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Ep. 452 Protecting Your Brain: Inflammation, Sleep & Neuroplasticity with Dr. Drew Ramsey

  • Team Cynthia
  • Mar 29
  • 48 min read

Today, I have the privilege of speaking with Dr. Drew Ramsey, a board-certified psychiatrist, author, and a leading voice in nutritional psychiatry and integrative mental health. 


With over 50 million Americans facing mental health challenges, Dr. Ramsey and I discuss the effects of loneliness, connection, and the quality of attachment. We explore the importance of boundaries and self-awareness, as well as the stigma surrounding mental health issues, and we dive into public awareness of mental health, factors that negatively affect brain health, and the crucial role of sleep in overall well-being.

Our conversation also includes insights on how to find high-quality mental health care from qualified professionals, and we look at protective factors for our brains, like neuroplasticity, inflammation reduction, and maintaining a diverse microbiome. 


I hope you find this insightful discussion with Dr. Ramsey as valuable, engaging, and enlightening as I did while recording it.


IN THIS EPISODE YOU WILL LEARN:

  • The challenges of being in a caregiving role

  • Perimenopause and the impact on women’s health

  • Dr. Ramsey explains the concept of interpersonal psychotherapy

  • Why self-awareness is necessary for improving mental health

  • How social media and modern lifestyles impact mental health

  • Urban living and its impact on sleep and mental health

  • Mental health benefits of maintaining a diverse microbiome and avoiding ultra-processed foods

  • Strategies for improving sleep quality

  • Why personalized mental health treatments are essential

  • The role of psychedelic medicine in mental health treatments


Bio: Dr. Drew Ramsey

Drew Ramsey, MD is a board-certified psychiatrist, author, and leading voice in Nutritional Psychiatry and integrative mental health. He is a Fellow of the American Psychiatric Association and the founder of the Brain Food Clinic and Spruce Mental Health. For twenty years, he served as an assistant clinical professor of psychiatry at Columbia University, where he taught and supervised psychotherapy and nutritional psychiatry.

Dr. Ramsey has authored five books, including Healing the Modern Brain, and three e-courses. He is a dynamic speaker, podcast host, and educator who has delivered three TEDx talks, and his work has been featured by The New York Times, The Wall Street Journal, the Today Show, NPR, and other notable outlets. He lives in Jackson, WY, with his wife and family.

 

“When you have a mental health problem, you need help, and when you have mental health problems in your family, you need self-awareness.”


-Dr. Drew Ramsey

 

Connect with Cynthia Thurlow  


Connect with Dr. Drew Ramsey


Transcript:


Cynthia Thurlow: [00:00:02] Welcome to Everyday Wellness Podcast. I'm your host, Nurse Practitioner Cynthia Thurlow. This podcast is designed to educate, empower, and inspire you to achieve your health and wellness goals. My goal and intent is to provide you with the best content and conversations from leaders in the health and wellness industry each week and impact over a million lives.


[00:00:29] Today, I had the honor of connecting with Dr. Drew Ramsey. He's a board-certified psychiatrist, author and leading voice in Nutritional Psychiatry Integrative Mental Health. We know that more than 50 million Americans live with a mental health concern. 


[00:00:43] And today, we dove deep into the impact of connection and loneliness and the quality of attachment, the value of boundaries as well as self-awareness, stigmatization around mental health, the impact of public consciousness around mental health, what negatively impacts brain health, the role of sleep and why it is foundational to our existence, how to navigate looking for a high-quality mental health expert, credentials, perfect fit, etc., what protects our brains, including neuroplasticity, a reduction inflammation and a diverse microbiome. This is truly an invaluable conversation with Dr. Ramsey. I hope you will love this conversation as much as I did recording it.


[00:01:32] Well, Dr. Ramsey, welcome to the podcast. I've been looking forward to this conversation. 


Dr. Drew Ramsey: [00:01:36] Cynthia. It's great to be with you. Hi everybody. Hi everyone listening. It's great to spend some time together thinking about mental health. 


Cynthia Thurlow: [00:01:42] Yeah, such an important topic. And I think especially for women navigating perimenopause and menopause, they may start seeing changes in mood, anxiety, depression. And one of the things that really stood out to me while I was reading your book was the public health crisis that's been identified by the previous Surgeon General about loneliness. And as someone who's in that sandwich generation where I have aging parents and teenage children, one of whom still at home, that concept of loneliness, where do you see this evolving as a psychiatrist, as a mental health expert, when you're talking to your patients, how does that impact their perception of the world? 


Dr. Drew Ramsey: [00:02:25] Well, we don't feel seen when we're in relationships, when we're only of service. And so, the example you're giving of being sandwiched between a lot of caregiving of parents and all of the mortality fears that brings up and it's just a hard thing to do, I'm there myself, attending to your kids and all of the various needs modern kids have, that is a certain role for sure. But sometimes, I don't think it feels like the most complete or most known role to women. And I think particularly in perimenopause, when the shifting hormones. I see a lot of my practice around the quality of attachment, how people experience their husbands or partners, how people experience the-- it used to feel like, really good service momming it up, maybe feels a little different, a little more burdensome, a little less attached, a little more frustrated. I hear the phrase no fucks left to give on my couch fairly often [Cynthia laughs] around perimenopause, in some ways a reclaiming of the self.


[00:03:23] I am happy to be of service, but I'm also going to take care of myself and serve the self, which I think is very healthy. And then I just think our matriarchs, the women who are in your role usually holding together a family love, treating women in the situation where there's so much responsibility, there's so much often like pleasure in the generativity of what's gotten created. And then a lot of times there's so much complexity. Not everybody is always healthy and feeling good. Families are complex. And so, I think there's a real shifting notion of perimenopause, I know, in my practice. I really feel like early in my practice, not tuned in a way that I needed to be. 


[00:04:00] That as women were hitting their 40s, some of the symptoms that were going on certainly were primarily related to hormonal changes. How you address that, the whole shift with hormone replacement therapy, that really just happened over the last couple of years, and then the GLP-1 medicines, where there's this real alternative narrative in perimenopause where women are being treated differently than they've ever been before with GLP-1 meds and HRT, where suddenly this is a period where women, many of them are stronger, they're at a weight they like better, they don't feel the same food noise. A lot of women, I find also give up some other bad habits like wine. And it's a very interesting time, I guess I want everybody-- everybody listening probably knows this, but just like, there's a lot of opportunity now that there wasn't. 


Cynthia Thurlow: [00:04:46] And I think that reframe is so important. I think the concept of that pause, I always say the pause period, whether it's perimenopause, menopause, andropause, it's helping people reestablish their perception of themselves. And I think for many women who've been in that mom role for so many years. And it's those years of you are providing everything to your children and your family, and then all of a sudden your children start becoming a little more independent in a good way. And you start having to redefine your role, and how do you find purpose if you don't already have that? And I think that the hormonal changes that are happening, I think estrogen is this people pleasing hormone. 


[00:05:26] And as a reformed people pleaser, one of the greatest gifts I've given myself, and I hear this from my own patients, is the value of creating boundaries and saying no and not going along with expectations that your family sets out for you. And I'm from a very loving, wonderful, large family, and the family expectations are heavy in some instances. And I found that my mother, who's a wonderful person, but she's Italian and she likes to unsolicitedly provide her input on a lot of things in my personal life. And I kindly have had to say to her, “I respect you enormously, but that doesn't work for us.” And I don't want to have to provide an explanation, but I hear from so many of my patients that they really feel like they're finding their voice.


[00:06:12] Maybe when they were younger, they went along with the flow and that loss of estrogen, even with hormone replacement therapy, has afforded them an opportunity to really determine what it is that is bringing them joy in their lives and what is not. And I think it goes along with that whether it's your job, whether it's your relationship with someone, whether it's your spouse or your significant other. I see a lot of people and I have several friends, very close friends, who got divorced in their 40s because they finally realized this was not the right partner for them. But they are finding what works for them and what does not. And I'm sure you probably see that with your own patients as well. 


Dr. Drew Ramsey: [00:06:50] Yeah, and I love this notion of a reassessment of boundaries, that what maybe was automatic caregiving and being of service, which again, a lot of pleasure in that. I don't want to seem like I'm critiquing that idea. I love being of service, but our lives often need to be more than that. And I think particularly this transition you're talking about for women of being in a primary caregiving role to then not that the caregiving goes away, but there's more time, there's more capacity, but it's a real role shift. We talk there's a type of psychotherapy called interpersonal psychotherapy. And interpersonal psychotherapy focuses on the T's, like transitions, trauma and role transition. 


[00:07:33] You're juggling a million things and keeping it all together with younger kids to having kids who don't need you as much, as you said, like appropriately launching. It's just something for us to be considerate of. It's where I start healing modern brain. Because when you're a therapist like me, the couch behind me for watching the video, that's a real psychiatry couch. [Cynthia laughs] A patient was just there about five minutes ago. [laughs] You get really interested in the story of what's going on and how people are transitioning in their roles and helping them through sort that and be clear about that. Well, the first tenet is self-awareness. And it's because my couch is a very personalized, specific place. There's certain words and language that you develop with a patient. It's just not like any other treatment that you're running.


[00:08:22] But in that context, how can we generalize a few things? And so, in self-awareness, I really try to generalize this notion of what we are after when we're in a psychotherapeutic relationship, which is more awareness of how we're feeling, like more clarity. Talk a lot about journaling in the book. There are some really interesting studies. There's a study out of Stanford on what's called ‘Affective Labeling,’ which is, as you're writing, what's going on, how you're feeling. You're putting names, you're putting words to those feelings. That's one of those general definitions of psychotherapy. Like, “What are we doing in here?”


[00:08:55] And it's like, “Well, part of is we're taking really complex human emotions and describing them better, getting a better sense of what they are, what you're actually feeling, if ideally where it's coming from, because that really prepares you best or puts you in the best stance to deal with these stressors. And so, self-awareness-- take the journaling Affective Labeling has been shown with a significant decreased risk of depression. Just journaling regularly has been shown to increase the activity. They do functional MRI scans where you have increased activity in the prefrontal lobes of the brain. These are the parts of our brain that get shit done. The executive functioning, decision making, working memory. And so, you see this significant increase in the functionality of that part of the brain as you journal more. 


[00:09:38] And so one of the reasons I wanted to get into these tenets was there are things we can all agree on. They're accessible to everyone. Almost everything in the book is free. You know, things like improving your sleep quality, improving your diet, improving the quality of your connections and their tenets because I think there are things we all agree on. There's so much right now that everybody is like disagreeing on when it comes to mental health. And so many arguments that are really filled, I think, with a lot of misinformation. A lot of people who don't actually take care of patients. And when you take a step back and focus more on what actually is known, there's a lot of science, there's a lot of opportunity. 


[00:10:15] And I really ask people in Healing the Modern Brain to adopt a new stance about mental health. Right now, we have a stance where you never want to meet me, ever. No one wants to hear, like, “You know, I think you should see the psychiatrist, right? Maybe you need a medicine.” It's like, “Oh,” nobody wants that. And that's the heart of stigma. That also sets up a system where none of us get the care that we want because we're not asking the questions or engaging in activities or thinking about a framework about our mental health preventatively. We're in this very passive, like, “Oh, I hope I don't get that” and that's horrible. One, it means that all of us delay treatment. Nobody goes and gets help. Because it's something you don't want it stigmatizing. 


[00:10:55] And it also prevents us from using the new science around prevention. When you look at the data, like I'm most familiar with the data around food from my other books in nutritional psychiatry like Eat to Beat Depression and Anxiety. And when you look at the opportunity of shifting someone's diet and that radically changing their depression risk and anxiety risk, but also really shifting if they do struggle with anxiety and depression, their treatment outcomes, it's very cool to me. It doesn't mean we've got to get rid of therapy or get rid of meds. It means that other tools that I can add on, they're side effect free. There's a lot of science behind them. And so, what you're talking about boundaries, to me, that's part of the self-awareness chapter of understanding. 


[00:11:34] You're a person who's like always in service, never says no, but really end up with a lot of feelings of resentment or not being appreciated or are you a person who's really gotten emotionally dysregulated during perimenopause? Just found that extra gear of whatever, irritability, criticism. And again, we start with self-awareness because I know everyone listening has a different story and is at a different place in their lives. And I wanted to really honor that and acknowledge that and not have everything be too generic. And at the same time, I really want to take like the pearls from my practice. What people have shown me over the years works to get us into great mental health and to pull those together into a book to give people the science, the hope, the encouragement around really taking charge of our mental fitness. 


Cynthia Thurlow: [00:12:20] Well, and I think it's so important. I think in many ways we stigmatize certain things. And I would say mental health is absolutely one of them. I was an ER nurse in inner city Baltimore, before I became a nurse practitioner and I saw the extremes of extremes. And I remember, at one point, one of the hospitals I worked at was across the street from one of the largest psychiatric centers in the United States. And it was called Sheppard Pratt. And so, we did a lot of their intake. And I remember saying to a family member who was a physician, I said, “I've just started adding to my list of things I hope I never have to deal with” because we saw such profound extremes. 


[00:12:59] And yet many people, if they are so concerned about the stigmatization around mental health issues, depression, anxiety. I think everyone listening has had moments in their lives where they have undergone things where they probably had a period of time where they might have been clinically depressed or they may have had significant anxiety. And there's a quote in the book that I want to share with listeners where you reference, the world is made for people who aren't cursed with self-awareness. And that for me, typifies that I think a lot of people, it's not that they choose not to be self-aware, they're just not capable of tapping into that intrinsic awareness of how their behavior or the behavior around them is influencing how they feel about themselves and I always say it's people that are flying at 30,000ft. They're just not cognizant of what they are experiencing. 


[00:13:51] And so, I love that your work is really bringing attention to what I consider to be foundational elements that every person listening can learn more about and implement. And then if they believe that they need more assistance, they can seek that out. And I don't ever want the message to be that there is not a place for medication, because there absolutely is. And I think for many people, because the science of psychiatry is evolving and I know you talk about this in the book, especially about what drives depression. I think for a lot of people, as the science matures, people get a better understanding that it is one of many strategies and one of many ways to support their mental health throughout their lifetime. 


Dr. Drew Ramsey: [00:14:31] I hope so. My goal is to really encourage people and to help folks cut through all the noise. When you have a mental health problem, you need help. And when you have mental health problems in your family, you need to have self-awareness, pay attention to that. I think self-awareness also, Cynthia, came from my own experience. I've been in therapy a lot. I'm a 51-year-old white male physician, so I try to be very aware of whether it's the language I use or whether it's some of the education I've had over my years working with a lot of women of just understanding and doing a better job in that dynamic as a clinician, whether it's understanding aspects of my own mental health that have really struggled at different points in my life. 


[00:15:15] I try to share more around that in the book. More stories of my transition being from rural America and then working as a psychiatrist in Manhattan and a faculty member at Columbia and then starting a new journey for myself. Moving back to my farm with my parents in rural Indiana and my wife and kids and then migrating out here to rural Wyoming, pretty isolated Wyoming in Jackson. So, this book was really written in the context of these massive transitions for me. I think I'm the kind of doc, I get really inspired by my patients. I mean, I don't know how I won the lottery on this, but I just get to treat such interesting, fascinating, complex, caring people.


[00:15:59] It's really been one of the biggest, I would say, almost surprises and delights of my life to sit with people and really hear the raw truth, hear what's going on, create a safe space to really get a sense of next steps and how to be helpful. But I really appreciate what you're saying because, so often we approach mental health through a notion of controversy like medications or we approach mental health through concerns about access. And I really ask everyone to start approaching their mental health through mental fitness just like our physical fitness, right? There's all this stuff. If you're not doing it, you know what to do. And that's what I thought was really different about mental health and mental fitness. 


[00:16:38] If I ask people, like, “Hey, work on your physical fitness,” like, “I want you to work on your core.” Everybody knows, like a plank, sit ups, you know this, right? We all know a bunch of exercises. Even again, if you don't do them. With mental fitness, I say, “Hey, I really want you to improve your mental fitness.” Like, what do you do? What kind of activities? Is it journaling or is it going outside? or should you try and spend more time with your romantic partner? And so, trying to give people a framework saying, like, “Hey, when you look at your week, if you don't see any time in nature, massive red flag, massive.” 80% of jobs in America are sedentary now. 


[00:17:14] So, you're sitting inside and that is bad for your health and your mental health. The number one thing that correlates with the risk of sudden death is how many hours you sit a day. So, really striking things that the modern world has done to our mental health. And really asking everyone, like, “What's your framework?” What are your nutritional goals? You're going to eat white beans this week, are you going to eat some anchovies or sardines? or you’re going explore fermented foods.” Just in the tenet of nutrition, there's so many different ways, not to again, overwhelm people. But maybe your target is that you are just really having a hard time with those sweet, crunchy, yummy, savory, salty snacks in the afternoon. It's like an awesome mental fitness goal. Like, “What are the best snacks you can think of? How can we implement those into your life?”


Cynthia Thurlow: [00:17:59] Well, and I think that's much more tangible. I think part of what makes the concept of mental health so challenging is, if you have knee pain or if you have chest pain or if you have weakness in an arm or a leg or a foot. I mean, that's physicality brings greater attention and awareness to it. And I think perhaps not our generation, but certainly our parent’s generation, they subjugated mental health. I have a parent who is now deceased, but struggled with depression and PTSD his entire adult life. And he went to a mental health specialist regularly. But I used to challenge my dad and I would say, “Well, do you feel like talking about these things is helpful?” And he would say “Yes.” 


[00:18:45] And then he would share things with me and I said, “Do you feel like you're making progress?” And he would say, “No,” and I would say “Okay that's the degree of self-awareness that I think is quite significant.” But I think that generation in many ways really struggles with sharing their emotions, sharing their feelings. At least that's been my experience as an adult child. Retrospectively, looking at my grandparent’s generation, my parent’s generation, they were expected to subjugate their feelings and just suck it up and keep moving forward. And I remember my grandmother, who was a retired nurse, telling me, “It didn't matter if you were in a bad marriage, it didn't matter if you had a lot of problems, you were expected to just put a happy smile on your face and keep moving forward.” And so, I hope that our generation and subsequent generations are going to make it more acceptable to share and feel more comfortable expressing what we are experiencing. 


Dr. Drew Ramsey: [00:19:37] I think there's more talk about that and more opportunity for that than ever before. There's more public consciousness about the mental health conversation. I think you're also speaking to something that makes mental health harder. When we break our arm, it's like everybody says, “Oh my gosh. Oh, right, what happened?” You get all this empathy. The first step oftentimes with mental health symptoms is you have to believe they're true. “Am I really depressed? Am I drinking too much? Is my anxiety something I need to do something about? or can I get by another day?” And oftentimes people who are struggling with their mental health can get by another day. It's incredible strength and resilience, also an incredible chronicity of these symptoms. 


[00:20:17] I think that other part you're talking about is there's a first step of awareness and getting help, whether it's a mental fitness framework, whether it's talking to a professional, whether it's talking to your primary care doctor. And then I think there is next step of once you communicate creating the framework and progressing. There's like, as you know with your dad, he gets into treatment, but he doesn't think it's actually helping him. Is that because he thinks PTSD is fixed. Is that part of that generation's belief that, people don't change. People with mental illness have mental illness, their brains are broken, like, good luck. 


[00:20:46] And so the notion of a mental health transformation, that you can transcend trauma, depression, you can have remission from your symptoms, that is something that I think people don't have as much faith in. And so, the rigorous exploration of our mental fitness options and our mental health treatments doesn't happen in America?


Cynthia Thurlow: [00:21:07] No, it really doesn't. And one of the things that I was considering before our conversation was what is it about our modern-day lifestyles that sets us up for being at greater risk for mental health issues? 


Dr. Drew Ramsey: [00:21:24] That's a great question, Cynthia. Let's just look at the stats on teenage depression. So, adolescence, when I finished training in 2004 about 8.1% of adolescents would be diagnosed with depression in a year. You fast forward a decade 2014, we have about 14% and then today we have 20%. One in five teens is struggling with clinical depression. So, something's really increased. We see similar thing happening, for example with autism. We see similar things happening, for example with women in ADHD, where a mix of a new channel. Where did the women ADHD trend, came from? I think it came from social media. Not that it's not true. It's an interesting, I would say, sexist part of mental health care that generally women with ADHD are much less likely to be treated appropriately.


[00:22:11] But we see these trends in shifts and growing numbers and it gets everybody worried. Boy, if we have good mental health treatment, why are so many more people struggling with mental health problems than ever before? And it creates a bit of a conundrum that creates, I think, a lot of suspicion and a lot of misinformation about the mental health system. In some ways that's where this book wants to come in and say, “These are kind of treatment questions and I'm wanting you to start with prevention and self-care questions.” That's what's missing or one of the pieces that's missing in our mental health. Let's talk though quickly about some of the things that I talk about in Healing the Modern Brain and a little bit what to do about them, right? 


[00:22:48] So, we all talk about the screen. We all know the screens in our life. In Healing The Modern Brain, I try to get into some of the data, how the screen is interrupting your sleep, how it really pulls you away from building what's called cognitive reserve. There's a way that the phone, I feel this very unintelligible [00:23:00] in my life, there's a pleasure of isolation and retreat, right? Like you get a little corner and a little sunbeam and you got your phone, it's cozy. And you got everything. [Cynthia laughs] You got your bank statement, you got your emails, you got your Instagram. You could go see your high school friends on Facebook. It's really a self-contained unit where it feels like you're socializing, you're getting a lot of visual stimulation. 


[00:23:29] My Instagram tends to—because I’m a middle-aged guy, it rotates between men building things in the woods, boobs, [Cynthia laughs] and avalanches. It's actually, it's a really common thing, middle-aged men. Just after the hit, her dad was like, “I don't know what to do. I want to keep up on social media, but I open my feed and I'm like accosted and overly stimulated. I don't want to look at this stuff, but it's just showing up”. And so, there's a bunch of new, I would say mental health challenges around the amount of stimulation. So that changed. We got access to the entire universe.


[00:24:01] I am fascinated that I was going to a basketball tournament in Idaho. I'm in the back of the car and I'm on my phone, but I'm on an AI device and I'm asking it to pull all of the data on antidepressant medications and help me understand the overall risk and benefit that we're seeing in the data. As I'm just cruising along in the back of a car, it's so in some ways like empowering and potent, like how cool. And then it's also a little overwhelming. The other thing that we're seeing along with all this excess stimulation, excess information, is we're seeing that our number of people we're connected to goes up while the quality of those connections seems to be going down. That people feel less well known, less seen. There are fewer people that folks-- people feel they can really rely on or trust. 


[00:24:55] And at the same time, hundreds of people in our feeds, commenting, talking, we're having strong emotional reactions. People we've like never met because of something they wrote in a comment. I've had this happen. I'm always a little embarrassed when I'm like riled up by some comment. [Cynthia laughs] I mean, what a strange phenomenon. So, we have all of that and then as we're moving towards an urban living, about 80% of people are going to be living in urban areas. I lived in New York City. I love urban life. But I'm from very rural America. I grew up on 125-acre farm. There's no one. The nearest grocery store is like half an hour away and those are very different settings. 


[00:25:28] In Healing the Modern Brain, I go through some of what's going on in an urban lifestyle and how it interrupts things like our sleep, the noise. So, a lot of just regular city life, you've got the amount of noise, like having a jackhammer next to your ear. It's really a lot of stimulation, a lot of nervous system stimulation. So, I don't recommend like everybody give it up and move to the country or rural Iowa, Wyoming, like I did. But more to again have some self-awareness of how these things are creeping in. I share the story in the book of when our second child was born, we moved into a bigger apartment. We looked like all New Yorkers do, looked and looked and looked. And we finally find this place. It's just barely in our budget. We move in, we get settled. 


[00:26:09] So great, because there's a subway station right there by the apartment building. And as I'm falling asleep the very first night I hear, [onomatopoeia] [Cynthia laughs] I can hear the subway announcement and I'm like, “Oh my God,” like what am I ever going to get a good night's sleep? Got a white noise machine adapted to it just fine. But again, when we think about what's changed in the modern world, more noise, more light stimulation, relational degradation, the nutritional piece, right, this ultra-processed food diet. So about 70 to 80% of calories that most people listening eat are ultra -processed foods. So, these are foods that are made out of food-like substances. 


[00:26:51] And you can spot them usually because there's a crinkle of the wrapper, things like energy drinks, things like low-fat yogurt, things like protein bars and a lot of usually simple carbs, low quality meat and not a lot of plants. The beige diet, we often refer to it as. It's a great example of how food changed and it's a piece of the puzzle. I think a lot of times what's happening in our mental health epidemic is people are wanting that single cause. It was this, it was that, it was a vaccine. And that's not how mental health conditions tend to work. They're multi determined, meaning a lot of different things, your genetics, your environment. In the book I write a lot about epigenetics. Epigenetics is again this very empowering notion. 


[00:27:34] If you start journaling today, you start to shift what genes get turned on and get turned off during stress. If you start eating fermented foods today, you start to shift how genes get expressed. And so again, I like this idea because while it can feel like maybe overwhelming, boy, such responsibility. I think it's really helpful, that there's a lot that we can do to improve, how our genetic code is getting played. I think it gets us away from the stance that when your mental health is off, boy, it's easy to feel, which is that something's broken. It's like the scariest feeling in mental health when you lose a part of your mind. 


[00:28:09] You can't control your irritability anymore you can't control your drinking, or no matter how much you give gratitude and thanks, you wake up and you just want to die. And, it's really scary and disorienting. Again, I think there are a number of shifts that we've seen in the modern world that contribute. I also am not a pure, like, let's go back to the hunter-gatherer or Paleo guys. I like the modern world. I think the modern is kind of world's cool. I think Paleo folks didn't have Prozac and so I'm always going to stay in the modern world because Prozac is awesome. Paleo folks, they didn't have a diagnostic notion of people's inner worlds, minds and mental health. I like that. 


[00:28:50] I like sitting with people and having a sense of what's going on with them and helping them navigate it. So, as much as I appreciate, we often need to simplify some things and we need to look where we came from ancestrally and try and live in line with some of those values. I just think it's really important for us to note, like, that ain't the reality for anybody. Nobody's living in a cave, nobody's killing their own animals and eating them and butchering them very much anymore. Very few people are growing any of their food. We're not hunter-gatherers. We go to the Whole Foods. And so, again, there's great opportunity in that. 


[00:29:24] But, there's also, I think, a lot of risks and a lot of stimulation and people can get very pulled in right between all of the alcohol and God, all of the gummies. Geez, there are so many gummies right now. It's like, I'm sure, you see patients, it's like, “Wow, Delta 8, Delta 9.” So, people are taking a lot of different things. And I think it speaks to how we're suffering. I think probably the psychedelic movement has really, in some ways, I would say, taken advantage of that or moved in on that, where people are not liking the solutions or struggling with their mental health and are looking for an alternative path and ending up in oftentimes really, I would say, unhelpful, unregulated, unhealing situations. That doesn't really get talked about as much as all the miracles that happen. 


Cynthia Thurlow: [00:30:07] I think that, for everyone that's listening, finding some degree of balance, the concept of balance is elusive, but when I hear what you're saying, it's saying in many ways, yes, our paleolithic ancestors, there were some benefits, but they worked and lived very hard. In some ways there was-- [crosstalk]  


Dr. Drew Ramsey: [00:30:27] They're also really miserable. They were cold, hungry, sick.


Cynthia Thurlow: [00:30:28] They’re used to famine and sick. [laughs] 


Dr. Drew Ramsey: [00:30:30] Like, everybody dies on you. You fall in love, that person's dead, 


Cynthia Thurlow: [00:30:34] Yep. You get eaten by a rabid animal. I mean, It's—[crosstalk] 


Dr. Drew Ramsey: [00:30:36] There’s no science. Oh, my gosh. Like, who wants to go back to paleo? There's no science. I love science. I was talking earlier about a study of fMRI where we radio label glucose and can tell which parts of the brain are more active or not. I mean, like, how cool is that? 


Cynthia Thurlow: [00:30:50] Yeah, well. 


Dr. Drew Ramsey: [00:30:51] So, again, I like outside. I like the simple solutions. As I said, the book Healing the Modern Brain goes into tenets that you have at your fingertips. And that's the empowering message of this book. It's not to burden you or overwhelm you, but really to empower you. Because as I talk about in the book, in the self-awareness chapter, I think I go after a defense that I see a lot called externalization. And externalization is when we end up in a bit of a helpless stance that the reason our lives are in the state that they're in and our mental health is off is because of other people. We got fired, girlfriend left us, our dog died. And so, these are all real things that affect our mental health. 


[00:31:33] I'm not trying to minimize them, but there's a way that when we externalize, we're placing the blame on others. And when we engage in that, it doesn't allow us to be empowered to seek out the solutions that are in front of us. It puts us in a very helpless situation. And so, I'm a big fan of venting and complaining and getting it out. But I really, in my life and for my tribe and certainly for my patients, I'm always looking for ways where you control the narrative where things get better or get worse because of what you're doing. Because of your actions, because of your potency. And it's a lot of times right now there's, you know, this mix of a lot of externalization, blaming other people, other the things, etc. 


[00:32:17] There's a lot of misinformation about science, like the idea we need to scrutinize whether SSRI medications are safe or not is like the most scrutinized class of medications ever. There's never been a class of medications that's been examined more closely. So, you know, there's just a lot of bias and misinformation. I think probably, I don't mean to be sounding so dire and paranoid here. I think probably what I'm suggesting to people is when it comes to your mental health, this is the most important asset you have. And you should only trust consummate professionals when you need professional help. If you're not in a situation where you're needing professional help. This book is a bit of a wake-up call that stop othering people who have mental health problems. 


[00:32:57] That idea that we have like one in five people have a mental illness, that statistic is such garbage. I hate that stat. It's so stupid because it makes it sound like 20% of us struggle with mental illness and 80% of us don't. But like that's every year. Like line up five people, you got to pick one every year. Eventually, all of them are going to get picked. And you see this, you don't see it in depression as well, but you see it in substance use. The lifetime prevalence for a substance use disorder in men is 50%. So, I'll just say we need to be really increasingly aware of the pressures on our mental health. Increasingly aware of, like the very cool science about this. 


[00:33:35] If your newsfeed is like, I don't know, wasting your time debating whether Zoloft works or not, that's not going to help your mental health. Most likely your person will never need to Zoloft, right? What will help your mental health is looking in your fridge. What will help your mental health is looking at your bedroom tonight. What does it look like? I just had a patient tell me it's great. She said “The full moon is always hard for me to sleep.” And then she had the solution right there. But I'm getting blackout curtains that are arriving today. I just love bearing witness. Just watching something like that happen, where it sounds like something really small, that's going to improve sleep quality night after night after night. And what do you do during sleep? 


[00:34:15] So, Again, new discovery 2014 researchers discovered this whole new part of the brain. It's only a few cells thick. So, when we like harvest brains and look at them, it collapses because it's this little thin layer sitting in the cerebral spinal fluid and it's called the glymphatic system. It's like the lymphatic system for our brain and it drains out all the waste. They say it's about 7 g of waste that we leak out of our brain every night and the brain cells actually shrink. There's a mouse model of this where it's like they make more room the rivers to flow in between the cells and clean all the waste. Super cool. So, we've all had poor sleep. It's not like your brain waste came leaking out your nose. 


[00:34:55] You can go through some nights etc., but over time or sleep means you're just not taking out the trash. And we all know what’s that now, just do that in your house for a few nights or a few days. We all know what that's like. So, again, new science, new opportunities and then translating into small acts. Now, this isn't 50 minutes of some complex, pre-sleep wind down. I think that's great if you do it, but it also can be pretty straightforward and pretty simple. 


Cynthia Thurlow: [00:35:23] Well, it's interesting to me how many female patients in that perimenopause to menopause transition start making significant changes to lifestyle choices given how important sleep becomes. And I will oftentimes say to women, because many of them in this transitional change are weight loss resistant. And so, they're focused on, I've gained 10 or 15 pounds and as you start digging, you realize like they're not sleeping, they're not managing their stress, they're eating ultra-processed foods, they're not exercising. So, like all of this constellation of domino effect choices that are ultimately leading to weight loss resistance. And one of the things that I harp on about all the time is that complex interrelationship between our brains and our gut microbiome. And in the book, you talk about how getting four hours of sleep equates to 70% reduction in immune function. 


[00:36:16] So, my new book is laser focused on the microbiome at this stage of life. And so, this is very much in line with a lot of things that we've been talking about on the podcast. But how many women will say, “I'm not getting good sleep and I'm getting sick more frequently, I've gained weight, I don't have the ability to recall or remember things.” And I tell everyone that sleep is foundational to our health. Every person listening, irrespective to gender, life stage, everyone should prioritize sleep because it is so profoundly impactful to our health when it's not being prioritized. There's no other way to put it. It's not a sexy topic, but it's an important topic. 


Dr. Drew Ramsey: [00:36:55] It's a personal topic for me too, because I felt like a real matter of struggle. Last winter, as I was finishing this book, I was struggling a bit with my mood. Book's a big thing. It's not like my practice goes away. 


Cynthia Thurlow: [00:37:05] I understand that. [laughs] 


Dr. Drew Ramsey: [00:37:06] And so just meaning that it's a lot of between parenting, having a full clinical practice and working on the book, it's a lot. My sleep got interrupted. I think it was a mix of andropause. I always been a great sleeper and suddenly I'd go to bed at 9:00 and I'd wake up at 1:00, fully rested. And it was really terrifying, to be honest. Just gotten on the other side of it through a number of things. I'm not somebody who likes to take a lot of supplements or something like that. And I found some of the common suggestions like melatonin leave me really depressed the next day. And also, the American Academy of Sleep Medicine has issued a statement saying we shouldn't recommend melatonin right now. There's just not enough research. 


[00:37:47] I found in the middle of the night I started conceiving that my sleep was two four-hour chunks. I did two sleep cycle, I would wake up. Once I got good at this, I'd wake up and I'd have a little thing waiting for me. I'd either put my journal out with a cup of water. Sometimes, I write myself a nice note. My brain chemistry is really off at 01:00 AM to 02:00 AM as I'm sure a lot of people listening. It's striking sometimes if I really couldn't fall back asleep, you see something shift at like it was about 05:00 AM when the sun starts to come up, where all of a sudden, I was like, “Oh, all those angsty thoughts and painful thoughts are gone all of a sudden.” 


[00:38:23] I really wondered what is that. I ought to say that I really had to do some work even for all the training I have. I treat insomnia left and right all day long. And what I found initially was I needed to embrace it and I needed to get up for about an hour, do some journaling, try not to doom scroll, do some stretching, try to put out some positive mantras, sometimes take some breaths, do some prayer, really, all this stuff, trying to experiment and then I get back into bed and I'd sleep four more hours. I found that work. And then eventually I've always been a big fan of saunas, even before the most recent craze. 


[00:38:55] And I found that an evening sauna, if I can get in at maybe 02:10 for 30 to 45 minutes, I’d just sleep through the night. And that's just been wonderful. And so, one is you're noticing some of those functional changes. I'm less worried about whether I'm getting demented or not because I don't feel as overwhelmed. I don't feel as, I'm not hanging on to things memory wise. I don't feel as fatigued or “Ah, it's that stage of life where I'm low energy.” As you know, if your sleep is off-- Oh and another big one, sleep apnea. If you're one of these folks who's just never been diagnosed and you got a lot of apneic events and snoring, again, really highly correlated with the sudden risk of death. 


[00:39:36] And your sleep hygiene is just never going to be spot on until you address that. And so, ought to say sleep. I think it makes sense to everybody. I think everyone knows it. And I hope you hear a little bit of the difference that my approach to sleep is A, more magnesium. Let's make sure you're taking the right type of magnesium. More melatonin, more L theanine.” [Cynthia laughs] This is what happens. And I find it interesting, Cynthia. This often happens by the same people who purport to be interested in root causes. And they're the same people often who say, “Oh, well, there's no Prozac deficiency.” It's like, “Well, there's not an L theanine deficiency either, right?” [Cynthia laughs] 


[00:40:11] So it's again, I just think people should pay attention to who's giving you information about critical biological functions like sleep and whether they actually have credentials or they've just read a little bit and they're dynamic and telegenic and they've got a nice feed. And those are sometimes hard to tell the difference between. I even see a lot of the sleep experts, they don't actually see patients. They're PhDs or they're researchers. They're opining about things that I don't know. How do you know about treating sleep if you've never actually prescribed sleep medications to anyone? It's easy to look at the data and call sleep medicines names or this or that. When you're sitting with somebody who's suffering. I don't know, you look at the risks, you look at the benefits, you create a collaborative plan together. 


[00:40:51] So, I want to say everybody, I want you to have really good, high quality, unbiased information around your mental health. And I tried to pull as much of that together as I could in healing the modern brain, really, based on my experience as a practicing psychiatrist. I've been seeing patients every week since 2001 solely in a mental health setting. And I've been very humbled by that. All of us who are in practice in mental health. It humbles you. One thing that works great for one person doesn't work great for another person, even though their symptoms look the same. And so, figuring out how to create great alliances and collaborative care with patients is something that is always on our mind in mental health. 


Cynthia Thurlow: [00:41:34] Yeah, I think the concept of bio-individuality that, just like if I were treating a patient for high blood pressure or hypertension, I could line up 10 women, same age, same life stage, and they might all need something different. And I used to tell colleagues, like, the sooner you understand that everyone is their own unique individual, I would have some colleagues, cardiologists, that would put patients on the same. Didn't matter how big they were, how low their blood-- They would put everyone on the same starting dose for certain drugs. And I would say, I've just learned medicine is an art in the science. There is that, yes, this is evidence based. 


[00:42:09] But I found that if I have a patient population that's a certain age, a certain body type, they're very tiny, I can't hit them hard with certain medications. I know what's going to happen. They're going to fall, they're going to break a hip, then I'm going to have a very angry patient in the emergency room and I'm going to have to answer to the ER doc and probably their spouse. And so, I think that concept of bio-individuality I agree with you that I think there are many, I have to believe, fervently well-meaning individuals on social media who are not clinicians, who are not practicing, that are not seeing patients and they speak as if they are an authority and that they themselves are prescribing. 


[00:42:43] We're starting to see a lot of it in the perimenopause and menopause space where people will speak with authority. And I'm like, “That's great. That's your experience and working with clients and you feel strongly about certain things related to hormone replacement therapy.” But you're not writing the prescriptions. You're not the one advising the patient about cost benefits, you're not talking about the alternatives. Your opinion is exactly that. It's an opinion. But please don't pretend that you are actually the one that's treating the patient. You are speaking to a specific concern. And your amplification of this message in many ways can be misleading. I'll give you an example. 


[00:43:20] There's someone that I follow who is a trauma expert and very well respected. And his point in an Instagram post was, whether it's narcissistic tendencies or trauma, please be careful who you choose to work with and here's why. You can call yourself a coach or a therapist, but if you're not looking at credentials, you may not know who you're actually working with. And maybe that's something that we can speak to before we pivot a little bit. How can individuals determine if someone has the credentials that they need to be looking for if they're looking specifically for mental health support? 


Dr. Drew Ramsey: [00:43:54] So, first I like to see training and so I like to see a minimum of a master's degree in therapists and a minimum of a doctoral degree in anyone who's prescribing. There's been a big push in America for psychiatric nurse practitioners, to have prescribing privileges. So, in my state, Wyoming, nurse practitioners don't need any supervision. The challenge with that is then you have individuals who sometimes had a couple of years of training. A number of people I think trained during the pandemic just didn't have a lot of inpatient encounters, a lot of video and you end up with comparing that to, let's say a psychiatrist. We have four years of medical school, four years of psychiatry training after college. 


[00:44:33] And so I would say looking for people, psychiatric nurse practitioners or board-certified psychiatrists, or also there are a number of I think primary care doctors and internists and OB/GYN doctors out there who are incredibly mentally health savvy. When I was struggling a couple years ago, I know like the top depression clinicians in the world, right, I went to my primary care doc, like right down the street, real easy, told her what was up, made a plan. So, I think that one thing to do is check credentials. They don't have to go to the best school, right? Yeah. I went to a fancy place to train. I went to Columbia for psychiatry, but before that I went to Indiana University Medical School. It's one of the top 25 medical schools in the country. 


[00:45:15] It's our largest medical school in our country. Amazing education. And then I think engagement, what we call fit. So, you sit down with a clinician and you feel like they're giving you their formula. They feel like they're putting you in kind of a box. I don't like that in mental health. Mental health care is very-- Cynthia, you said it's very unique, very bio-individual. What you like in a clinician is different than what I like in a clinician. And then I look for tone. I have probably one of the more experienced mental health professionals. I don't know, I've got maybe 40,000 hours under my belt of caring for patients in a mental health setting. So, I don't mean to be like arrogant or brag.


[00:45:51] I've spent a lot of time in this space and my approach is still very humble. I get confused a lot. I ask a lot of questions. I do not know the next best step all the time try to. And so, making sure you're working with somebody who has confidence and humility. I'm very confident. If I'm in your corner, it's going to be a tenacious fight to get you better until you're better. I'm not always confident on the timeline of that. Almost every time I say, “Oh, you know, I think like two months would better,” it's a very humiliating statement to sit with when someone who you're treating is still suffering quite badly at two months. So, again, just to go over these credentials, right, that they've trained, that they have trained in something. 


[00:46:30] It's not just like a general mental health thing that if you look on their website, they talk about their credentials. There's a therapist here in our community who I know a little bit, we treat some patients together. I looked at her credentials. Boy, she really detailed all of the training and supervision. And not only did she go to a great institution, but she really shows, “Hey, when it comes to this eating disorder, CBT, like I'm really well trained.” And so again, there's that part and then there's the fit. You go, you sit down, how's it feel? It just feels like they could be kind of your person? Can you feel it? Get a sense over time? You might be able to tell them some things you haven't told people. 


[00:47:00] I would say, like psychotherapy, that's like the stuff you don't talk to anybody else about. When people are like, “Oh, what's the difference between this and a friendship?” It's like you tell me all the stuff you're not supposed to tell your friends and can't tell your friends. There's a great quote, this analyst, Otto Kernberg, says “Psychotherapy begins where friendship ends.” And I've always thought that there's something very friendly, something very related, but it's not a friendship exactly. So, those are some of the things that I look for. You want it to be a working conversation and you want to feel known in seen. And also, I try to show my patients very clearly that I want feedback. 


[00:47:37] If I seem a little sexist or I seem a little tired, or I seem a little hell bent on prescribing X, Y or Z and it doesn't sit with you, boy, I want to know that right away. And so, clinicians who are interested in that, what we call the alliance and the maintenance of the alliance, that is also something that I look forward see as a really strong indicator of a good mental health professional. 


Cynthia Thurlow: [00:48:01] I think all of those are so important. And you know, that collaboration between patient provider and being very clear, like obviously the state that I'm in, NPs have only been autonomous, I believe, for the last five years. So, I had been, gosh, I'd been an NP for almost 20 years by that point. And I recall saying to someone, I said, I feel badly if a nurse practitioner has not been practicing for more than five plus years with supervision. And I said, “This is not demeaning.” I worked in critical care, cardiology, ER medicine. I am an adrenaline junkie at heart. I had very sick, very medically complex patients. You better believe that when I didn't know something, I asked and I said, I think when we talk about autonomous practice in the right circumstances, I think it can be very, very powerful. 


[00:48:51] But by the same token is, I think in some ways someone may lose opportunities to be able to collaborate on a regular basis. So, even now, I still have clinicians that I will reach out to when I'm trying to get clarification. I think something even for an experienced clinician is to know when you don't know. And I'll tell patients. I'm not 100% sure on that, but I'm going to find out and I'm going to get back to you. 


Dr. Drew Ramsey: [00:49:14] It's also one of the fun parts of practice is we're always learning. There was just a study that came out in the fall that really affected my practice looking at patients with bipolar disorder. I was just looking at patients on stimulants, sorry, and comparing Adderall to Ritalin. And Adderall has a six times increased risk of mania or psychosis compared to Ritalin. Wow. That really actually shifted how I practiced over the next several months. So, there's a constant evolution of the science. I've been out of training for a long time. I've been in practice for a long time. 


[00:49:45] You know, a lot of medicines that are out, there's a lot of research that's out just all come out in the last maybe 5, 10, 15 years that really should be influencing and shifting how we practice. So, yeah, I think also maybe you're noting something that when people are part of a group that sometimes can be helpful, you know, it shows that they're integrated, they're part of a group, they're probably getting some supervision. They're talking about cases in a case conference or patients on a case conference. We have a small team here in Wyoming. And I think people get much better care because we sit as a team. And if there's a challenge, a problem, a question, but even just saying, “Hey, this is what I saw, this is what I'm thinking, this is what our plan is.” In order to run that by another clinician is something that, some people don't have that tradition in how they practice and that's a little bit of a red flag. 


Cynthia Thurlow: [00:50:30] Yeah, I say this respectfully. I am a nurse practitioner. Our training is quite different. I feel like physicians have many years between med school, residency, fellowship training before they're practicing. NPs really learn on the job the first five plus years that they're practicing. And I think that the one thing that I always say to my children is I'm a lifelong learner. So, I am always learning. My husband had a healthcare hiccup and was hospitalized and had surgery. And I remember looking at the thoracic surgeon and the pulmonologist and I said, I just learned something new today. And they were both so humbled. They were like, “Really?” And I said, “Yes.” With all this critical care training, I said, “I learned something new.”


[00:51:10] And I think they were so appreciative of the fact that I was admitting, I'm deferential. I am incredibly humble. I will be the first person to say I'm always learning. And we know that, many instances, academic medicine where the research in many instances is being implemented a bit earlier, it can take 5, 10, 20 years to trickle down into private practice. And so, I think on many levels, the fact that we collectively are working and endeavoring to remain current and collaborative and synergistic, I think ultimately helps our patients. 


[00:51:42] Now, when I think about the things that are protective for the brain, I think this is relative and important because I think for a lot of people, they've been led to believe that, we have so many brain cells and what we're born with is what we have kind of like when we think about women's ovaries, we're born with a finite amount of eggs and when they are gone, they are gone. Brain cells are unique and different. And I would love for you to speak to the things that are protective for the brain because this also impacts mental health quite significantly. 


Dr. Drew Ramsey: [00:52:09] It's a great question. We know that this idea really shifted when I finished training. We didn't know that you gave birth to new brain cells in your hippocampus in other parts of the brain. Now that's pretty common knowledge and accepted. We didn't know about BDNF, brain-derived neurotrophic factor that we mentioned earlier, which is this like miracle grow molecule for the brain. So, in terms of protective factors, I think they've in some ways like shifted a little bit. In a lot of ways, the tenets are about trying to bolster this. We know that it's protective for your brain and your mental health to have a community and to socialize. We know it's protective for your mental health to have a diverse microbiome. Each one of the tenets, I can make some type of statement like that. 


[00:52:52] We know that sleep is critical for protecting your brain health and mental health as we just discussed. And so, in terms of protecting our brains today, let's talk about the main poisons. And so, I think there's the poison of misinformation and bandwidth overload. And really those two things being very intertwined where even for myself I sometimes feel this surreal dissociative sense of like, do I know what's actually true? Like, do I know whether these things work or not? So, I think that is very damaging to our brain. It kind of usurps our confidence and our self-actualization. I think probably another poison, let's call it, of modern mental health or substances that there's just a tremendous amount of alcohol being consumed in America. 


[00:53:39] I've spent a lot of my life being one of those people and stopped drinking a few years ago. And it's really quite remarkable to go from something that, you want to do less of or you find yourself in the habit of it. I was one of those have a couple beers a night to relax kind of guys and it just didn't do great things to my mood or my gut as I got older. It's strange now being a headspace where I just don't like think about it at all. But along with alcohol, I just think people are doing a lot of different things at once. I find a lot of people are taking lots of supplements, like they're safe. They're going to lots of psychedelic retreats, like it's safe. 


[00:54:17] People see studies, like, there's a study that psilocybin mushrooms interrupt the default mode network for two months. And I saw a lot of people online like, cheering that. It's like, how bizarre, your default mode network, the way your brain, it's like the resting state, it's disrupted for two months and that's good. It just feels like again, a lot of people who haven't maybe spent time with folks in clinical settings that you see, it's actually a mix of things. When people go to retreats, they come in the next week, they're oftentimes very, very activated, very loose, as we say, very intense, sometimes a little delusional still. But that doesn't get reported as much. What gets reported as all the healing, which is great. I don't want to be like a negative Debbie Downer. 


[00:55:00] I just think people are doing a lot of different things and in some ways trying to skip over the basics. I find a lot of people are going to Peru to do ayahuasca, but they don't journal or eat well or move their bodies or work on their connections. And so, I think there's some situations where that's probably appropriate. But I don't know, sometimes I just get really concerned that we are missing the apparent degradation of the systems that keep our mental health in check. Community, good sleep, good nutrition, moving your body, engaging, going out in nature, living a life with purpose, focusing on engaging in your hobbies, activities, work and love, fundamental stuff. And instead, we're looking for something that's going to radically shift our brain and have us be different in the world. 


[00:55:46] And I'm a big believer of your power to transform and to be in the world in a very, very different stance. My experience clinically is that usually doesn't happen on retreat weekends. That happens through engagement with the self and really pushing and promoting and focusing on your mental fitness and your journey in that. Like, what's that mean to you? Or they'll say to some people, like, what would the mentally fittest version of you look and sound like? What would be different? Because as soon as that answer starts, you're beginning to hear some goals, right? You're hearing a visualization of an optimal state. You're seeing that delta, that gap between where somebody is now and where they want to be and you're off to the races. Like that treatment has started because you're now working together to try and get towards that optimal state of mental fitness. 


Cynthia Thurlow: [00:56:35] Well, I think it's important, and I think the desire for people to look for a bright, shiny object is in many ways like human nature. Maybe it's a byproduct of the influence of social media. But I, 100%, agree with you that sometimes the basic tenets or foundational elements to not just physical, but also emotional health, mental health are not sexy. And I think for many people, that bright, shiny object may be that ayahuasca trip that they took in Peru. And I say this with great reverence and respect. I have colleagues that have done this. 


Dr. Drew Ramsey: [00:57:09] We all have colleagues who've done this at this point. [laughs] 


Cynthia Thurlow: [00:57:12] [laughs] Yes. And I think it's one of those things. I was at an event in New York and there was this wonderful cardiologist that I was talking to, and he was telling me about his family. And then he mentioned this ayahuasca experience, and he was like, “You must do it.” And I said, “I think that's great.” That scares the bejeebers out of me personally, but that is just me and looking at it just isn't. It isn't not the right decision for me. But I do know that it's not just ayahuasca, it's microdosing of some of these psychedelic drugs or plants-- [crosstalk] 


Dr. Drew Ramsey: [00:57:43] You see a lot of microdosing with psilocybin, which the data says doesn't really do anything. There's a nice study of microdosing psilocybin where the idea is it expands creativity and nonlinear thinking and no, actually, if you look at the research and you give people a microdose and give them a placebo, there's not a lot of discernible differences. Shockingly, there are a lot of things, DMT, ayahuasca, psilocybin, MDMA. Ketamine is the only legal psychedelic in most states now. And so, part of moving to Wyoming and with the psychedelic renaissance, as much as I sound contrarian, I opened a psychedelic clinic. We have a journey room right across the hall where we've had several hundred people come and experience psychedelic medicine. 


[00:58:22] I think it probably shows a little bit of how we learn in mental health, there's a reading of the studies, there's the talking to colleagues and then there's the what does it look like in front of you? And what does it feel like to be a psychotherapist and be speaking with patients and then to have them in a psychedelic state? What does that do to the relationship? Does that progress the treatment in some way? But I think also that attitude you mentioned of the cardiologist. And I think this really gets to what-- just annoys the hell out of me about the movement. It's this idea that it's for everyone. Without knowing you, without knowing your psychiatric history, If you have a family member with schizophrenia or bipolar disorder, these medicines can be quite dangerous. 


[00:58:59] Before knowing that, everybody's like, “You got to go.” And I know this is probably like a [Cynthia laughs] light conversation. But it skips over something that I find very important when it comes to our mental health. As you say, not just going from shiny object to shiny object, but being intentional and being intentional with your mind and your brain. It's a great asset and wonderful gift that we've all been given. It doesn't feel that way when your mental health is off, but it's true. And so not that I want to discourage anybody from exploring or experimenting or fear monger in any way. I just think there's a little bit of a Pollyannish attitude that all of mental health is just easy, go trip and you're good. 


[00:59:39] Anybody who's responsible in the space of psychedelic medicine knows that's just simply not true. And I think a lot of the hype has really settled down over the last few years where some of the research is being questioned a little bit. And then just the functional capacity of these medicines is horrible. To treat you with Prozac, if you have significant depression, about 60% of people will get better. It costs $5 for the year for your medicine. The most recent research shows that a psilocybin journey to treat clinical depression lasts about two months on average. So that's five to six journeys. And nobody's figured out a way to do this for under thousands and thousands of dollars because you need two clinicians in the room, and it's eight hours of clinical contact time. And that's just the journey. 


[01:00:21] Before that, you got to prep, you do a medical eval, you do another prep session, an after journey, you do integration sessions, a lot, a lot of time, a lot of money. And so far, the studies say that these medicines are equal to SSRI medications, not superior. And so just from a simple if we're talking in a state where we're worried about efficiency, those are big questions that get raised when you actually start looking at how viable and efficient these procedures and medications are. But I don't get into Healing the Modern Brain much, into psychedelics much. I do end the book a little bit, telling the story of a man who comes to see me wanting to engage in psychedelic medicine, but it doesn't really have a clinical indication at all. Like a lot of people, he's wanting to expand his consciousness. 


[01:01:04] He's wanting to get in touch with the spiritual self. And I find myself in a little, I would say, dilemma, but I like those goals. I think that's kind of interesting, but it's not exactly psychiatry. And it's a little hard to know who you maybe include and who you turn away other than those clear contraindications. And so, I guess my hope is that this book will allow people to see, regardless of what happens with the psychedelic movement. And I'm very hopeful that good things will continue to happen and we'll have more data and more clarity. Underneath all of these interventions is a set of activities, behaviors, ideas, knowledge that I just think people should have more of if they're going to take care of their mental health effectively. 


Cynthia Thurlow: [01:01:47] Well, I couldn't agree more. It's been such an enjoyable conversation. Dr. Ramsey, please let listeners know how to connect with you outside of this podcast, how to get access to your new book, Healing the Modern Brain, which I really enjoyed and look forward to being able to support your book launch. 


Dr. Drew Ramsey: [01:02:01] Cynthia, that's the first copy I've seen. 


Cynthia: [01:02:02] Oh.


Dr. Drew Ramset: [01:02:03] We pulled that up again. 


Cynthia Thurlow: [01:02:04] Yeah, yeah. 


Dr. Drew Ramsey: [01:02:04] Oh, my God. I've not seen one yet. 


Cynthia Thurlow: [01:02:07] This is your baby. 


Dr. Drew Ramsey: [01:02:07] I'm going to start crying right now. [Cynthia laughs] Oh, my God. So intense. Everybody. First, thank you. If I didn't go off on too many rants here--[crosstalk] 


Cynthia Thurlow: [01:02:16] No, I thought it was great.


Dr. Drew Ramsey: [01:02:16] --this or that. I hope you hear my encouragement and I hope you don't feel in any way overwhelmed. It doesn't matter whether you eat a little more lentil or a little more arugula tonight. Either one, you get lots of points from me, especially if you enjoy it and pair it with a little bit of love. I'm easy to find. I'm drewramseymd.com is my website. @drewramseymd is my Instagram. Healing the Modern Brain is also available as an e-course that's up on my site. If you want to spend more time with me going over these concepts and then the book's available everywhere. 


[01:02:48] I really would love you to take a look and see what you think. I really appreciate feedback and hearing how the book hits you or doesn't, but it's really important to me to have these ideas get out there into the world and I hope effect change for you. So, thank you so much for letting me spend some time with your audience, Cynthia, and everybody who's listening, thank you so much. It's just a real honor to get to talk about your mental health with you wherever you are, and I hope this helps you take some important and necessary next steps. I don't mean to fear monger, but it's a different world we're living in and your mental health merits deserves and just frankly needs more attention than it has before. And so, I hope this book helps you get started with a good framework. 


Cynthia Thurlow: [01:03:27] Great. Thank you so much. 


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