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#067 Dr. Ashley Mason On Drug-Free Approaches For Treating Depression, Insomnia, And Overeating | Found My Fitness With Dr. Rhonda Patrick

Key Takeaways

  • Whole body hyperthermia is being evaluated for potential future approval as a depression treatment
  • People with depression often have temperature dysregulation, higher nighttime body temperatures, and are not as efficient at cooling the body
  • Sauna mimics cardiovascular exercise so could be a good onramp for people who will not otherwise exercise, are sedentary, or are disabled
  • In early studies, positive effects of sauna on reducing depression score persisted for six weeks
  • Non-pharmaceutical sleep tips: (1) don’t use your phone or any devices in bed; (2) sleep and wakeup at the same time every day; (3) use the bed only for sleep and sex – if your mind is racing with thoughts, get out of bed; (4) sleep restriction: limit time in bed and work on improving efficiency
  • Mindfulness tips for overeating: (1) set up your environment to promote healthy choices; (2) act slower and get connected to how everything feels – maybe the first two bites are amazing then it fades – stop at two bites

Introduction

Dr. Ashley Mason (@DrAshleyMason) is a clinical psychologist and director of the Sleep, Eating, and Affect Laboratory at the Osher Center for Integrative Medicine at UCSF. Her research centers on nonpharmacological approaches for treating depression, insomnia, and overeating.

In this episode of Found My Fitness, Drs. Rhonda Patrick and Ashley Mason discuss hyperthermia versus sauna use, the benefits of sauna use for people with depression and cardiovascular disease, sleep disorders, and sleep hygiene.

Host: Dr. Rhonda Patrick (@foundmyfitness)

Whole Body Hyperthermia (WBH)

  • WBH is a method to heat core body temperature
  • Heat shock proteins: protective stress response proteins that prevent muscles from atrophy, help the body deal with heat stress
  • Whole body hyperthermia: heated consistently and for a lengthier time than sauna (over an hour), with much more controlled experience
  • WBH is more intense than a sauna and has potential clinical indications
  • Protocol: 144-150 degrees, lying down in heated sauna dome but with the head sticking out; participant given water when thirsty and cool cloth when they feel hot
  • WBH protocols are being tested for treatment of depression: studies have shown changes in depression scores decreased and were sustained for six weeks post-WBH experience

Exercise & Heat To Improve Depression

  • One of the most common side effects of Selective serotonin reuptake inhibitor (SSRIs) is sweating
  • Temperature dysregulation in people with depression, higher nighttime body temperatures, not as efficient at cooling
  • When people with depression receive treatment, their body temperature decreases
  • Aerobic exercise has been shown to improve depressive symptoms – but – getting depressed people to exercise is challenging
  • Sauna could be a good way to get physical and mental health benefits of exercise without actually exercising
  • Cardiovascular disease and depression are often comorbidities
  • It’s easier to sit in a sauna than convince someone to go for a run
  • Sauna mimics cardiovascular exercise so could be a good onramp for people who will not otherwise exercise, are sedentary, or are disabled

New Studies Exploring WBH As Depression Treatment

  • Measuring many biomarkers: including brain-derived neurotropic factor (BDNF), heat shock proteins, inflammatory cytokines
  • Participants enrolled will have a major depressive disorder and receive WBH in addition to cognitive behavioral therapy
  • Cognitive-behavioral therapy is the gold standard for non-drug depression treatment
  • It can often be difficult for participants to engage and be active in cognitive behavioral therapy so don’t get the benefits
  • A second study will split participants so one group receives cognitive behavioral therapy alone and a second group receives WBH + cognitive behavioral therapy
  • Gaps Addressed:
    • Measure participants’ receptiveness to consistent WBH sessions
    • Measure body temperature at night
    • Measure depressive symptoms daily
    • Measure biomarkers
  • Hope: develop a model for maintaining a reduction in depression symptoms through WBH

Non-Pharmacologic Treatments For Chronic Insomnia

  • Chronotype: whether you are a night owl or morning person is biologically determined
  • Chronic insomnia: difficulty falling asleep, staying asleep, waking up too early in the morning, and not being able to get out of bed on 3+ nights per week
  • Chronic insomnia is genetically induced a small percentage of the time but largely induced by stress, change (e.g., new job, retirement), things that disrupt 24-hour clock, etc.
  • Quitting sleep medication can be very difficult and in itself induce anxiety – try tapering
  • Cognitive-behavioral therapy can also be used to address the underlying things causing insomnia and other sleep disorders
  • The benefits of cognitive-behavioral therapy are long-lasting – once you learn the tools, you have them available to you
  • Things that perpetuate insomnia are not the same things that started insomnia: for example, maybe you start skipping exercise because you aren’t sleeping so are too tired, maybe you are increasing caffeine intake to make up for lack of sleep, etc.
  • “Nothing in bed except sleep or sex.” – Dr. Ashley Mason
  • Try sleep restriction: work backward from wake up time 7-8 hours + 30 min. grace period – example: if you wake up at 8 am, go to bed at 12:30 am, and don’t allow yourself any other time in bed
  • To shut down anxiety and a racing mind, try: develop a thought more reflective of reality – for example, “I don’t always perform my best after a bad night of sleep but I usually do fine.” – that will not eliminate but will reduce anxiety
  • Progressive muscle relaxation: focus on different muscles in your body and contract then relax muscles
  • All sleep hygiene is not created equal! Most important: (1) sleep restriction, (2) stimulus control – don’t do anything in bed that isn’t sleeping or sex
  • Book: Quiet Your Mind And Get To Sleep by Colleen E. Carney, Ph.D. & Rachel Manber, Ph.D.
  • Apps: Insomnia coach, Sleepio

Non-Pharmacological Treatments For Overeating

  • Overeating can be induced by stress, not eating, or other factors
  • First question to ask: do you want to change or not?
  • It’s hard to think about the adverse outcomes 10-20 years away when you feel relieved at the moment when you indulge in the behavior, e.g., a soda, candy, etc.
  • Negative reinforcement: in the moment of indulgence, you feel reward and remember that so it’s reinforced over time
  • Mindfulness tips: take a few moments before indulging and really consider it – is it worth it? Does it taste as good as it does in your head? Will it solve the problem?
  • Slow down and really see how that thing makes you feel and be connected to the experience: maybe the first two bites are good but then it’s diminishing returns so you can stop there
  • With mindfulness, we don’t have to use willpower to force ourselves to stop – you are rewiring your response altogether
  • Set up your environment to promote healthy choices
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Notes By Maryann

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