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If panic attacks are very common across us as humans, and we certainly all experience some form of anxiety from time to time, is there a beneficial adaptation of this?
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If you go back to evolutionary psychology, what's the benefit of a panic attack?
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We're in the middle of a panic attack.
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How is this conceivably helping, or is it just miswiring?
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We've shared an email thread, but I'd love your thoughts on that.
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Yeah.
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Fear is evolutionarily favorable.
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And the thing that I think really strikes people when I say this is that your brain isn't concerned about your well-being.
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It's concerned about your safety.
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And so, evolutionarily speaking, somebody who's gathering berries in the woods and hears the growl of a hungry tiger in the woods and is able to effectively mount a fear response that is strong enough to quickly get them out of danger will be more apt to be able to reproduce and die.
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pass that trait on to their descendants as opposed to somebody who maybe has a blunted fear response or perhaps those who flop and they aren't able to get away or fight the danger.
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And the thing is that our brain isn't very good at discerning real from danger sometimes.
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Have you ever heard of the study of the little Albert study with the kid and the bunny?
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No.
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Okay, so this is an old, they were so mean to kids back in the day.
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There's this study.
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It took this little baby named Albert, and they sat him down, and they put a fluffy bunny in front of him.
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And he's, like, reaching out, and he's touching the bunny.
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He's like, oh, this is so nice.
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And happy, happy bunny, no fear.
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The next time they put him in front of the bunny, they blast a loud horn behind him and scare the living daylights out of him.
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They repeat that stimulus.
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They expose him to the bunny, the loud horn.
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And so then he started to cry when the bunny came near, even if there wasn't the scary horn.
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It's the Pavlovian effect.
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Like this is not rocket science, right?
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Right.
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So what we found in that research that was, I think, a particular interest in this conversation is that his fear became generalized to all sorts of fuzzy critters.
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And so people who experience panic and anxiety oftentimes are,
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that feels like out of the blue, or I have no idea why I'm having this response, it could be that, number one, they have this predisposition to having anxiety to begin with, perhaps evolutionarily favorable.
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And secondly, is that the body has stored some sort of association with that cue that's in their environment as dangerous.
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And the salience network is an association of brain areas and the insular, the thalamus.
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And it's scanning all of the data in the environment, billions and billions of data points from your external environment, your internal environment.
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And its job is to decide, is this relevant?
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And I need to pass it on to the amygdala, the emotional processing part of the brain, or is this irrelevant?
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We can ignore it.
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We ignore lots of stuff going on around us.
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But...
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There may be things in the environment that we don't know that the insula sends to the amygdala, and the amygdala asks the hippocampus, hey, have we seen this before?
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Memory part of the brain.
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The hippocampus is like, oh, yeah, this reminds us of this, this, and that.
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And then the amygdala will send on a fear signal to your hypothalamic pituitary adrenal axis, and we may be panicking before the prefrontal cortex, your logical brain, even knows what's going on.
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And so not only is this biologically wired into the human brain where emotions travel faster than thoughts and logic, but then these stored programs that are adaptations that are trying to protect us can become maladaptations that actually create panic and anxiety, which can feel like they come out of the blue.
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Yeah, because you you can't they you feel them, you can't explain them.
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And in fact, when you try to explain them, they make no sense.
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So the traditional ways to address these right and you went to school and learned some of these, maybe not so much from a psychiatrist perspective, but certainly some of that training, I would imagine.
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It's about the chemical imbalance theory, but that's not a complete picture.
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How do you view the chemical imbalance?
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Well, first off, what is the chemical imbalance theory and how do you kind of view that theory?
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Yeah, I write about this in, I think, chapter six in the book.
Load full transcript
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And so the chemical imbalance theory came from when they discovered a teeny little cell in the gut and they called it enteramine.
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which is serotonin.
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And so they're like, wow, this is an amazing groundbreaking discovery.
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What does it do?
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And they found that if you were to manipulate the levels of that neurotransmitter so that there were more serotonin available, that interestingly, some people felt better.
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And so there's a big jump in conclusion.
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Oh, more serotonin means less depression.
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Less serotonin means more depression.
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Therefore, depression must be caused by an imbalance in serotonin.
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We just got to give people more.
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And so then naturally, pharmaceutical companies were like, let's try to help give more serotonin.
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So they created Prozac.
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It was the
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the first psychiatric medication.
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It took more than 20 clinical trials to beat placebo, but that's neither here nor there.
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We don't have to talk about that.
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That's neither, right?
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Placebo.
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Yay, it beats placebo one time in one study.
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And so, by the way, I've just had some conversations recently about this because because in our mind, like we just said, it beats placebo.
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And and the way that I've always interpreted that and probably a lot of the audience is like, oh, great.
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Then it cures depression.
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No, it has some impact on depression or whatever it is they're trying to address.
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And it can be as low as a three percent difference.
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And now you have a viable medication.
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That's crazy.
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But go ahead.
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Touche.
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I love it.
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Yes, it's true.
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And so then we made this gap, this leap across this huge chasm, and now it's a cause and effect.
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And not really much changed.
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And this was in the 1960s until around 2022.
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There's this giant meta-analysis that was done looking at the research papers pertaining to the philosophy that a chemical imbalance, aka balances in your neurotransmitters, so serotonin, dopamine, and
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adrenaline, things like that, that that's the cause of mood disturbances.
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And it turns out that that was completely unsubstantiated.
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The data did not say that.
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And so 2022, we're like our main understanding of mental health is now out the window and
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And it leaves us scratching our heads.
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And I think that's the best place to be in medicine and research.
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Because when we don't know, that's when we get to start being curious.
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Right?
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We get to start asking questions.
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So your depression is probably not caused by a chemical imbalance.
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Maybe it could be.
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Some people do truly feel better.
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But it may not be because your serotonin goes up.
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Some antidepressants.
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tend to be a little bit anti-inflammatory.
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And there are also domino effects that can occur with these medications.
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So it's not necessarily like stop your antidepressant.
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They don't do anything.
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That's not what I'm saying.
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I'm saying that the conclusion that we drew that says that a chemical imbalance is the cause of your depression, that that is not a scientifically rigorous conclusion.
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So is it possible that the chemical imbalance is in fact the cause, but the solution is significantly more complex than just introducing more of that chemical, more or less, or trying to control that specific chemical?
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I think that's a really brilliant hypothesis.
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It's not cause, but yeah.
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I like the direction that you're going though, because you're looking at, we know that manipulating chemicals in the brain can create changes.
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But how do we get between the letter A and the letter Z?
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What are all of the letters in the alphabet, all the biofeedback loops in the middle of that?
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We don't know.
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We don't know.
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We have tons of theories.
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And I talk about tons of them in the book.
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But wow, we have a lot of questions that we don't have answered.
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And I think that's really exciting for mental health.
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And my impression is that there are a lot of medications that, yeah, great for depression also may cause suicide, right?
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Like there's these situations where it's counterintuitive.
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I think even Ambien falls into, hey, great for sleep, but you may find yourself driving down the middle of the road still asleep later, right?
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So it really is significantly more complex than I think the...
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That theory suggests.
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All right.
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I want to interject there really quickly.
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I think what you're pointing at is something really important is that even if symptoms are mitigated, we don't see evidence of greater health.
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And I think that what you just pointed out was really important.
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And really, I think something to think about is, okay, maybe the goal is to solve the problem of anxiety and you're not anxious anymore, but now you're suicidal.
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Well, I solved the problem, but we don't see greater health.
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And I think that's the rate limiting step.
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So thanks for letting me interrupt you there.
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Yeah, I know.
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I like that.
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So so again, it needs to it goes back to kind of traditional medicine tends to be the whack-a-mole situation as opposed to like, hey, there's a whole game here.
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And if you could just get under the game, you can figure some stuff out.
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I hope you enjoyed this episode of the Live Beyond the Norms podcast.
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