Why We Get Depressed with Heather Berlin

What is depression? Neil deGrasse Tyson and co-hosts Chuck Nice and Gary O’Reilly break down the neuroscience behind major depression, its treatments, and the factors that contribute to this pervasive condition with neuroscientist Heather Berlin, PhD.

Speaker names marked ? are inferred from speaking time and the show’s known hosts — they are not voice-verified.

• 0:00Chuck Nice?

  Everything was a problem. Everything seemed so hard. And I just pushed through it because I grew up at a time where that's what you were supposed to do. Suck it up. Suck it up, man. Suck it up. And so I got to a place where it was literally killing me. And I went and saw a professional and they were like, yeah, we, we, we can help you with that, man. We just, and as a result, now when I feel happy and I'm in a like social setting, um, I'm not faking it anymore, you know? And, and some people were like, I wish you would go back to faking it because you, you're a little much.

• 0:39Neil deGrasse Tyson?

  Welcome to StarTalk, your place in the universe where science and pop culture collide. StarTalk begins right now. This is StarTalk special edition. Neil deGrasse Tyson here, your personal astrophysicist. And as you know, for a special edition, we have Gary O'Reilly. Gary, how you doing, man?

• 1:05Gary O'Reilly?

  Hey Neil, I'm good, man.

• 1:06Neil deGrasse Tyson?

  All right. And of course we got Chuck. Chuck, how you doing, man?

• 1:09Chuck Nice?

  Hey, I'm doing well, man. Thanks for asking.

• 1:12Neil deGrasse Tyson?

  All right. All right. Love you Chuck. Today, we're going to talk about something I don't think we've talked about before. We're going to talk about depression, something that we all know about. It afflicts so many of us. And Gary, what, how did you put this show together?

• 1:30Gary O'Reilly?

  Uh, well, we started off thinking about seasonal depression because, you know, we're recording this, it's January and it just makes everybody feel less vibrant. And then we realized then, you know what, there's more to this and we have to go way deeper than the winter blues.

• 1:47Neil deGrasse Tyson?

  Oh, wait a minute. So that seasonal depression, they made that into an acronym if I, the seasonal affect-

• 1:52Chuck Nice?

  Affective disorder.

• 1:54Neil deGrasse Tyson?

  Disorder.

• 1:54Gary O'Reilly?

  Which is-

• 1:55Chuck Nice?

  Sad.

• 1:56Neil deGrasse Tyson?

  Sad. Yeah, okay, go on.

• 1:58Gary O'Reilly?

  Yeah, so there you go. We asked ourselves, what's the difference between anxiety and depression? Is it all about your serotonin levels? How do other cultures cope with seasonal depression? Do we need to be sad to actually learn to feel good?

• 2:20Gary O'Reilly?

  Um, how much low level depression in society actually goes undiagnosed and unnoticed. We had the questions, but we didn't have the answers, which is why we needed an expert.

• 2:33Neil deGrasse Tyson?

  Oh, I know what expert we get for this.

• 2:35Gary O'Reilly?

  Oh, yes, we do.

• 2:36Neil deGrasse Tyson?

  Oh, yeah. Where's the cheerings and the crowd?

• 2:38Chuck Nice?

  Our returning champion.

• 2:40Gary O'Reilly?

  Yay. Da, da, da.

• 2:45Neil deGrasse Tyson?

  Our returning neuro champion, Heather Berlin. Heather, welcome back to StarTalk.

• 2:49Heather Berlin?

  Hey, thanks. Thanks for having me. It's always a pleasure.

• 2:52Neil deGrasse Tyson?

  So you're not only a good friend of StarTalk, you are also a neuroscientist. We've done so many shows on the brain. You're also a clinical psychologist, importantly for this episode, clinical, which means you see patients, right? And you're also associate professor of psychiatry and neuroscience at the Icahn School of Medicine, Mount Sinai, New York. So, welcome back to StarTalk on this very important subject.

• 3:22Heather Berlin?

  Thank you. Yeah.

• 3:23Neil deGrasse Tyson?

  So, so we just got to start at the bottom.

• 3:27Heather Berlin?

  Okay.

• 3:28Neil deGrasse Tyson?

  Or the top, or start at the front door. What is depression?

• 3:32Heather Berlin?

  What is depression? Well, depression can be many things and there are various sort of configurations. But when I think most people are talking about depression, they're talking about what we would call major depressive disorder, or often it's if somebody has what's called a major depressive episode. And, and we define that as it's lasting at least two weeks. You have to have significant depressed mood, loss of interest in pleasurable things. You sometimes end up eating more or eating less. So change in your eating pattern, change in your sleeping pattern, you might be sleeping more or sleeping less. And there's various

• 4:13Heather Berlin?

  other symptoms, but usually it's just having this very pervasive sense of sort of hopelessness, maybe you lose energy, you're less motivated, and the things that used to make you feel good or happy or bring you pleasure don't bring you pleasure anymore.

• 4:29Neil deGrasse Tyson?

  So Heather, why two weeks? That feels so arbitrary.

• 4:32Heather Berlin?

  Well, you know, we all have various fluctuations in our mood and we sometimes have depressed days, days where you don't feel like getting out of bed, you don't feel motivated, you just, again, feel this pervasive feeling of maybe sadness, loneliness, isolation.

• 4:45Neil deGrasse Tyson?

  You call that normal?

• 4:46Heather Berlin?

  Yeah, I mean, everybody has fluctuations in mood and that's, that's normal. It's okay to feel sadness. Sadness is a feeling that evolved over time and, you know, there, there, there are reasons to be sad in life, right? You know, and you, you might have something really tragic happen or, you know, a really bad day at work and sometimes you get into, you know, what people will call a bad mood, right? But it becomes clinical when you can't seem to shake it. It's just day after day after day. And, you know, sometimes you can feel sad for a number of days, but then it kind of clears up and you get back on your feet again. But, so that's why it's, again, it's, it's kind of arbitrary, the length of time, you know, it's give or take and it's not like there's this clear mark where, okay, as soon

• 5:28Heather Berlin?

  as it's two weeks, it's definitely, you know, you have a chemical imbalance. But on average, it tends to be if it lasts that length of time, there's probably some sort of underlying, um, maybe neurochemical dysfunction or it's hormonal, but there's some sort of biological imbalance and nothing can get you out of it and then you need a little bit more help.

• 5:48Chuck Nice?

  And it also, it also helps when it's not coinciding with an event or like, if you have a death of somebody close to you, you are in what we call a period of mourning. That can actually last for a couple of years, but running parallel to that, you feel normal at times and then you slip into depression because you, because of that event. So even if it lasted for two years, it's, it's still natural because it's mourning. But when nothing happens and you feel that way, there's something really wrong.

• 6:23Neil deGrasse Tyson?

  Thank you, Dr. Chuck Nice.

• 6:24Heather Berlin?

  There's this, we call it the, um, there's actually a bereavement exclusion. Um, so if there's been a death or maybe even there's a significant, you know, a breakup, a divorce, um, then it's sort of allowed, you can have depressive symptoms for up to two months after, say, the death of a loved one. Um, but then if it's you can't sort of get out of it and it starts to it's almost like thinking about it like long COVID, you know, you have these post-COVID symptoms after a certain amount of time, you get diagnosed as long COVID and there's no real cutoff time. But so we have this exclusion criteria for bereavement. The problem is that when people start-

• 7:00Neil deGrasse Tyson?

  It's a whole pass for bereavement. That's what that is.

• 7:02Heather Berlin?

  Yes, exactly. Exactly.

• 7:03Neil deGrasse Tyson?

  Right, right.

• 7:04Heather Berlin?

  But the problem is when people feel depressed and it's biological, but sometimes they try to tie it to events that are happening in their life. Oh, I'm only feeling this way because of X or Y. It must be because of this. And it becomes more clear to a person when things in their life are going well and they still feel depressed that, okay, maybe there's something in my neurochemistry that needs to be treated, maybe with medication. But sometimes it's not clear because it it is a correlation between negative things that are happening in your life. Um, so that's what we're trying to differentiate as a clinician. Like, is it is it biological? What's their history? What's their genetic history, family history? Um, have they had this before in their life?

• 7:42Chuck Nice?

  Are you a parent? Are you a parent?

• 7:44Heather Berlin?

  Right.

• 7:45Chuck Nice?

  Yes.

• 7:46Gary O'Reilly?

  So where do we go? Where do we go, doctor, with with anxiety and depression? Do they come as a partnership?

• 7:54Neil deGrasse Tyson?

  I've always hear I hear them so often. I hear them so often together as a diagnosed-

• 7:58Heather Berlin?

  They they're really highly comorbid, meaning they tend to co-occur with one another. Um, but they are-

• 8:03Neil deGrasse Tyson?

  Did you say co-morbid?

• 8:04Heather Berlin?

  They co-occur together.

• 8:06Neil deGrasse Tyson?

  They coexist.

• 8:07Heather Berlin?

  They coexist. They tend to, you know, um, occur together, but not always. And they are two different things. So anxiety is more, it's a different neural system. It's that kind of fight or flight response that we have. It's it's the anticipation of a future threat. It's imagining something bad is going to happen and then you have these physiologic um, reaction to that imagined threat, even though there's nothing bad happening in the moment. Um, so some people have chronic anxiety, um, or specific phobias that they're anxious about specific things. Whereas depression is different. It's more to do with this sadness, the lack of motivation. It's more the serotonin system seems to be involved, but it's not just serotonin. And we can get into that, too. It's this.

• 8:52Neil deGrasse Tyson?

  We will, we will.

• 8:53Heather Berlin?

  Yeah. But it's a different neurotransmitters are involved in depression, but there is some overlap in the that they both involve things like serotonin and dopamine and norepinephrine. So there's some overlap between the two.

• 9:07Neil deGrasse Tyson?

  So Heather, I collect old science books, and some of them are medical textbooks and medical, you know, what people thought was going on with human physiology in the day. And a common term back then was melancholy. Did that term like predate the word depression? Did it mean something else? Clearly, it existed as a condition long before our modern ailments started affecting us.

• 9:32Heather Berlin?

  Yeah, it started, I mean, really, when you go far back, and, you know, we thought that, well, scientists thought that all of these psychological disorders had to do with an imbalance of certain fluids in our body. And so melancholia was actually too much black bile, which I think is like too much poo, basically.

• 9:50Neil deGrasse Tyson?

  Wow, so that's where the word comes from. Wow, okay.

• 9:53Heather Berlin?

  And they, and they, it was, so, so that was the sort of, you know, the, the dark sadness. And now we would have.

• 10:00Neil deGrasse Tyson?

  But wasn't there also, like, your uterus was, of course, making you depressed?

• 10:04Heather Berlin?

  Hysteria was, they thought hysterical women was the uterus was detached, and it was kind of floating around the body and causing us to be hysterical. That's where. Oh, my God, I'm grabbing my throat.

• 10:20Neil deGrasse Tyson?

  Damn, people were idiots. Which makes me wonder, what are we going to think 200 years from now?

• 10:25Heather Berlin?

  Oh, shit. But I mean, this, this exists, you know, for as long as humans existed. We called it different things. We thought there were different causes. But, but there's this, what we have, we call them out dysthymia or persistent depressive disorder is a little bit different than what, what we'd call major depressive disorder. Dysthymia is having that low level, like sadness. It's not as intense as a depressive episode, but it lasts longer. So it could be like two years of just a kind of. Down mood. Um, and, and so there are different like gradations of what, what people used to categorize as different things in the past. Now we're trying to differentiate it and correlate it to underlying, you know, brain dysfunction.

• 11:04Gary O'Reilly?

  So if you've got a persistent state of depression,

• 11:08Heather Berlin?

  Mm-hmm.

• 11:09Gary O'Reilly?

  Uh, you're most likely going to get prescribed antidepressants. Now are they the cure or are they now seen as part of, what is it, a serotonin hypothesis? And the, the sort of yes, no, maybe scenario that plays out there?

• 11:24Neil deGrasse Tyson?

  Yeah. What's, what's a, what's a quick primer on the chemicals of happiness and sadness?

• 11:30Heather Berlin?

  Okay. So, um, for many years, we had this kind of hypothesis. It's the, the monoamine neurotransmitters, which are, um, you know, serotonin, um, dopamine is related. The idea is that there's, there was too little serotonin in the receptors. Um, and this is what was causing depression. And so the, the treatments that developed over the last, say, 50 years were how do we increase serotonin in the receptors? And that's what's called SSRI, selective serotonin reuptake inhibitors, meaning you inhibit the, the, the neurons from sort of cleaning up the serotonin out of the synapses.

• 12:12Heather Berlin?

  So it stays there longer, um, and it can activate the neurons for longer. And, and that is part of it. But what we've learned is that there are many other, um, things that are contributing to depression. It's not just serotonin.

• 12:24Neil deGrasse Tyson?

  But just so I understand what you're saying.

• 12:25Heather Berlin?

  Yeah.

• 12:25Neil deGrasse Tyson?

  Um, so this, this medicine,

• 12:28Heather Berlin?

  Mm-hmm.

• 12:29Neil deGrasse Tyson?

  it doesn't add more serotonin to your system. It prevents your sys, your system from getting rid of it.

• 12:36Heather Berlin?

  Yes, or it, it prevents it from being, so the neurons will get activated and then they'll release serotonin into the synapse and then it'll affect the neuron next to it as long as it's in that synapse, right?

• 12:46Neil deGrasse Tyson?

  So why is it better than just taking a serotonin pill?

• 12:50Heather Berlin?

  Well, um, there are.

• 12:52Chuck Nice?

  Because that's, that pill is called Molly.

• 12:57Heather Berlin?

  There are actually other ways. So there are other ways to increase serotonin in the receptor, in the, you know, in between neurons, you want to have more serotonin. So there are ways that you can get to that. There used to be other drugs, older drugs called monoamine, monoamine oxidase inhibitors are MOAs, but they weren't as effective as the SSRIs or just much more selective. And there are different receptor sites for the serotonin. So you could actually be selective in like those receptor site, you know, one A and one B. And so we're getting more and more honing in on exactly where we want to target. And there's different serotonin

• 13:39Heather Berlin?

  receptor sites, receptor sites in different parts of the brain. So again, instead of like coating the whole brain with serotonin, you can be more targeted with what you're, where you're trying to activate the serotonin. Like you can target it more toward the prefrontal cortex. If there's more, let's say serotonin receptor A1 in the prefrontal cortex. This is getting into the weeds, I'm sure, but, but, but it is more selective with, that's why they're, you know, selective serotonin reuptake inhibitors.

• 14:05Gary O'Reilly?

  Okay. Have we gone down the route successfully of alternate treatments outside of this is chemical, we'll deal with it with another chemical?

• 14:16Neil deGrasse Tyson?

  And you see these ads, not, I've read somewhere where a walk in nature has some chemical value to your brain through the woods.

• 14:24Heather Berlin?

  Absolutely. You can increase your, you know, your, say your dopamine and your serotonin through just, you know, interacting in the world. I mean, that's a lot of what talk therapy is doing and just social, being social, being around friends can make you feel good. Walking in nature changes your brain, right? When you change your environment and the stimulation. So it doesn't have to be just with drugs. But when you have, let's say, genetic predisposition, where you might produce less of this neurotransmitter.

• 14:54Heather Berlin?

  Then that's where the kind of drugs come in, that you need an extra little boost on top of these other strategies.

• 14:59Gary O'Reilly?

  Yeah.

• 15:00Heather Berlin?

  But the other aspect is that not everybody is, it doesn't work for everybody. So SSRIs are the first line treatment, but sometimes you need, some people have SNRIs, which is affects also the norepinephrine system. And even those don't work for some people. And then we get into what we call treatment resistant depression. And then we get into these alternative treatments that we have now.

• 15:26Chuck Nice?

  Like what?

• 15:27Gary O'Reilly?

  Yeah, exactly. Yeah. What are we doing?

• 15:29Chuck Nice?

  Shock, shock therapy? Uh, yeah?

• 15:33Gary O'Reilly?

  Yeah, a good, a good talking to. You know, what, what, which is what used to happen and now we've, we hopefully have progressed.

• 15:47Speaker 04

  I'm Ali Khan Hemraj and I support StarTalk on Patreon. This is StarTalk with Neil deGrasse Tyson.

• 16:02Chuck Nice?

  Before we go into this subtopic, let me just say that if you're a person who is experiencing what Heather just talked about, the telltale sign is other people may not know you're depressed because you learn how to mimic what it is to be a happy, normal person. So if you find yourself kind of empty and feeling like, wow, all these people seem really happy and I'm just acting that way, you might be a good candidate to talk to a doctor about something that, something that's good, baby. Something that can help, something that can help you out is what I'm saying.

• 16:41Neil deGrasse Tyson?

  Heather's shaking a bottle of prescription pills that we cannot read because the resolution on the screen is not on.

• 16:46Chuck Nice?

  So she was talking about SSRIs. Uh, that is, this is a dopamine reuptake inhibitor.

• 16:53Heather Berlin?

  Nice.

• 16:53Chuck Nice?

  Because, because I don't make enough dopamine. My brain does not make enough dopamine. And so as a result, without this, I found myself faking it through life for a very long time.

• 17:07Chuck Nice?

  Dragging myself out of bed. Everything was a problem. Everything seemed so hard. And I just pushed through it because I grew up at a time where that's what you were supposed to do.

• 17:17Neil deGrasse Tyson?

  Suck it up.

• 17:18Chuck Nice?

  Suck it up, man. Suck it up. And so I got to a place where it was literally killing me. And I went and saw a professional and they were like, yeah, we, we, we can help you with that, man. We just, and as a result, now when I feel happy and I'm in a like social setting, um, I'm not faking it anymore, you know? And, and some people were like, I wish you would go back to faking it. Cause you, you're a little much.

• 17:46Neil deGrasse Tyson?

  You were funny back then.

• 17:51Neil deGrasse Tyson?

  Chuck, if I worry if you keep talking that Heather's gonna have to charge us for a session.

• 17:56Heather Berlin?

  Well, I was gonna say, he's a great example of see, in that case, you know, it's affecting the dopamine energy system. It's not just about serotonin, right? Some people have too little dopamine or too little norepinephrine. Um, there, there is the glutamaturic theory of depression now, which is, is really interesting. And I think is really helping us make the most significant advance in treatment. That's been for, you know, as long as I've been studying the brain, um, which is a couple of decades. Um, is that, that glutamate is involved and that's an excitatory neurotransmitter. Um, so let's say there's too little excitation. Um, and ketamine is this alternative treatment that is now FDA approved. You can do it intravenously, intramaisely.

• 18:39Heather Berlin?

  You have to do it in the office with the physician. Um, and it's seemed to be really helping people where the SSRIs don't work and nothing else has worked. Um, ketamine is an alternative treatment. There, there's also, I mean, ECT, which is electric shock therapy, which has some side effects. Um, and but, but a more.

• 18:58Neil deGrasse Tyson?

  I see why you abbreviated. We're talking ECT today.

• 19:02Chuck Nice?

  One of the side effects.

• 19:03Neil deGrasse Tyson?

  Electrocompulsive therapy.

• 19:04Chuck Nice?

  One of the side effects includes having an afro where you didn't have one before.

• 19:10Heather Berlin?

  But that, you know, it can affect your memory, but it's not as dramatic as it's portrayed in like films, you know, they're not, people aren't like kind of all things and you know, you're sort of sedated. But an alternative to that is, is transcranial magnetic stimulation, which is whereas ECT is more like you're turning a computer off and on if it doesn't work and just something happens, like you reboot the system and it works again. But transcranial magnetic stimulation is you're having just a magnet and you're, you're sort of stimulating certain parts of the brain very specifically. And you do that daily for a couple of weeks. And that seems to have a significant impact as well.

• 19:48Neil deGrasse Tyson?

  So Heather, when we talk about triggers, one of the more common ones we heard about is, as we mentioned earlier, seasonal affected disorder, or SAD, where the sun stays low in the sky in the winter months. And if you go above the Arctic Circle, the sun doesn't rise at all. My wife grew up in Alaska, where the sun would rise at like 11:00 in the morning and set at 2:00 in the afternoon, something like that, or 1:00 and 2:00 in the afternoon. So she grew up in that and didn't know anything different than that. It's just dark. It's

• 20:27Neil deGrasse Tyson?

  not nighttime, it's just dark. And if you, if that is your life, then how could it be a trigger for something if that's all you've known? And so therefore, is that, is seasonal affected disorder something only for people who are totally into the summer months?

• 20:45Heather Berlin?

  True.

• 20:46Neil deGrasse Tyson?

  And then it extends upon them as November, December arrive?

• 20:51Chuck Nice?

  Yeah, like if his wife had moved there from Jamaica, I'm sure that would have really messed her up, you know? Oh, just like, go on now, man, where is the sun?

• 21:02Chuck Nice?

  What did you do with the sun, man?

• 21:09Heather Berlin?

  Yeah, so there's with depression, you know, we have, it's called the stress diaphysis model, meaning that certain people might be born with a kind of predisposition toward depression, but they might never develop it unless there's some sort of environmental stressor. So like, why is it that, you know, only certain people, it's similar to PTSD, like, a lot of people can go to war and only certain of them, a percentage of them develop PTSD and others have this sort of resilience. Why is it that when the winter months come, a certain, you know, percentage of people go on and get seasonal affective disorder and others are fine? And it might be that they, they have this genetic predisposition toward depression and the, and the lack of light and the darkness and is, is the trigger

• 21:54Heather Berlin?

  for it. So sort of, you know, it has this kind of cascade effect. And then the symptoms come on.

• 22:01Neil deGrasse Tyson?

  I would have guessed naively that when you walk into your home, you turn on the lights, right? And all the lights are on anytime you are indoors. When there was a day where if you came in at night, you'd light a candle and work your way around the home or light the oil lamp. And so dark sunset was a major shift in your exposure to light. Not anymore. I walked through Times Square, Midtown Manhattan, I don't even know if it's nighttime.

• 22:27Chuck Nice?

  You can't even tell if it's nighttime.

• 22:28Neil deGrasse Tyson?

  You can't even tell.

• 22:29Heather Berlin?

  But there's a certain type of light, right? So it's also, you know, we're also thinking about the, these hormones and as well as, you know, neurotransmitters, but like melatonin. So for example, when you're just looking at your computer light or a certain indoor lighting, blue light, that is different than natural light, which is more the yellow spectrum of light. And, and different kinds of light can affect your melatonin system in different ways. So for treatment for seasonal affective disorder, there are special lights that are within the sort of spectrum of natural light that you sit in front of to actually, to help, help release the kind of neurotransmitters and the hormones that you want from natural light. But artificial light doesn't necessarily get you that, get you there because of the different wavelength.

• 23:12Neil deGrasse Tyson?

  In principle, that's a knowable problem, right? I mean, I could create exactly the wave. Now with LEDs, I can create the wavelength of light that I want.

• 23:22Gary O'Reilly?

  They do this on aircraft now, on long-haul flights. They will change the lighting in the cabin.

• 23:28Chuck Nice?

  For the reason that Neil just said, because they now have LEDs in the aircraft.

• 23:33Heather Berlin?

  Yeah, so it is a controllable problem. We can start to, you know, figure out what's the best setting and the timing and to help people that are, you know, prone to get this kind of, you know, this depression during the winter months. But I also would suggest, and this is something that I'd actually want to look into, because I think it is interesting. If you grow up in one of these places like Alaska or, you know, Iceland or Norway, you know, you might just adapt to it over time, that your brain, you know, adapts and adjusts to it. Whereas if you move there from somewhere else, it might really be a shock to your system and enough to trigger a depression, if you're, again, if you have that predisposition toward it.

• 24:10Neil deGrasse Tyson?

  And what about social, cultural causes, like poverty? Or, in fact, let me say it both ways. I can imagine poverty where you don't know where your next meal is coming from, that can bring a level of depression to you. But so too, if you're fabulously wealthy, there's an expectation of how every day would go, and if one little thing goes wrong, that really stands out as a force of sadness in your life. And is this, might that be an explanation for why suicide rates are not higher in those who are, who are, suffer abject poverty than those who are fabulously wealthy? But is, or what is the latest numbers on the suicide rates? Do we know?

• 24:56Heather Berlin?

  Well, this is the thing. This is what researchers found, is that there tends to be this, as I said, this underlying biological predisposition, let's say it's genetic, right?

• 25:08Heather Berlin?

  Regardless of whether you're in the worst poverty circumstances or in the best, you know, whatever, you're super fabulously wealthy, that it doesn't have that huge of an impact. So you, you know, people have done this research where they go to like India and people are, you know, living in dirt, poverty, dirt floors, whatever, and they're just happy and enjoying life. And it's like, what, you know, what's going on here? And then you get some guy who knows everything in the world and is horribly miserable and, you know, commits suicide.

• 25:37Chuck Nice?

  On his yacht.

• 25:38Heather Berlin?

  On his yacht, exactly. Like jumps off the yacht. But, but, and they also found that when, when something really good happens to someone like, like they win the lottery, um, you get this little blip of like happiness and then they go back to whatever their baseline is. So if they're generally a miserable person, they'll end up going right back to being miserable.

• 25:54Chuck Nice?

  Being a miserable person with money.

• 25:54Heather Berlin?

  With money. Exactly. And then if you take somebody who has like resilience, they might, you know, get in a horrible car accident, you know, become paralyzed. They'll have a little blip of, you know, sadness and then they recover and go right back to being this wonderful, happy person.

• 26:08Chuck Nice?

  Great person.

• 26:08Heather Berlin?

  So it's like almost a little bit independent of environmental circumstances, whether you have this kind of resilience or not. Um, and, and, but there is this also idea of inoculation. We need to have little disappointments to inoculate us against bigger ones that happen later in life. And you're not kind of building up that resilience in people and having what we would call like exposure therapy, meaning you have to sit with something that makes you uncomfortable for a while. You can't just avoid everything. Um, because then it becomes, you, you start ending up in these anxiety disorders, right? I can't be around anything that makes me feel uncomfortable and you can't tolerate any distress.

• 26:42Chuck Nice?

  Right.

• 26:43Heather Berlin?

  So it's actually not healthy.

• 26:44Chuck Nice?

  And you quit, you quit everything that you do.

• 26:46Heather Berlin?

  Yeah. Yeah. Because any kind, anytime there's a little bit of distress, it's like, okay, I'm not going to do this anymore. I can't, you know, it's, so, so that's kind of the thing with like, if you grow up with hardship, I mean, I'm not saying this is a great way to grow up, but, but there is this sense of building up a resilience. That you're not this, you know, I guess they call like snowflakes and whatever like being, you know, like any little thing will disturb you. You kind of get this buildup toughness. That being said, however, there is, um, when you have chronic stressors over periods of time, you know, you can, a low level stressor, which could be living in poverty, not knowing when your next meal is going to come, you know, it can lead to things like PTSD, it can lead to intergenerational trauma. Um, and that's, you know, what I think is prevalent in a lot

• 27:28Heather Berlin?

  of these cultures where like if you think about Native American Indians living on reservations, they have a high rate of alcoholism. And, you know, we haven't really talked about all of the things that people do to try to self, self-medicate themselves, you know, when they're having these negative feelings that everyone can afford or have access to going to like, you know, the best psychiatrists and psychologists, a lot of people in rural areas. So you get alcoholism and, you know, um, impulsive behaviors, you know, pathological gambling and shopping and drug addiction and all of that, that are often trying to treat these negative feelings that they're having.

• 28:03Neil deGrasse Tyson?

  People don't, they're not actively thinking that they're treating it. They just know they feel better for doing it. But in fact, in total, it doesn't.

• 28:12Heather Berlin?

  Yeah, it's a numbing and a tried of escapism. Yeah, it's a numbing of, of the feelings. But, you know, and that's why, you know, often people come to me and they're, if they've never been on medication before, they're, they're hesitant, right? They're, they're kind of afraid and, you know, what's this going to do to me and whatnot. But it's, you know, the larger question is what, what is it going to do to you if you don't get treated, right? You know, what, what are you doing? What kind of self, you know, soothing behaviors are you doing that are really detrimental? Um, and I don't think medication is for everyone. And I'm very conservative when I kind of would recommend to a patient when to see a psychiatrist, um, for medication. But when it is needed and when there is a neurochemical imbalance, it can really make a difference in a person's life, as Chuck may testify to.

• 28:55Gary O'Reilly?

  Yes. So in society, Dr. Just how much of this low level depression, oh, mind you, some of the things you've just described aren't quite low level, but how much in society is undiagnosed?

• 29:08Heather Berlin?

  You know, it's, we don't really know, right? It's hard to say. There are, there are, um, cultural differences, but sometimes it's just.

• 29:16Heather Berlin?

  You know, not, it's not socially acceptable to have a mental health issue, right? Like it's becoming more so, especially in the younger generation in the United States to like, it's acceptable to say, I have depression.

• 29:30Chuck Nice?

  I would still say there's a big stigma attached to it, you know? There's like, you know, even people who's talk about it freely, such as myself, you'd be surprised how many people, when you tell them that you suffer from this, you know, I have friends who are just like, not you. Or, oh, come on, man, you don't need that. Or, you know, they'll, they straight up just feel like this is not necessary. There are other ways that you can get your brain to do what you want it to do.

• 29:56Neil deGrasse Tyson?

  Wait, wait, but doctors also, um, why are you using dandruff shampoo? You don't have dandruff.

• 30:02Chuck Nice?

  Right.

• 30:07Chuck Nice?

  And then the answer is, exactly.

• 30:12Heather Berlin?

  There are people, you know, exactly when you start taking medication and then they start feeling better. And then they say, well, I don't, I don't really, do I really need this medication? And you get into this conundrum, right? And then I'll say, okay, well, you can go through a trial period and get off it and see how you feel. Because it's like, once you're on it and you're feeling better, you're saying, what do I really need to be on medication for? So sometimes patients cycle through this a couple of times where they go on and off the medication just to sort of prove to themselves that that actually it is doing something and that they need it. Um, but the stigma really, it, it, it's so frustrating. I mean, I do think it is getting better compared to where it was in terms of the acceptance. But the brain is like any other organ, you know? It's like, it's okay to say, oh, I'm taking this antibiotic because I have this, you know, infection.

• 30:54Chuck Nice?

  That's what we're calling it now? Oh, thank God.

• 31:00Neil deGrasse Tyson?

  I knew an actor who is, has depression and, but he, when he's about to go to make a film, that you have to go through a medical examination, especially if the film is very expensive and because there's an investment being made in you. And they had issues with his depressive, with his depression diagnosis. And he said, first time I heard it put this way, I'm just echoing what the two of you just said, but from a real life situation. He said, I'm medically treated for my depression.

• 31:33Neil deGrasse Tyson?

  And so therefore I can work. You shouldn't think of that as different from anybody else being treated for any other ailment that might interfere with their work. Provided the medicine brings you back to where you need to be. And that it was so sensible and so clear that the brain is just another organ that's being treated.

• 31:52Heather Berlin?

  Yeah, and for some reason, we think that it's like it's like if someone had MS and they said, okay, some times I have flare ups, but you know, I have this medication that helps me with that, right? They wouldn't be a liability. And it's the same thing when you're being when you're you have a neurochemical imbalance and it's being treated. You know, I mean, there are some stipulations where they say, um, you know, for example, in in in child custody cases and things like that, well, you know, it's predicated on the fact that they have to be on their medication. They have to stay on their medication, right? Because that is what's keeping them in balance. But this idea of like, oh, just suck it up, you know, like, like that you can make just be happy, right? Make your sadness go away. It's like

• 32:30Neil deGrasse Tyson?

  Don't worry.

• 32:31Heather Berlin?

  Right.

• 32:32Neil deGrasse Tyson?

  You need to have it.

• 32:34Heather Berlin?

  It's stupid.

• 32:35Neil deGrasse Tyson?

  I bet actually it'll keep a lot of people out of depression.

• 32:37Chuck Nice?

  The Bobby McFerrin treatment.

• 32:38Heather Berlin?

  Like, just be happy. Like, you don't think I'm trying?

• 32:58Gary O'Reilly?

  So, Doctor, how do our hormonal differences affect the depressions within us?

• 33:05Heather Berlin?

  Well, for example, you know, estrogen or progesterone, um, which is you you see more in in women can actually affect our serotonin levels in the brain, which then go on to affect our emotions. And depending on the balance, whether it's too much or too little, it can make you more irritable, um, or it can make you feel depressed or sad. And so there's this this delicate balance between these hormones and their impact on the neurotransmitters, which then go on to affect us emotionally.

• 33:36Neil deGrasse Tyson?

  But if I if if I, as a man, take those hormones, will I start having those same effects or will be fighting my testosterone to have the whole other effect?

• 33:45Heather Berlin?

  Yeah, because you have, and and women have testosterone too, right? And there's all these differences, right? You know, but testosterone can lead tends to lead to more like aggressive behavior. But if if if we were to give you some progesterone, um, Or estrogen, it might just help like modulate the effects that the serotonin is having and just kind of make you less aggressive, but not, not necessarily make you feel depressed.

• 34:08Chuck Nice?

  There you go. Instead of saying, take a chill pill, we should be saying, take some estrogen, man.

• 34:13Heather Berlin?

  No, what you really need is oxytocin. So oxytocin is the sort of love hormone. Oxytocin is also a hormone that acts as a neurotransmitter as well, but that's the sort of bonding love.

• 34:24Chuck Nice?

  The hugging, the hugging.

• 34:25Heather Berlin?

  If you hug, it gets a, a, a calling. My Paul's acted a lot of research on this. Um, hugging can release it, but it's released during breastfeeding, during sex, um, you know, these times when you're really like bonding. Um, so if we give everyone a little bit of oxytocin, we had discussions in the psychiatry department about this, like, we just a little oxytocin in the water and maybe everyone would just like chill out.

• 34:48Chuck Nice?

  War would end.

• 34:49Heather Berlin?

  Yeah.

• 34:50Chuck Nice?

  Like fluoride.

• 34:51Heather Berlin?

  That's the answer. That's the answer to everything.

• 34:54Neil deGrasse Tyson?

  Is postnatal the same as postpartum depression? Is that the same thing?

• 34:57Heather Berlin?

  Postpartum, yeah. Postpartum depression. Yes. Yeah. Um, postpartum depression, there's menopause when there's lots of hormonal changes. Um, and there's around, there's something um, called PMDD, which is like premenstrual disorder, disorder, I believe, where it's, you get severe changes in mood, you know, around your, your time of month when there's these hormonal changes, but it's so severe that you actually need medication for it. And people take SSRIs to, to treat this PMDD. And so when I, just like, you know, if somebody says I have, you know, a kidney stone or a kidney infection, whatever, like that's okay, but not to say my brain, you know, is out of balance. Somehow that doesn't seem

• 35:42Heather Berlin?

  real to people. Um, and that always really bothers me.

• 35:45Neil deGrasse Tyson?

  Can you think of any evolutionary value for postpartum depression?

• 35:48Chuck Nice?

  Uh, children.

• 35:49Heather Berlin?

  That's a good question.

• 35:51Chuck Nice?

  I think children are the evolution.

• 35:53Heather Berlin?

  Well, there is a book on.

• 35:55Neil deGrasse Tyson?

  It's like, what, what half I wrought here.

• 35:57Chuck Nice?

  Exactly. It's just like, that is, that is your body and the universe saying, don't do this again. Don't do this again.

• 36:07Neil deGrasse Tyson?

  Let you go this one time.

• 36:08Chuck Nice?

  Hey, look, look, we, okay, yeah. Everybody gets one. Everybody gets one. Now, after that.

• 36:17Heather Berlin?

  So there's a book, it's called Good Reasons for Bad Feelings by an evolutionary psychologist named Ramsey Nessie. And it really goes through, it's a really, it goes through all the different evolutionary reasons about why we have these emotions. But one theory about depression is that it actually helps elicit, elicit help when you need it. So all the outward signs of depression, like, you know, you're, you're huddled up in a ball, you can't get in bed, you're crying, whatever, that actually will elicit help in your community. So people will come to you, you know, oh, hey, let me help you take care of like your child, you, you're not in a good way, right?

• 36:52Chuck Nice?

  Right.

• 36:53Heather Berlin?

  And so that, that might have been one adaptive reason, evolutionary reason for depression. Um, the, the, but, but not everybody shows those outward signs, like Chuck was saying, I mean, there's this great commercial, I can't believe that they have these commercials on television, by the way, for, you know, psychiatric treatment, because then you have patients coming to you like, oh, I saw this commercial, can I take this drug? But there's this wonderful commercial where they have these people holding up these happy masks, you know, and they're walking around with like a happy face on.

• 37:18Neil deGrasse Tyson?

  It's the fake, first the fake.

• 37:20Heather Berlin?

  The fake, yeah, and they're like, really, they're, they're underneath. And I find that actually comedians, all the comedians I've met, and I've met quite a few, they all have come to me and said some level of like depression or anxiety, they're all in therapy.

• 37:33Chuck Nice?

  Of course. All the therapy, and they all have the happy mask.

• 37:36Heather Berlin?

  Right. And it's like this really, they're like, well, I never feel as good as I do when I'm on stage and when I'm making people laugh. And then it's almost like therapeutic in a way. Um, so I think that's that, I don't know if there's been studied done, but, but again, anecdotally, there's a higher prevalence, um, of like depression and anxiety in comedians. Um, at least, I mean, again, this is my small sample size, but, but it's quite a few. So there's this idea of masking, but if you get away.

• 38:01Neil deGrasse Tyson?

  We have a sample size of one here, and it's a hundred percent.

• 38:03Heather Berlin?

  Right, this is exactly evident. Right, yeah. That's an A.

• 38:06Neil deGrasse Tyson?

  Yeah, this is our experiment.

• 38:09Chuck Nice?

  Yeah, exactly.

• 38:10Gary O'Reilly?

  So, so doctor, go back, go back to the, the woman who's. Crunched up in a ball and in suffering severely. And an elder woman comes along and says, it's okay, I'll take care of the child for you right now. That's fine if you live in a small tribe, a small village and everybody. Does this work in the 21st century when everyone is disconnected and there's concrete walls between everybody?

• 38:32Heather Berlin?

  This is, that's a really great question. So one of the, the, the concepts in evolutionary psychology is that all of these feelings evolved for a specific reason. Um, but then they're butting up against modern society where it no longer is useful. Right? So let's say it makes sense for us to be afraid of heights. So you don't fall off a cliff. Right? And there's experiments where there, there are these babies and it's this cliff experiment where it's like, there's actually a clear plexiglass. But it looks as if there's a big drop and the mom's on the other side of it. And just going, come here, come here. And the baby will just like be frozen, like you won't crawl across this clear plexiglass.

• 39:06Neil deGrasse Tyson?

  That's a f***ed up experiment. Yeah, it really is. Yeah.

• 39:10Gary O'Reilly?

  Thank you. That is actually, yeah.

• 39:13Neil deGrasse Tyson?

  Do I have to be the one to say that? I'm sorry.

• 39:16Gary O'Reilly?

  But you know about your.

• 39:17Chuck Nice?

  Can't believe my mother is trying to kill me. I cannot believe my mother is trying to kill me.

• 39:23Heather Berlin?

  It's true. It's pretty, there are these videos, the poor baby like doesn't know what to do. It's like, mom, come on, come on. It's just like frozen, but it's, it's instinctive, right? But now for someone to be afraid when they're just on the 33rd floor of a building. Because that same old evolutionary program, which was adaptive, is no longer adaptive, adaptive in modern society. Um, and so a lot of disorders are sort of things that were normally adaptive that become either maladaptive because they're, they're sort of so extreme. Or because there's a mismatch, it's this mismatch theory between what was purpose useful before, no longer useful in modern society. Um, but every, but the other thing is this, there's no line that, that like where suddenly something is clinical.

• 40:05Heather Berlin?

  It's just how much distress is it causing you? How much distress is it causing other people or your ability to function? Some people don't think that, like narcissists don't think they have a problem, but everybody else does. But they think they're just fine. Right? So, but often it's subjective. How much distress is it causing you? Um, and then we sort of get to these clinical areas where a treatment is required.

• 40:25Neil deGrasse Tyson?

  Heather, I got time for like one more question. I want to sort of take the liberty of asking it. If someone comes into your practice and they, how do you decide?

• 40:37Neil deGrasse Tyson?

  If, well, they just need to come to see me three hours a week for two years. Or you just, and that'll change them chemically, or emotionally, or psychometrically, whatever. Or you just give them a pill and say, you know, call me back.

• 40:53Chuck Nice?

  Good luck.

• 40:55Heather Berlin?

  The phone call is that easy?

• 40:56Neil deGrasse Tyson?

  Yeah. You, you come to psychiatry as a neuroscientist. And these are two different approaches to solving the problem. One of the person's laying down on the couch. The other one is they're taking medicine. Of course, you can do both. But I foresee a day, am I, am I wrong here? Where you don't have to keep showing out cash to a psychiatrist or a therapist. So we know exactly what the problem is. And this is the exact medical cocktail to fix it. And it's a one stop shopping.

• 41:28Chuck Nice?

  I see, I disagree. That can't, that day is very, very unlikely. Because the human brain is so different from person to person. And the one thing that I'm, in my experience is you take a medication and your doctor tells you, listen, we're gonna try this. They don't tell you, take this and this is what's gonna happen. They say, try this and keep an eye on it.

• 41:50Neil deGrasse Tyson?

  Before Newton, people said, oh, these planets are all moving differently from each other. Well, this is very complicated. They all have their own movement. They're all doing their own thing. And Newton says, here's one equation, it's got it all. So, so I'm, I'm, what I'm asking is,

• 42:06Chuck Nice?

  I see what you're saying.

• 42:07Neil deGrasse Tyson?

  Not is the brain complex, but are we just not there yet? And will neuroscientists come and save the day?

• 42:13Heather Berlin?

  Okay, the, the brain is more than just the physical matter, right? It's the mind as well. So the brain is this really wonderful organ and it's physical and it has neurochemicals and, and neurons, but it also has the subjectivity. So it's both. Now, research shows that. Medication alone can have a significant impact. Therapy alone can have a significant impact. When you get them together and it's the right medication, because it is individualized, not one medication fits all. When you get the right drug with the right therapy, you get this synergistic effect. That combined, it's much greater than the sum of its parts. So, they, they, they need to work in conjunction. If it was only enough to give a person a pill and say, be done with it, great, you know,

• 42:58Heather Berlin?

  and, and I could just be out of business, at least in my clinical psych business and go straight back to neuroscience. But, but the, but the issue is that not everything is just neurochemical. There's also the way your brain is kind of wired, and, and that's why it is actually unique. Because we all have different experiences throughout our lives and our brain gets wired up. It gets sort of, it's like a piece of clay that gets molded throughout our lives and each brain is slightly different. So, things that might trigger you don't trigger me and, and vice versa. And so, it's, it's, it's, it is complex. And it, it's more than just changing the under... So, I'll give you just one example. Two people can have a lesion, like brain damage in the same part of the brain. And one person has this severe, you know, neurocognitive deficit or some psychiatric

• 43:42Heather Berlin?

  illness due to it, and the other person doesn't. And, and that's because they're, they're wired slightly differently, or their neurochemistry is slightly different. So, it's just not one size fits all.

• 43:51Neil deGrasse Tyson?

  You would have known that decades ago if you could just open up people's skulls just in a laboratory and just do that routinely. But, you're stuck with the two people who happen to have the same accident and brain lesion, right? You have to wait for the, for people with brain issues to come to you, right?

• 44:08Heather Berlin?

  Yes. But, now, just as like, you know, go to the alternative treatments, when, when the SSRIs or other kinds of, you know, chemical treatments don't work, the ECT doesn't work, the TMS doesn't work, the ketamine doesn't work, right? What's, what do you have left? There's what we call deep brain stimulation, where we actually can plant electrodes, I mean, and part of the brain called the answer is cingulate. And, and Helen Mayberg, who's at Mount Sinai, was one of the founders of doing this work. To treat depression where this now you can actually implant electrode. It's being stimulated, connected to a battery pack implants in your chest. And you can control it, you can turn it up, you can turn it down. And you can literally change people's emotions in the operating room. Where you're like, they don't know whether it's turned on or off.

• 44:52Heather Berlin?

  And suddenly you turn it on and they're like, whoa, suddenly I feel great. I feel like I just won the lottery. And it's this level of control. And maybe that's, you know, where we're headed toward these neural implants.

• 45:03Neil deGrasse Tyson?

  That comes from nerve linkers, not from psychiatrists. That's all I'm saying.

• 45:06Chuck Nice?

  And when they put this in you, when the operation is complete, do they go, it's alive. It's alive.

• 45:16Heather Berlin?

  But there are.

• 45:17Neil deGrasse Tyson?

  Now, Heather, you're worrying me. I don't want to ever like, take a nap while you're anywhere within a mile radius.

• 45:24Chuck Nice?

  Cause I don't. Wake up, wake up with a chip in your head and a bunch of magnets around you. Talking about, why do I want to kill the president?

• 45:36Neil deGrasse Tyson?

  All right, we gotta, we gotta end it there. Heather, it's been a delight having you once again as our guest on this subject that I'm disappointed we haven't treated before. And perhaps we can pick it up again when you see new developments on the horizon. You could bring it straight to us and we'll put it right on StarTalk's special edition. Heather, where can we find you in social media? And weren't you doing some TV right now?

• 45:58Heather Berlin?

  Yeah, well, my, my Nova series is now out. You can find it online. It's called Your Brain on Nova. I'm on Instagram and Twitter at Heather underscore Berlin. There is a book in the works that's like to be continued. We'll have, you know, I'll talk more about it, but people look out. And yeah, that's it for now.

• 46:19Neil deGrasse Tyson?

  Hi Gary, good to see you, man. Likewise, my friend. All right. And Chuck, stay healthy. Rattling your pills around in front of us.

• 46:27Chuck Nice?

  This is why I'm healthy.

• 46:30Chuck Nice?

  I feel great, baby.

• 46:31Neil deGrasse Tyson?

  I said, stay healthy. So, okay. All right, this has been StarTalk's special edition. Neil deGrasse Tyson, you're a personal astrophysicist. Keep looking up.