Richard Jacobs: Hello, this is Richard Jacobs with the Finding Genius Podcast now part of the Finding Genius Foundation. Today, my guest is Dr. Chris Aiken, director of the Mood Treatment Center. He’s also Editor-in-chief of Carlat Report. He’s an instructor in Clinical Psychiatry at Wake Forest University, part of the School of Medicine.
Tell me a bit about your background. How did you get to the university you’re at, become the director and all that? Also, I want to go into your current work.
Dr. Chris Aiken: I came through this work, starting out my career working as a research intern at the National Institutes of Mental Health. I had a background in computer science, actually, but I wanted to work with people. I didn’t want to just sit at a computer all day the rest of my life, so I made a swap. I said, I’ll do your computer work if you teach me Psychiatry, and got started there, went on to Yale Medical School, and then to Duke here in North Carolina for the rest of my training. I just love it here in North Carolina. So I’ve settled here the past 20 years. While I’ve done that, one thing that’s unique about where I practice in North Carolina is that there’s not a lot of Psychiatrists. So I’ve gotten to see a lot of patients that I wouldn’t get to see otherwise. I became pretty attuned to something going wrong in the way that we are treating people with depression, something that surprised me. It took up that and took up some of the research and worked with Harvard clinic on developing better diagnostic instruments to identify Mood Disorders more accurately. I work with some other people throughout the country to identify better treatments. A lot of those treatments involve not just medications, but things that people can do in their own lives.
Richard Jacobs: What kind of conditions are you focusing on?
Dr. Chris Aiken: Mainly with mood disorders, which are characterized as bipolar and depression. There’s a whole spectrum between them from what most people think of is bipolar disorder, which we call Bipolar 1, where people have full manias and full depressions all the way on the other end of the spectrum where people have just depression. One thing that’s interesting is the recognition in the last 20 years or so that there’s a lot of people in the middle who have features of both and don’t fit nicely into the diagnostic classifications.
Richard Jacobs: If you talk about some of the mood disorders, what are the characteristics of bipolar disorder and depression? How do you characterize these various disorders that you see?
Dr. Chris Aiken: It’s easiest to think about these as disorders of energy, not of emotion. All emotions are normal for people. Psychologist sometimes divide them up into the nine basic emotions, everything from surprise, disgust, joy, sorrow. Whereas, mood disorders are really more about the energy, your motivation, and your drive. In depression that gets turned way down and people don’t have any motivation to do anything. They don’t feel any urgency to anything, all the way up to the manic level where energy and motivation are super fused, and people are doing way too much.
Sometimes at the manic level, they’re doing things that are very productive and colorful. Things you might read about in the papers like having affairs and starting new businesses, but more often, they’re just literally going in circles. We’ve done studies where we’ve put Fitbit type monitors on people with this type of mania. They just literally run around in circles, they might move all of their furniture from one room to another kind of meaningless, random, and destructive activity. There’s also manias, where people are very goal directed. They will literally change all the decorations in their house and redo it in a way that’s very colorful and very organized.
Richard Jacobs: These episodes where they get into, such as mania where they all of a sudden get focused and are hyper actively doing a ton of things. Do you contrast that to the times where they just can’t bring themselves to do anything? Is that with this bipolar disorder nature? Is it everything or nothing?
Dr. Chris Aiken: Like I said, a lot of people don’t have bipolar or of any sort, they just have the depressed side. It wasn’t actually until 1980 that as a field, we Psychiatrist even bothered to separate the two because for 100 years, people had tried to tease them apart. Jimi Hendrix sings, “Manic depression has captured my soul.” What does he mean? Well, back then in the 60s, we just called all mood disorders, manic depression. Whether you’re a manic or depressed, it was all lumped into one box. In 1980, they tried to split them apart and have called one side bipolar, when you got manic and depressed, and one side depression, where you just got depressed.
What’s happened since 1980, is just a ton of research telling us that the separation is not as clean as we’d like it to be. There’s a lot of people in the middle who have depression with maybe some agitation racing thoughts, they feel kind of wired. They might say, they feel tired and wired at the same time. In essence, there are two opposite forces, pulling them apart at the same time. It creates great anxiety. The opposite forces don’t cancel each other out, like we would like them to. So they’re pulled in a manic depression. They’re driven to do something and they’re pulled in a depressed direction. They don’t know what to do, so they have this restless feeling, this anxiety, the constant feeling of something terrible is going to happen. There’s kind of an urgency to desperation. In psychiatry, we call that a mixed state because the two are mixed together.
Richard Jacobs: If you’re working with someone that has bipolar depression versus just depression, what do you have to watch out for? What do you have to do to help them? Between those two different conditions, how different are they?
Dr. Chris Aiken: Night and day, it’s amazing and that what really changed me in recognizing that we weren’t treating it right, because the big difference is that if you’re on the depressed side, antidepressants are generally going to help and they’re not going to do much harm. There might be some physical side effects, but they’re not going to do much mental harm at all. If you’re on the bipolar side, and antidepressant, which is what most doctors prescribed for mood disorders, is going to make your mood worse. It might make you feel even more depressed, more agitated, irritable, anxious, tired, wired, and not able to sleep. Even it can make you feel full blown mania sometimes, although that’s a lot more rare. We have to be very careful these days about how we pick who to give an antidepressant to and who did not.
Richard Jacobs: What’s to be done with people that are bipolar? Do they need two kinds of therapies, one when they’re manic and other when they’re depressed? Also, you said, the difference is night and day.
Dr. Chris Aiken: When I said night and day, I meant the difference between people with just depression and those with bipolar depression, so they have ups and downs just like night and day because we use very different medications for the two sides. But to your point, suppose someone does have bipolar of some sort. There’s many different types of it, then we’re really looking at addressing their mood disorder from a different direction. We know two things that are different. First, this is almost always going to be a lifelong condition, we’re going to have to use a lot of prevention. Second, what is driving their depression is what we call Cycling. So their mood is cycling, like a sine wave going up and down. We can’t just simply stop the depression, else we’re going to create more mania. So the goal is to stabilize that cycling. In doing so, we use mood stabilizers, the oldest of them is Lithium. It’s still surprisingly one of the best in the research for a lot of patients. It still stands out, but in the last 20 years, they’ve developed a lot of other mood stabilizers that we use as well.
Richard Jacobs: Does it seem like mood stabilizers help bipolar people, they never get too low or too high? Is that what it does to them? What’s the effect?
Dr. Chris Aiken: In some ways, that is the goal with it. On the other hand, we don’t want people to feel what you might call over stabilized. I see that more as a side effect, where if we use too many medications, people might feel sedated. They might not be able to feel their emotions, but this is not an emotional disorder. We’re not looking to treat people’s emotions or medicate their emotions. In essence, that’s not the goal here. In fact, a lot of Psychologists are thinking of mental health. This is something called the mindfulness direction. For those of you familiar with mindfulness, as the ability to feel and accept all of your emotions, emotions are very important signals they guide our decision making. There are studies where they find stockbrokers who are more in touch with their anxiety, for example, have better returns make sense when you think about it. So we don’t want to block people’s emotions, we don’t want them to go through their life judging their emotions or thinking that their emotions are off. The one thing that happens when people come out of mood disorders, they end up second guessing everything they do, like I’m really angry at my spouse, but then again, I have bipolar. Should I say anything? If I do, she’s just going to say, “Did you take your medication?” Just imagine this, it’s like, you can no longer speak up for yourself in the world or express anger without people thinking you’re ill or you thinking you’re ill. So we do a lot of therapy work around that. We certainly don’t want the medications to make them feel over stabilized. It would be a side effect if they’re suppressing their emotional life.
Richard Jacobs: Are you saying that once you’re labeled as bipolar, anything you do or any way you act is viewed through that lens?
Dr. Chris Aiken: Very much, I think that people are treated differently. They internalize that and they see themselves differently. In other words, this is a real, you could say, identity crisis. Here we are as doctors, nurses, and therapists, giving out this identity. We need to do it very carefully. I don’t think we’re doing a good job of that, we need to do a better job of explaining to the public and to the patient what this really means, because this isn’t really about who they are. There’s not a stereotype of who a person with Bipolar is. I first started my career I remember seeing on people who are literally quiet librarians with bipolar. It’s not the stereotype at all, it can affect anybody. It’s not a statement about your personality or your emotions.
Richard Jacobs: People that are bipolar, is it more important for them versus anyone that they have kind of a support network of other people like them? Do they not tend to interact well with each other? Does it become a self-absorbed or self-absorbing type of disability, where’s the nature of being bipolar, like self-absorbing condition where you just don’t have room or space to interact with a lot of other people?
Dr. Chris Aiken: It’s a great point. I think it’s very helpful as particularly as a starting place, if you’re first diagnosed to meet other people with it. It can give you hope that there’s a road ahead and you can recover fully. It’s the unique thing about depression and bipolar, they can expect a full recovery. There’s just a lot of things that go on in your mind that you probably never share with anyone else. So it’s helpful to see other people who have similar kind of thoughts and that you’re not alone. I think that’s helpful for anyone.
Now to your point, we have studies showing that people with bipolar disorder are a lot more extroverted on average, than people with depression. I said that it doesn’t tell us anything about their personality and I was somewhat wrong there because the studies we do have shown that on average, people with bipolar disorder have actually personal strengths;
I tend to be kind of action oriented, so they can move forward. This gets to be sometimes a problem in therapy. A lot of times therapy is built on looking back and understanding the past. Many patients with bipolar want to move forward and build something positive in the future, so that can be a conflict there.
Richard Jacobs: When bipolar people are in depressed mode, how is that mode different from people that are just depressed?
Dr. Chris Aiken: it’s practically identical. The only difference we’ve found, which pretty much makes sense is that the bipolar depressions have more signs that they’re biological (physical) symptoms, such as your arms feeling really heavy, your appetite being higher low, you’re in your mind, you just literally can’t think, you can’t go from one thought to the next, your brain is not functioning, your sleep is really off, and your energy is really down. So those symptoms will be more prominent and Psychiatrist called those Neurovegetative Symptoms. It’s one of our fancier words, which tells us that there is a strong biological component to this depression.
On the other hand, we see a lot of that and people with regular depression. The difference is that when the Psychiatrist use the word Depression or in the DSM, Major Depressive Disorder, it’s the same thing. We know that represents a whole lot of people with very different problems;
So there are many different types within the category of depression. When we talk about bipolar depression, there’s not as many different types. Certainly, a person with bipolar disorder can get demoralized just like anybody else can, but they’re also going to have a lot of these biologically driven depressants that we can recognize.
Richard Jacobs: You talked about treatment being night and day. What are some of the fundamental differences in successful treatment that you observed?
Dr. Chris Aiken: When we talk about medications, it’s basically night and day. I’ll read some of the mood stabilizers that we use these days just to get the names familiar;
There’s a whole handful of about 15 or so that we use as mood stabilizers. They don’t have any antidepressant qualities. They do treat depression, but they do not resemble the chemical structure or the chemical effects of an antidepressant.
Richard Jacobs: Has anyone tried mood stabilizers? Does it work better or differently for them than antidepressant medication?
Dr. Chris Aiken: Well, that’s exactly the point, people started to make when they tried to split them in two. They did that in 1980. Immediately, Psychiatrist started arguing back to the DSM’s creators saying, “How can you split them in two? There’s people with regular depression, not bipolar, who respond really well to Lithium.” It was back in 1980, now if you look at some of the meds I mentioned, some of them are actually FDA approved to treat regular depression. Some of the ones that cross both areas are Abilify (Aripiprazole) and Quetiapine (Seroquel), these are FDA approved in both disorders. So the answer is yes. It’s the part of the evidence as to there being an overlap between these two poles of Only Depression and Bipolar Depression.
Richard Jacobs: Are you up to date on the latest and greatest in treating bipolar disorders? What’s coming or what’s new?
Dr. Chris Aiken: Yes, the latest is not always the greatest. Earlier, I mentioned that the old one, Lithium was discovered in 1949 and it continues to surpass many of the others in long term treatment studies when we look at people for the long term. Now, that’s a kind of an important distinction, because in our country to get something FDA approved, you only need to do a six week study. Once you’re FDA approved, you can do all the marketing and advertising you want, and just convinced every doctor on the whole public that this is the answer for bipolar depression based on a six week study. We’re talking about a condition that affects people for 50 years, like what is six weeks? So Lithium really shows its superiority in the long term studies, but in terms of what’s new, we have Lumateperone, whose brand name is Caplyta. It got FDA approved last year for Schizophrenia, then this year they found that it treats Bipolar Depression.
Right now, the FDA is looking at the papers and I expect it will be approved in the fall or winter. I have looked at the studies myself and most of them were positive. I think enough to satisfy the FDA, that’d be the latest.
Richard Jacobs: What’s special about this latest drug? What is it do that the other ones don’t?
Dr. Chris Aiken: In some ways, it’s not special at all because it’s classified as an Atypical Antipsychotic. These have been the drugs that have made the biggest splash in the last 20 years as drug companies have gotten them approved for all sorts of things from Autism. In that respect, it actually just treats aggression during Autism. Sometimes this can be misconstrued as though it’s a treatment for Autism, but it’s really not Schizophrenia, bipolar, or depression. They’re used for a lot of things. They have been highly profitable medications in 2015. One of them is Abilify (Aripiprazole), which rose to number one as the biggest money making medicine of the year. It got me thinking, like “In America, what do you think about that the number one profitable medication would be an Antipsychotic? Are we all psychotic in America, like what is going on here?” Things gotten out of hand with this. These Antipsychotics are a bit over prescribed, over market, overused and limited prone is going to be one of them. It is a little different from the others and that it doesn’t block dopamine as much. The bottom line of what that means is, it seems like it’s going to be better tolerated for patients, which is very important.
Richard Jacobs: Is it prescribed just for people that are having psychosis or is it probably prescribed for people that are just depressed too?
Dr. Chris Aiken: No, I don’t mean to say that. Everybody in America is psychotic because the Antipsychotic are going out there. What I am referring to, is that we always respected in Psychiatry, going back to the 1960s and 70s these Antipsychotics are serious medications. They’re what you might call heavy duty. Most of them have about 6 or 10, black box warnings of serious things that can happen. We don’t like that. I mean, an average medication might have zero or one black box warning, we don’t want six. So they should be used for people with serious psychiatric illness is what I’m saying. People are not having severe dysfunction from their psychiatric problems, it may not be the place to go unless they actually have Schizophrenia, which is where people hear things, see things, get delusional and paranoid. It’s what the Antipsychotics were developed for, back in the 1950s, until recently. It’s what they’ve always been used for. It wasn’t until 2000 that they started to gain all this FDA approval for other conditions.
Richard Jacobs: Is there a drug or prescription creep? Meaning drugs are approved for X, Y or Z, but in the field, maybe there’s a lot of frustration in treating depression and bipolar disorder, etcetera. Therefore, drugs that should not normally be prescribed are being prescribed.
Dr. Chris Aiken: I’ll just tell you a story of how that works. Now in my practice, I no longer allowed drug reps into the practice, but I used to and meet with them. One of them brought me a study of an Antipsychotic and Schizophrenia. He said Dr. Aiken, “I just want you to look here at what it did for the anxiety. Just look at that.” We’re talking about people with Schizophrenia who are paranoid. Of course, it’s going to help their anxiety, but what was going on in that conversation, was she knew that as a psychiatrist or any doctor, the main thing that doctors treat is anxiety. Why would you go to the doctor? Unless you’re anxious, so anxiety is kind of the catch for why people go to doctors of any sort, because they’re worried about something. If you can talk a doctor into treating anxiety, well, you’ve just got a blockbuster drug. So that is an example of prescription creep.
You can see it in the numbers and you can see evidence of prescription creep with a lot of things from stimulants for adult ADHD. Those have exploded beyond rational numbers in the last 20 years. Even one of the founders of that field, Keith Conners who died a few years ago. He at the end of his life, turned against what was going on and stopped giving pharmaceutical sponsored talks, and instead started giving talks on how we need to turn back the tide with all of those stimulant medications that people use for ADHD and people take off label in a creep kind of way to enhance their cognition. You could classify Ritalin as a nootropic, but it’s really a psycho stimulant. Its prescription is a controlled substance, a drug of abuse. I want people to know that some of you may have heard of this journal, I think it was either nature or science. One of those top science journals surveyed their readership as to who is taking psychostimulants to enhance their work and stuff. It was 30%. I don’t think that 30% of top scientists have ADHD, so something’s going on there.
You can do the same study with professional chess players, with all kinds of people working at a high level, Judy Garland or Elvis Presley. People have to go on stage, be up, energetic and perform. People with high pressure careers, John F. Kennedy and Hugh Hefner have for long term stimulants to enhance their productivity. Let’s take John F. Kennedy and Hugh Hefner. Both of those men were on stimulants in the 60s. In both cases, there close cohorts had to grab them by the hand and get them off them because it was making those two people paranoid. One of my biggest concerns with them is they can make people paranoid. Another concern, and this is a new study. They found that indeed, for a lot of people, these do enhance your cognition the day you take them. Frankly, rectified take a stimulant, I’ll probably do a little better on my SATs, but then they looked at it the next day. They found that people did worse the next day. Why was that? It was because the stimulant was disrupting their sleep quality and sleep is the best nootropic that’s where learning sets in, whether you’re learning a new sport, a new musical instrument or learning textbook stuff, that’s where it sets in and improves our performance. During sleep the brain whittles away memories that we don’t need and preserves the ones that we do need for what could be better than that. Right? It’s a great mechanism. So we don’t want to disrupt sleep.
Another study came out looking at the effects of these stimulants. We’re talking about Amphetamine, Adderall, Ritalin, and Vyvanse. Professional chess players, we knew they were using them. So let’s just see what they do. Here’s what they found. The chess players lost more games on the stimulant. Why is that? It’s because these are performance enhancing drugs. What I think happens here is that cognition (thinking abilities) are very complex and it’s hard for me to imagine a drug that’s going to make it better across the board. Usually, it’s going to change things and make some things better and some things worse. We know these stimulants can make people a bit obsessive, hyper focused, overly detail oriented, kind of self-conscious, or second guessing everything. You’re overly attempted, like the opposite of ADHD. You check everything three times. Basically, the bottom line is that the chess players were losing more games because they spent more time and second guessing their moves on the stimulants and that was the problem.
Richard Jacobs: I’m sure there’s also a crash where you’re depleted of X, Y or Z and then you feel like crap. You’d have it again, so it leads to probably an addictive cycles.
Dr. Chris Aiken: You sound like you’ve talked to some people that have taken them because the one of the hardest diagnoses for a psychiatrist to make is so called adult ADHD. Do you know how many adults think they have concentration problems in this world? Often, it’s because of sleep deprivation. Anyway, we have a very hard time making that diagnosis. So if we do make a mistake and give those patients say, Adderall. They come back with the kind of story you just described. One is they feel it more as an energy pill, then a concentration and hamster. They’re not really more organized, they’re not getting things done in a more meaningful way, and they’re just more energized. You get that crash, where at the end of the day, you feel drained and you get that cycle, then you get tolerance to it. After a couple months, you want a higher and higher dose, because it’s not working like it used to.
Richard Jacobs: There’s a lot of medications like natural supplements. I could see why people might think they not work, because they’re very subtle, but drugs seem like a really strong punch to the head. They leave you hurting later, it just seems to be a universal theme.
Dr. Chris Aiken: I fully agree with you. I use that analogy of a punch to the head for something that scares me. In our work there is something called Neurotoxicity and Neuro-protection. So that’s a field that pharmacology is going in. We want more medications that enhance Neuro-protection, so they help the brain cells repair, grow and strengthen. I have good news for the people that nearly every psychiatric medication has been shown to have some Neuro-protection involved, particularly Lithium. All antidepressants have mood stabilizers. The ones that have not are mainly the stimulants we just discussed and the Benzodiazepines, which are like Xanax, Klonopin, and Ativan. If you know about these two meds, they are also drugs of abuse.
One thing that stands out in my mind is, the way I’m thinking. I’m not just worried about people abusing drugs. Of course, it’s on me because I wrote the prescription, but they might abuse drugs anywhere. They can get these things anywhere. I’m worried about causing neurotoxicity to people’s brains, that’s like as a psychiatrist, the number one thing I don’t want to do. The brain is a very delicate organ that’s why it’s protected by this big skull. It’s the only organ in the body except the kidneys that you can’t feel. When you go to the doctor, she’s going to stick her fingers up your ribs to feel your liver, they can feel every organ, they can even feel your heart beating there, but your kidneys and your brain, they can’t palpate and feel.
Richard Jacobs: What do you mean? It’s essential to protect those organ because you’re not going to feel anything and all of a sudden, you’re going to have a problem.
Dr. Chris Aiken: You can’t live without them. You may hear about these really extreme cases where somebody is submerged in a cold lake for hours, and they somehow live. Basically, the body just shuts all blood flow to the kidneys and the brain, like keep those alive at all cost. Back to Neuro-protective, I have nothing against them. If I just feel like if we’re going to use them, let’s make sure that they do well for the brain health long term. Sleep is Neuro-protective that enhances brain growth. Without sleep or even just leaving the lights on at night, it’s going to shorten the dendritic spines that are involved in learning and cognition. Imagine that you’re sleeping with the lights on and the light is passing through your eyelids and your brain is not getting the healing that it needs. Mediterranean style diet is highly Neuro-protective for a lot of reasons. Within that diet, blueberries, we have the most evidence for enhancing cognition. There are now about 12 studies, some done in children and many done in older folks. We’re just having the average dose about half a cup of blueberries a day and within a month, we can see changes in cognition and brain function in a positive direction. You could possibly add dark chocolate to that list as well. Although, there’s some risks there for your teeth, reflux, sugar, and diabetes, but there’s a lot of good in that dark chocolate as well.
Richard Jacobs: What do you see besides just a new drug? Is there anything in the near term future of depression that you think will be very helpful?
Dr. Chris Aiken: Back to what brought me into this field. The part that inspired me was realizing as I trained in med school in the 90s, that we’re entering the kind of pharmaceutical way of thinking about all our problems like, I’ve got a problem, there must be a drug for that. It goes on, whether you have mental illness or not. Everyday people feel that way including people with schizophrenia. They’re looking for that solution. Obviously, I prescribe medications all day, I have nothing against that solution. I just felt like we were losing track of some of the other things we can do. I want to empower people to take a more active role in their life and not just feel like medications is the only solution they have.
The things I’m talking about, they largely don’t have any funding behind them. For many of them, the science is just about as good as what we have for medications. The effect in the study, one thing we look for in medicine is called the Effect Size, which is basically how much better than a sugar pill is it or a fake treatment of placebo. We want things with a big effect size where we can see a difference. So when it comes to lifestyle interventions that have a big effect size, talking about aerobic exercise, 30 minutes a day and the Mediterranean style diet, both of these have effect sizes that are equal to or surpass antidepressants. They’re better than antidepressants in other ways, like they help cognition and concentration, they help sleep, and they help your physical health. Those are pretty well known. I think people know that the Mediterranean diet is healthy. There’s lots of resources online for that. It basically involves eating a lot of vegetables and fruits of different colors, particularly berries are good for the brain, dark green vegetables like Kale, Broccoli and Spinach, and eating a variety of nuts. Some people say, almonds or walnuts are the best for the brain. They’re just the most studied, but the probably the key is getting a variety. More fish and lean meats. They’re kind of pretty obvious as a standard healthy diet. I went on this diet myself, when I learned about it five years ago.
There are two things that were new to me. One is changing all of your oils and butters to extra virgin olive oil. It has extra ingredients in the extra virgin, like polyphenols that help protect the brain. You can think of them like antioxidants and vitamins. One myth about that is that you can’t cook high heat with extra virgin olive oil. Well, I’ve seen some new studies where they’ve compared them to other oils. Extra virgin, actually comes out better because it has those extra antioxidants in it. It’s less likely to degrade under high heat. It has the protection built in.
The other thing that was new to me was switching all of your carbs to 100% whole grains. A couple things about me, I didn’t know anything about nutrition when I went on this. I’ve read that and I thought, well, bread is bad for you. They must be just doing that as like a lesser of evils, but no, the whole grains are so good for you. They prevent diabetes, they have many benefits beyond the brain. It’s not just a lesser of evils, you actually want to eat whole grains. The other myth is just that there’s a lot of products out there that advertises like made with whole grains, wheat, bread, and multigrain. None of these are any good. It just means they sprinkle in a few whole grains and the rest of it is enriched, stripped away junk. So you want it to say 100% whole grains or the first ingredient should be whole wheat, whole corn or whole whatever grain it is. Some of them have an orange stamp that says Whole Grain Council, which is nice, otherwise there’s no real official labeling unfortunately. You can substitute your pastas for 100% whole grain, your white rice for brown rice, and popcorn. If you make it at home as healthy as 100% whole grain you can get crackers, breads, cereals, and a lot of pancake mixes out there 100% whole Grains. Anyway the bottom line with these things is the most people know that fruit is healthier than fruit juice, because fruit juice is stripped away of a lot of the fiber and nutrients. You’re just getting the sugar, so it’s the same analogy here. Regular bread is stripped away of a lot of the good stuff and just left with the bad stuff. Whole grains has the whole thing and extra virgin olive oil has the whole thing. It’s not stripped away of the good stuff.
I went on this diet about five years ago. I just did it as an experiment to know what my patients are going through, and I can’t get off it now. If that’s a side effect, like I love Chick-fil-A sandwiches. I can’t have them, now I feel sick if I have them. It actually changes your body. I didn’t know about that I thought I’d just try it out. Now, I’m stuck with it. I go out, like today I went to this wonderful breakfast place. I would have loved the chicken and waffles, but I had to get the whole grain salad because I know how I’m going to feel three hours later. One way that it changes you as it changes the microbiome and billions of bacteria in your gut. It has been another area of new directions in mental health. From anxiety and depression all over, is understanding that a healthy microbiome is going to secrete chemicals that are absorbed into the system and then communicate through the vagus nerve with the brain and through the inflammatory system that make us less depressed and anxious, better concentration, less tendency to crave junk food and be obese.
An unhealthy microbiome, which happens when we eat too much of the western style diet. We’re talking here about the things you want to avoid on this Mediterranean diet, such as simple sugars, fried foods, processed foods, fast foods, sweets, and simple carbs. When you eat too much of that, you get a less diverse and less healthy microbiome. They secrete the opposite chemicals. They secrete chemicals that make you more inflamed and more wanting to crave junk food or the stuff that they want to eat. If you think about it, the bugs in your stomach are making you want to eat the stuff that they want to eat, like McDonald’s. If you’ve seen the movie Super-Size Me, you know what I’m talking about. The guy had depression after a month of that. It gets to two areas of where we’re making new discoveries. Inflammation, we’re finding that 30% of people with depression have a strong degree of inflammation causing the depression. So what I mean by that is, there’s inflammation in the body, which is what happens when your body’s trying to fight off infections and bad stuff. After COVID the long post COVID syndrome is one example of inflammation, but even before COVID we knew that 30% of depressions have a lot of inflammation. Now we’re trying to develop Anti-Inflammatory therapies and medications, which can cut through that.
Right now, the thing that’s most successful for inflammatory depression is Anti-Inflammatory lifestyle, which is Aerobic exercise and Mediterranean diet. You can take a prebiotic, there’s about 30 or so studies showing that does improve anxiety and depression. It can be helpful as well, but probably you’re going to need to. If you swallow that probiotic, you want it to have a good place to land. So you want to have a good garden or a good array of prebiotics. Prebiotics are basically the foods that healthy bacteria like to eat, such as fiber. The stuff in the Mediterranean diet, nuts, and berries, you want that in there so that they have a good place to land and they can thrive.
Richard Jacobs: What’s the best way for people to find out more about your practice? I don’t know what areas you serve or don’t serve in telemedicine, but what are some resources?
Dr. Chris Aiken: We’re finding that mainly bipolar, but also regular depression are highly driven by abnormal Circadian Rhythms, the 24 hour cycle. It’s really important to everyday health as well. I’ve taken that on in my life, I don’t have bipolar or depression, but it helps me function better.
To put it in simple, is having bright light in the morning, such as outdoor light or a light therapy, like a Dawn Simulator that turns on a gradual sunrise in the morning. These help depression and total darkness at night because we have so many blue light emitting devices at night from iPhones to laptops. Even energy efficient bulbs emit a lot of blue light. We have our patients wear these orange glasses that filter out a hundred percent of blue light and they put them on about two hours before bed. The result is they sleep deeper. They sleep in a pitch dark room, especially they wake up with better energy, concentration, less depression and a lot less bipolar. I started wearing them and when I don’t wear these glasses, people tell me I’m more irritable. So something must be going on with them. A lot of sports teams are wearing them as performance enhancer in a way because that deep sleep improves your sports performance.
If these are the things you want to put into your life, the place to start is www.psycheducation.org. It’s a nonprofit website that I created with a Psychiatrist, Jim Phelps. He helped develop these what we call Dark Therapies and these orange glasses that trick the brain into thinking they’re in pitch darkness and help people sleep better at night. We have a lot of information and resources there about where to buy these products on Amazon. There’s a lot of blue light filtering glasses out there. It’s getting quite popular, but most of them are not blocking a hundred percent like people need. There’s only a few that really do that.
