Hey y'all. I'm Dr. Alo Kenoja, a Harvard

trained psychiatrist, and today we're

going to watch some comedians joking

about mental illness. Hopefully, we'll

laugh. But what I really want to do is

explain the mechanisms behind the joke.

So, let's dive in.

>> Self diagnosed with a dissociative

identity disorder.

>> Dissociative identity disorder.

>> It's dissociative.

>> It wasn't me cheating on you. [laughter]

>> Self-dagnosed. Important.

>> What does that mean, though?

>> What that mean? That's what used to be

known as m multiple personality

disorder. It's a controversial

diagnosis. I'm not getting into it.

>> Yeah,

>> you can. Just so you know, like you can

totally

>> You get to walk off stage after this. I

got to meet these people in the parking

lot.

>> When you say these people, do you just

mean one?

>> Okay. So, let's get into multiple

personality disorders and why it's a

controversial diagnosis. So I once asked

one of my mentors, professor of

psychiatry at Harvard Medical School,

hey are multiple personalities real? And

he said,"I believe in multiple

personalities in the same way that I

believe in aliens, which is like

statistically yes. There is probably

something out there called multiple

personalities or people do really have

multiple personalities, but I never

believe anyone who says they've seen

one." It was, you know, it was it

happened within literally 24 hours and

it was like here's my two other

personalities and their names and I was

like,

>> can I ask and I don't mean to be rude,

but remember this is all fake. Uh,

[laughter]

>> we'll talk. Okay, so is it fake? We'll

get to the fakeness later. [laughter]

>> We we'll we'll talk about is it fake?

>> Can I ask?

>> We'll explain what it is.

>> Can you like tell me like when when they

introduced the other people, was it like

Actually,

yes.

>> Or was it or was it like they're back

here

>> to tell you what they're saying?

>> Both. Okay. So, this is really

interesting. Let's understand what

multiple personalities are first of all.

So, normally you have your mind, right?

And your mind is connected and you adopt

different roles. So, like if I'm, you

know, deeply in love with someone in a

secure relationship, I may start talking

to them in like a baby voice. Oh, baby,

I love you so much. Oh my god, you're so

amazing. I love you. And then when I'm

like when I go into work, right, I may

adopt a different personality. So I'

I've worked with patients, for example,

who are executives at highpowered

companies. And one of the really

interesting things about media, which is

somewhat correct, is sometimes people

who are in an very dominant positions

will engage in like submissive sexual

fetishization. Okay? So we have all

these different hats that we put on in

our personality. But the thing is our

personality is all connected. So, I want

you guys to think about like your

personality is a crystal that has lots

of different facets. What happens in

multiple personality disorder is that

there's a psychological trauma that

basically imagine taking a hammer to the

crystal and then all the pieces shatter.

So, in multiple personality disorder,

there's a great um text about it where

they talk about how trauma causes the

personality to shatter along fault

lines. So in the way that there's like a

weakness in like a certain like let's

say piece of stone or a tectonic plate

and then it cracks along those lines,

that's what happens in multiple

personalities. So whereas all of the

different hats that you put on are all

still connected, when someone has

dissociative identity disorder, their

hats are no longer connected. So I don't

know if this kind of makes sense, but

all the hats that they put on aren't

just hats. They sort of become different

people. And this is where things get

kind of interesting because they're all

still connected though, right? because

it's like one brain. So sometimes they

do have different mannerisms, sometimes

they have amnesia from each other

because one alter like won't let another

altar know what's going on. And then the

other thing is also true where since

they're all connected by one physical

organ which is the brain, they can

actually communicate with each other as

well. So when you're doing like

psychotherapy with some of these

patients, what you can do is ask them,

hey, can you let soand so come forward?

And then I I know this, you know, that

there's that move and stuff like that,

but what's really interesting is you'll

see changes in tone of voice. You'll see

changes in like accent, mannerisms, even

body language, posture, stuff like that.

I thought I was on an anti-depressant.

It turns out I'm not. It turns out I'm

actually on a mood stabilizer that they

use as an anti-depressant. Fun fact

about prescription drugs, everything

they prescribe, they actually use for

like four different things.

>> This is correct. know what your deal is

until you find a combo that works and

then Google all your pills by yourself.

>> So here's what's we got to understand

why we do this in psychiatry. This comes

down to pharmaceutical company and FDA

shenanigans. So in order for a drug to

be approved by the FDA and to a certain

degree the European Union as well. You

have to show efficacy. So if you're a

pharmaceutical company, you have to show

that it works really well. So often

times what pharmaceutical companies will

do is they will design a medication that

is shows a large effect for a very

specific condition and once they get it

approved you are allowed to do something

called off label use. So I am as a as a

medical doctor can prescribe something

for a condition once the drug gets

approved that means it's generally

speaking safe and and stuff like that.

So then I can prescribe it for any

condition that I want to. And we see

this right now with nothing more than

the ozic, right? The pick. You're on a

bit of the pick, which is actually like

approved for like obesity and like, you

know, severe obesity and things like

that. But everyone's getting

prescriptions for it out of pocket.

Insurance isn't covering it if they're

like normal weight and just want to like

lose some weight and be prettier. So,

this happens all the time where a drug

company will get something approved and

then what they'll actually market it to

is a completely different way more

common condition. So, after years of

trial and error, I finally found a

combination of things that worked for

me. And 6 months ago, I decided to

Google it cuz what the hell? And it

turns out that everything I'm taking is

primarily used for bipolar disorder,

which is what mood went back to my

psychiatrist and I was like, "Hey,

[laughter]

>> do we think?"

And she was like, "Oh, yeah."

>> Yeah. This is sad but unfortunately

true.

[applause]

And I was like, "Is this how you

TELL PEOPLE?"

>> Often times we don't tell people.

>> No, of course not. We didn't know. I'm

glad we figured it out. And I was like,

"We?" [laughter]

>> I said, "You really didn't know that I

was bipolar." And she goes, "No, of

course not. We thought we were treating

anxiety and depression." And I said,

"Okay, cuz this kind of feels like a

putting your dog's medication in cheese

situation." [laughter]

>> Yes.

This is sad. We'll explain all this.

And I was like, I don't know how I feel

about this diagnosis. And she goes,

well, if it makes you feel better, you

don't have to say I am bipolar. You can

say I have bipolar. Which feels a lot

like someone going, I said you were

being A

Not that you are a Okay. So,

here's why a psychiatrist may give you a

mood stabilizer if you're depressed. So,

basic thing to understand, in

depression, we have low mood. But

bipolar disorder is different. It is low

mood plus elevated mood at times. So if

we look at an anti-depressant

medication, it elevates mood. If we look

at a mood stabilizer, it elevates mood

and it brings down excessively high

mood. So a psychiatrist may prescribe a

mood stabilizer to a depressed patient

because it actually elevates mood. And

sometimes what happens in people with

depression is we just don't know if

they're bipolar yet because they've

never had their manic episode. So, we

start with an SSRI or an anti-depressant

medication, maybe doesn't work great. We

try another one, maybe doesn't work

great. But us as psychiatrists, what we

do is, okay, let's try a mood stabilizer

because some patients are more

responsive to mood stabilizers than they

are to anti-depressants. So, we give

them a mood stabilizer, their mood gets

a little bit better. Now, here's the

tricky thing. At that point, are they

bipolar? And the answer is really scary.

We don't know. Because the way that we

diagnose bipolar disorder is you have

depressive episode, depressive episode,

depressive episode, and then at that

point you've got MDD, but the moment

that you become manic, that's when you

get the diagnosis. So imagine someone

has bipolar disorder, depressive episode

number one. Number two, they haven't

become manic yet. So they may truly be

bipolar but we don't have information

that tells us definitively that they are

bipolar at that point which is how we

end up with this ridiculous situation.

One of the upsides of co might be I hope

>> is uh empathy for mental health stuff

right

>> everybody was isolated

>> and human beings don't do well with

isolation

>> this is true

>> we still got cave brains right so we

think if we're isolated

>> that the tribe is rejecting us

>> and that and then we start picking away

at ourselves and finding fault that

aren't there and

>> basically our mental health declines

right so I hope in the future that

People have empathy when someone else

someone says like I'm depressed or

anxious. They'll go like oh yeah I I I

remember that.

>> Let's talk about isolation because this

is a really good point. Human beings

evolved in social tribes. And so the key

thing to understand is that since human

beings are tribal in nature like we are

not great at hunting on our own. We're

like pack hunters. We have division of

labor. Isolation meant death. So if you

were exiled from the tribe, right? And

this is something that I don't know if

you guys have ever wondered about. Like

exile doesn't seem like that bad of a

punishment to me. Like if someone sent

me to a different city, like I would

like not that big of a deal. But exile

used to be basically a slow and painful

death. That's what the sentence was. So

when a tribe pushes us away, we become

isolated. We our risk of dying increases

and our brain tries to protect us from

that. And the way that our brain

protects us from isolation is actually

shame. So let's understand this. If a

lot of people at school are making fun

of me, they're like pushing me away from

the group. I feel ashamed. And what does

the emotion of shame try to get you to

do, right? So, if people make fun of me

because I don't have a particular pair

of shoes, what would a teenager want to

do? I want those pair of shoes. Shame

induces a behavioral change that leads

us to acceptance by the tribe. Okay?

Now, it's abused and stuff like that all

the time, but here's the key thing to

understand. When we feel ashamed, we are

isolated. That's how it kind of evolved.

So if you artificially isolate someone,

they will start to feel a lot of shame.

And this is where things get really

messed up because generally speaking,

isolation and shame and ostracization,

all of those things go hand in hand. If

I use the wrong language, everyone gets

upset with me. They stop getting sending

inviting me to parties, things like

that. Okay, let's just keep going.

[laughter]

>> No, I'm all right. I got a therapist

recently. Nice. Yeah.

>> Let's go.

>> Yeah. [cheering]

>> Yeah.

>> Audience is on board.

>> You have to, guys. You You do like

>> Well, like if you're going to complain,

as much as I complain, [laughter]

unfortunately, you do have to get one.

Like, um, yeah,

>> this is actually a really good point.

So, people will say like, "Hey, everyone

needs to be in therapy. Is that true?" I

think no. But if you have a lot to

complain about in life, therapy is a

great place to start. If you have a lot

to complain about and you are not

mentally ill, coaching is a great place

to start. Hey, if y'all want to learn a

little bit more, by all means, watch

another YouTube video. If you guys are

actually interested in finding the

practical tools to change on your own,

that's where memberships comes in. And

if y'all are interested in getting some

help or achieving a particular milestone

4 weeks, 8 weeks, or 12 weeks from now,

check out coaching. So, if y'all are

interested, check out the link in the

description below.

>> Like my friends were starting to be

like, "You should pay someone to do what

you expect of us." I was like, "Oh,

okay. I found this therapist." And and

>> so, one quick point about that. So, what

is the limit of being a friend and when

should you see a therapist? Really

simple reciprocity. So, if you are

emotionally supporting someone and on

balance, they're emotionally supporting

you in the same ballpark. You helped me

through a breakup. I help you through a

breakup. That's what friendship is. When

things become lopsided is when you

should consider working with a

therapist.

>> Really smart and uh we zoom and uh he

said something interesting where he said

remember you are not the feeling like

sure you feel consumed by the feeling

but you are not the you and within

[snorts] everyone there's like a very

still neutral internal self and and you

know you experience the feelings but

you're you're not consumed by them. And

he said rather than identifying so much

with the feel like I'm anxious, I'm

this. He said you don't be consumed by

the feeling, just observe the feelings

as they come with curiosity.

>> Yeah, this doesn't work. This is

correct, but it doesn't work.

>> Apparently, that's the

>> So, I think you're just be like, huh?

[laughter]

>> This presumes a certain intensity of

feeling

>> experiencing

rage.

See, we as therapists

>> curious.

>> Okay, this is fascinating. So, let's

talk about this. This person says,

"There is a place of stillness within

you." I call it shunya. Just don't

identify WITH THE FEELING. OH, I didn't

think about that. Oh my god. I Oh, and

now that you've told me there's this

eternal place of peace within me, now

that I know it's there, I can access it

immediately. Not how it works. So, let's

understand a couple of things. People

who say just be curious about the

feeling. This is something that blew my

mind that I learned after finishing

residency. Okay, so I'd been a

psychiatrist for three years or

something and then I finally realized

this. People's emotional experience, you

can rate it from 1 to 10, but one

person's 10 is not another person's 10.

If we look at research on people who are

highly sensitive persons, if we look at

research on conditions like borderline

personality disorder, even if we look at

I suspect conditions like major

depressive disorder, what what's really

confusing for a lot of people is that

when I say I'm 10 out of 10 sad today,

that may actually be half as sad as

somebody else's sad. The volume on all

of our emotions is not the same. And so

this idea of being curious about your

emotion is absolutely effective. But

generally speaking works better when you

have less emotion because when we have

very very strong emotions just this is

how it works in our brain. Our amygdala

and the lyic system are so powerful they

shut off the part of our brain that is

capable of curiosity. So, one of the

things that really frustrates me is like

a lot of people will say like, "Hey, do

this thing." And another good example of

this is like, "Hey, are you feeling

lonely? Just put yourself out there.

Just put yourself out there, bro." But

these people are assuming a certain

degree of lack of social anxiety.

they're assuming a certain like their

experience of putting themselves out

there is not like filled with anxiety

and terror whereas somebody else's

experience is filled with anxiety and

terror. So I think this like just being

curious about a feeling absolutely does

work but let's be clear that it is way

easier for some people to do than it is

for other people to do. And this is

where we get to I think one of the the

kind of like modern weaknesses of

therapy which gets better with every

year is there are the some of these

concepts right like you have this

eternal place of stillness inside you.

You can observe a feeling with

curiosity. Both of these are true but

they require skill to do. We don't do

them naturally. In fact that's not how

our brain naturally works. You have to

level up the ability to do it. For me I

had a ton of emotions that took control

of me. I had an ego that took control of

me. I was crippled with with fear of

failing out of Spanish and crippled with

lust that was unrequited and feeling in

love and falling in love with all kinds

of people and it wasn't working out and

I literally like had to go sit in an

ashram for three ashram for 3 months in

India to train in these skills and

that's where I discovered things like

shunya meditation which I teach on the

channel absolutely love it is the skill

building of finding that emptiness

inside you and once you learn how to do

that you can like put negative feelings

ings into that and they disappear into

the void. It's really weird. But when I

work with my patients, I teach them very

specific meditation practices that they

learn over the course of 4 weeks, 8

weeks, 12 weeks, 16 weeks, 20 weeks, and

that's really when it starts to work.

So, I think that there are a lot of

therapists out there who will utilize

this truth, but sometimes are not

trained as well in terms of teaching

this skill to people who have very

intense emotions.

>> I meet so many people, okay? I meet way

more people than you. Um, it's not even

close. So,

here's the thing. People usually say

nice things to me, you know? They're

like, "Oh, thanks for coming. I had a

good time." Conversations naturally will

turn and I'll ask somebody, "Oh, what do

you do?" Do you know what I hear like

98% of the time? They'll be like, "It

sucks. I hate it." And then I

go, "Oh, why don't you do something

else?" And they'll go, "It's too late.

My life's It's good to meet you,

man." And they walk away. H Yeah, that

sits in my head. So, I think about it,

but I have advice. And this is this is

the advice that I hope you leave with.

All right, this is it. You just need to

learn to do one thing really well, and

it's this. You need to learn to manage

your expectations. It's not an innate

thing you're born with. It's a skill. If

you work at it, you'll get good at it.

And the more you manage your

expectations, you'll feel, less

depressed, happier overall.

>> I'll share with you my life's greatest

disappointment, which in retrospect is

my fault. I didn't know it at the time.

I do now. We'll talk about this.

>> And I'm going to tell you, it's going to

be upsetting to some people, but

hopefully we can use it as a learning

tool. So,

>> let's try.

>> Here's what it is. All right.

[sighs and gasps]

I think that 69ing is overrated and it

sucks. [cheering]

[applause]

>> Yeah. Yeah. You see that? Some people

clap and some people are like, "Arest

this man." But listen, [laughter]

the story of why is more important. Do

you remember when you first heard about

it? I do. I was in third grade and

that's too young. All right.

One of the older kids told me and I was

like, "What?"

>> Prepubertal exposure to sexual activity

and pornography is one of the highest

risks risk factors for pornography

addiction. Seeing pornography or being

exposed to sexual material before your

brain knows how to react to it in an

appropriate manner can really end up

with this is what your brain does. He

does such a good This is why it gets

messed up and that's how you end up as a

professional comedian.

>> Every birthday, every Christmas, my dad,

I go, "What do you want?" I go, "I want

69." He goes, "Shut up and stop saying

that." And I was like, "No." Defiant.

No. 69. 69. It's going to be the best.

Be the best. Be the best. Be the best.

Be the best. 69. It's going to be like

smoking meth out of God's dick. I want

to do it. I want to do it. I want to do

it. [laughter and applause]

And I built it up. And I built it up.

And I built it up. And when I finally

got to do it, I finally got to do it.

You know what the first thing I said

was? Get off me. All right.

>> So, I want you guys to understand what's

happening here is that some part of his

brain has latched on to the idea of

something that has really high value,

but he doesn't understand what it is. He

doesn't have context around it. So, then

what he starts to do is builds up a

fantasy or an idea or an expectation

around what it is, right? But that's not

based in reality. Let's talk about

expectations for a second. One of the

key teachings of the contemplative

traditions is that expectations are a

huge source of our suffering. Let's

understand why. So I want you all to

think about how happy a surprise is.

Like a good surprise, right? So if you

have like a surprise birthday party or

you're not expecting something and you

receive something good, it's not even a

surprise birthday. If someone just for

no reason whatsoever is like, "Hey, I

baked you cookies because you're an

awesome person and I care about you."

All that is is like straight joy.

Whereas y'all may have heard of take

your favorite video game or movie that

has been hyped up. And the more that

something is hyped up, the more prone to

disappointment that you are. So

generally speaking, what the eastern

contemplative meditative traditions

teach us is that there is a skill of

sitting at neutral and the less we

expect, the less we will be

disappointed. Right? Because you cannot

be disappointed unless you have an

expectation. Something can still be bad.

So if I was expecting a really good

burger and I get a bad burger, this

negative loss is this big. But if I was

never expecting a bad burger and I get a

bad burger, then I just experience this

loss. So literally like expectations

when it comes to one's happiness are not

really good to have. Now we should make

predictions about the future. I'm not

saying don't make predictions about the

future. The key thing is what is the

difference between an expectation and a

prediction? An expectation is the idea

of a certain result. It is a presumption

of a certain result. And a prediction is

a possibility of a result or a

probability of a result. Okay? So, by

all means, make predictions. Don't

ignore the future, but don't presume a

result. Don't count your chickens before

they hatch.

>> What about persistent genital arousal

disorder?

>> Uh-oh. That is a fancy way of saying

never not coming.

>> No, it isn't.

>> These are people that have orgasms every

90 seconds and they can't have jobs. Why

can't they have jobs, Tom? Cuz they're

coming all the time.

>> This is correct.

>> Not appropriate

>> for you to be like, "Can I try on this

shirt?" And the guy's like,

>> "Let's talk about persistent genital

arousal disorder." actually is is quite

damaging. So, first thing about

persistent genital arousal disorder is

it is not orgasming all the time. It is

just being aroused all the time. And the

really scary thing about this is that

often times people with persistent

genital arousal disorder in order to

make the arousal go away. They have to

orgasm sometimes multiple times to

complete the cycle. So, persistent

genital arousal disorder isn't

orgasming. It's being aroused. sexually

aroused, being erect, having vaginal

lubrication at really inappropriate

times. And here's why this is actually

so damaging. So, the first is sometimes

it's like really hard to give yourself

multiple orgasms or for somebody else to

give you multiple orgasms, including

men, and there's a refractory period and

all that kind of stuff. So, it's

actually quite debilitating to be like

aroused all the time, especially when

you're trying to concentrate, trying to

do work at a funeral. The other thing

that I think is even more subtle and

psychologically so damaging is that it

destroys your association between

arousal and pleasure. So for most human

beings when we get aroused that is like

something that we covet, we look forward

to or that ends well. And it's like a

really basic part of human happiness and

fulfillment. Like getting aroused,

getting laid, cuddling afterward.

There's so many good things that come

with that. With persistent genital

arousal disorder, the problem is that it

happens at all of these inappropriate

times. We start to loathe it. It causes

us problems. Can cause us physical

suffering. If you have a prolonged

direction for a long period of time, if

you're trying to focus on your work, if

you're trying to take a test and you

have sexual thoughts all the time, you

can't do anything. It creates all these

really negative associations. And in my

opinion, the most psychological damaging

thing is it takes sex and arousal

outside of the column of things that you

enjoy in life. So it's kind of like the

best example analogy that I can give you

all is imagine that you really love

eating hamburgers, but you're allergic

to them and you vomit every time you eat

a hamburger. Now you can no longer enjoy

hamburgers, right? But the good news, if

you like of a gluten sensitivity, is

there's still lots of other foods that

you can enjoy. Imagine, I have some

patients who have have things like

cyclic vomiting syndrome and stuff like

that where it's like all food makes you

vomit. And then imagine for a moment

what your life is like if you can no

longer enjoy food. That's what's scary

about persistent genital arousal

disorder.

>> I'm somebody who has it, but I got to

tell you about it in case you have it.

>> Can I just say I hate hard-coded

subtitles, especially in comedy. It

ruins the punchline. It's like this is

so bad.

>> I want you to know it's okay to have it.

I'm having a great week. I'm on day

seven right now of uh anti-depressants.

So,

if you don't laugh, [laughter]

no,

we'll see. No, just No, I wouldn't I

wouldn't do it here, but I I don't

[laughter]

It's too tough to get a hearse through

the city. Um, so

come on.

>> It's actually scary how many people

consider convenience and not

inconveniencing their loved ones when

they're considering ending their life.

It's it's like shocking how important

that is. The other really interesting

thing is it blows my mind how many

people the most powerful protective

factor against ending your life or

suicide is actually who's going to take

care of my pets. Really common for so

many of my patients. Anti-depressants

are fickle because everybody says you're

supposed to give them about 4 weeks

before you feel anything, which is

strange. Feels like if you're depressed,

the last thing you have is time.

[laughter]

>> This is one of the problems with anti.

>> That's why it's a hotline,

[laughter] not a PO box.

I got hooked up with this drug dealer

over at the pharmacy and [laughter]

she was the one who told me, she was

like, "Just so you know, when you're on

anti-depressants, uh uh it takes about 4

weeks for you to feel anything." I was

like, "Um,

>> two to four weeks."

>> Well, do you have a same day option?

>> Yes, we do now. It's called

>> I am depressed right now. [laughter]

>> That's why it's so I'm more depressed

since you told me this. We are we are

headed in the wrong direction right now.

[laughter]

She was like unfortunately nasal spray

too.

>> Your brain needs time to become

desensitized to the drug about 4 weeks.

That way it won't notice the change.

And I was like, "So to be clear,

[clears throat]

>> I am to wait a month before I feel

anything, at which point I will be so

used to the drug that I will not feel

anything." [laughter]

>> That's actually somewhat correct. Let's

talk about this for a second.

Anti-depressant medication, specifically

SSRIs. Problem number one is that

benefits take 2 to 4 weeks. It's not

going to take you 2 to four weeks to

feel anything. It's going to take you 2

to 4 weeks to feel good things. Side

effects happen early. This is one of the

hardest things about anti-depressants is

that often times people will feel the

negative side effects of

anti-depressants within a day or days

after starting them, but they don't see

the benefits for weeks. Now, the reason

for this is because of the way that

anti-depressants work. Probably what

they they do is they don't have a direct

chemical effect. They're not like

caffeine where they turn on our cells.

What anti-depressants probably do is

create more machinery for for ourselves.

So, this is kind of like, you know, when

you see one of these ads about some

product on TV and they're like, "Allow 3

to 5 weeks for delivery." And the reason

is because they don't have the product.

They get all the orders and then they

send the order to the factory and the

factory produces it and then sends it

your way. So, that's how

anti-depressants work. They don't turn

on your cells, which is what cocaine

does or caffeine does or benzoazipines,

alcohol, marijuana, take your pick. What

they do is change what machinery your

cells have. So your cells starts

building more serotonin transporters or

whatever. Okay? So the problem with

anti-depressants is that when they are

working, we feel normal. We don't feel

great. They're not happy pills. We just

remove the depression. And they work so

gradually and sometimes we'll see an

effect size of like 30 to 50% for an

anti-depressant. So it doesn't do take

it all away. So it happens so gradually

and what it does is makes you feel

normal and then people are still

experiencing the side effects and they

look at their anti-depressant and

they're like I feel fine. I don't need

this anymore. And then they stop the

medication and then the depression will

start percolating back. But it doesn't

happen within a day. Doesn't happen

within 2 days. Remember this is cellular

machinery that we're talking about. So

after a while the cellular machinery

eventually gets broken down and then

weeks later the depression can emerge.

So one of the key things that I do with

my patients is if I start them on an

anti-depressant I try to have them stay

on it for about a year which is the

natural course of a depressive episode

and then we can try to take it off. that

if you feel normal and you feel like the

anti-depressant isn't really doing

anything, that could actually be a sign

that it's working because it's restoring

you to normality.

>> She was buming me out. She was like,

"Just so you know, when you're on

anti-depressants, you can't drink." I

was like, "You can't drink. [laughter]

You don't know about me. I have

unlimited potential. You have no idea

what I could do on anti-depressants."

She's like, "I mean it. if you drink on

this medication, you will have internal

bleeding.

And I was like, well, if there's no

mess, [laughter]

I'll keep it to myself. You know what I

mean? I'll I'll keep it in. [laughter]

She's like, I think keeping things in is

what got you here in the first place.

I was like, you're actually pretty good

at this, son. I'm not going to lie.

[laughter]

Then I had her ring me up for a

six-pack. I got the out of there. You

know what I mean? [laughter]

Oh yeah, you can check.

>> Okay, let's talk about anti-depressants

and drinking. So there are some

medications that we prescribe that are

like really really bad to drink with

because they act synergistically can put

you in a coma. Top of the list is

something like a benzoazipene or an

opioid. The most common problem that I

see clinically with anti-depressants and

people who drink is not that they can't

drink, which is you still shouldn't, but

it's that there are many patients I've

worked with that feel like

anti-depressants don't work. And what

drinking does, the most common effect

that I've seen clinically is that

alcohol cancels or prevents the benefit

of an anti-depressant. And even very

small quantities of alcohol can do this.

So, you really shouldn't drink on an

anti-depressant. But it's kind of like

the real problem is like, okay, I'm

dieting. I'm I'm on keto and I'm doing

intermittent fasting and in between my

intermittent fasting, I'm just going to

eat a bag of chips when I feel like it.

And it's like that defeats the purpose.

That's really the most common clinical

impact that I've seen. As for the

bleeding risk, absolutely true. He must

be talking about SSRIs because not all

anti-depressants are the same. SSRIs and

do increase bleeding risk. So should be

used with a lot of care with other kinds

of things like if you've got

anti-coagulation or warin or whatever

things like that. If you have a history

of bleeding things like that then you

have to be careful with

anti-depressants. That's correct dude.

Um I'm jealous today. Like they got the

internet to shame their parents into

paying attention to them.

Yeah. Something we didn't have. I

realized this a couple years ago when I

was having anxiety attacks. I'm at the

doctor's office and she goes, "All

right." All right. She goes, "Before I

[clears throat] give you any

medication," she goes, "I want to know

what do you take for your ADHD."

I was like, "Uh, this is the first time

anyone's ever told me that I have that."

[laughter]

She like, "Wow, anxiety and ADHD. You

had me bouncing off the walls when you

were a kid. How did your parents handle

that?" I'm like, "They hit me."

>> Unfortunately, really common,

>> which I do not condone hitting kids.

Don't tell. But ADHD and anxiety, like I

could not stand still, right? Like what

are you going to do? A timeout? I can't

stand still now. I got to go stand in

the corner and look at a wall for an

hour, [laughter]

right? Forget that. Timeouts can be

absolute torture for kids with ADHD. So,

this is what's kind of scary about it is

like we'll give them punishments, but we

don't understand if you're neurotypical,

you don't understand the subjective

experience of the punishment on the kid

with ADHD. Second thing here is that you

know physical corporal punishment

yelling a lot is also really really

common in kids children with ADHD and

there's a really scary mechanism about

around this. People don't usually hit

their kids as much as they used to but

people will yell at their kids. Here's

why parents end up yelling at their

kids. So when you have ADHD you need a

large stimulus. If you're hyperfocused

on something you need a large stimulus

to break through your attentional focus.

So if your parents call your name you

don't hear it. They call a bit louder,

you don't hear it. Then you have to yell

to snap their attention. So in order to

get their attention, you have to use a

very high volume. The problem with ADHD

is that even though you need a high

volume to get attention, the effect of

the yelling on the other parts of your

physiology are not reduced. So you need

to yell in order to basically get their

attention. But when you yell, their

cortisol still spikes, their stress

hormones spike, their heart rate

elevates, they are startled by the yell

because the yell still startles them.

And then you create a really scary

scenario because every time I need my

kids attention, I have to scare them.

That's the only way that I know how to

get it. There are ways around that. So

one of the things that I do with my kids

is I actually train one of my daughters

is neuroatypical and so one of the

things that I do is I train her with an

attention word. So, we play this really

fun game where there's a word that we'll

use moose juice, goose juice. For

example, what I'll do is like when I

want her attention, I'll be like, "Okay,

when I say and I did this when she was

like five. I'd say like moose juice,

goose juice, look at me when you hear

moose juice, goose juice." Okay? So, I'd

say moose juice. She looks at me and

then we we turn it into a game where I I

will start to say it quietly. I'll sneak

into the room and I'll whisper it and

over time she wants to win the game. And

once you orient her towards trying to

pay attention, then something really

cool happens where she's like now she

knows the game, she likes to win, she

gets a prize, whatever becomes fun,

right? I'll sneak up behind her, I'll

hide behind the couch, I'll say moose

juice, goose juice, and then I'll

whisper it something like that. And then

she learns to she trains her mind to

actually pay attention to it. And then

when I need her intention, instead of

yelling, I will say moose juice, goose

juice.

>> Smack me. Let me go run around in a

yard. This is [laughter] true. Right.

Trying to fix ADHD and anxiety with a

timeout would be like trying to stop

someone's asthma attack by having them

do jumping jacks. [laughter]

>> That can work. Okay. So, let's talk

about one other thing, ADHD and anxiety.

So, one of the features, one of the new

features that we've understood about

ADHD is that emotional dysregulation is

a core component. So, when someone says,

"I have ADHD and anxiety." Now, as a

psychiatrist, what I think about is if

they have ADHD, I assume that their

negative emotions are more intense than

baseline. So, they may have a separate

anxiety disorder, but these kids tend to

be prone to more anxiety, more

depression, more shame because the part

of their brain that restrains their

impulses, the part of their brain that

controls the other parts of their brain

is a little bit weaker. which means the

part of your brain that controls your

negative emotion is also weaker. Which

means unfortunately these kids often

times have a lot of intense emotion. The

real problem with that is that since

they've got intense emotion and they

have difficulty shifting their focus

once they start to have an intense

emotion, it becomes really easier to get

hyperfocused on it for that intense

emotion to spiral in their mind and only

intensify over time, which is what makes

them prone to dopamineergic sources,

drugs, devices, video games, etc.

because that's the tool that they use to

get rid of their negative thinking. It's

fine to laugh about some of this stuff,

like trying to clean your living room

and ending up with more of a mess, but

then the question is like, what do you

do about it? So, we actually have a

great video on developing skills with

ADHD that you guys can find in our

membership. Check out the link in the

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