预防和治疗抑郁症的政策与个人措施
@Nicholas Fabiano : 我认为应该强调预防和持续缓解抑郁症。预防可以通过生活方式和其他多种途径实现。为了更好地促进这些生活方式参数的普及，我们可以采取以下措施：例如，医生可以开出运动处方，为患者提供免费健身会员资格或参与运动俱乐部的机会，以鼓励他们保持运动习惯，从而预防抑郁症。在饮食方面，我们需要确保人们能够获得高质量的食物，因为低收入人群更容易食用超加工食品，这可能导致抑郁症状。此外，睡眠问题也与社会工作时间和压力有关，因此需要优化工作制度，以保障人们的睡眠质量。在治疗方面，我们需要让医生能够为患者开出适当的运动处方，并建立更好的转诊途径，以便医生可以将患者转诊给理疗师或私人教练。同时，需要为医生提供激励措施，以鼓励他们与患者讨论运动。在个人层面，除了已知的多运动和优化睡眠外，还应注重教育，以便人们能够更好地了解如何预防和管理抑郁症。医生应该为患者开出正式的运动处方，并跟踪其益处和副作用。频率、强度、类型和时间（FITT）原则可以将运动分解为处方。将运动作为日常的一部分，而不是额外的任务。
我最近与精神科医生Nicholas Fabiano博士进行了一次深入的访谈，探讨了抑郁症的成因、治疗以及预防策略。Fabiano博士的研究重点是运动、营养和补充剂对精神健康的影响，他的观点为我们理解和应对日益增长的抑郁症发病率提供了宝贵的视角。
运动：不仅仅是治疗，更是预防的关键
Fabiano博士强调，运动对抑郁症的疗效已得到大量研究支持，其作用甚至可以与药物和心理治疗相媲美。他认为，运动的益处并非仅仅体现在治疗阶段，更重要的是其预防作用。运动能够调节神经递质（如血清素、多巴胺和去甲肾上腺素），增加脑源性神经营养因子（BDNF），并减少炎症，这些都是对抗抑郁症的关键机制。此外，运动还能促进神经可塑性，帮助人们“忘掉”负面思维模式，从而改善情绪。更重要的是，运动提供了社交机会，增强了社区归属感，这对于那些因抑郁症而感到孤立的人来说尤为重要。
不同类型的运动，如力量训练、有氧运动和身心练习（如瑜伽），都可能有效，但关键在于坚持。Fabiano博士建议，循序渐进地增加运动强度和时长，找到适合自己的运动方式，并将其融入日常生活，而非将其视为额外的负担。他特别指出，即使是短暂的高强度运动，例如短跑，也能带来显著的情绪提升。然而，他也提醒我们注意运动成瘾的风险，并强调在运动中寻求平衡的重要性。
营养与补充剂：关注饮食质量，探索辅助疗法
Fabiano博士的研究还涉及到饮食和补充剂对精神健康的影响。他特别关注超加工食品的危害。大量研究表明，超加工食品与抑郁症和焦虑症之间存在关联，甚至随机对照试验也显示，减少超加工食品的摄入可以改善抑郁症状。他认为，这不仅是因为超加工食品热量高，更重要的是它们缺乏营养，并可能导致炎症和胰岛素抵抗，这些因素都与抑郁症的发生发展密切相关。因此，他建议尽量减少超加工食品的摄入，选择富含营养的天然食物。
关于补充剂，Fabiano博士重点介绍了肌酸。研究表明，肌酸可以改善大脑能量代谢，从而缓解抑郁症的一些症状，例如低能量和注意力不集中。此外，肌酸还具有抗炎作用，这对于炎症性抑郁症患者可能尤其有益。然而，他强调，目前关于肌酸剂量的最佳方案以及其对认知和精神健康的长期影响的研究仍然有限。除了肌酸，他提到了藏红花，一些研究表明它与抗抑郁药物联合使用可能具有协同作用，但仍需更多研究来证实其疗效。他还提到，膳食中摄入足够的肌酸也可能对预防抑郁症起到保护作用。
微塑料：一个不容忽视的潜在风险因素
Fabiano博士的研究还触及了一个新兴领域：微塑料对精神健康的影响。最近的研究发现，人体大脑中存在大量的微塑料，并且痴呆症患者大脑中的微塑料含量更高。考虑到超加工食品中微塑料含量较高，Fabiano博士推测，微塑料可能在超加工食品与精神健康问题之间起到了中介作用。然而，目前缺乏直接证据来证实这一假设，需要进一步的研究来探索微塑料对大脑功能的影响机制。
应对日益增长的抑郁症发病率：预防与持续缓解并重
Fabiano博士认为，应对日益增长的抑郁症发病率，需要在预防和持续缓解方面共同努力。在预防方面，他强调了优化生活方式的重要性，包括规律运动、健康饮食和充足睡眠。同时，他也呼吁政府层面采取措施，例如提供更多公共运动设施、改善食品供应链，以及制定更合理的劳动政策，以保障人们的健康生活方式。
在治疗方面，他建议医生应该能够像开药一样开出运动处方，并提供相应的指导和支持。此外，还需要建立更完善的转诊途径，以及为医生提供激励措施，以鼓励他们积极参与抑郁症的预防和治疗。
个人层面的行动：将健康融入生活
Fabiano博士给出的最重要的个人建议是：将运动和健康的生活方式融入日常生活，而非将其视为额外的任务。他建议人们预留出固定的时间进行运动和其他自我保健活动，并将其视为日常生活中不可或缺的一部分。
总而言之，Fabiano博士的观点为我们理解和应对抑郁症提供了新的视角。通过关注生活方式的改善，积极寻求医疗干预，并重视预防和持续缓解，我们可以更好地应对抑郁症的挑战，创造更健康、更幸福的生活。
Edit:2025.07.07
00:00
In a depressed state or in an anxious state, your brain has learned to make automatic associations between different things. Imagine you see someone laughing in public, someone with anxiety or depression.
00:08
depression may automatically assume these people are laughing at me because I'm a loser or because I look weird or something like that. What I see exercise to do is it allows your brain to enter almost this neuroplastic state where you're more amenable to unlearn some things and you may see additional benefits in things like therapy when you're going there and able to unlearn some of these wired thought patterns. When depressed, when in this increased metabolic state, your body's processes to make energy through the form of ATP are impaired.
00:34
And this is where creatine comes in and it's able to essentially quickly replace that ATP or energy level within the brain to help with some of the symptoms of depression. Nicholas, welcome to the show. Thank you for having me.
00:47
Yeah, I'm excited to have you on the show. And on X or Twitter, I see you post a lot about the effects of creatine and exercise and mental health, which is very popular right now with creatine having shown to be more than just a muscle-building supplement. There's a lot of research about the brain benefits, but many people aren't aware that it also has mental health.
01:13
And you've written some nice papers about this, reviewing those effects. So yeah, we'll be talking all things about mental health with the fundamentals of improving mental health with some exercise and creating some other things. So we'll have a good discussion.
01:31
Yeah, no, thank you. And I think, yeah, it's definitely been an interesting area that's been developing from both the creatine and exercise side. And like you said, I think traditionally we've more seen creatine to be this fitness supplement for muscles. And there's been a paradigm shift recently where we're being more interested beyond even mental health, but just the brain gains, for lack of a better word, for creatine. But I think a big question that remains is what is the optimal dosing protocol? What are the expected benefits? Because
01:58
There are hundreds, if not thousands of papers from a physical performance perspective, but there is only very preliminary literature for cognition and mental health. And most of the mental health literature for creatine is, again, largely focused on depression. And that's kind of how we usually see a lot of different studies come out is first starting with the less of the quote unquote severe mental illness, where we start with depression, and then we move on to other things like schizophrenia and such. But it's very exciting to see it starting up.
02:26
Yeah, what was the, maybe you're going to give an overview about the recent paper you made about creatine? Yeah, so with the recent paper, we published it in the European Neuropsychopharmacology, and essentially what we did was provided a brief overview of how creatine may work in depression and highlighted some of the key trials that have been conducted so far. So in that paper, to speak from a clinical lens first, we highlighted two trials that were completed with creatine, and
02:55
The first one, what they did was essentially pair creatine with an antidepressant agent, and they compared it to just placebo plus the antidepressant. And what they found was that there was a pretty early response where we saw antidepressant effects as early as two weeks.
03:08
more so than that of the antidepressant alone, which is very promising because in psychiatry and mental health, we know that these antidepressant agents can take a long time to have an effect and sometimes don't even have a noticeable effect after many, many weeks. So if there's an agent that can be paired with some of these treatments to help,
03:24
I think that's very promising. And that was repeated in a number of other trials where they paired creatine with an antidepressant and saw improved antidepressant response. But one of the newer trials that came out was just in 2025, again, in European neuropsychopharmacology by Sherpa et al. And they combined creatine with cognitive behavioral therapy.
03:44
And this is one of the first line therapies for the treatment of depression. And they found a very similar effect where at the end of eight weeks, there was an improved antidepressant benefits. And what we did was in this paper, beyond just summarizing some of the results of it, we also wanted to speak mechanistically in terms of maybe what is creatine doing in the brain. And from that, the way we framed it was very similar to muscle. We know that creatine, it's stored as something called phosphocreatine within the muscles.
04:12
And that essentially allows your muscles to reuse energy when needed. So when exercising or when, you know, running, weightlifting, all these different things. So what we proposed was a very similar mechanism in the brain that something is happening along the same lines where when you're in a depressed state or when you're in a sleep deprived state, your body's in this state of increased metabolic demand.
04:34
Where creatine comes in is it's able to store in the brain very similar to the muscle as phosphocreatine, providing this backup system for energy. So the thought process is when depressed, when in this increased metabolic state, your body's processes to make energy through the form of ATP are impaired.
04:51
Um, so we need to rely on some of these backup systems and this is where creatine comes in and it's able to essentially quickly replace that ATP or energy level within the brain to help with some of the symptoms of depression. So again, whether that's low energy, whether that's poor concentration, um,
05:06
And that's really the thought behind it. But then a lot of questions come up from there because we know that most creatine goes to the muscles and we know that we need likely a higher dose to get into the brain and for a longer duration of time. And these aforementioned trials that I referred to, they use pretty low doses. So just five grams per day, which is your standard sort of fitness dose. And it was only eight week long trials. So both of those two things
05:31
I think there are room for optimization for future trials. And that was just kind of the point we made there. And again, the big point was summarizing some of the recent trials, but also providing a little bit of that mechanistic lens. Yeah. So it's almost like the increased energy, the ability to, you know, let's say, act in the world from creatine that would mitigate the symptoms of depression, which
05:59
makes you withdraw from the world. So it's almost like depressed people don't have the desire or motivation to do things that would reduce their depression, like exercise and those kind of things. But with creating or giving yourself this short energy boost,
06:16
That would make them want to do those things, if I get it correctly. Yeah, and I like to think of it similar to the physical realm, where you're able to do more physical reps, whether it's your bench pressing and whether you're running. I see it as creatine gives you that little bit of an extra buffer for mental reps. So by no means is it saying that depression is a creatine deficiency.
06:39
More so is to say that, you know, depression and some of the symptoms that are associated with depression may benefit from that energy buffer. And we're actually seeing an increasing interest in conceptualizing depression through more of what we call a bioenergetic lens than the more traditional view of depression, which has been just low serotonin causes depression, which we know now isn't the case. But I think at a large population level, many people still have the belief that
07:06
you know, I'm depressed just because my serotonin is low and this is why antidepressants work. But we know it's much, much more complex than that. Yeah. Is there anything else that creatine does maybe to the neurotransmitters or anything like that to have an effect on depression or mood?
07:22
Yeah, it's hard to say at the neurotransmitter level because there's not a lot of mechanistic studies looking at it specifically even within depression. But we do know that creatine can even have some anti-inflammatory effects, which we know for depression, whether that's unipolar or bipolar, has potentially a causative role. And even recent literature has suggested that some of the depression subtypes may fit under more of this inflammatory depression. Hmm.
07:48
So, again, it's an area of research that's very nascent. There's a lot still to be done. But I think it's very exciting because having more treatment options for depression makes sense because we know depression is one term, but there's thousands and thousands of different ways of defining it. And it presents uniquely in each different person. So I think…
08:08
Via that lens, having different treatment options, whether it's creatine, whether it's exercise, allows for more personalized care and more of a symptoms-based approach than a diagnosis-based approach. Yeah. Another condition that's characterized by this high inflammation and oxidative stress is TBI, so traumatic brain injury. And there is actually some research that creatine helps with that.
08:34
I guess, feeling the gap in that energy in the brain that would happen under TBI. I don't know if you've seen those studies. Yeah, it's actually interesting. I know you had Darren on the show before. We're actually writing up a paper conceptualizing… So TBI was under this umbrella, but…
08:54
to the point that I made before where we probably need higher doses to have those brain benefits and the same thing probably applies for TBI. And the study that we mentioned in that paper that we had written up and will be published soon essentially looked at giving children that had TBI creatine. And I believe it was 10 grams per day for a prolonged period of time. And they actually had pretty severe TBI. So they were in the ICU or the intensive care unit because of that. And
09:19
And they found that creatine had a lot of benefits to cognitive but also functional outcomes. And there are even associations with getting out of the ICU faster. So I think, like you said, it's applicable beyond just depression, this bioenergetic lens that we look at different disorders. And even traumatic brain injury can be conceptualized via the state of altered brain biothergetics, but also altered brain creatine metabolism. So I think…
09:45
across disorders, there is applications and it extends beyond the realm of mental health. Yeah, that's interesting. 10 grams for children is quite high. What would be the equivalent dose for adults? Yeah, so it's hard to make a direct comparison between the two. And the reason is,
10:06
When we're looking at creatine doses, some of these studies do weight-based, so, you know, a gram per kilogram of body weight. But even that isn't necessarily an accurate one-to-one comparison because to really ideally see what someone's unique dose would need, you would almost need a DEXA scan to see what is their muscle composition, what is their lean body mass. And it's very complex. And specifically within children, we know that their body types and
10:29
proportions can vary so widely, even more so sometimes than adults. So it's hard to say a one-to-one comparison. And the thing is, a lot of these studies, they're using varying doses, usually on the lower end. But I think we're going to start seeing higher and higher doses from the brain perspective. And we've seen a handful, specifically in the lens of sleep deprivation as well, too, which have been promising.
10:54
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11:46
Is there any effect on anxiety or some other mental health conditions? So not necessarily anxiety through the lens of generalized anxiety or social anxiety, like the more traditional ones that we would describe in clinical practice, but a disorder that falls under the realm of anxiety and not anymore in the newest edition of the DSM, but post-traumatic stress disorder.
12:08
They looked at supplementing people. It was an open label trial with creatine and again found some benefits to PTSD related symptoms. So some of those can be related to what we would describe more traditionally as anxiety. So the hypervigilance or always feeling on edge and stuff like that. So there are some benefits outside. And as I mentioned before, there was even a trial using creatine in people with schizophrenia.
12:30
And again, an open label trial, not a randomized control trial. And what they found was benefits to some of the symptoms of schizophrenia. And they supplemented them with, I believe it was 10 grams per day for about six months. And this was an inpatient sample. So people that were in hospitals. So again, not necessarily saying that creatine is going to cure schizophrenia or ever replace some of the agents that we use to treat schizophrenia. But I think it has a role because in schizophrenia specifically, one of the
12:57
Worst, one of the ways we're not really good at treating is the negative symptoms. And these are the persistent cognitive symptoms or lowering of someone's mood. So when we treat someone with antipsychotic agents and we stop those hallucinations or delusional thought patterns,
13:13
Sometimes you're left with someone that has a lot of this amotivation or decreased mood, and it's not really fully accounted for. So I think supplements like creatine may have some utility here to help treat some of those residual symptoms. So yeah, those are some of the other areas, and it's still a very nice scenario, but exciting to see. Gotcha. Would anyone…
13:35
with, let's say, no depression get any prophylactic effect if they are supplementing creatine? Is there any research about that? Yeah, so not from a supplementing lens, but there was a study that looked at dietary creatine and looked at depression at a population level.
13:52
So essentially what they did was they separated the creatine intake based on diet, based on the NHANES survey in the US. And they broke it up, I believe, into quintiles or quartiles. I'm forgetting right now. But they found essentially an association between higher creatine intake and having a lower risk of having depression. So that to me is very promising. But in that study, they did exclude people that were supplementing creatine and that
14:20
This is a very important caveat because we know dietary creatine has much lower levels than those people that are supplementing. So to get a single scoop's worth or five grams of creatine, you need to have about five or sorry, three pounds of red meat.
14:35
So unless you're on a carnivore diet, you're going to be having a hard time keeping up with someone who's supplementing five or 10 grams of creatine per day. So I think it's a very interesting signal to see that potentially there's a protective effect through a dietary lens. But to my knowledge, there's no study looking at a protective effect for mental health via a supplementation lens. Yeah. Yeah.
14:58
We mentioned earlier that creatine will increase the person's energy and willingness to move around and be active. Is that the effect coming from the exercise or is it just from the creatine? Is there any way to differentiate that? Where does this antidepressant effect come from? Because exercise, we generally…
15:25
think these are good for depression and mood. Yeah. So I guess to break up the question to two points. So the exercise point, we know exercise alone, even minus creatine,
15:36
Looking at the large scale meta-analysis when you bring studies together has equivalent antidepressant effects to therapy and medication. So that's even without the creatine. And then when you add into the creatine to that, it's hard to really tease the two out. And the reason being is twofold. So number one, there are no trials adding creatine plus exercise together for the treatment of depression yet. We've actually applied for a grant to hopefully set up a trial looking at creatine plus resistance training or weightlifting.
16:05
for depression. So that will help tease out maybe which effect is happening where, and if the creatine in isolation can actually have an effect. But it's hard to say exactly what creatine is contributing through that lens. But it's all to say, you know, exercise has these major antidepressant effects. It seems like creatine is an effective adjunctive treatment, and combining the two would hopefully have a synergistic effect through that lens. Gotcha. Yeah.
16:33
why does exercise have antidepressant effects and why does it improve mood? Yeah. So, yeah, I think that's, that's a nice and big question. So I'll break that one down to is, um,
16:42
First off, before I describe mechanism of exercise as antidepressant effect, I always like to bring back to the original problem that we have that we actually don't know what causes depression. So to say that we know what cures depression would be hard because we don't necessarily know what causes it. And to go back to what I originally had mentioned before with the serotonin hypothesis of depression, we know that no longer is depression the state of just being low serotonin. You just need to have that replaced sort of thing.
17:10
But what we know that exercise does is a number of things. So I like to break it down through what's called like a biopsychosocial model. So bio is when we talk about those neurotransmitters, brain changes, physical health changes. Social is, you know, what's happening at the social level and psychological is what's happening in your mind sort of thing. So to break it down via those lens biologically, which is what most people are interested in.
17:34
We know that exercise can upregulate some of those neurotransmitters that are implicated in depression. So serotonin, dopamine, norepinephrine, we see increases with exercise. We also know that exercise and the muscles specifically can function almost as endocrine organs where the muscle can communicate with the brain via what we call myokines.
17:56
One of the important myokines is something called BDNF or brain-derived neurotrophic factor. And a lot of people call that the miracle girl for the brain.
18:04
Um, so we know that's important because depression, as I mentioned before, is the state of increased metabolic demand. It can, it can be very hard on your brain. So to have something counteracting that would, would likely have some antidepressant benefits. And we actually see changes in people's brain when they exercise. So increases in the size of the hippocampus, which is an area that's important for, for memory. And then the other point that I had alluded to before from the lens of creatine, but we know
18:29
exercise also decreases inflammation. So both peripheral, but central in the brain, which is implicated in depression and severity of depression. So that's through that biological lens. And there's a number of other things there too. You can read endless papers of mechanisms and stuff of that sort. But one thing that I think is under-recognized is the social lens. Particularly for older individuals, there's
18:51
Exercise can be a time of just being with someone else, whether you're going to the gym, whether you're going for a run in a run club or something, whether you're on a sports team. This may be the only time that someone's actually seeing someone in person. And particularly, as I mentioned, for older individuals that maybe are widowed and don't have a lot of family.
19:09
And that social connection we know is so important for people and having that sense of community. And even in isolation, removing the exercise, we know how toxic it is to be in an isolated environment and not to have that support. So I think the social realm is very important for exercise too. And then psychologically, a way that I like to look at it, and it kind of meshes in the biological lens, but exercise we know can induce neuroplasticity within the brain.
19:35
What that means, people usually look at it through the lens of learning. Your brain can learn new things and adapt. I like to look at it through the lens of unlearning. In a depressed state or in an anxious state, your brain has learned to make automatic associations between different things. So imagine you see someone laughing in public. Someone with anxiety or depression may automatically assume these people are laughing at me because I'm a loser or because I look weird or something like that.
20:00
What I see exercise to do is it allows your brain to enter almost this neuroplastic state where you're more amenable to unlearn some things. And you may see additional benefits in things like therapy when you're going there and able to unlearn some of these wired thought patterns. So I think through all of these lens, we see the benefit of exercise. And again, going back to my original point, we don't even know what causes depression, but we know there's a variety of mechanisms that help with the antidepressant benefit via the exercise lens.
20:29
Yeah, that's interesting because one of the characteristics of depression is this rumination on negative image of yourself or negative events ruminating about those things. So unwinding that rumination, making it more neuroplastic might help to unwire some of those ruminating patterns. Yeah, I agree with that for sure. You mentioned that
20:59
or at least one impression I got was that depression is almost like a similar disease you are
21:06
diagnosed with as diabetes that imposes certain negative effects on your physiology, like this increased energy demand in the brain and inflammation. The same way with diabetes. But diabetes is obviously more like a scale that we all have a certain amount of blood sugar in our bloodstream and after a certain threshold it is diagnosed as diabetes. So if it's chronically elevated and
21:34
there's certain numbers for fasting blood sugar and your oral glucose tolerance test, etc., that is diagnosed as diabetes, but there's obviously a normal level of blood sugar for survival and health. Is it the same with depression, that there's a scale that you're maybe…
21:52
you have might maybe someone might have like some depressive episodes or symptoms but it's not diagnosed as depression yet yeah so i i think in just the normal human experience i think it's important to feel some of those bad or what we would deem to be called bad emotions so you know if you lose a loved one or if something bad happens and you're like you lose your job
22:15
you're going to feel sad, right? And sometimes that's important to have that sense of community. An example would be something like grief. When you lose someone that's in your family or something, it's almost innate and human nature to be able to feel that sadness.
22:30
And what people sometimes describe after being on an antidepressant is rather than feeling sad, there's more an essence of feeling numb. So the inability to feel that high or low. So I think to go back to your question, I think, yes, it's almost very similar to diabetes where, yes, there are blood glucose levels that can be used to diagnose and other symptoms that pair that. Like if you're eating more, if you're drinking more, going to the washroom more.
22:58
And I do think it falls on this continuum of normal emotion and getting into this depressed state. Where I like to draw it in, there's a million of different definitions of depression, whether it's the DSM, whether it's the ICD. My important thing is just speaking to the person in front of you and seeing, is this causing functional impairment? If you're having these feelings of feeling low, lack of motivation, sleep deprivation, is this impairing your ability to live the life the way that you want to? And if so,
23:26
then let's do something about it. Because I think sometimes we get too stuck under the lens of the DSM says, this is how we diagnose depression. You now have depression. We should start you on an antidepressant. You should do therapy. And the problem is what I mentioned before, where depression can be defined so many different ways. And even two people that have the exact same number of symptoms can
23:48
can have such a different severity level of symptoms. So someone's depression can be heavily driven by sleep problems. You can imagine if in isolation, you're sleeping three hours a night, you're super tired all the time, you can't get your work done properly, all these different things. By fixing that small node of insomnia, you may resolve the whole depression. And does that insomnia necessarily need a medication? Maybe not. So I think that's where we kind of
24:15
are led astray in our training and we operate based on diagnoses.
24:21
And it goes back to your point where, yes, I do think it's important for people to be able to feel sad and feel happy. And I do think it falls on the spectrum. But I think there's more utility individualizing our approach and seeing what does this person's depression look like in front of you and what factors can we modify? So whether creatine may help, maybe exercise, maybe medications, maybe therapy, maybe all of them together. But I think.
24:45
We need to speak to the person in front of us and see how that evolves rather than just having a very simplistic approach of depression means medication. I think that's where we fall short in psychiatry.
24:55
Yeah, sometimes it's just sleep deprivation. Other times it's B12 deficiency or lack of sunlight or something like that that manifests as symptoms of depression. But is it like you're not going to get diabetes overnight? So typically it's going to be a long process of chronically elevated blood sugar over the course of many years. With depression, is it also similar that…
25:21
before you actually get fully diagnosed with depression or you fully meet all the criteria of depression, is there like a slow trickle away that, yeah, like you might feel a bit sad or down after a week of bad sleep, but
25:39
If it doesn't keep compounding, then it doesn't happen overnight. Or is it something like that? Yeah, I think there's a lot of factors that go into it. So I think that these chronic stressors, but I think there's also beyond that, there's genetic, there are personality traits that maybe make you more vulnerable. So you can imagine two people going through the exact same situation. Let's say they both lost their job. The same outcome, same everything. That doesn't mean that necessarily both people will become depressed.
26:08
And that doesn't mean that person A or person B is any less of a person because one does or does not become depressed. But it's just to say that there are a lot of personal personality vulnerabilities and genetic vulnerabilities that may predispose someone to go on and develop that depression. So for sure, you can have maybe person A who lost their job and they're sad, they're having a hard time, but they start noticing this and maybe they seek help early. They start exercising, they start taking control of that. Maybe that prevents from slipping into that full on depressive episode.
26:37
Whereas maybe for person B, the same circumstance happens, but that progression happens and there's no intervention and it kind of spirals into this full-blown depression. And we know that the longer this depressive episode is going on, the harder it is to treat. And the more, you know, toxic it is for your brain, the more of these episodes you have, the more likely you are to have another and the more likely you are to have other different disorders. So whether it's anxiety or even things like dementia, we know that people that have recurrent episodes of depression throughout their life,
27:05
are at an increased risk of dementia too. So it shows you how harmful even something as simple as depression can be on the brain and how differently life circumstances can affect someone to either go on to a full-blown episodes of depression or to kind of have a bump in the road and be able to kind of continue along the way. Yeah, that's interesting. You know, you can have some death of a loved one or some very…
27:29
very serious life event that happens, death of a child or something like that. And obviously, many people would consider that an adequate reason to go into depression. But, you know, there are some people who don't because of genetics or maybe they have a bigger bucket for stress or depression, whereas other people might have their bucket already filled up with sleep deprivation and other problems. So, yeah, you know, it kind of shows that you always have
27:59
the opportunity to, um, you know, fight back against depression or make yourself immune against depression or reduce the likelihood of yourself getting depressed, uh, with your lifestyle. And even just the perception of the world, I would imagine that your mindset about things like one-on-one great book about it is, um, not specifically about depression, but a man's search for meaning by Viktor Frankl, like a Holocaust survivor and, uh,
28:25
And, you know, just being able to reframe the experience had like a very powerful effect on their ability to survive. No, no, it's a great point you make. And I think that's why in our current society, we have so much emphasis on treatment. So beyond depression, even for schizophrenia and
28:44
Each year you see these novel fancy drugs come out that cost billions and billions of dollars to develop and oftentimes don't have a whole lot of different of effect compared to some of the existing ones. But I think we do a disservice in terms of prevention. So those go to some of the things like you mentioned, too.
29:01
If you're able to optimize someone's lifestyles, whether that's their exercise habits, whether that's their sleeping habits, whether that's even on a large scale like dietary habits, and that these can have interventions at a policy level to ensure people are more active, to ensure people are eating healthier, to place priority on high quality sleep.
29:20
Then you can have someone that has more of this reserve. And to your analogy of the bucket, their bucket is now less full. So they can handle more stressors. And that's not to say that nothing will fill up that bucket. There are things in life that no matter how prepared you are, that bucket is going to overflow. But it's to say that it can give you that much more reserve to function. So if there is something filling up that bucket, you can continue to move forward and even use that as to the other example you showed where
29:48
reframing your mindset on different things too is very powerful too. But that also requires a lot of cognitive reserve to be able to have that and to be able to reframe a very difficult situation for someone who may already feel very beat down. So that's why for the lens that I see, I think we need to do a lot better of a job on prevention. And that can be via some of these lifestyle measures that we know are so important for not just our mental health, but also our physical health.
30:16
Gotcha. Um, circling back to exercise. So is there any research about the different types of exercise and how long and, and frequency? Yeah. So they've done, um, a few meta-analyses where, which is again, where they bring the studies together to say which exercise is the best. And the, the, the overall theme is that there's not necessarily a clear winner. Um,
30:40
We like to break up exercise into resistance, which is things like weightlifting, aerobic, which is things like running, or mind-body, which are things like yoga. And among these three categories, you can imagine there's a lot of overlap between different sports and things, but there's not necessarily a clear winner. The most important fact seems to be adherence. So is someone going to actually commit to whatever exercise regimen they want to do, and will they continue to do it? And it's very similar to a diet where you're
31:07
If you prescribe someone this perfect diet that costs $1,000 a meal, it's super high nutrients, but it takes hours and hours to make.
31:18
They're probably not going to be able to do that because it's not sustainable for them from that front. So I think that's where we need to use the same lens for exercise to say, what does this person in front of us actually want to do and what is sustainable for them to continue to engage in? The only general association we see with exercises is with its association with intensity. So we traditionally see higher intensity exercise to have greater antidepressant benefits. And again, there are caveats to that too. So particularly within the older populations,
31:47
We like to break intensity into mild, moderate, and vigorous. But for older populations, it's more on this side, to the mild, moderate. And it's likely due to some of the reserve that they have in their body and also more likely to become injured. If you can imagine, if you're 90 years old doing a vigorous marathon run or something, you might not get as many antidepressant effects if you're actually injuring your body too. So I think it's
32:10
Again, the underlying thing is adherence, something that's sustainable for you and to an intensity level that you are able to enjoy and derive some of those benefits from. Gotcha. Yeah, so sprinting is a good form of exercise in terms of the antidepressant effects. And I think, you know…
32:30
If someone does do a lot of, let's say, a few bouts of sprinting, then the elevation and mood is quite noticeable in my experience. Yeah, and I think that's a point from that too is with exercise, you can use it as motivation. So starting low is always the goal because you imagine someone who is currently depressed. They're not going to go from being sedentary, not moving at all, and now running a 42-kilometer marathon or something like that.
32:54
They're going to need to start low and build up from there. But like you said, after that one bout of exercise, you can already start to notice some of that almost motivation immediately after or even during that exercise. And that's what you can really use to build up. So maybe next session you run a little bit further or at a little bit higher intensity and you just keep building up from there.
33:15
rather than setting these objectives that you need to reach. Because I guess to speak to your first point again, there are parameters that we know that are better for antidepressant benefits. So we spoke about intensity. There's not a clear winner for the type of exercise. We know frequency, the benefit is usually between three to five times per week. And then the timing of these sessions usually aim between 45 to 60 minutes. But you can imagine that this varies a lot based on sprints. You're not going to sprint for…
33:39
45 or 60 minutes, that's just not sustainable. So the literature is very sparse in this area in terms of what is the best, but I actually think it's for the better that we don't have a clear answer there. Otherwise, with prescribing and guidelines, we would become so fixated on you need to do this, you need to do that. And for someone with depression, that's not very helpful. It's more so like I mentioned, adherence and building up over time because those initial antidepressant benefits from going from not moving at all to even moving a little bit are exponential and continue that way.
34:08
Gotcha. Yeah. What if someone exercises, you know, too much or every day a lot? And I actually wrote a paper on that, I think, a year ago now. It was more through the lens of depression of is exercise a form of self-harm or can exercise be a form of self-harm? And I think yes, in some instances. And particularly…
34:28
Particularly in people that have more of this exercise dependence, there's one thing to have exercise as a positive coping mechanism or just a hobby that you're doing. But then there's another realm where if exercise is becoming this thing that you need to do in order to function, and it can even be attached to some maladaptive thoughts around body image or needing to expand a certain amount of energy to offset food intake.
34:51
It can become unhealthy, and this can then contribute to some of the depression sort of effects. And in the paper that I had written about, I asked the question, too, could exercise even be a form of self-harm? So when I speak about self-harm, the traditional things are things like cutting or burning and things that we see of that sort. But we never really think of exercise as a form of self-harm outside of the eating disorder sort of population.
35:17
But, you know, in speaking to a lot of athletes and different people, it seems that, you know, when people are going through hard times, sometimes they use exercise almost to feel that pain. They want to go to the gym and feel the pain in their muscles or run excessively far to feel the pain to change that emotional pain into a physical pain.
35:34
And in my eyes, society reinforces that. So if you go to your doctor and say, I'm having a hard time, I'm exercising so much, they're going to say, great. You're going to tell your friends that they're going to say, great. And most of the time, that is probably a good thing. But I think in some instances, if it's being used for the through the lens of self-harm, it can be this.
35:53
counterproductive behavior that is harmful to the person that is now being reinforced and you have this pocket of people that are not being seen by even their psychiatrist because it's being reinforced as this only good thing. So I think we need to see the other perspective too, although my view remains that exercise is largely a positive thing. I think that there is a class of people that have exercise dependence and even people that may be using it as a form of self-harm that also warrants
36:20
discussion and opening that conversation because that curve that i alluded to where you're going from sedentary to just moving a bit having the benefits it does taper off eventually and there is a thing as you mentioned too much exercise um so i think it's an important counterpoint to the discussion because again i love that exercise is always praised and how how amazing it is and i i think it is but i think we also need to be aware of the other side
36:44
Yeah, absolutely. So exercise dependence, they need exercise to either burn enough calories to not gain weight or to maintain good mood. So would it be that some people need more exercise to not get depressed and to not get low mood? And is it also like then that if you are, let's say you have a big, your bucket is starting to overflow because of, yeah, maybe there was a tragic life event or something like that.
37:13
you need more exercise to offset that bigger traumatic event and bigger depression surge. Whereas maybe after a while, after a few months, I guess the symptoms of the depression would go away or you get over some of the trauma or the tragedy and then you also need less exercise. So is it along those lines that the exercise, the bigger requirement for exercise to feel normal mentally would…
37:40
would come from all these other things that increase the depression bucket. Yeah, no, no. I think, I think it's, it's a great analogy. I think in hard life events. So you often see in, in, uh, when people go through breakups and things like that, they have their, their gym arc or they, they start going to the gym more and they're, they're working out more and stuff like that. And I think some of these things can be viewed as, as a positive thing where you're taking some of that negative energy, putting in the gym and you're hoping to, to,
38:06
get some of those bad emotions out. And like you mentioned, in a state where maybe their bucket is more filled and maybe they're at the verge of actually tipping into a major depressive episode, maybe this allows them to offset that. And as you mentioned, over time, as they get out of that…
38:20
maybe they can not exercise as much and they can be able to function. I think the defining factor comes from, again, that functional impairment. When this person is doing these activities and everything, are they still able to tend to the other areas of their life? Are they still able to
38:36
you know, if they're in school, perform well in school. If they're in other sports teams and stuff like that, can they still do that? If they have other commitments or relationships or family members, can they uphold that? But if it's all going into one bucket and it's becoming functionally impairing, or if it's through the lens of more of an eating disorder lens where,
38:53
I need to exercise because I had two Rice Krispies instead of one. Now I need to go for a really long run. This is where it starts becoming functionally impairing and more pathological. But it's, again, it's a very individualized sort of look at it because you can cross-sectionally look at any person and say, oh, this person exercises three hours per day. Like this must be a problem. And again, maybe it's on the verge of that, but you don't know until you talk to that person and see, okay,
39:18
how are they able to function in other areas of life and how do they perceive it? And sometimes the person doesn't realize it themselves, specifically within eating disorders. They see the exercise as necessary to offset some of these caloric intakes. And that's where you need another perspective. But I think, again, it's about talking to the person in front of you and seeing how is this impacting their life. Yeah. Yeah. So does the exercise dependence also apply to…
39:48
needing to exercise to just feel normal and happy? Because I think we both agree that everyone should exercise, right? And so there should never be a time where you're not exercising for at least several months or years of never exercising. But do you need to exercise to be happy or…
40:13
should you not depend on the exercise in that sense? Yeah, no, I think it is a fundamental pillar for a lot of people. So like what you eat, how you move, how you sleep, a lot of these factors you can say are causally dependent on how your mood state is or to be happy.
40:30
I think it becomes an issue where how I look at it is in life, you should have several pillars that control not just your happiness, your mood, your cognition, such that it's not just one. And if you have one pillar and you're relying just on exercising and going to the gym today, then I'll be happy. Or if I go for my run,
40:47
Then I'll be happy. And once my run is done, I'm sad again. Then this is almost a sort of reinforcing behavior. And it can be akin sometimes to even substance use disorders where you see people that use stimulants or different medications to feel that high. And then when it's not there, they're in that low again.
41:03
And the same thing can even apply for exercise sometimes where you need to run, go to the gym to feel that high. But over time, that high doesn't become a high. It becomes I exercise to feel okay. Some people exercise and they feel on top of the world and then that takes them throughout the day. But if you're now exercising to go from here to just feel okay and then go back down here, that's where it becomes more of this sort of dependence. And it's very similar to substance use disorders where people become reliant at first on using like a stimulant because it makes them feel great.
41:31
And then over time, it makes them feel less great, less great. And then it becomes without it, I can't function and I need to do it just to be okay. That's where I think it becomes functionally impairing. And that's why it's important to have other pillars. So whether it's lifestyle factors, whether it's social connections with people in your life, whether it's having meaning in your life because of your job or some goals that you have, these are all other factors that I would hope are present in people's lives.
41:57
So that when something comes by and knocks out one of those things that they have, they still have other pillars to rely on. And an example for myself is when I was in my first year of medical school, I actually broke my arm arm wrestling and I was really getting to the gym at the time. And I have a nice scar right here from that. Yeah.
42:13
So when that happened, I was like, wow, because I think I was really relying on that pillar of just exercise. I really looked forward to it every day. I was really busy with school and everything. And when that pillar was knocked down, I was like, wow, like, what am I supposed to do now? And that's when I realized how important it is. Like, you need to have multiple pillars. You can't just rely on that one thing. And I think lots of people fall in that exercise sort of dependent spectrum at one point in their lives, especially when you're getting into fitness and getting so, you know,
42:39
It's such a new thing and it's so fun that it becomes almost everything for a little bit. But that's where that dependence may start and it can progress from there. So I think, yeah, a long winded way just to say having a lot of pillars is very important, not just for your mood, but your overall health. I'm not relying just on one thing.
42:55
Yeah, and if you're injured, then it doesn't always have to be an actual workout, just going for a walk. I think also if I were to be ever injured, I would still walk. And I think that if you mentally acknowledge that, okay, I'm injured, I can't do it right now, or you're traveling or whatever, you just accept it, but I can still walk, then I think for me at least it would be enough that I still get to move a little bit and enjoy walking. Yeah.
43:23
Yeah, I think that's the thing, being able to adapt to different things, too, because you never know what happens in life. You never know. Even if you're traveling and stuff, right, you're not going to have access to the same utilities that you would have at home and stuff like that. So I think beyond just pillars outside of exercise, even having many pillars within exercise of different things you like to do. Otherwise, you get too stuck on doing one thing. And when that one thing isn't there, then you're kind of lost of what to do next. So I think it's very important to have a lot of different options from that front.
43:51
Yeah, gotcha. So another maybe next pillar, diet. Is there anything specific about diet? You mentioned creatine, dietary creatine. Any other important nutrients or things that people need to get? So I think the largest focus of some of the stuff that I've looked at so far is not necessarily what to get, but more what not to get. And the most important thing that the literature has shown so far is ultra-processed foods.
44:20
In America, for instance, over 50% of energy intake now comes from ultra-processed foods. And we know that these ultra-processed food intake is associated with depression, anxiety, and there's even been randomized control trials taking people in a depressed state that had a poor diet, so high ultra-processed foods, and then removing some of those foods. And in the absence of even changes of medication, et cetera, et cetera, they saw reductions of their depression scores.
44:47
So I think we clearly have an association on a population level, but now we even have randomized control trial data to say ultra processed foods are, you know, likely causing some of these depressive symptoms. And again, it probably goes both ways. When you're depressed state, we know that the brain is actually rewired to crave more carbs, more ultra processed foods. So it's not just to say that ultra processed foods just cause depression. It's likely that depression also causes increased intake of ultra processed foods, but I think it's
45:15
particularly an issue now because we're seeing such increase in the amount of ultra processed food. It's available to children, it's available to adolescents, it's available to adults. And we're also seeing a rise in depression. And again, not to just say because these two things are happening at once, they have to be associated, but with the aforementioned things that I had discussed,
45:33
I think it's a pretty strong indicator. And there's a lot of mechanisms via the lens of inflammation, mitochondrial dysfunction, and all these fancy buzzwords that we use for other different disorders that link the two. So I think from a dietary advice, it's important to try to avoid some of these ultra processed foods. It's not impossible. It's not possible to bring it down to zero likely in our current society. But I think it's something that
45:58
Personally, we need to be aware of, but also policy level, if there can be changes from that front. Gotcha. Is it even independent of calorie intake? So let's say you eat one donut, but otherwise your diet is healthy and you're not gaining weight. Would it have an effect? Yeah, so the literature is not as clear there, but my thought on this is this, is the independent of calorie intake by eating ultra-processed foods
46:25
through the lens of even nutrients, you're now replacing nutrients that you would get from whole foods and replacing it with ultra processed foods. So your donut example, you could even eat a donut and depending how big it is, maybe it's 500 calories. That's a pretty hefty amount of calories for someone's daily caloric intake. Then that 500 calories, the amount of fruits and vegetables you need to eat to get that small donut, you could probably have a massive bowl of whole foods that would be full of fiber, full of nutrients and stuff.
46:54
So that's important for your bowel, that's important from a micro and macronutrient level that helps your body essentially function. So independent of calories, I would say yes, the answer is that ultra processed foods do contribute to adverse mental health. And it's not just that they're more calories, although they are, we know, as I mentioned, it rewires the brain for you to want to eat more and you feel less full. So not only are you eating more calories,
47:22
but you're eating less nutritious food and it perpetuates the cycle. And I think that's where the problem of ultra processed foods really lies and why it's so pervasive in society too, because people eat them and they're frankly almost addicted to them too, more so than eating an apple or eating a carrot or something that may be healthier. Yeah. Gotcha. Um,
47:44
What is it in the processed food then? Does it cause inflammation? Is it some of the ingredients, the sugar or something like that? So I think it's a few. So inflammation is always a hot topic with depression or mood disorders or anxiety. So we know that ultra processed foods, peripherally and centrally, can increase some of that inflammation, which can lead to things like depression, anxiety. I think also a relevant portion is, as you mentioned, the sugar component can be something that's relevant because we know that
48:09
Specifically within depression, we know insulin resistance, which is something that happens before someone has a full-blown sort of diabetes, can be a predictive factor for developing a depression. And they've done studies looking at different measures of insulin resistance and someone's risk of developing depression, say, five or 10 years later. This was in the American Journal of Psychiatry. I don't remember the exact author, unfortunately. But yeah, so via the lens of inflammation, via the lens of increased caloric intake, via the lens of
48:38
sugar and insulin resistance, all of these causes of factors come together to contribute to depression. And again, not to say that just eating poor quality foods is going to make you depressed. I mean, it probably can, but couple that with life events and our analogy of the bucket. You can imagine eating all these poor quality foods just fills up your bucket so much more. So when something bad happens, your likelihood of going into depression is just that much higher. So I think there's a lot of factors, a lot of different mechanisms, and it's beyond just the calories that the foods contain.
49:07
Gotcha. Yeah. I think I saw another paper that you published about microplastics, which are very prevalent in processed foods, in the packaging and the processing of them. So do those microplastics also have an effect on depression? Yeah. So to give context for that paper, recently in Nature Medicine, there was a study that looked at…
49:30
people, the brains of people that had dementia or were healthy and had passed away, and they looked at their brains specifically for the microplastic content. And the shocking finding was that they found a spoon's worth of microplastics within the brain. So that's a large amount. And it was mostly what we call nanoplastics, so the smaller version of that, which makes sense to cross the blood-brain barrier, probably smaller particle. But they also found an association with people with dementia had higher amounts of microplastics in their brain than those without dementia.
49:59
So that was a very interesting finding because this is one of the first studies that looked at one of the more neurological or psychiatric manifestations of microplastics, whereas other studies looked more at clots and different things like that. So in our paper, what we had posited was
50:14
Perhaps we know that ultra processed foods they contain high contents of microplastics That's because of how they're packaged how they're processed and all the different steps that are required to make these foods An example that I had cited was chicken nuggets contained 30 times the amount of microplastics compared to chicken breasts so we can see the orders of magnitude higher of microplastic content and ultra processed food versus whole foods and
50:41
And in that, based on what I described before, we know that ultra-processed foods are associated with adverse mental health outcomes like depression and anxiety. We know that ultra-processed foods have higher microplastic content. So what we wrote in that paper was, you know, does this microplastic content mediate the association between ultra-processed food intake and adverse mental health outcomes and even things like dementia? And right now, there's no studies to directly answer that question. And the reason is it's very difficult to study. You
51:10
estimating someone's microplastic exposure is very hard. They don't write that on their population-based surveys that people fill out. How many microplastics do you eat a week or something like that versus a general diet? So what we had posited in the paper was potentially making a dietary index called the Dietary Microplastic Index to guesstimate the amount of microplastics in different foods that people are reporting they're eating. And the goal of this would be to then post-hoc, you could even, based on existing trials that the data's available,
51:37
estimate that. So the randomized control trial that I mentioned about removing ultra-processed foods from someone's diet called the SMILES trial and seeing the depression score change, if there's data to say how much microplastic content was removed by removing the ultra-processed foods, we can kind of get a post-talk analysis to say how much did microplastics mediate this effect
51:59
So it's very right now in the air. There's no clear literature linking one to the next. But I think it's a very relevant problem worth studying because, again, as I mentioned, how prevalent microplastics are, how prevalent ultra processed foods are and the rising rates of mental health disorders. So it's a question we don't have an answer to, but I think it's a one that hopefully we will in the coming years. Do you do microplastics also then?
52:24
cause inflammation or disrupt some other brain function? Yeah, so right now a lot of the studies for microplastics mechanisms are not based on humans. They're based on animal and cell culture studies. So it's always hard to draw one-to-one associations because we know we can't always compare the two from that front.
52:43
But as you mentioned, it's always a very common link of inflammation, oxidative stress, and different things of this sort, and even different immune-mediated mechanisms that could be implicated in cancers and stuff of that sort. So again, most of it's based on animal cell culture studies, but we're seeing some of these very similar mechanisms that ultra-processed foods have as well too, which again, maybe strengthens that link where we're seeing similar mechanisms between the two, maybe because they are the same thing driving the adverse effects. The question is, number one,
53:13
How does it even cross the blood-brain barrier? There's not a clear answer.
53:17
We know that the nanoplastics, which are smaller, typically can get across more, which maybe is a propensity for, you know, just having a hard time getting across smaller particles. There's been some studies looking through the olfactory pathway, so the nose, and getting into the brain via that way. But there's no clear consensus to say, how are these microplastics getting into the brain? How do we remove them and things of that sort? So there's a lot of question marks in the space of microplastics, but I think it's a very relevant space.
53:45
Gotcha. Yeah, makes sense. But yeah, you know, it might be also that people, or at least, you know, the biggest reason people get microplastics is from processed food mostly. And that is like a confounding variable that people who
54:04
have more depressive symptoms tend to eat more processed foods as well. So it's a very vicious cycle in every direction. Yeah. So it's this bidirectional association that frankly will never be able to fully tease out in terms of which causal factors contributing more are people eating more because they're depressed or is the ultra processed foods contributing to that depression? And like I said, I think it goes both ways. It's probably a pretty even split between the two.
54:33
But it perpetuates this cycle because once you're in that depressed state, once you're eating more of those foods that are potentially causing some more of this damage to your brain, for lack of a better word, it's perpetuating that cycle of eating more foods that are not healthy, replacing those nutrients, remaining in that depressed state. So it's a matter of breaking that cycle. And again, depression isn't just caused by foods, but this is one of the relevant factors that we need to pay attention to. Gotcha. Yeah.
54:59
Are there any other supplements out there besides creatine that show price for mental health? Yeah, so one that I'm not… Oh, sorry. Yeah, so I was going to mention that one thing I did…
55:11
I remember seeing from a recent meta-analysis was I think that saffron was quite effective. You combined it with other antidepressants compared to other ingredients. Yeah, so you read my mind there. I was going to say saffron. So by no means am I an expert in saffron, but it was one that I've been keeping my eye on in terms of its effect.
55:31
they recently did a network meta-analysis looking at different supplements for depression and rank them. Um, and they found saffron plus an antidepressant had one of the highest benefits. The caveat is that there wasn't a lot of studies and it seemed to be driven by one study having a larger effect. So when you see that, you want to see more replication to see that is this consistently happening? Uh,
55:50
And I don't know a whole lot about the mechanism and everything of saffron. It's something that I haven't done a deep dive into yet, but I think it's something that I want to keep my eye on because it's interesting to see its effects. I've seen some literature on saffron. Again, I haven't done a deep dive. Something that's common with antidepressants is even sexual dysfunction after being on an antidepressant. And I saw a paper recently, and I haven't done a full deep dive looking at saffron for that sexual dysfunction, and it did seem to have some benefits. So I think…
56:17
I think it's going to be interesting to see more literature on saffron. I think it did seem to come out when they put the studies together. But I think sometimes you get outliers when there's a small study that has a really large effect size. So we need to just kind of be careful in interpreting the results fully. Because I'm not sure if you're aware of the, there's a meta-analysis for exercise in the BMJ, I think it was a year ago, and dance came out on top. It was a very clear winner above everything else.
56:42
that's also maybe a similar effect where you're seeing one study that had a really large effect and there's not a lot of other studies looking at dance and exercise. So that's maybe why, but I'm excited to see more and more research coming out for the saffron literature, because I think, again, it's nice to have more options and more adjuncts that you can add to treatment versus our very simplistic, frankly, route of antidepressants or therapy. And
57:08
Even with that, we know the response rate for some people can be around 50%, and then people are deemed to be treatment-resistant, and then what sort of thing. So I think saffron's promising, but I want to see more research come out first. Yeah. With the dancing, it's…
57:21
I don't think that study was done people on dancing alone. They were probably dancing with other people, which obviously has a very positive effect on mental health versus other forms of exercise. Other forms of exercise people tend to do alone or gym and running people tend to do alone or very rarely in bigger groups. Yeah, I think it goes back to that what I mentioned. The social part of exercise is one of the things that we often overlook so much because we see people
57:49
exercise we think of athletes doing their different fitness routines and we think of the physical manifestations of exercise of being physically fit in that but we don't think about just being present with another person or a whole team and how important important that is and you know again removing even exercise the importance of social connection is just so important beyond your mental health we know so many outcomes are so much poorer when someone is isolated and
58:15
even in a physical realm from a cardiac or kidney perspective. So I think it's really important and it's great that exercise is able to pair some of these antidepressant mechanisms together.
58:28
You mentioned that depression rates are rising in the world. What are some of the biggest things on a government level and individual level we should do to mitigate that? So I think one of the biggest things, as I mentioned, is emphasis on prevention is one thing. And the other thing is an emphasis on sustained remission.
58:52
So prevention can be via the lens of lifestyle. It can be via the lens of a lot of other things. So just because we've mostly been speaking about lifestyle, I think we need to facilitate prevention.
59:02
some of these lifestyle parameters a little bit better to the population. So for things like exercise, it would be great as a physician if you could, if someone came with depression or even not with depression, but it was in this kind of prodromal sort of state that we discussed before, where you could give them a exercise prescription to the, and then that would maybe cause their gym membership to be free or allow them to get into a different exercise club or have some fitness training sessions.
59:26
That may go a long way to help kind of precipitate that person to stay exercising, potentially even prevent a depression. Or if they go on to develop a depression, once they are able to get out of that state, to be in a state of sustained remission. I think for diet as well, too, right now we need to place a lot of emphasis on making sure that people have high quality foods accessible to them because we know that there's quite a disparity between
59:49
based on someone's income. So people that have lower income are likely eating more ultra processed foods. And this can also contribute to depressive symptoms. And then things like sleep too, I think stems from a large societal issue of working hours and the amount of commitments that people have just to sustain themselves. An example, even selfishly for myself as a resident right now, working 24 hour call shifts, you know, once a week or so,
01:00:14
And some people do it even more often than that. It can be pretty detrimental to your sleep. It can be detrimental to your metabolic health. So I think different parameters, even outside of residency and restrictions in terms of how people work and optimizing their sleep can be very important. And these are all more so through the lens of prevention.
01:00:33
But I think through the lens of treatment, specifically exercise, we need to make it possible for physicians to actually prescribe it to patients. I think we often talk about how beneficial exercise is for people, but we don't actually train physicians on how to prescribe it. Most of the time you go to your doctor, whether it's for depression, whether it's for being overweight, you know, if someone tells you go run or go exercise, that's condescending. It's not helpful. You need to have a physician who can speak to you about it and prescribe exercise appropriately.
01:01:01
We also need better referral pathways. So if you're a physician that wants to refer someone to exercise, having a referral pathway to a physiotherapist or a personal trainer direct from your clinic to set that patient up right there, similar to the way that you would do if you're referring someone to therapy, we have direct sort of resources. I think those need to be in place.
01:01:20
And then the other thing is on a policy level, we need to have incentives for a physician to want this change. So some discussions that physicians have with patients and they take time, they're financially compensated for it. So if you discuss smoking cessation or different things, then you can be compensated for that time. And I think if we really want change, we need to have some incentives, unfortunately, for the physicians as well to have that discussion. Because again, they…
01:01:47
they're in such a time crunch that discussing something like exercise may not be as feasible as here's your prescription for your antidepressant. So I think there's a lot of individual prevention opportunities
01:01:57
measures, but also policy measures that we can take both again at the prevention and treatment level. But there's a lot of steps that we need to take. And I think it starts with education first, because I think there's quite a disconnect between we know the benefits of exercise. We know all these different things, but we still don't do it. It's even in the guidelines, but we still don't do it well. So clearly there's a disconnect that we need to address.
01:02:18
Yeah, that's interesting. And what about the individual level? Should they, you know, obviously many people already know what they need to do, exercise and sleeping up and etc. Is there anything like specific? Yeah, so what on the individual level is specifically like it goes back to the education lens. So yeah, you're right. A lot of people know, you know, exercise more, sleep, optimize sleep, but it's not always possible. I think
01:02:46
At the individual level with the physician in your office, what you can actually do is prescribe that exercise appropriately. So some of the parameters that we spoke about in prescribing exercise, we need to do the same thing as we do for medication. So if you go to your doctor and you're started on an antidepressant, they're going to tell you the antidepressant. They're going to tell you the dose. They're going to tell you the route you're taking it. They're going to tell you how often to take it. They're going to tell you side effects, all these different things, right? But you go to your doctor and on an individual level, they say, go exercise.
01:03:15
We need to make a more of a formalized sort of prescription to communicate with your patient and also track benefits, side effects, et cetera. So we've developed or we wrote about actually the FIT principle, which puts together some of the things that we said before. So it's F-I-T-T. So frequency, intensity, type and time. So that breaks exercise down into a prescription. And you can actually write that down within your notes or to the patient, the different exercise parameters that you've discussed.
01:03:42
and that the patient can hopefully try to adhere to. So therefore, at your next appointment, when you come in and they say, you know, this is really working for me, I've noticed a benefit in my depression, or maybe the frequency was too high, can we lower that a little bit? You can actually facilitate that discussion. So I think at that individual level, we need to do a better job at speaking to our patients in an actionable way that can result in changes in someone's
01:04:08
habits of exercise and hopefully have some of those policy level changes to facilitate it too. Yeah, that's a very important component, I think.
01:04:21
Well, yeah, it's been great talking with you. And before I ask my last question, where can people learn more about you and your work? Well, thank you for having me. And yeah, I think I'm mostly active on X or Twitter. I'm trying to be a little bit more active on Instagram now, too. This is the same handle. So it's NTFabiano. I try to, on my X, at least write about an article like once a day sort of thing and kind of break it down. So if you're interested in hearing about exercise or any other things like that, feel free to check me out. But yeah, thank you for having me.
01:04:50
Well, it's great. And I'll put the links in the show notes. My last question is, what's this one piece of advice or a habit that you wish you'd adopted sooner? I think the piece of advice that I would, that's a good question.
01:05:03
I think implementing exercise as a part of your day rather than an addition. So it's something that you need to do within your day. It's part of your day. It's similar to kind of going to work and not from that dependency lens, but to say, you know, this is part of my day. I've reserved an hour to exercise and I'm going to respect that because it's very easy to forget that your day gets busy. You know, you need to have all these other tasks to do. But if you really cement it in your day and say this hour,
01:05:28
is reserved for my self-care of exercise or whatever it may be. I think setting that aside goes a long way because your life only gets busier as you get older and school and different responsibilities. So I think my piece of advice is set that hour aside, whether it's for exercise, whether it's for anything else, that's time for you because your life will never stop getting busy. You need to take that time for yourself. Yeah, I agree.
01:05:51
Well, yeah. Well, thanks for coming to the show. It was great to talk. And yeah, I'll see you around. Okay. Thank you for having me. All right. That's it for this episode. Make sure you check out my new book, The Longevity Leap on Amazon. I'd also appreciate if you share this episode with a friend or family member. Other than that, my name is Seem. Stay tuned for the next episode. Stay empowered.
Edit:2025.07.07