00:26:19 Tim Ferris: I mean, beyond anyone's wildest expectations. That would be one tool. I also think that preventatively focusing on daily or weekly habits that prevent depression is really the ounce of prevention being worth a pound of cure. It's very hard when your mind goes into this sort of depression logic that is self-defeating to pull yourself out of it. So certain types of exercise oftentimes related to balance or acrobatics, anything that where you're moving your body through space as opposed to a weight around your body. Secondly, meditation. I meditate almost every morning for 20 minutes. evening as well or no? Less so in the evenings, but I do have mindfulness practices in the evening. And then nutrition, there are a few key sort of cornerstone elements that if I control will not prevent me from ever being depressed, but will mitigate it tremendously. And what I've also come to accept is I do think that it's very common among people who try to create anything original. I think that it's very hard to have the kind of manic ups that allow you to see connections between seemingly unrelated dots without having some troughs. And maybe that's just rationalizing and accepting depression, but it's very hard for me to find people in that type of profession who don't have this pendulum.

00:27:48 (someone): It's interesting because a lot of people talk about the relationship between the two, creativity and depression, but as if the arrow is traveling in one way, which is that depressed people – people like to look at – say look at a hundred very, very creative people and look at the incidence of depression.

00:37:15 (someone): And after it was done, just as you would predict, the people who had given the speeches to the disapproving audience, they said they were in a bad mood, and the other ones were feeling kind of pumped up. And then they asked these people who had given the speeches to make collages, which they had professional artists rate for creativity later on. And they found that the people who had given the speeches to the disapproving audiences created more creative, better rated collages. And that this was especially true for people who came in with a kind of hormonal profile that seemed to predispose them to emotionally vulnerable states. There's a lot of these different kinds of studies that we can look at. And at the same time, there's also data showing if you're truly depressed, you're actually much less likely to be creative because depression is such an emotional black hole that sucks up everything. But I think there's something about that in-between state where You're not depressed, so you're functional, but you're acutely aware of the gap between the desired world and the one that we inhabit. And the desire to fill that gap, that's really the creative impulse. If you look at my favorite, Leonard Cohen, he would talk explicitly about that being what drove him. His son, Adam Cohen, talks about how his whole idea was that this world is beautiful and it's broken, and what he was doing with all his songs, that they were a transcendence delivery machine. Cigarettes are a way of delivering nicotine. In this case, it's music delivering transcendence to people who are inherently broken and beautiful.

00:27:36 Tim Ferris: And maybe that's just rationalizing and accepting depression, but it's very hard for me to find people in that type of profession who don't have this pendulum.

00:27:48 (someone): It's interesting because a lot of people talk about the relationship between the two, creativity and depression, but as if the arrow is traveling in one way, which is that depressed people – people like to look at – say look at a hundred very, very creative people and look at the incidence of depression. It seems to be higher than among the general population but you're suggesting potentially I guess that there's a causal arrow maybe moving in the other direction, which is if you choose to be a creative type person, you're engaging in an activity of kind of reinvent, you know, a blank page every day that inevitably might produce highs that might also be accompanied by, you know, periods of real mental drought.

00:28:25 Tim Ferris: I think so. And this is just from my own personal experience and observations of friends who are also writers or songwriters or whatever it might be. The more time you spend in your own head, I think, the higher this probabilistically, the more likely you are to latch on to some weird Right. Circular reasoning, but I don't romanticize depression in that way that, for instance, some musicians fetishize drug use. They're like, well, you know, you do your best work when you're on coke and heroin and all this stuff. It brings out the muse and so on. I think that's a dangerous logic.

00:28:58 (someone): Well, I appreciate you're talking about it because it strikes me as a huge paradox, suicide particularly but depression also, which is that suicide is rather prominent in the West and particularly in the US.

01:20:46 (someone): Speak to your dealer or your medical practitioner in all truth. But one of the things that we know is that, and you're asking about different substances, depression and MDMA, not probably the best mix. Curiously, what I'm finding is micro doses of LSD or mushrooms may be very helpful for depression because they make you feel enough better that you do something about what's wrong with your life. And depression is not necessarily, we've made it an illness. It may be the body's way of saying, you better deal with something because it's making you really sad. And I was just looking at a book on Lincoln, which talks about his depression. And in those days when you were depressed, people said, he's really depressed.

01:21:40 Tim Ferris: Melancholy.

01:21:40 (someone): It was assumed that you'd have to deal with it. So I'm really re-looking at depression. But if we look at substances, ketamine, this is again a very odd substance because it's used in veterinary medicine as an anesthesia, it's used in humans as an anesthesia, but at another level it's psychedelic. At another level, it apparently overcomes depression in a totally different way than antidepressants. Antidepressants, you take it, and then take, take, take, take, take, take, take, and four to six weeks later, maybe it'll be the right one, and if it isn't, you take another one, take, take, take, take, take, four to six weeks. Ketamine, you take it, and about 15 minutes later, you're not depressed.

00:54:28 (someone): And then a study in this country of major depression. And that will be getting underway this year. I think if these drugs can really make a dent in those indications, it would be enormous. It would just be you know and the depression study is very interesting how that came about um the researchers you know had looked at depression in their population of cancer patients they were they were dealing with both depression and anxiety and the results of those studies found that in roughly 80 percent of the cases uh the patient the volunteers had had um statistically significant reductions in symptoms of depression and anxiety so a pretty big deal very strong treatment effect much stronger by the way than the treatment effect that got ssris approved um but when they went to the fda seeking permission to do a phase three trial in cancer patients the fda regulators said to them We've got a much bigger problem, a much larger population of people struggling with depression. And there's a strong signal here that these drugs may help with depression. So we want you to study that. And part of the reason they did that is they well recognize that there's not a lot of drugs in the pipeline and the SSRIs are, you know, losing their effectiveness, which was never too great to begin with. We're learning, you know, that SSRIs do perform slightly better than placebos and their effect appears to fade over time. And also people hate being on them because of the side effects.

00:56:12 Tim Ferris: So you mentioned Something that may surprise people and that is FDA support in this case and Certainly, we don't we we don't necessarily have to get into MDMA but MDMA was granted breakthrough therapy designation to which is remarkable expedite the process of phase three trials for PTSD and that seems at odd with

01:03:15 Tim Ferris: Another would be, trying to identify coping mechanisms that actually exacerbate the condition you're trying to avoid. In other words, if you can't fix depression, which is a big mountain to try to climb at once, and I don't think it's very productive to say, I want to defeat my depression, you can you can look at the antecedents of depression or the ingredients, right? And potential triggers. So, like, when do you tend to get depressed? Is it when you're tired? Is it when you go to bed too late and wake up too late and feel behind the eight ball from the moment you get out of bed? And these are personal examples. Does it correlate to consuming too many stimulants, too much caffeine, which leads to the sleep and so on, and then try to compensate for that by consuming more stimulants. Does it correlate to social isolation? Is it inversely correlated to exercise? And this is another thing where people who are depressed are going to say, yeah, no fucking shit, Sherlock. Like, I know these things. I just can't. deal with them. The time to deal with them is in practice when you don't need the safety net, right? So for me, I began to put in place, and this is in combination I should say with meditation, and the most effective

00:48:23 (someone): It's totally normal. And what you could do for someone with depression is listen and accept and recognize. But don't say, hey, let's look on the bright side. That's literally the worst thing you can do. So that's among the things that I've learned.

00:48:39 Tim Ferris: So what can you do in that case? I mean, I certainly, as someone who has suffered from very severe depression, I mean, almost offed myself in college, so I have some firsthand thoughts as well. But what have you seen to help in those cases?

00:48:55 (someone): Oh, definitely professional help. The last thing you want is your buddies or your friends saying, Here's some quick fakes stuff it just professional help because I mean there are people who spend their entire lives researching whether they're therapists or psychiatrists and for many It is amazing how effective pharmaceuticals are. I'm in the drug discovery, drug development industry. I don't take a lot of drugs because they may have, I just don't. There are a lot of things like, oh, you know what, something aches, I'll get over it, no big deal. I don't really wanna put stuff in my body. But I've just seen first hand, and I know for many people with depression, even small doses, of the right med, literally will, because you really do have a bio, it's a biochemical imbalance. It's like, what do you call it when the shoulder falls out of the socket? Shoulder dislocation or subluxation.

00:39:39 Tim Ferris: So lithium is a monotherapy for, say, bipolar depression, might be prescribed at 1500 milligrams, and it might be, say, lithium carbonate, I believe. There are people who believe, and there's some good writing in the New York Times, for instance, and I think the article is, maybe we all just need a little bit of lithium, something like that. If you search New York Times, maybe we just need lithium, you'll find an article that discusses groundwater concentrations of lithium and inverse correlation to, I believe it was, suicide, homicide, manic depression, and so on. and based on that and the recommendation of a doctor that I work with, note even I work with qualified MDs on all of this, I began taking five milligrams of lithium orotate on a daily basis and it appears to take the edge off and mitigate to some extent anxiety and potential spiraling towards the edge of the precipice as was put earlier with respect to depression. So, could be psychosomatic, but that's 99% of life, isn't it? So, for the time being, I will continue taking it, but I do, much like everything else, cycle both on and off of these things. So, Jasmine, hopefully that helps. I do take things that you might not think of as a supplement. For instance, apple cider vinegar, I'll typically have a tablespoon of that in water, both in the morning and before bed, which might be considered an old wives' tale for boosting immune function, but for whatever reason, seems to work for me. And when combined with honey, also helps with sleep for thousands of people who have tried it. And you can look up Seth Roberts, honey and apple cider vinegar,

00:20:17 (someone): And I think that some of the confusion about depression has to do with the way in which we use, throw depression around as a term, like, I spilled my coffee and I'm depressed about that. Now, yeah, that is a disappointment, right? But it's not, that kind of experience isn't what we're talking about when we talk about depression. When we talk about depression is more about the experience that you're talking about. The way that depression can be a pervasive mode of being that invades every aspect of one's life and experience of the world. It affects the pattern of your thinking. In other words, instead of, as you say, seeing the world as a mixture of risk and opportunity, you see the negative in everything that you engage. It affects the way you make judgments. Instead of being able to make judgments based on reasonable risk reward kinds of decisions, everything's colored by the negativity. What people often don't appreciate about depression is that it goes beyond sadness. For many people, It can be a complete blunting of emotional experience and people describe sometimes the loss of feeling. One of the people that we treated with ketamine said that she was just amazed to have feelings again after her depression began to lift. And people often describe feeling blue when they're depressed because the contrasts in the world, their visual experience of the world is as if the normal contrasts are blunted and colors seem duller and things that are exciting and rewarding seem blander and a kind of sapping of life's essence. This kind of depression is associated with

00:38:09 Tim Ferris: Correct. Yep. For much of your life, emerging from it only in my early fifties. This is you. How did you emerge from it in your early fifties?

00:38:18 (someone): You know, I wrote a book called Spontaneous Happiness, which is about emotional mental health, and it really goes into great detail about how to manage depression, anxiety with non-medication means, knowing that the medication is there if you need it. But for depression, we have tremendous evidence of the value of physical activity, both as a preventive and as a treatment. Tremendous evidence for the use of supplemental omega-3 fatty acids, fish oil or fish. There's an enormous variety of psychological methods, things like cognitive therapy, which I think are extremely useful. There's a whole range of spiritual techniques that should be looked at, whether it's meditation, mindfulness, or even gratitude. There's very interesting research showing that just the simple act of keeping a little journal of things to be grateful for and making a note of that as you go to bed can improve mood for lasting effects for a month. Another area of research that I find fascinating is that moods are contagious. And you can track them through a population just like you can track movements of an infectious disease. If you live within a half mile of a happy person that you know, your chances of being happy are increased by a certain percentage and the effect falls off with distance. I mean, fascinating.

00:17:25 Tim Ferris: Whenever possible try to get some type of physical motion in the morning and right beside me now for instance is a kettlebell i ordered it on amazon ship to prime. And this morning, I wanted to get directly to doing some writing, but did about 30 swings with this kettlebell beforehand. Very minimal effective dose of exercise, but just enough to sort of change my hormonal state to activate my entire nervous system, which changes the lens through which I look at any problem that might pop up during the day. Second is certainly diet. And third, this is not necessarily an order of importance, is sleep. And I highly recommend checking out a podcast episode with Matt Walker. and Peter Attia. This is on The Drive, a podcast hosted by Peter Attia. Matt Walker also wrote a book called Why We Sleep that has been recommended by multiple podcast guests, most recently Amanda Palmer. And there are a few other questions here that will also have, or I should say, relate to one of the tips. uh for avoiding depressive episodes or potentially uh reversing a tailspin uh so this question here is what would you suggest is from anonymous and related to what we were just talking about what would you suggest to an individual considering a major life transition Example given stable successful career entrepreneur what were your key considerations and that applies to the depressive stuff in the following capacity i would recommend. Fear setting the fear setting exercise and you can find that on the blog. forward slash ted it was the subject in part of my ted presentation which at this point has five million or so or six million views and fear setting takes whatever is causing your fear uncertainty or doubt in your mind which can often precipitate loops that lead to physiological and psychological depression

00:57:04 Tim Ferris: So I don't want people to, and the reason I'm saying all this understanding that I'm not a clinical psychologist, MD, or researcher, is that having struggled with depression for so long, there can be a hopelessness beyond the depression and so I I think it's At least what I want to do is impart some hope to people who are listening as someone who? Has struggled with very severe depression for decades, but not experienced any major depressive episodes in the last four or five years That there are tools available that can help you to sort of put orthotics on your flat feet and and that it doesn't have to be a self-reinforcing pattern where you're depressed and then you're depressed, you're depressed, and assume you're a broken toy that can never be fixed, and therefore what's the point? There's this slippery sort of logically compelling with faulty assumptions process that is really scary that people can end up in. So for those people listening, I would just say that There are tools out there. You should see a professional if you're suffering from major depression, which I have done in a somewhat unorthodox way, but I have. And also to explore the tools that will supplement any type of pharmacological intervention or prescription that you would use, because there are resources that can help. Yeah, so I'm talking a lot, but I just want to make two recommendations. The one is to take a look at a William Irvine book, which is on stoic joy, which for many people seems like an oxymoron.

00:42:39 Tim Ferris: We don't have to get into that, it's getting pretty highfalutin, but That desire to create or recognize beauty has become much more of a driver for me in the last five years, I'd say, in particular, and it seems to check off a lot of other boxes. check off 20 different things that I need or solve 20 different problems if I have a compass that is pointing towards creating something of beauty. But however you end up recognizing that yourself, it seems to really solve a lot for me. Let's talk about an experience of not being able to see beauty. I mentioned depression earlier. How do you think about depression? What do people get right or wrong about it? I don't know if you've suffered from it yourself. And in all of your exposure to various types of treatments and methodologies and pharmaceuticals, what's out there that actually seems promising?

00:43:47 (someone): You know, that's a great question. I learned a lot about depression in the last few years that I knew nothing about. You know, I'm very fortunate to not have had either depression in the family or experienced clinical depression myself. But what happened the last few years is I got to know somebody closely with depression and realized a lot of wrong things to do. That in fact, no matter how much I thought I either was self-aware or There are just so many traps. In fact, one big trap that's incredibly common to people like, let's say you and me, who are really looking to improve how we go about our life in the world.

00:16:01 Tim Ferris: Imperial College London and elsewhere. There are also a lot of tools that I think can be very valuable. Byron Katie, the work I would encourage looking at if you feel like you are a prisoner to thought loops that may not be the most beneficial or helpful. That is a set of exercises and questions you can find for free online that I would recommend. Tony Robbins, controversial figure in a lot of respects, but many of his exercises, the Dickens process included, I have found to be very, very powerful. Defining the driving values and whether or not you may have competing values and goals, very important. Other things that I have developed as habits which are really foundational would be exercise. It's very easy to try to think your way out of a funk or some type of depression. And it is as tony would say i'll quote him again you start with state your physical state then story story tell yourself and then the strategy but if you're in a depressed state the story you have is going to be class half full it's going to be. cloudy with a chance of rain and therefore the strategy you come up with is going to be inferred by that negative state so first is exercise and i really do. Whenever possible try to get some type of physical motion in the morning and right beside me now for instance is a kettlebell i ordered it on amazon ship to prime. And this morning, I wanted to get directly to doing some writing, but did about 30 swings with this kettlebell beforehand.

00:21:43 (someone): And people often describe feeling blue when they're depressed because the contrasts in the world, their visual experience of the world is as if the normal contrasts are blunted and colors seem duller and things that are exciting and rewarding seem blander and a kind of sapping of life's essence. This kind of depression is associated with a loss of energy, a loss of concentration, difficulty sleeping, waking up early in the morning, tossing and turning, in difficulty relaxing and feeling comfortable, being overcome with pervasive, intrusive, recurring thoughts on negative things like, I'm a terrible person, I let people down, over and over and over, ruminating on these negative, horrible ideas, and I mentioned a sapping of energy, loss of appetite, decreased interest in activities, a kind of withdrawal. This state was deemed by the Greek Hippocratic doctors as a kind of fundamental negative mode of being that they thought was connected to black bile, which in Greek had the name Melon for black, Colia for bile, and then has been known as melancholic depression ever since. And there's another kind of depression that we also see, which is people who have the capacity to see good and bad, but who cannot constrain the way in which they react. So something good happens, they can, react in a normal way to it, but something bad happens to them and they spiral downward in a very negative way beyond their control to despair and hopelessness and extreme distress. That is not the typical profile of traditional melancholic depression, but it's a kind of reactive depression. One of the things that we appreciate about depression is that can be a very heterogeneous things, that there's a whole array of different kinds of depression.

01:14:59 Tim Ferris: to hold promise for conditions that are frequently thought of as intractable or untreatable.

01:15:06 (someone): And separate. I mean, one of the interesting things about this is that the indications, the forms of mental disorder that they seem to work best on, I was very skeptical of this panacea idea, too, and I was interviewing Tom Insel, who was former head of the National Institute of Mental Health, And I said, isn't it a little suspect that the same drug would work for depression and anxiety and addiction? And he said, why? And I said, well, you know, it's like, it's a panacea. And she said, no, he said, don't assume those conditions are so different. They may be a product of the, they may be different symptoms of the same mental formation, which is an excessive rigidity in the brain. They're all forms of stuckness. They're all forms of destructive narrative. And so we may learn something about the nature of mental illness in this research too, which is very exciting. And psychedelics seems to work on those kind of locked-in conditions that all are characterized by obsessive thinking to one degree or another. And as somebody said, who I interviewed, depression is regret about the past. Anxiety is regret about the future. They're similar. They're very similar. And addiction and depression often go together. So I thought that was very interesting. But then there's a whole, so that's one end. If you think of mental disorder on a spectrum, and at one end you have those very rigid, closed down brain conditions,

01:27:47 Tim Ferris: That is not a monotherapy or high-dose, This is not lithium at 1500 milligrams or something like that. Lithium can produce very significant side effects, especially in high doses. I take it at very low doses to effectively mimic, or I should say, enact the takeaways from an article I read a long time ago in the New York Times, which was sent to me, called something like, you'll be able to find it, maybe we all just need a little bit of lithium. It talked about the inverse correlation of groundwater lithium levels and hospital admissions of psychotic episodes, cause of death attributed to suicide, things like that. But certainly read the article and speak to your medical professional. Don't forget the basics. Exercise, sun, mitigating caffeine, cutting out alcohol. That's a big one. And also cold exposure. There are, I think, very legitimate reasons why back in the day, people like Van Gogh would be prescribed two cold baths per day. Because it does have, at least in my case, significant antidepressant effects and anxiolytic effects. That would be anti-anxiety effects. So those are a few. Okay, let me take a look here. Aha!