Navigate Depression And Anxiety With New Tools

Introduction and Speaker Background 0:00

Welcome to the MS and Neuroimmune Summit. I am so pleased to introduce, Dr. Drew Ramsey Now, Drew and I have known each other for many, many years. and we share a common bond and mission that food is vital for the brain. Drew is a board certified psychiatrist, author, mental health advocate. He focuses on clinical excellence, nutritional psychiatry, male mental health, and creative media. He founded the Brain Food Clinic, a digital mental health clinical practice. He's been featured by The New York Times, Wall Street Journal, Lancet Psychiatry, The Today Show, BBC, NPR.

He's given three TEDx talk. He's the coauthor of many books. he courses on nutritional psychiatry for the public and clinicians. he has, his books Eat to Beat Depression and Anxiety, Eat Complete, 50 Shades of Kale. I love that book, by the way. the happiness that explore the connections between mental health and nutrition. He's on the advisory board at Men’s Health, Editorial Board at Medscape Psychiatry, and the Scientific Advisory board for the Anti-Stigma nonprofit Bring Change To The Mind. He lives in Jackson, Wyoming, with his wife and two kids.

Drew, welcome. I'm so glad you were part of our, summit. Terry, thank you so much. And everybody listening. It's such a treat to be with you and to be a part of your Summit. this is an important community for me. And talking about mental health and brain health is, you know, it's such a treat to do that with you. and I remember when I first met you since, like, 2014, and your card had Kale on it, like, one side was just a picture of Kale, and I was like, we're going to be friends, so let's be friends.

It's great to see you, too. You know? and we were talking, that, you know, when people get diagnosed with MS or Neuroimmune condition, it's terrifying, because the future, is terrifying. We're afraid we're going to be in a wheelchair. and so I invited you to think about, a success story to give people hope that, a good life could still happen. Well, there are two answers ahead of that question. The first is the idea that engaging wherever we are in our journeys, whatever illness or mental health concerns that we're struggling with, engaging in the process of getting better, of improving our mental health, improving our mental fitness, and engaging in the therapeutic process.

I, I get motivated because I see that work every day, and I think we don't hear enough about the success stories in mental health. We hear a lot about, you know, concerns about whether antidepressants work or not or, whether therapy works or not. But we don't often hear that. people make discoveries often in every session, about themselves. they hear themselves say something. So, if that's not a part of someone's support team, I always look to how to understand that or get more of a what I call process conversation going, and to understand how you as an individual are being impacted by this illness, what your supports are, what needs to be bolstered, who needs to be added to the team?

What are your resources? So, so having that therapeutic process going, I think is essential. And should always give people, hope. I think the second way to answer is just as a nutritional psychiatrist and in our practice, we, do general mental health,

Hope Through Therapy and Food 3:40

but make sure to incorporate food in that starts really in a straightforward way of asking individuals about their relationship with food, not just from the standpoint of eating disorders, which is often a mental health we how we approach it. But from what people actually eat, how they acquire their food, how they think about food, whether there's a psycho spiritual connection to food in some way. who are their influencers? I work with a lot of young men, and so there's a lot of talk about protein, but there's also a lot of talk about testosterone and lectins and oxalates and all these kind of misinformation and kind of rumors that run through the the, I guess, you know, male optimization, nutrition world.

And so success and, around mental health and food really looks like, the food journals I see, like, I started working with the young man a few weeks ago, and he, keeps his of food journal in a little Apple Notes program that he shared with me. And it's great. Instead of scrolling Instagram, I get to, you know, see what a young man in America is up against and see all the great choices he made. I saw I saw pasta with clams on there, and I know he is really you know, that's a patient is trying when he talk about the importance of B12 and you see them enacting it in their food journal.

And so the the real motivation success I see is, through small steps. And, Terry, you're such an inspiration and, nine servings of greens. I wouldn't call that small steps, but through intentional steps, all of us, no matter what we're struggling with, can make progress. And our health can live robust, creative, productive, impactful lives. thank you for your, you know, I'm sure you're aware of this as well. So everyone who's listening often, the longer we have multiple sclerosis, the greater the probability is that I may develop symptoms of anxiety.

Depression. it may be diagnosed with anxiety, depression. You know, I can think about my own personal journey. When I was an adolescent, I began to struggle with, depression. I also, as a overachieving female, I developed an eating disorder. So unfortunately, I did eventually work my way out of that. but depression has always been part of my my journey. And I figured out that exercise made a huge difference. in my mood. what what, you know, for the listeners who may be having, issues with low mood, either low mood symptoms or an overt diagnosis, what suggestions might you have for them?

Terry, first, thank you for sharing so openly about some of the, pieces of your mental health that have been challenging to you anxiety, depression and eating disorder. And I got really curious to hear a little bit about, you know, depression and how it functions for you and some of the lessons that you have. I mean, I'll start, you know, as you heard in my, my sense about, you know, what should motivate us and give us hope. And what's a success story, for people who haven't engaged in therapy or found the right therapist for someone to speak to, I think that's always a great place to start, because it allows there to be a framework and a context and a model of the mind that you can at least begin to talk about.

Right? What is anxiety? How do you think about it? Where does it come from? When did it start? What's the quality of it? You know, and, you know, I've, I've heard that, the, the, the the, native Eskimo peoples have so many words for snow, hundreds of words for snow. I kind of think it's a little bit like psychiatrist. You know, anxiety. We have a lot of different words and ways that feels to us because that's kind of the world we live in. A clinically. And so, that's one place, I think that the kind of buckets I'd put interventions for depression and anxiety, one, are around the lifestyle factors of just checking in with those.

So you're a big inspiration to me to I see I see images of you in my mind pretty frequently because I met you at a kind of pivotal time in my life, maybe, you know, ten years ago or so, and just the way that, I just think about you often around inspiration and exercise, just the, the the doing it. I see a lot of pictures of you, like, on, on your bike or just I don't know why it's stuffed in my head often when I'm struggling with motivation. And so, you know, making sure you're moving your body.

I'm working. I'm just finishing up a new book, Healing The Modern Brain, and it's about all of these things, along with nutrition that we can do to really optimize mental fitness. you know, our brain health, the resilience of our brain. And also know that when we're struggling with anxiety and depression, like, that's what it is. Meaning that it's not because you're not moving your body, you're not depressed because you're eating lots of ultra processed food. We know you're not depressed because you, you know, lack one of these elements of mental fitness, like self-awareness or spirituality.

And, and so that's where, you know, the lifestyle factors, I think nutrition and diet, and exercise being the ones that have, you know, the most data behind them. But then a number of others, you know, having a mindfulness practice, having a way to settle your nervous system down and making sure that your sleep hygiene isn't, you know what I mean? A lot of people that don't sleep hygiene sense something you know, everyone knows about, but a lot of people. Why don't we define sleep hygiene? Because people may not know it's true. Means sleep hygiene to me.

Treating Depression and Anxiety 9:20

Means that you wake up feeling rested. And most of the day you feel reasonably productive. And unless you're one of these people that has to have an afternoon nap at three for like 15 minutes or 20 minutes. sleep hygiene is a set of behaviors around late, so means getting, you know, off of the screens off of Netflix, kind of really, I would say managing your exposure to artificial light. I'm getting early morning light, then part of sort of growing up on a farm is that you, you get this real relationship with the natural.

So I'm so I'm so acutely aware. I think everyone is in a primal way that is spring is coming. You know, you feel it right away with this extra light, this extra energy. I begin to hear a kind of expansive ness in all of my patients and a little optimism. So, a sleep hygiene also has to do with managing the sleep environment and having a place where it's going to be quiet, where I like having an air filter in there to make sure I really like the idea that for eight hours, yeah, I can really, like, be a control freak about my environment.

I can get like Hepa filter there. I can have the temperature just where I want it. I, and I think that's really good for our body, right? Where you can really just. Like temperature or we talking about, we sleep better warm at night or cooler. I well, I would say the, there is a strong, I think, opinion that cooler is better. And I think a lot of experience that like when we go out camping, you know, like, wow. I would say comfortable is also important, in the sense of, you know, if you get really disturbed by being cold or your hands and feet get really cold, you know, it's important to do your best to sleep through the night.

you're catching me at a weird time. I just finished putting in a sauna and trying to understand, like. Like how does how does that fit into my life? And I've understood that if I get into the sauna at nine and I get into bed at nine, 45 or 10, I sleep through the night. And that's is a middle aged guy that, that's been a little elusive to me over the last year, kind of always waking up at, you know, between 1 and 3. Let's say, just hopefully for a little bit sometimes not. So, you know, there a little I think also called them hacks, but, you know, pieces like that around sleep hygiene.

I have my patients, I, you know, I have no affiliation, but, I wear one of these tracking rings. I like people collecting data on sleep, especially, if someone's having, like, a clinical insomnia. Right. They're really not able to fall asleep or not able to stay asleep or being woken up by nightmares or night terrors. you know, it's nice to have metrics, even if they're not perfect metrics around, you know, seeing that we make progress. I feel really confident saying that to you about sauna y. I, I know what my sleep scores were for the last four years, and I know what they were for the last week.

And I can see the sleep architecture and it's really, really clear its effect on me. I like to take a daily sauna as well. So I do my sun in the morning, and then I go sit outside immediately afterwards. So I see a little bright light, and I take a cultural. to what am I missing in terms of the morning sauna? You know, I have the effect on sleep, but how do you find it in the morning? And is it something you think you know, like twice a day? I could do. You know? Yes. You could definitely do it twice a day.

Your comments make me think, you know, perhaps I should explore doing a sun in the evening. It just happens, you know? And for the listeners, I want you to think about how it fits into your day. and so I, you know, I'm, so pleased that I retired from the VA. So I worked part time for the university, and so now I can get up, I do my meditation, I do my workout, and I do my sauna. Then I do my shower, and then I start working, you know, usually around 9:00. with. I was still working at the VA. I'd have to be there, you know, much earlier, and I wouldn't be able to do all the self-care in the morning.

Well, let's, we should maybe Instagram live a sauna sometime, but I'll try one in the morning and let you know how it goes. And you try one in the evening and what do you want to. Do that would be fun for. Us on Instagram and let us know your sort of plan. I'm always curious. It's it's, you know, I think your question was about treatments for depression. And I said, you know, lifestyle matters. We got into sleep hygiene. I think also, I find that people don't really explore and think about the medication and psycho pharmacological interventions and the extensive science about those.

I think especially the wellness world has a little bit of a kind of anti-psychiatry anti SSRI bias where, you know, sort of, you know, the the analyzes that like serotonin meds not work, get a lot of airtime. The analyzes that they do work for some people that doesn't get a lot of airtime. And so sometimes I meet people who, you know, they've had extensive really obvious depressions and they've never tried Zoloft or Prozac or Wellbutrin. or even something from the natural world like Rhodiola or omega three fats, where, you know, there's less robust data.

But, I like I like when there's movement, and. Yeah, so I'm one of those docs where, you know, if I'd rather you be on the left, but you want to take rhodiola and omega three fats for six weeks. Okay, let's see if that works too. Now we're engaged in the process of trying to get you better. And so, so those are some of the places, you know, psychotherapy, medication, supplements, nutrition and lifestyle factors. I think with the psychedelics kind of in the milieu and something that our clinic, space mental health, I've been involved with.

Psychedelics or. Psychedelics are, a set of compounds. And also with the Tropic, breathing practices. But mostly we're thinking about compounds that lead to non ordinary states of consciousness, which are called psychedelic states. And so the classic of these would be like magic mushrooms or LSD. These were researched pretty extensively in the 50s and 60s and around their effects on psychotherapy, their effects on trauma, their effects on things like alcohol use disorder, and then all the kind of funding and, research got shut down as these, medications were criminalized, scheduled, and became inaccessible to researchers or patients, except in the underground world.

there has been a legal psychedelic medicine that we know is a powerful antidepressant. It's a medication called ketamine. People have often heard of that in its context as an anesthesia or a horse tranquilizer or a party drug. but it also, if dosed properly in the right set and setting, is a very powerful psychedelic medication or psychedelic, psych, compound. And so these medications are now being used in psychiatry. There's been an explosion in research around, treatment resistant depression, complex trauma, substance use disorders, PTSD.

a lot of these have, achieved status to sort of, you know, be rapidly investigated by the FDA. and so those are also something, you know, again, as people are thinking broadly about if you're struggling with your mood, what are the options out there? You know, I mostly care. I think what people should hear is there are a lot of them. I think it looks, sounds and feels much better being in mental health, like needing mental health services than ever before. And at the same time, you know, a lot of people don't feel they have access at all.

And so, those are my thoughts on what to do about depression and anxiety. So again, I think, all of you who are listening to this, I think the overwhelming messages, there are things that we can do

Sleep Hygiene and Sauna Routines 17:20

to, reduce the anxiety symptoms, reduce the, low mood. and lifestyle. There are medications, there are talk therapies. and, if someone is experiencing this, do they go to their primary care person, their specialist? What should they be asking for? that's a great question. I think one is kind of know who you have. So, I used to live in Manhattan, where I had, like, all the therapists, psychiatrists, psychoanalysts, you know, like anyone you wanted to see, you could hear not not not as much. And so one, I think understanding sort of the telemedicine services and how you're comfortable with that.

During Covid, I had a lot of patients like, you know, before had been like, no way I'm going to do that telemedicine thing with you on zoom. It's 3 or 4 sessions and they're like, wow, this is a little different, but it's really effective. And in some ways it's a little better. I'm a little more comfortable. So, you know, that is certainly, I think, an option if you, are the kind of person where you don't, like maybe talking about yourself or you don't have access to a therapist or having some symptoms of depression and anxiety.

You have a primary care doctor you like. I think one step we miss, Terry, is making sure there isn't something medical that's going on. I've got a couple of videos we make, you know, make sure you don't have been just speaking with the family today. And, they're really concerned about medications, but feel it might be helpful for a family member. And I said, all good. Sounds good. But first, let's make sure this I doubt it. It doesn't seem like it makes sure this isn't be 12 being low or fully being low, or that's the eye rolling condition or an anemia.

you know, a lot of things can cause depression and anxiety that we screen for. and so that's where going to a primary care doctor is often a very accessible, low cost way for people to get a quick screening. Right? Get your labs taken, tell your primary care doctor here the options. And that's also often the lowest cost. Most efficient way for some people to get treatment. You know, if you're someone, for example, who's listening, who believes in medications, have people in your kind of community and tribe who've benefited from them, that's probably an indicator, you know, might be a nice option for you if you know you're in a world that's really kind of anti medication or you've, you know, have bad experiences yourself, again, that might not be an option.

But speaking to someone ideally, medical or mental health professional and if not that just, you know, friend, family, anyone that you're struggling with some symptoms, that's probably the first most important thing. And that's the scariest thing I think, to people. But I would say almost always helps because, you know, you're not alone in it. I was like struggling with my mood recently, and I had a great conversation with a colleague, and then I spent a month later, he was on the ski slopes and some other place, and he sent me a picture of himself, just said, you know, I was like, you know, going through the snow thinking here.

So and it was just the nicest thing, just the littlest, most just the nicest thing. And so, I think about that effort for everybody listening when you are brave and you reach out and you share it is a couple things. One, it sets you up to in the future. Receive right in the future. It sets you up to hear from that person. You've opened up a bandwidth that we care about each other's mental health. I have a lot of because I'm in mental health, a lot of people where I feel that from them, and then I feel a kind of obligation almost if I'm really struggling, like, you know, I do need to talk to them or I need to, like, step up into the things I know we're going to help me feel better.

And and so, reaching out, speaking up. that's that's very I think, a key step, a hard step, but always pays dividends. Again, you set yourself up to when people in your community are struggling to be able to help them, which always is a wonderful feeling. and then you instantly aren't alone in it. You know, not everybody is great about following up or checking up, but just that conversation without a lot of expectation on your part. It helps. I think that's another really important things. We also talked a little bit about mental fitness.

Yeah, yeah. what do you have any tips that you can suggest? Yeah. So mental fitness is I would say my new obsession, which is that, I really am a mental health clinician, and I really it's important to fight stigma around mental health. So I hesitant to have another term. But what I think the difference is that mental fitness is around your plan. You know, just like you have your health, right, but you have your physical fitness and all of like the gear and the outfits and the options, for mental fitness.

You know, we don't have a lot of things we think about go to therapy, take meds, take supplements, eat well. Right. Like, well, what else is there? And is a therapist and a psychiatrist now, like more than 20 years. There's just the stuff you see that works over and over and over again for people. If you build loving, meaningful relationships. I mean, that's just like that is fun. Nothing better for your mental health. if you, increase your self-awareness, you know, understand some of the habits and character quirks and things

Mental Fitness and Daily Habits 22:40

about your personality that, you know, help you and things that maybe challenge you. It's like really, really helpful and useful for people. And so mental fitness is a set of behaviors, habits, concepts, and evidence and a lot of ways that we use to set ourselves up for success when it comes to achieving optimal mental health that I know, going into a situation with the patient when they're exercising. I have a lot of patients like this where it's wonderful work because, you know, they're they're they're doing the work.

They're they're walking the talk. They're exercising. They're eating well. They're making that part of our conversation. They're, reflecting on themselves and really kind of understanding their feelings and their emotions. so, you know, those are all aspects of, of mental fitness. I think there's some that surprised people, like, it's very important as you get to be middle aged, my age of thinking about, spirituality and connection. And so it's really it's the focus of the new book. I'm just finishing up the first draft, Healing the Modern Brain, which is all about these aspects of mental fitness and how that's our day to day, like that's our daily fare when it comes to mental health, that we make mental health just about like symptoms and, substance use and, you know, and, and suicide and, you know, all important subjects.

But like, the rubber hits the road with our kind of daily fare. What do you do day in, day out, with your community to create mental fitness and mental health? You know, I'm sort of thinking about, the sedentary nuts and sedentary time that's but. And low intensity, activity, moderate intense activity and high intensity activity. and so I'm used to thinking about that in terms of my physical fitness commitment. I am not going to ask you if I was going to think about this for my mental fitness. Is there something sort of comparable, to the mental time?

Yeah, I love that idea. I mean, there certainly is. You know, I would say, if you have a little bit of anxiety and you didn't, you know, kind of a lot of people I speak to when the door closes, you know, they don't feel they bounce back from the Covid isolation as well, not quite as social. They feel a little anxious. So, you know, a low intensity exercise for some of you might just be, you know, going on movies tonight, you know, calling a friend to be like, I've been to a movie theater and why or let's go and getting all the snacks and just kicking up your feet and having a good time watching a movie.

For some people, that is a low intensity piece of mental fitness. Maybe it sounds surprising, but it's not. I mean, if you haven't been social, you know it's in front of you. One of the great things about mental health, I think, is that if we allow ourselves to just speak, you know, kind of truthfully from the heart up, we right away say what the problem is, what we're struggling with. You know, it's it's it's sometimes it feels very elusive to people. Like a phrase I hear a lot is, I don't know, people will tell me exactly what they're struggling with and then they'll say, I don't know.

It's like, oh, you just it seems like, you know, and, and and that, you know, I don't think it's important to say that for one listening because mental health can seem so, like, elusive. so moderate and low intensity things I think are challenging ourselves, to improve an aspect of functioning in our mental fitness and mental kind of, health lifestyle. if you're a person who's gotten feedback, you know, you talk too much or you don't speak up enough, you know, those are kind of, maybe pieces of yourself that you're wanting to challenge a little bit.

if you, you know, don't move your body a lot, or you've shifted environments like moving from, you know, rural Indiana moved from Manhattan to rural Indiana to Jacksonville. Those are very different environments. To be an athletic person. And so a lot of people I see, they don't sometimes transition so well. And people have been through so many transitions over the past 4 or 5 years, often, you know, moving multiple times. So kind of getting things set up again for yourself is also something that I think is really key for, mental fitness.

Just like, you know, a lot of people have their outfit, their gear, their gym, their gym bag. If we just had a little bit of 10% of that dedicated to mental health, you. Know. And, and high intensity, you know, I've seen a bunch of those high intensity, wide range from, you know, hopping into an intensive therapy. you know, sometimes things kind of bubble up and almost boil over and people come in the store and, you know, it's, it's a lot, right. And and, right from the start. and so just therapy is incredibly intense because, you know, people are sharing things often that they've never shared before this, this great, New York based, psychoanalysts that's very famous Otto Cronenberg.

And he has a great quote. psychotherapy begins where friendship ends. So I think a lot of people say, oh. That is beautiful. It's a it's a nice one. so that those are, you know, so some of my, you know, kind of thoughts about, oh, and high intensity. Another would be like retreats, you know, if you're someone who's, you know, you know, had awful male figures in your life or went to, you know, had a really bad experience, and I'd say the military or were picked on or bullied, I'd be an incredibly, you know, again, high intensity experience to go on like, a men's retreat in the woods with a bunch of other men and, you know, talk about this being a place for men and talking about their feelings or and this is where I see a lot of people, you know, I'm a little concerned about a tree, to be honest.

I see a lot of people using the psychedelic medicine in a very high intensity way, without the context of mental health. That's, you know, I think for a lot. Of us, that can be. Yeah, that. Can that is worrisome. Or just, you know, a lot of us are hearing a, I guess, a lot of stories, fracture, or this I am but and so we can talk more about that, but I think that's an example done well of a very powerful, high intensity experience sense where again, being in a non ordinary state of consciousness and kind of the current models are, you know, there's subtle manipulation around sort of activating inner healing systems and receiving messages.

But you know, there's also a lot of that that happens. And so it's a very wonderful thing to witness when it works and to be part of. so that would be examples, I think, of high intensity experiences.

Psychedelic Medicine and Finding Support 29:20

You know, for some people in Texas, experiences are also just speaking up. You know, some of my patients, it's really, you know, it's hard for folks to understand sometimes if you don't have bad anxiety, but just. To speak up for yourself. And speaking up at work or, you know, to a teacher or, you know, to a spouse or just, you know, speaking your mind a little more freely. So, yeah, true. This is wonderful. I always love our conversations. Now, thanks Terry, it's great to see you. Yeah, I look forward to the next time we can be together.

have some green tea together and, really have a deeper, deeper conversation. Well, thank you so much. And for everyone listening, I really appreciate your time. And I hope everyone hears, you know, in some ways a very simple message that, you know, mental health is and some of it is better than it's ever been before. We can talk about it. There's all kinds of ways to access it. and there's a lot of science behind the things that you can do. And, you know, the hope is that, you know, people can really minimize their suffering, maximize their happiness, use some of these new frameworks like mental fitness, you know, not, as, you know, fear mongering pressure that if you don't do these things, it's going to be dire and horrible, but is is a wonderful opportunity for us all to to feel our best.

I mean, it's it's a great thing about these interventions. It's kind of like the proof is in the pudding, try them out for a little bit and then, you know, I have experience at the sauna, like, go back for a reason. That's why it feels good. It does something in there. You can tell. So Drew tell us how people can find you. your, your website, social media handles, and the titles of your next book. Yeah sure Terry, thank you so much. And so if folks are interested to learn more about nutritional psychiatry and our clinical group, these, my what my website is drewramseymd.com, and @DrewRamseyMD on Instagram and Facebook.

I also have a website for our clinics, sprucejh.com. Spruce Mental Health is an integrative mental health clinic here. That's where I'm sitting in Jackson, with a dedicated team to do very responsible psychedelic medicine using Ketamine-Assisted therapy protocols. so we have a journey room and a nice space to allow patients, in the context of mental health concerns, to explore and utilize, utilize, you know, in some ways, everything that there is currently legally above ground available. also with, you know, hopeful that, you know, given the data coming out about MDMA and PTSD and MDMA lately being scheduled in 2024, we're very hopeful that have have all of the infrastructure set up to quickly and rapidly help people who continue to really, you know, suffer with mental health symptoms as there's evidence and new compounds available, which as you can appreciate clinically, going from, you know, a model by which, you know, people get medications and therapy to a model where people come in for eight hours now for very intense experiences or where we integrate, you know, it's been really a wonderful thing building a team to, to do that.

Well, so that's where to find me. The next book is Healing The Modern Brain, and I've got a new podcast, Dr. Drew Ramsey up on Spotify and Apple and YouTube where, we're going to have Terry on very soon as soon. As we're very excited. And, everybody, thank you so much for your time. I hope this helps you all feed your mental health. And, if you have any questions, easy to find. And, Terry, thank you so much for giving me an opportunity to share with your community. And, you know, thank you for being such a leader and inspiration to so many of us.

You just, I've always been someone with a foot in academia and a foot in responsible media and a foot in research, and then a personal advocate. And that's just it's it's just so wonderful for, the movement around health and brain health. And so thanks for being you, Terry. And thanks so much for, being supportive of me in my work. It just meant the world to me. Well, much love to you, your work and your family. Thank you Terry. Same to yours. And I look forward to seeing you soon. You got to come anytime you want to come and bask in the energetic power of the Tetons.

I will look forward to working with you with open arms.