we're definitely going to do a part two today um and i never want to end an episode on a sour note so

[00:56:39] not that there was sour like on i want to try and give something uplifting what are you

[00:56:44] seeing happening positively in this space you know what we started with which is um i'm i'm so pleased

[00:56:53] about the progress that we have made over the last even decade on the conversations around

[00:57:01] uh mental well-being um and how crucial it is to one to not only an individual's

[00:57:13] um sort of success but society's success and i think that um we've come a long way in that time

[00:57:22] i think um in whether that's in even a place like toronto but i do think even worldwide the

[00:57:30] conversations are improving and i'm hopeful actually that over the next 10 years this is going to

[00:57:36] continue we've seen more funding uh for mental health treatments we've seen more funding for mental

[00:57:42] health research and i'm hoping that trend continues because i think that's going to lead to the

[00:57:48] demystification i think that's going to reduce stigma i think that's going to allow people

[00:57:52] to go out and and get help and i think platforms like this like what you're doing samir i think this

[00:57:58] is fantastic i think this is something like this wouldn't have been around 10 years ago thank you for

[00:58:03] saying that that's uh that's ultimately the goal here is how do we normalize these conversations and

[00:58:07] destigmatize this idea that men don't suffer from mental illnesses um and truthfully any for everyone

[00:58:14] i mean they're you know equal parts women who are also just i'm good i'm fine but are equally struggling

[00:58:20] and i think that's what's made this series resonate with so many people across across a wide spectrum

[00:58:26] of society right of how do you how do you pull the curtain back on this and go hey it's okay to not

[00:58:32] be okay yeah but now you got to do something about it right obviously you got it it's okay to say

[00:58:39] i'm not feeling the best version of myself today tomorrow it's been a week it's been a month

[00:58:44] but now how do i which is why i always ask for practical advice like how can you actually

[00:58:49] either be the support or go seek the support because then maybe that helps destigmatize it

[00:58:56] and if one person goes and does that success exactly so ishrat thank you so much thanks for having this

[00:59:02] was fantastic i want to do this again if you're up for it i think i'd love to to pull on that thread

[00:59:08] of the the psychedelics piece i've had on a few guests talk about it who um one has talked about

[00:59:15] it from the sense of like it's completely changed his life around interesting um and then i've had on

[00:59:21] another guest talk about it from the lens of how it's being used for therapeutic purposes when it's you

[00:59:27] know like psychedelic assisted therapy i think it was called um but i'm fascinated by this idea of

[00:59:33] you know under the age of 28 certain things have not developed yet and what can potentially happen

[00:59:39] and you're right i mean with the ability to access all of these things you kind of want to make sure

[00:59:45] that it's being done the right way exactly um and i'm the third item that i'd want to pull on is

[00:59:52] drugs yeah alcohol just understanding the real effects of those on you how much can you have how

[00:59:58] much should you have when should you consider not having it if you know you're noticing certain

[01:00:03] things happening so all that to say i think a part two is definitely going to be needed um and i thank

[01:00:08] you so much for your time you do amazing work please keep it up and uh yeah we'll be in touch soon

[01:00:15] that's it chat about part two sounds great thank you so much everybody thanks take care bye