Why Modern Life Fuels Depression with Dr. Stephen Ilardi (Part One)

Theresa Hubbard [00:00:00]:
Today we are really excited to introduce to you Dr. Stephen Ilardi, author of The Depression Cure. He has a new edition coming out. His first one was in 2009 and it will be coming out sometime, I think in August of 2025. He is a clinical psychologist, neuroscientist, and he's an associate professor in the Department of Psychology at the University of Kansas. After earning his doctorate in psychology from Duke University in 1995, he launched a career devoted to uncovering the neurobiological roots of major depressive disorder and translating that science into practical interventions for everyday life. The TLC program blends research around cognitive neuroscience, evolutionary psychology and clinical trials, positioning him as a leading voice in lifestyle based approaches to mental health. Fascinating fellow.

Theresa Hubbard [00:01:02]:
I have heard about him for several years. I knew about The Depression Cure, had read The Depression Cure, and then my youngest son Luke had him as a professor for three classes during his time at KU. And one time during one of those conversations I made the connection that Dr. Ilardi was Dr. Ilardi. And then we reached out to him and asked him to be a guest to talk about that. And so today we'll be talking about The Depression Cure and then actually he's going to come back on with us and talk about AI and psychotherapy. So we are very excited for you to meet Dr.

Theresa Hubbard [00:01:46]:
Ilardi. And here we go.

Dr. Stephen Ilardi [00:01:50]:
And when I'm working with somebody with depression, when they walk in and they're suffering and I know their pain circuits in the brain are lit up and I know they're in agony, they may be fantasizing about death as a, as an escape. They, you know, they, they've, they've lost things that matter to them and they're hopeless. And in my mind's eye, a little piece of my brain is envisioning what they're going to look like two months down the road or three months.

Theresa Hubbard [00:02:19]:
Yeah, me too.

Dr. Stephen Ilardi [00:02:22]:
And it sustains me and it gives me this sort of courage and this groundedness of like, okay, it sucks right now, but, but that's not the end of the story, you know.

Walker Bird [00:02:38]:
My Inner Knowing empowering you to find your compass for the journey. We are dedicated to supporting you to rediscover and trust your natural ability to see navigate life. Each day. By sharing insight and experience through the lens of two professional communicators and their guests, we intend to prompt internal inquiry that supports all those willing to explore a unique path.

Theresa Hubbard [00:03:06]:
So welcome. Dr. Ilardi, thank you for joining us today. I have been looking forward to this interview for Months. Months.

Dr. Stephen Ilardi [00:03:15]:
You're so kind. Thank you. I'm very happy right now. It's a pleasure to be with you, with you both and with. With your, your audience and looking forward to this.

Theresa Hubbard [00:03:28]:
Yeah, thank you. So what I was thinking about was when we go into the therapy room, that's what we were talking about before we got rolling. And that presence that is, I believe, so important for a clinician to be able to hold. And what I was thinking when you were sharing was how much practice and training and self awareness that I had to go through early in my career to learn how to really learn to be present with a client in the room, how to be aware when I wasn't present, what do I do to help my body be more present. And so for me, several things that I did were around sensory stuff to really train my body, essentially conditioning it, that when I sit in this chair and I do these things, I want this kind of presence in the room. So.

Dr. Stephen Ilardi [00:04:30]:
Absolutely, yeah. So for me, I did my, my graduate training in clinical psychology, a PhD program at Duke University, and from 1990. I started in 1990, and I was a little bit of a second career student. So I was 27. I'd been background was math and computer science and economics and had worked at CDC, Center for Disease Control, had worked for Wells Fargo bank, had done commercial real estate valuation. Never taken a psych class until I was 24. Started volunteering at a psychiatric hospital after work at the recommendation of a friend of mine, a lifelong friend, a good friend from first grade. And we were talking and I was 24, and I was like, I hate my job.

Dr. Stephen Ilardi [00:05:27]:
And he's like, well, they pay you a lot. And. And I said, yeah, but like, I don't. I need to feel like I'm doing something worthwhile and meaningful. And I just feel like everything I'm spending my energy on just feels very empty. And he said, well, he was a psych major, which I used to tease him about, so draw your own inferences about karma at this point. But he said, you know, there's this psychiatric hospital, this was in Atlanta where I'd gone to undergrad at Emory University in Atlanta, and there was a state psychiatric hospital with very, very severe patients, and many of whom had been hospitalized for decades with.

Dr. Stephen Ilardi [00:06:18]:
And in fact, I signed up to volunteer on a unit. They said, well, we really need the most volunteer help on a unit that most of the patients are ngri, not guilty by reason of insanity.

Theresa Hubbard [00:06:33]:
Wow.

Dr. Stephen Ilardi [00:06:34]:
And I said, okay, sure. You know, I was fearless and it Changed my life. I mean, just hanging out every week. So I said, well, what's my job? And they said, just be present with these. In most of them, Most of these patients are psychotic. And I said, I don't know what that means.

Theresa Hubbard [00:07:00]:
Right, right.

Dr. Stephen Ilardi [00:07:02]:
And, you know, I learned very quickly. Yes, many of them had a diagnosis of schizophrenia or schizoaffective, other adjacent sorts of disorders. And they said, just be present. Most of these patients are cut off from their families. They're never going to leave the hospital.

Theresa Hubbard [00:07:21]:
Yeah.

Dr. Stephen Ilardi [00:07:21]:
And nobody cares about them, you know, other than maybe staff, hopefully, or other patients. And it just kind of pulled me down this rabbit hole. Like, okay, here are these fellow travelers who are. You know, they're fellow human beings. They. They. They have the same array of emotional experience, the same magnitude of hopes and dreams. And.

Dr. Stephen Ilardi [00:07:52]:
And yet they were tormented often by experiences of hallucination, things that weren't there, that they perceived to be real and delusional thoughts and. And. And I was just absolutely smitten with, like, I'm gonna. I want to work in this area. Like, this is a profound. And it wasn't necessarily that I wanted to work with psychotic patients, schizophrenic patients, but I. Or those who, you know, most of them had committed some pretty serious crimes. But.

Dr. Stephen Ilardi [00:08:28]:
Yeah, while they were under the influence of delusions. And I just thought, well, this is something. This is a source of incredible suffering for lots and lots of people. And it feels like we're just getting a scientific toehold and, you know, this understanding of the brain and the mind. And because I had a programming background, the neuroscientific angle was I started reading on my own. It was like, oh, okay, I get it. You know, the brain is like, not exactly hardware, but like wetware. And the mind are perceptions and memories and judgments are like more or less like software.

Dr. Stephen Ilardi [00:09:11]:
I think we're learning that more and more every day with AI, which we can talk about later. But it gave me a set of intuitions off the shelf of like, okay, like, I have a set of heuristics or rules of thumb, ways of understanding the mind, brain connection that felt very intuitive and sort of almost obvious in the sense of like, yeah, this is a really, really hard set of problems, but there are lives at stake and they're. You know, there's been suffering on the line. So I would be honored to devote my career to this sort of thing. And took three psych classes at night, night school, and just had the audacity. You took the gre. Luckily, did pretty well. And this is back in the day when you could do.

Dr. Stephen Ilardi [00:10:06]:
I don't even think this could be done anymore because the bar is so high now to get into a PhD program in clinical typically. But I got into most places I applied. I didn't know what the hell I mean, I didn't know the game. So on my application, my personal statement, my essays, you know, they're like, well, what sorts of things are you interested in doing? And you know, PhD programs are research oriented program. And I'm like, well, right. You know, I'd done some research at CDC center for Disease Control. That was my work study job as an undergrad because I'm going to this fancy expensive school from a very middle class background. You know, my parents couldn't afford it, but between scholarship and work study and, you know, all kinds of things.

Dr. Stephen Ilardi [00:10:53]:
But I had a research background at CDC and they counted it and my essay, I just said, well, you know, I'm really interested in personality disorders. And the guy, the professor who became my mentor at Duke, where I ended up going, was a depression researcher who had recently become obsessed with the intersection between personality functioning and depression. Both risk factor, protective factor, moderator of clinical outcome, personality disorder as a vulnerability factor to recurrence. All kinds of. So he and I met and he's like, well, you're interested in personality, I guess that's personality disorder. I'm like, yeah, yeah, sure, we'll go with that. And. And it just became this fantastic fit.

Dr. Stephen Ilardi [00:11:58]:
Okay, I'm. I think I can land the plane here. All the way back to your original question, which was about presence, clinical presence. Right. And while we're sitting with folks that were. We have a healing, hopefully healing relationship with. And they're coming us in their pain and they're turning to us as hopefully partly just as fellow travelers, but also as those who have specialized training and expertise. And I was lucky enough to be at the med center there when Marsha Linehan, and I don't know if that name.

Dr. Stephen Ilardi [00:12:37]:
Oh yeah, you know, she's very famous in the field as the originator of dialectical behavior therapy, DBT and as one of the most influential clinicians when it comes to integrating mindfulness based practices in different therapy protocols. And so I was one of the early adopters in an outpatient program for patients with borderline personality disorder, which is. Yeah, I don't know how much to assume your audience would know about it, but really turbulent, really affects functioning a lot of different domains, including interpersonally. And I walked into this setting As a trainee. And it's like, this is a really difficult, patient population. And I'm not a centered person.

Dr. Stephen Ilardi [00:13:38]:
easily by nature. I'm, you know, my Buddhist friends would say I have monkey mind, you know, kind of like all over the place. And, And. And I learned really quickly, like, no, no, no, no, no. Like, you got to walk in and really locked in. And my first supervisor said, you know, how in many of the martial arts, the first thing you learn is how to be centered, how to have your body centered on the ground on which you're standing, centered in your stance and balanced. And that if you are centered and balanced, it doesn't matter what somebody throws at you. With appropriate training, you are able to address that, maybe deflect it or depending, turn it back on them.

Dr. Stephen Ilardi [00:14:35]:
And you'll hardly have to use any effort because you're centered and balanced. You could just deflect, redirect the energy coming at you. And if you're not balanced, you're toast. You're going to get knocked over so easily. And I thought, man, that is a beautiful analogy for what it's like walking into a therapy setting. Also for me, as a university professor, walking into a classroom setting, because, you know, I mean, a lot of our students, they're really good at challenging, they're really good at critically thinking, but also many of them have their own mental health struggles. And, you know, so whenever we're talking about these sorts of topics, man, they, they don't hold back. They're, you know, they're really, really engaged and interested and curious.

Dr. Stephen Ilardi [00:15:34]:
I feel like I'm just kind of rambling. But that brings it back around to, like. I mean, it resonates so much with me, this idea that when we walk into a healing setting, we have to really be centered, we have to be balanced, and then we have to be fully present. And I mean, this is a little bit off topic maybe, but hopefully relevant to that point. I was talking to a junior colleague very recently, a therapist out in the community, and she was talking about her level of burnout, which I, you know, is. Is a real thing for. For. Oh, yeah, a lot of therapists.

Dr. Stephen Ilardi [00:16:16]:
And it, for whatever reason, it had not ever really been fully internalized for her that, like, there's nothing in this that's about you, really, as the clinician. It's like you're. I'm probably overstating it, but like, that your mandate, your calling, your mission is to be there for this patient as best you can. That doesn't mean that you don't bring your full self into that moment that you don't bring your. Even sometimes, every once in a while, your own vulnerabilities, every once in a while, a little bit of self disclosure when it serves the patient, you know, and really struck me in that moment. It's like she didn't get that in her training.

Theresa Hubbard [00:17:09]:
Right.

Dr. Stephen Ilardi [00:17:10]:
Like, this is not about you at all.

Theresa Hubbard [00:17:13]:
Right.

Dr. Stephen Ilardi [00:17:14]:
This is. And so if you can't be fully present for the patient, you know, then take that really seriously. Get yourself fed, get yourself, you know, whatever you need so that when you walk into that session, it's not about you.

Theresa Hubbard [00:17:30]:
Oh, Steve, Sorry. Oh, I could talk about this for hours, this topic. And I know that's not what we're talking about today, but I know it's.

Dr. Stephen Ilardi [00:17:40]:
Well, do you. I mean, I saw you nodding, so I'll, you know, I hope for your listeners sake they don't sitting there going, oh, man.

Theresa Hubbard [00:17:48]:
No, Steve, I'm actually writing a book about that right now. I am absolutely right in process.

Dr. Stephen Ilardi [00:17:57]:
Well, amen. Nice.

Theresa Hubbard [00:18:03]:
Yeah, I mean, I struggle. I often say I don't think universities are teaching therapists what this job is anymore. And maybe they didn't in the past, I don't know. But I hear you. It resonates completely.

Dr. Stephen Ilardi [00:18:21]:
I, I can tell you in, in my training, it was loud and clear. You know, it was just. Could not have been more strongly emphasized. Like, you know, you, you need to have the mindset of you are there for this person who's come to you in a state of incredible vulnerability often. Yeah, incredible. You know, I mean, there's. There's a really old book that was very influential in this day by a psychiatrist named Jerome Frank called Persuasion and Healing. And he talks in there about how the typical patient will come to us in a state of what he referred to as demoralization, which he characterized as a confluence of helplessness and hopelessness.

Dr. Stephen Ilardi [00:19:21]:
Helpless in the sense that there's something that they're suffering with, something that's troubling them and they've exhausted their repertoire. Get better. Like they've got something they can think of to, you know, and it's still there, right. So that, you know, they're feeling helpless. Like, I can't figure this out. I can't get my own. Hopeless in a sense of like, well, it hasn't gotten better and I don't even know if it ever can get better. And then they, you know, they come to the.

Dr. Stephen Ilardi [00:19:53]:
He called them the culturally sanctioned healer. I'm using air quotes now. The cultural you know, because he said you can apply the same principles to traditional healers in any shaman. Shamanistic healers, or traditional, you know, that, that like they, they have been sanctioned by the culture as like you're. You have the mantle, maybe you have the priestly robes, you know, whatever.

Dr. Stephen Ilardi [00:20:22]:
You're. I guess in a med center, you have the white lab coat, you know, and the modern pre. Sleep, and it's like, all right, part of your job then is to instill a sense of hope. Instill a sense of okay, like, this may seem hopeless, but there's a way out.

Theresa Hubbard [00:20:47]:
Yes.

Dr. Stephen Ilardi [00:20:48]:
And I'm committed as the healer. I'm committed to being there for you. Help with that. And for me, as someone who specialized in clinical depression, treated hundreds and hundreds of patients, I have the incredible good fortune to be pretty optimistic by nature.

Theresa Hubbard [00:21:12]:
Yeah.

Dr. Stephen Ilardi [00:21:13]:
But not like irrationally confident or irrationally rationally. Like, I like to think of myself as an optimistic realist, you know, but what I mean by that is like, I had a professor in grad school who said, is this okay, Walker? Hey, is this. No, it's good. Just break it.

Theresa Hubbard [00:21:38]:
Yeah, he just knows I'm loving what you're saying, Steve. That's really what he's.

Dr. Stephen Ilardi [00:21:43]:
Interlude.

Walker Bird [00:21:44]:
She has been like a kid before Christmas. Actually.

Dr. Stephen Ilardi [00:21:48]:
I was thinking, well, we got our trial attorney here and like, I object.

Walker Bird [00:21:56]:
No, I'm thrilled. This is great. I already. I told her in advance, I said, you know, that you're both professionals. You're in an arena that I have experienced in only as a recipient of services. But in any event, no, I'm. I'm thrilled. Throat.

Dr. Stephen Ilardi [00:22:10]:
So please proceed and I'll.

Theresa Hubbard [00:22:13]:
I'll explain more when you. When you're finished, but go ahead.

Dr. Stephen Ilardi [00:22:16]:
Well, I. I was just. I was just. Just about to launch into another little. Little insider story of. Oh, back in first year grad school, I had a professor, the professor who taught the class that I teach right now called Advanced Psychopathology. So that's for first year grad school. Whirlwind tour of all the mental illnesses, like reading lots of originals, scholarly articles, yada, yada.

Dr. Stephen Ilardi [00:22:41]:
And we get to depression and, you know, we have all the articles. We come in, we've all done our reading, and he just looks us dead in the eye. It's eight of us around this table and him, and he's like, I just got a level with you all. He's like, you know, I don't treat anybody with depression. You know, that whole emotional contagion thing. They start going on about, like, how hopeless everything and how dark. And he's like.

Dr. Stephen Ilardi [00:23:07]:
And I'm just sitting there nodding my head like, yeah. It's just, it's awful. It sucks. And, you know, and I'll even. We're both in worse shape. I really, I loved his honesty.

Theresa Hubbard [00:23:18]:
Yeah.

Dr. Stephen Ilardi [00:23:19]:
Because it kind of built on a bigger point, which he said, which again, we could go down this rabbit hole. We probably won't. But bigger point for your listeners is every therapist probably has their kryptonite.

Theresa Hubbard [00:23:32]:
Yes.

Dr. Stephen Ilardi [00:23:33]:
Metaphorically or figuratively? Like, you know, we probably all, as therapists have certain kinds of disorders or conditions that we're not very well suited to working with.

Theresa Hubbard [00:23:49]:
Yeah.

Dr. Stephen Ilardi [00:23:49]:
And for whatever reason, from our backstory, our personality, what, whatever. And then we probably all have our. I know this is cheesy. I hope it's not cringe. But, like, we all have our superpowers. We all have our, like, oh, for whatever reason, who knew? But I'm, like, really effective with this population.

Theresa Hubbard [00:24:07]:
Right.

Dr. Stephen Ilardi [00:24:07]:
And so I heard just being thrown into the fire, like, huh. I really am strangely immune to the emotional contagion. And let me, let me, let me bracket that, because that could sound really callous. And I, I, I don't mean that at all. I am moved by it. Right. It makes me sad to be in the presence of someone who's really suffering, but it doesn't overwhelm me and it doesn't stay with me.

Theresa Hubbard [00:24:43]:
Right.

Dr. Stephen Ilardi [00:24:44]:
So I can get back to equipoise to equilibrium very quickly.

Theresa Hubbard [00:24:48]:
Yes.

Dr. Stephen Ilardi [00:24:49]:
Even if I'm leading a depression group. Session one, everybody around the table is an incredible pain for two hours and I'm there. And I'll have a grad, you know, I've done this several times. I have a grad student trainee in the room. And then we deep, you know, we debrief after. And they're just sitting there like, oh, my God, that was just so much. And. Yeah.

Dr. Stephen Ilardi [00:25:15]:
And I'm like, yeah, I know, you know, you will develop an emotional immune system, but it only goes so far, you know, depending on the person. So anyway, I, I am an optimist by nature, and when I'm working with somebody with depression, when they walk in and they're suffering and I know their pain, pain circuits in the brain are lit up and I know they're in agony. They may be fantasizing about death as an escape. They, you know, they, they've, they've lost things that matter to them and they're hopeless. And in my mind's eye, a little piece of my brain is envisioning what they're going to look like two months down the road or three months.

Theresa Hubbard [00:26:02]:
Yeah, me too.

Dr. Stephen Ilardi [00:26:04]:
And it sustains me and it gives me this sort of courage and this groundedness of like, okay, it sucks right now, but. But that's not the end of the story, you know.

Walker Bird [00:26:18]:
Have you ever felt confused or overwhelmed in relationships? Theresa and I have come up with a free mini course that we think will really help you out with a lot of the common relationship experiences so that you can improve your communication skills with all of the people in your life and really make a change for the better.

Theresa Hubbard [00:26:35]:
Yeah, we really believe that everybody deserves the opportunity to learn healthy relationship skills. Skills so that we can get through life having a good, healthy relationship experience. So click the link, put your email in, you'll get the PDF, spend a few hours working on it, and please let us know what your experience is. We know it will benefit you in some way. Thanks.

Walker Bird [00:26:58]:
Thank you.

Theresa Hubbard [00:27:01]:
Yeah. Okay.

Walker Bird [00:27:02]:
I thought that one's pretty good.

Theresa Hubbard [00:27:03]:
Okay, sounds good.

Dr. Stephen Ilardi [00:27:04]:
Okay, check, check. And so I don't know, I find that really, really important. I don't, you know, and I don't judge therapists or clinicians or, you know, or just lay folks because I think the same differences exist, you know, in. Just in people with their friends and family. You know, like, some people just have an incredible gift of being able to be present with others when they're hurting.

Theresa Hubbard [00:27:34]:
Yeah.

Dr. Stephen Ilardi [00:27:34]:
Without being, you know, just to be a comfort and sort of an intuitive. Sort of, you know, like intuitively. What do you need right now? Like, do you just need me to sit here with you in silence?

Theresa Hubbard [00:27:47]:
Yeah.

Dr. Stephen Ilardi [00:27:47]:
Do you need me to touch you on the arm? You know, do you. Do you need a hug? Do you need. Do you want to talk? And, you know, it. It's a gift. But I don't know, I guess it comes all the way back, Theresa, to the topic of your book. Like, it, when we walk into that therapy setting is like, you know, there's incredible potential for us, especially when somebody is, I believe somebody's depressed of, like, now we're playing for really big stakes because depression robs people of their clear thinking, of their ability to work at their best, of their ability to love at their best, temporarily, of their ability to be the, you know, the, the best friend or even to want to be around other people, of their ability, of their, you know, often of their sex drive, of their. Of their. Of their.

Dr. Stephen Ilardi [00:28:53]:
Not only their zest for life, but just their. Their desire to keep living. And. And it's the biggest cause of suicidality, which claims the lives of over 50,000 Americans every year, over estimated million people globally. So, you know, the stakes are really, really high. And it, that never fails to, I don't know, it gets me up in the morning a lot of times just thinking, okay, we're playing for keeps here.

Walker Bird [00:29:29]:
Yeah, yeah, there's a, there's a real responsibility there on your side of the, of the couch or however you set up your, your clinical setting. But also you said something that I thought was, it's, it's really important and that is this the power of your optimistic hope. Whether you state it or not, the fact that it's there, I think carries through to the person that's sitting across from you. And that holds so much to understand that somebody believes that you will get better.

Dr. Stephen Ilardi [00:30:11]:
Absolutely. Yeah. And I think, I love that you said whether, whether you say it or whether I say it or not. No, it's because we are, we're constantly reading each other's non verbals.

Walker Bird [00:30:24]:
Right.

Dr. Stephen Ilardi [00:30:26]:
You know, there's a way that you carry yourself. There's a way that you convey whether or not you believe what you're saying. Yeah. You know, and I'm sure as a trial attorney, you know, you've studied that when you're, when you're making closing argument, you know, to a jury, like.

Walker Bird [00:30:48]:
Yeah, in a crass way we would say they can smell bullshit a mile away.

Dr. Stephen Ilardi [00:30:54]:
Absolutely. You know, and well, and psychotherapy patients know the same.

Walker Bird [00:31:01]:
Yeah, yeah.

Dr. Stephen Ilardi [00:31:03]:
And they really know. I mean, back to Theresa, part of what you were saying earlier, like, they know whether or not you actually are there for them. They know whether you care and they, and they know whether you, you feel like you can offer them a path and join them on a path, you know, out of their suffering. And, you know, that's part of why it's been really transformative for me, I would say, over the, my journey over the past 20 years or so, as a, as a psychotherapy, as a treatment developer, as a protocol developer. Because early in my career I was a clinical neuroscientist. I mean, I was doing NIH funded studies that maybe 50 people would read about, you know, because we were looking like differences in hemispheric lateralization of processing. I mean, you know, and I was happy as a clam doing that. I thought it was like, oh, you know, that's how science works.

Dr. Stephen Ilardi [00:32:08]:
Like you do your one, you have your little tiny brick that you put in this grand edifice of all these discoveries and it's it's totally fine. But I was doing a little bit of therapy on the side because I'm trained, you know, as a clinical psychologist. I'm a licensed therapist, and I was just doing a little. So I'm a university professor and, and just doing a little bit of psychotherapy and my training. Like so many therapists these days, probably the majority was in cbt, cognitive behavioral therapy, and I'd even had even taught national workshops in cognitive behavioral therapy. My academic advisor at Duke had trained with Aaron Beck, who's a really famous name in the field. He's the pioneer, the originator of cbt, cognitive behavioral therapy for depression. And that was that, as the kids would say, some of them, you know, that was my jam.

Dr. Stephen Ilardi [00:33:09]:
You know, I was like, therapy, people get depressed. I mean, according to this model, people get depressed primarily because of the negative cascade of negative thoughts and extreme sorts of, you know, effects on behavior and so forth. And so the intervention CBT primarily focuses on helping people identify their negative thoughts, which are, you know, legion in depression. Identify them and then learn to. So be mindful, I guess, although that's not the language that she's being mindful of. Our thought process and then connecting our thoughts to our emotions, how we interpret events, and then taking a step back and saying, all right, you know, I said hey to that person, that neighbor, when I was walking in the mailbox, and they didn't seem to return my greeting, you know, what a loser. So there's a cascade of negative. They know I'm a loser.

Dr. Stephen Ilardi [00:34:05]:
They, they hate me. They, you know, I'm so unimportant and horrible and, you know, whatever. It's like, okay, well, let's treat those as just one possible set of interpretations, not as fact. When, when we have an interpretation, we just treat it as gospel truth. It's like that's, that's the only possible way things could be. Of course they hate me and they could tell I'm a loser and, you know, whatever. And then cognitive therapy would say, well, no, let's treat that as one hypothesis, see if we can generate alternative hypotheses. Like, oh, well, maybe they were distracted, maybe they had something on their mind.

Dr. Stephen Ilardi [00:34:43]:
Maybe they didn't see me, maybe they didn't, you know, all of, you know, we could do that. Or let's examine evidence. You know, what have been the last 10 interactions with that neighbor? Oh, they, you know, brought you, you know, a meal when your mother in law died and, you know, they were. And it's like, oh, maybe they don't hate Me, you know. Right. I mean, so it's a useful set of techniques. Yeah, but it has limitations. And what I was discovering, especially as a clinical neuroscientist, is the depressed brain is often an inflamed brain and people with depression often have altered body clock function, circadian signaling, circadian rhythms, and that then messes with their sleep, which then messes with their serotonergic signaling and dopamine or so serotonin, dopamine.

Dr. Stephen Ilardi [00:35:41]:
Every. Everybody knows about those allegedly feel good brain chemicals, but they're important, you know, in, in our, in our functioning. They often have nutritional deficits. They, they often have. Oh, here's one. They often have problems with having enough energy supply in their brain cells. So pain doesn't use glucose properly, doesn't get enough glucose. Even though their blood sugar may be high.

Dr. Stephen Ilardi [00:36:12]:
Glucose is just, you know, the form of sugar that we talk about as being biologically active and available. So their blood glucose could be high, but they're not getting that glucose in the brain. Or they get that glucose in the brain, but they don't have the right chemical key to unlock it. Insulin, you know, so the receptors are not, you know, they're, they're prediabetic in their brain. So now the glucose gets in there, but the brain can't use it. Or down to a molecular level. The power plant of the brain, the mitochondria are, you know, not healthy and they may be degrading maybe because they don't have enough antioxidants. So there are these, these reactive, oxygenated.

Dr. Stephen Ilardi [00:36:57]:
I mean, we could go down, you know, a very, very deep rabbit hole there. But I'm just like, all right, well, Aaron Beck, you know, he, he got a lot right about negative thinking and depression, but he didn't know about and didn't talk about any of this shit.

Theresa Hubbard [00:37:12]:
Right.

Dr. Stephen Ilardi [00:37:12]:
Matters.

Theresa Hubbard [00:37:13]:
It matters, yes.

Dr. Stephen Ilardi [00:37:15]:
And you know, and then I stumbled across a really interesting case report from an anthropologist named Edward Schieffelin, who back in the 80s had spent about a decade with a hunter gatherer band in Papua New Guinea in the highlands called the Kaluli people. And Shiefelin was really interested in forms of psychological disorder in other non Western cultures, but particularly what we think of as more aboriginal, you know, turns out, lived in a lot of ways lives that are much more similar to those of our ancestors. So think about sort of evolutionary selection pressure, the kind of world, the sort of Stone Age Pleistocene world that was the crucible within which anatomically modern Homo apiens evolved. And the world has changed, obviously, very rapidly since then. And since the Industrial Revolution, just eight, nine generations, it's become unrecognizable and there hasn't been time for any evolution. We still have the same basic genes building the same basic brains as, say, folks 250 years ago in colonial America or, you know, any other part of the world. And yet we live such radically different lives. So, you know, when I, when I read about the Kaluli and the fact that they hardly ever get depressed, I was like, wait, that can't what? You know, and I read, you know, a little more deeply, and it's like, well, they get bereaved when they lose a loved one.

Dr. Stephen Ilardi [00:39:05]:
They have all these really, I would say, very emotionally healthy ceremonies of bereavement and grieving the dad, their loved one, but they can still function and they derive enormous comfort and healing and support, and then they can move on, still remembering, you know, the dearly departed. But, but they're present, you know, for them because they've grieved and I think in a really healthy way. And, but they don't get, they don't get just, you know, shut down like we do out of the blue. And as a depression researcher, this is like 2003, 2004. I'm looking at the data and it's like, my God, like, pretty soon it's gonna be one out of three Americans are getting struck down by this. I mean, and we're talking disabling. The technical term, of course, is, is major depressive disorder.

Dr. Stephen Ilardi [00:40:08]:
Right. Major clinical depression. Major, I call it depressive illness often. And it's like, well, this is nuts, because, like, we've had a 300% increase in medication use and psychotherapy is still being widely used, and we're becoming more materially affluent as a country, and the rate of depression just keeps going up, up, up, up, up. So what the hell's going on? Clearly not a Prozac deficiency or, you know, I mean, one out of, I mean, depending on exactly which population survey you trust the most. I, I, I tend to trust the one that says roughly one out of seven American adults has taken an antidepressant in the last month. One out of seven.

Theresa Hubbard [00:41:04]:
Wow.

Dr. Stephen Ilardi [00:41:06]:
And it's roughly 400 or four fold increase since 1990.

Theresa Hubbard [00:41:12]:
Wow.

Dr. Stephen Ilardi [00:41:12]:
And this, how about this? The social burden of depression keeps going up and we're throwing a mountain of medication at it, and it hasn't moved the needle. And I use that with my students where I say, all right, let me stipulate it's time for me to Stipulate this. I'm not anti medication. I'm not anti medication. I am very in favor of anything that will be helpful. But I think we need to be honest. Yeah, I think we need to be honest and realistic about what the meds, current meds, can't do. I actually believe that probably by 2050, assuming we still have civilization in 2050, that I think there will be psychiatric meds that are so much more effective.

Dr. Stephen Ilardi [00:42:06]:
Look back on this as the dark ages and people will be like, oh my God, I cannot believe you were just throwing an antidepressant at somebody without taking into account like what was going on with their gut brain axis and what was, what were their genetics and, and wait, what about the, the dosage? And like, are they a fast metabolizer or a slow metabolizer? You weren't checking their blood levels. You weren't like, right. People are going to be like, you're just freaking throwing darts in a, in an unlit closet at a dartboard, you know, just hoping that you maybe hit the dartboard somewhere.

Theresa Hubbard [00:42:41]:
Yeah.

Dr. Stephen Ilardi [00:42:42]:
And then you turn the light on and you look and you're like, oh, well, you know, almost got the dartboard, you know. So as a researcher looking at all that and then stumbling across the Kaluli, it was an epiphany. It was like a light bulb moment where I'm like, oh, depression fits a pattern of diseases of civilization diseases. And by the way, there are dozens of these diseases that are endemic and very common in affluent, industrialized, wealthy, sedentary, you know, fast food laden indoor kinds of societies and largely non existent among aboriginal groups who still live like our ancestors for tens of thousands of years. And you know, other, for folks who are curious, like atherosclerosis or, you know, hardening of the arteries would be another disease of civilization. Diabetes, obesity, tooth decay, largely hemorrhoids, interestingly, you know, only occur in populations that sit a lot. Asthma, I mean, go on and on. Many cancers, it turns out, are virtually unknown in aboriginal groups.

Dr. Stephen Ilardi [00:44:13]:
Not because they allegedly die at, you know, die when they're 25 or 30. If they survive childhood, they typically will live into their 70s or so. They, you know, they experience old age, but they remain fit and active and, you know, vigorous in old age. And so that was like a light bulb went on for me and I was like, okay, if depression is largely a disease of civilization, then, well, what are the Kaluli doing? That's protecting because their lives are difficult. You know, they, they may live in, in the old age, but they don't have modern medicine.

Walker Bird [00:45:01]:
Right.

Dr. Stephen Ilardi [00:45:02]:
They, they will appear occasionally, have a week or two where there's no available food supply and they'll just, you know, be fasting involuntarily for a week or two.

Theresa Hubbard [00:45:13]:
Wow.

Dr. Stephen Ilardi [00:45:14]:
They have a pretty high rate of death due to intergroup conflict. So, you know, basically limited sort of skirmishes. Warfare with hostile out groups.

Theresa Hubbard [00:45:31]:
Yeah.

Dr. Stephen Ilardi [00:45:31]:
Which, you know, was probably part of the. Well, we know from the fossil record lots of bashed-in skulls and other, you know, I mean, intergroup conflict has been part of the, you know, human condition for a long time. It's horrible and it is a, you think a really big trigger for clinical depression. But the Kaluli don't seem to get depressed because they're protected. What protects them? They don't do psychotherapy, they don't take meds, they don't. It's their lifestyle. What makes us so vulnerable that, you know, we've had a 400% increase in antidepressant use and yet the rate of depression keeps going up and especially in our young people. Well, we've left behind everything that protected the.

Dr. Stephen Ilardi [00:46:23]:
Nearly everything that protected the Kaluli and we've added some new things that are psychological toxic. So what I, you know, tell my students is like, look, we have really strong scientific evidence that a, a lot of 21st century American life is psychologically toxic. And we need to also reclaim some healing habits of the past and weave them into the fabric of day to day life in the present. And they're like, well, so are you like the Unabomber bomber or something? Do you want to. It's like, know, clearly I do not live in a, in a cabin in Montana I have no designs on. It's like I'm, I'm not a big fan of superhuman AI. I'll lay my cards on the table. I think we need to slow that shit down till we can be sure we get it done right and safely.

Dr. Stephen Ilardi [00:47:14]:
But in general, I'm a big fan of technology and a big fan of modernity, a big fan of modern medicine. Big fan of anesthesia when you need to. Big fan of antibiotics when you have. You know, I mean, I think I'd be dead, honestly without modern medicine. Yeah. But I want us to have our cake and eat it too. You know, I want us, I want people to keep their laptops, keep their mocha latte, you know, but also be really smart and leverage things for. From the past that we know are antidepressant and anti anxiety and protect us from brain aging and storage of dementia and, you know, help with our focus and attention.

Dr. Stephen Ilardi [00:48:02]:
So. I know that's a lot, but.

Theresa Hubbard [00:48:04]:
No, I was thinking in your. The first edition of The Depression Cure that came out in 2009 and you've got your next edition that just got released August 5th, you had said.

Dr. Stephen Ilardi [00:48:19]:
Well, I. We'll see. From your lips to God's ears. I don't know if it's actually going to drop on August 5th or not. Publishers are. I shouldn't even be bringing this up, but they don't always hit their targets. How about that?

Theresa Hubbard [00:48:36]:
Okay, good.

Dr. Stephen Ilardi [00:48:37]:
That's sufficient. I don't want anybody, if they hear this. I don't know when this episode is going to kind of drop, but yeah, you know, if it's like mid August or late August or September or whatever. Okay, can I tell them we're recording on July 26th? So.

Theresa Hubbard [00:48:52]:
Okay.

Dr. Stephen Ilardi [00:48:54]:
You can edit that out if you need.

Theresa Hubbard [00:48:56]:
No, it's fine.

Dr. Stephen Ilardi [00:48:58]:
But I don't want them to be disappointed if they're like Amazon, it's like, oh, it's number one or whatever. Sometime very soon.

Theresa Hubbard [00:49:09]:
Sometime very soon. Okay, well, you said that the TLC addresses the modern depression epidemic at its source, the fact that human beings are not designed for the poorly nourished, sedentary, indoor, sleep deprived, socially isolated, frenzied pace of 21st century life. Is there anything that you would add to that sentence today versus 16 years ago?

Dr. Stephen Ilardi [00:49:37]:
Oh, that's good. I like that question. Yeah. So I mean, I guess, you know, in a, in a broader sort of framing, that question is, is could be interpreted as like, well, did you need a second edition of the book? So the first edition came out 16 years ago. What has changed? And to unpack that question, you know, I love the question. John, Packet. I think the first part A for me is has the science changed on anything that I recommended in the first edition? Was there something that we thought 16 years ago that was helpful, that now with better studies. This happens all the time in science, by the way, is like, oh well, maybe high dose Omega-3 fats are not as antidepressant as we thought.

Dr. Stephen Ilardi [00:50:31]:
Turns out they are. Thankfully, it turns out everything that was part of the core set of recommendations 16 years ago has stood the test of time pretty well.

Theresa Hubbard [00:50:44]:
Thank you for joining us today. We are excited to explore life with you. We encourage curiosity, self growth and we strive to be more compassionate and every day.