How to Harness the Power of Mindfulness with Dr. Stuart Eisendrath [Episode #453]
This week’s topic is: How to Harness the Power of Mindfulness with Dr. Stuart Eisendrath
I am so excited to have a very special guest, Dr. Stuart Eisendrath, a best selling author, a senior clinician and research psychiatrist and the founding director of the UCSF Depression Center. Listen in as Stuart shares why depression became his focus of work, how to use his mindfulness technique and start going beyond prescribed medication.
How to know if you’re going through temporary sadness or moodiness versus actually being depressed…
The biological and psychological components of depression…
Whether prescribed antidepressants, sleeping aids and anti-anxiety medications are over prescribed…
Dr. Eisendrath shares why depression became the focus of his life work…
Going beyond pills and antidepressants and what really works…
What the mindfulness approach is and how to dislodge self-doubt…
Who can use the mindfulness technique and how long it takes to start feeling better…
If you can do this program on your own in conjunction with antidepressants…
Stuart’s work goal for people who integrate these practices…
About Dr. Stuart Eisendrath
Stuart Eisendrath, MD, is the author of When Antidepressants Aren’t Enough and the founding director of the University of California San Francisco Depression Center. A senior clinician and research psychiatrist at UCSF, his lectures on mindfulness-based cognitive therapy for University of California TV have been viewed more than 1.5 million times.
Stuart J. Eisendrath, MD, who has been on the front lines in the treatment of depression as both a researcher and a clinician for over twenty years, presents an easy-to-implement program, based on mindfulness-based cognitive therapy (MBCT), to bring relief to chronic sufferers of depression.
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Kimberly Snyder: Hey beauties, welcome back to our Monday interview podcast and I am so excited about our very special guest today, Dr. Stuart Eisendrath, who is a bestselling author, a senior clinician and research psychiatrist and the founding director of the UCSF depression center. His new book is called “When Antidepressants Aren’t Enough”. And so we’re going to get all into depression, which is something that affects millions and millions of people, so it may be something that is in your life right now or a loved one or an acquaintance. It’s so widespread at this point we felt like we really had to cover this topic and we’re really excited to pick Dr Stuart’s brain, who is such an expert on this.
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Interview with Dr. Stuart Eisendrath
Kimberly Snyder: I always say it’s a great form of self care to keep the episodes coming in regularly so you stay connected to the community and to wellness and improving your life. All right, so all that being said, we have Dr. Stuart who is waiting patiently on the line. Dr. Stuart, thank you so much for being here with us today.
Dr. Eisendrath: Thank you for having me.
Kimberly Snyder: Now, Dr. Stuart, you are located I assume in San Francisco?
Dr. Eisendrath: That’s correct.
Kimberly Snyder: Where your depression center is and we hear so much about depression now Dr. Stuart. I hear about it not just with adults, but you know with teens, with kids, which we’ll get into in a little bit later on in our show, but I guess my first question is how do you know if you’re just going through a temporary sadness or a little bit of moodiness versus actually being depressed?
How to know if you’re going through temporary sadness or moodiness versus actually being depressed
Dr. Eisendrath: Well, there’s a couple of ways of differentiating that. One is, do you have a certain set of symptoms? And we typically think of those as sad mood, suicidal thoughts, slowing of your movements or agitation, trouble concentrating, an altered sleep pattern where you sleep more or less than usual. Altered appetite where you eat more or less than usual, and those trouble concentrating trouble with your thoughts. And usually if these last for two weeks or more, it’s important to think of depression as compared to somebody having a more transient event from day to day and just experiencing a reaction to a normal life event.
Kimberly Snyder: Well you know these life events, for instance, I lost my mom a couple of years ago, which was really hard. And or let’s say you go through a bad breakup, and I’ve been through a bad breakup, and I’m sure a lot of us listening to this have as well. And some of those symptoms you mentioned like you’re overeating or you lose your appetite or you’re having trouble sleeping or whatever, they can usually go on for two weeks. So are you saying that depression can be kind of for some people it’s based on one incident or are you more concerned with people that kind of fall into this pattern over months and years?
Dr. Eisendrath: Well, it can certainly last months or years. The people in our major study of using mindfulness for treating depression, the average duration of illness was seven years. So it can go on a long time. But if somebody has a major loss, like a loved one in their life, two weeks is the shortest period to make a diagnosis. But sometimes they can go for several months beyond that, where those symptoms persist. And one good way of differentiating between what’s normal grief, for example, and what’s depression is how the person feels themselves. If they feel that they’re a bad person, if they feel they’re guilty, if they feel they’ve done something wrong, that’s an indicator that they’re depressed, whereas the person who’s going through a normal grief reaction still feels okay about themselves. So that’s one question I always ask a person, how do you feel about yourself?
Kimberly Snyder: So another thing that I’ve always wondered about depression, because I think we hear different opinions about this is that there’s something off, like a neurotransmitter or there’s something biochemical in our brain that causes some people to tend towards depression versus just an emotional coping mechanism or tendency. How much of it is actually biochemical in the body do you think?
The biological and psychological components of depression
Dr. Eisendrath: Well, that’s a good question. We use to… We think of depression in a biopsychosocial model. That bio means that there are things like neurotransmitter disturbances or a circuitry disturbances in the brain. There are certain circuits that are disturbed in depression. So there is a biological component and then there’s a psychological component. So if you have say an upsetting situation that you’re involved in that can actually lead to depression and lead to biological disturbances. If somebody has a stress, and often when you see somebody who’s depressed, there is some stress. It doesn’t choose to happen out of the blue, it happens in a relationship to a stress. Biological, psychological and social, meaning there’s usually some interaction with the important people in their life.
Kimberly Snyder: So I love the title of your book “When Antidepressants Aren’t Enough”. And as we all know, a lot of physicians are very quick to prescribe antidepressants, sleeping aids, antianxiety medications. I mean I think it’s an epidemic, a lot. I mean, you know the numbers, doctor, better than me, but millions and millions of people are on these. And as a doctor yourself, can you give your perspective, your opinion about whether you think these things are over prescribed, or yes or no, and why? And then also what some of the detrimental effects may be of over-relying on medications or you’re not doing anything else, but just taking the meds for months and years and years. And what does that do to your body and what can that do to your brain longterm?
Whether prescribed antidepressants, sleeping aids, and anti-anxiety medications are over prescribed
Dr. Eisendrath: Well, the most common treatment for depression is actually no treatment. People don’t identified. They don’t get identified. And if they do, the common response is, “Pull yourself up by your bootstraps.” Or, “What are you depressed about anyhow?” So a lot of people who are depressed don’t actually get any treatment. Then if they’re going to get some treatment, if their primary care physician sees them, most likely they’re going to get an antidepressant. And don’t forget, 75% of the antidepressants in this country are prescribed by primary care doctors, not by psychiatrists. So the problem with an antidepressant, and I’m not against antidepressants, they can be lifesaving for certain people.
Dr. Eisendrath: The problem with them is this, that if you take a person and give them an antidepressant, only one in three people will recover with that. And if you take the people who haven’t recovered, you’ll get another 20%. so after two full treatments of antidepressants, only 50% have fully recovered. So that means 50% haven’t recovered. And so despite the ads of a smiley face on TV for example, many people don’t have enough of a response with antidepressants and they need something more. That’s really the reason we started, started to study this problem and developed our program at the UCSF depression center.
Kimberly Snyder: Well, let’s… I see the problem with people not responding. But let’s say even if people do for a while, I believe I’ve read somewhere that teens for instance, I believe it was teens, young people that do take antidepressants have a higher tendency towards suicide. Is that right? Could that be possible?
Dr. Eisendrath: It could be possible that younger people in their teens or early twenties have to be watched more carefully if they’re given an antidepressant because they are more likely to have adverse effects. [crosstalk 00:11:44] or worsening of depression or even suicidal thinking. So you’re right that young people need special attention. They’re not as… Whereas if you get into the mid range of age and the geriatric population, there’s much less risk of worsening with an antidepressant. But for young people there is.
Kimberly Snyder: I see. So I want to get into your work now, Dr. Stuart, about an alternative or something that can be used in conjunction with medications so that we’re not just relying on taking pills, but first, can you tell us a little bit about why you’re so interested in depression? I mean it’s become the focus of your life work, your personal relationship with depression. I’d love to see why this… I’m always interested in how people get into the work they do.
Dr. Eisendrath shares why depression became the focus of his life work
Dr. Eisendrath: Well, there’s sort of two stimuli for my getting a focus on depression. One is that it’s the most common cause of disability in the country. It’s more disability with depression than heart disease or cancer. So it’s a very big cause of disturbance. In fact, on any one given day, over 300 million people are suffering from depression in the world according to the World Health Organization. So it’s a major public health problem throughout the world. The second reason I’m interested in depression is a personal one. I’ve experienced depression myself in the past and I know how unpleasant and difficult it is for a person to go through that, and I’d like to help people to get out of their own depression and prevent further episodes if it’s at all possible, because I know that’s important for me.
Kimberly Snyder: So when you say episodes, in your personal experience, were you depressed for periods and then you kind of snap out of it and then you’d go back into it? Is that a normal depression, pat… I mean, I guess, I don’t know what’s normal, but is that a common depression pattern?
Dr. Eisendrath: That’s a common depression pattern where a person starts to slip into an episode of depression where their mood sort of takes a dip downward and proceeds downward and it may stay there for a period of a number of months. And then if they don’t get any treatment, they will probably gradually emerge. Maybe it takes a year or two years until they get back up to baseline. With treatment, that cycle can be shortened. That’s the important thing about treatment. It actually aborts the time that a person is in the depressive episode.
Kimberly Snyder: So tell us a little bit about your approach, Dr. Stuart, about going beyond pills and antidepressants. What have you found really works?
Going beyond pills and antidepressants and what really works
Dr. Eisendrath: Well, what we did was set up a study called the practicing alternatives to heal depression study. And we took people who had failed to recover despite two or more antidepressants and taught them… taught half of them a mindfulness meditation as a way of coping with their illness. And it was a specific forum called mindfulness based cognitive therapy. And we compared it to another group, the other half of the group that got training and the physical therapy, music therapy and art therapy and compared the two groups. And at the end of the trial we found that the people who had had the mindfulness approach had decreased depression, more self compassion, decreased rumination and a general overall sense of wellbeing compared to the control condition. The comparison condition.
Kimberly Snyder: So when you’re talking about mindfulness based cognitive therapy, I believe I said it right, is that different than regular cognitive behavioral therapy? More traditional?
Dr. Eisendrath: Yes it is. In traditional cognitive therapy… One of the commonest symptoms in depression are negative thoughts. Things like, I’ll never feel better. I’m not as good as my neighbor. I should be thinner or healthier or I should be richer. I should be any number of things, but not being satisfied with themselves and being pessimistic about what’s going to happen in the future. So that’s what you typically see. In cognitive therapy traditionally you helped the person to try to counter those thoughts with an alternative or a more balanced thought. So example, if the person says, “I’m not a good person.” Well, let’s look at that. Is there… are you a good person in any way? Can we say, “Well, you helped the old person cross the street. So there’s some good in you,” for example. And the trouble with that approach is that some people it’s very valuable for, but for some people when they’ve been stuck in depression for a long period, and as I mentioned in our study, they were stuck in it for seven years or more-
Kimberly Snyder: Right, there in it.
Dr. Eisendrath: They’re in it and they can’t come up with an alternative thought. They’re so stuck in it. And I taught cognitive therapy for a long time, and what I found with a good number of people is that they’re so stuck in it I felt like I was an attorney trying to argue with them about why they could have a positive thought.
Kimberly Snyder: Wow. Yeah. So they’re so mired in it that, that it’s not in your experience perhaps the most effective, because I know that when your belief system is so deep or has gone on for so long that you can’t really see the other side. So how has your mindfulness, which rings to me a little bit about meditation and spirituality or just this idea of questioning our thoughts. Maybe I’m super imposing that, but is that how your approach, some of that is a little bit different?
Dr. Eisendrath: No, you’re exactly right.
Kimberly Snyder: Yes. I love mindfulness. Yes.
What the mindfulness approach is and how to dislodge self-doubt
Dr. Eisendrath: Yeah. You hit the high points. In the mindfulness approach instead of trying to argue with the thoughts you learn that thoughts are just thoughts and that you can actually let them go. I’ll give you an example. If you’re walking down the street of a town and there’s storefronts down that street, in traditional depressive reaction to it if those storefronts are filled with negative thoughts, you go in the store and buy those thoughts and take them along with you, and they become part of your life and you believe them and are stuck with them. In the mindfulness approach. You walk down the street and you notice the negative thoughts and the thoughts are still present inside the store, but you don’t have to go in and buy those thoughts. You can keep walking down the street and go where you want to go and not be mired by taking those thoughts into your person. And so you can see them, but you don’t have to accept them as being yours. That’s probably the biggest difference.
Kimberly Snyder: Well, Dr. Stuart, in our community where we are largely women and we have a lot of negative thoughts as you’re speaking about whether it’s, I’m so fat or I’m not enough. I’m not pretty enough. I’m not good enough. You’re so mired in that you have so much self doubt, you lack confidence, how do you start to really dislodge it? Can you take us through the process? Is it every time it comes up you pause and try to look at it or tell us your process in that example that I gave you, please, with common female thought patterns, which do lead to depression of course in comparison and all the things that we talk about.
Dr. Eisendrath: yes, well we do utilize mindfulness meditation where we teach people basically how to focus their attention. And they can focus their attention… We start out by having them focus on the breath because that’s a relatively neutral thing to focus on and everybody has it. And so if you focus on your breath and sit down for a few minutes to try to do that focus, you’ll notice that your mind begins to wander. It wanders too what’s for dinner or maybe a negative thought, like you just said, I’m not doing this right, or other people are doing this better than me, or I’ve got the wrong clothes on to do the meditation or I don’t [crosstalk 00:22:42]. Yeah, so that’s… one woman in a, in a class we had said, “Well, I’m the only one in the group who has white shoes on and I feel very badly about that.” I mean, what a… So you can see how people, their minds can wander to negative things. Sometimes not negative, but in depression there’s a tendency to wander to the negative.
Dr. Eisendrath: And what they learn is when your mind wanders, you congratulate yourself on noticing your mind has wandered, and so you’re paying attention to your thought. They’d wandered to that thought. Now I gently and compassionately bring it back to focus on the breath. So you start to learn how you can actually focus your attention and let go of thoughts and bring your attention back to the breath. Or as we do other meditations like the body scan, bring it to sensations in the body and other things. The sounds around you and so on. You start to learn how you can focus your attention and let go of the negative thoughts.
Kimberly Snyder: I love how this is very yoga. Dr. Stuart, have you studied any yoga? Have you been to India or travel to any countries like this or read any new yoga books that have influenced your work?
Dr. Eisendrath: Well there is… We actually incorporate some yoga into our classes, so we have yoga which is very akin to what I’ve been describing where you’re focusing your attention on body sensations as you’re doing it, and you’re also learning to focus on, well is there some pain involved as I take this pasture? And notice what happens when the pain comes up, can you just notice the pain for a short period and accepted as it is? And that’s true of what we do in the classroom or as we teach people individually how to become more mindful. So there is a lot of yoga involved. Yoga, incidentally, there are some specific forms of yoga that have been used to treat depression, [Pseudo Krishna 00:25:18] yoga has been studied as a way of helping people, and there’s some very good studies in India that indicate that it can be a useful modality. So you’re right, there is a lot of connection to yoga.
Kimberly Snyder: I love that. And I find, Dr. Stuart, over time more and more of this sort of research will come out to prove about some of these Eastern concepts. Turmeric, for instance, and some of the Ayurvedic information and yoga. When it’s studied, it’s producing all these positive… reinforcing… it just backs up the benefits. But then some of it doesn’t have the funding yet, but as a yogi myself, I know I feel great meditating every day. So I just, I love that. Anyways, I just wanted to ask, because I love how that is such a part of your work and you’re a clinician and a doctor and a psychiatrist, but you’re bringing that in as sounds like a really big part of your program.
Dr. Eisendrath: Yes, it is. It is. It’s an important… and it’s really what we do in our program is offer people different meditations. The breath sounds, the body sensations and yoga is another form of meditation that… So we give people, I like to think of it as a buffet and they can kind of choose what they like from that buffet and what works for them. And certain techniques will work really well for one person and not for another and vice versa. So yoga can be an important choice and many people when they’re depressed like to do something with their body. They to have body sensations and then maybe more comfortable for them to do that than to sit and focus on the breath.
Kimberly Snyder: In your experience doctor, with your clinic, some of these more extreme cases you were talking about where people can go into depression for seven years. Have you found that even the most severe cases you can help… Some of these techniques like focusing on your thoughts or the body sensations can be taught to people that are really deeply mired in that funk? The more serious longterm cases, have you found that this is really effective, this can work. Because if anyone’s listening to this and saying, “Oh that sounds nice but I’m really depressed or my mom or my such and such, I don’t know if that’s enough to help them.” What would you say in that case?
We discuss who can use this mindfulness technique and how long it takes to start feeling better
Dr. Eisendrath: Well, I would say in our research we found the people who were most depressed had the biggest change in their depression levels. So yes, people who are significantly depressed can use this technique. And I think part of it is that the technique itself is empowering. It’s giving the people something that they can do themselves. It’s not a pill, and it’s not even so much involved with therapy. It’s something that they can do themselves and be empowered to take action when they’re experiencing depression.
Kimberly Snyder: And how long would that take doctor, if they are following your program? And I know there’s a lot more to it, that’s why you have a whole book about it. But let’s say they are starting to practice some of these techniques and go into your program. And I know there’s… people always ask me this question, when can I lose weight? When will my skin get better, when will I feel more connected to myself. And I know there’s not a one answer fits all. But in general, in your research, what are the general timelines? Does it take months? Do you see it happen in a few days, sometimes? When can we see some relief from depression with the program?
Dr. Eisendrath: Well the program is originally designed to last eight weeks, and what we find is that people usually at about the midpoint are starting to really benefit from it. So after four weeks they’re starting to get the hang of it and learning to focus their attention and be able to start picking out meditations that really work for them. And then by eight weeks they’ve made very significant progress in their ability to start adjusting their mood and being able to get out of a depressive state.
Kimberly Snyder: So people don’t have to come to your center then. Your book is the culmination of research and personal experience and working with depression for so long so people can actually do the program, or start to do these mindfulness practices on their own without the guidance of a professional? I mean even as I say this question, I know it’s tricky because as a doctor you’re probably saying, “Well you should still have a doctor or this doesn’t automatically negate seeing your physician or taking antidepressants.” But I guess my question is, can you do this program on your own even if you are continuing to see a psychiatrist or psychologist or your primary care doctor that may be still prescribing meds?
If you can do this program on your own in conjunction with antidepressants
Dr. Eisendrath: Well, yes, you can certainly do it in conjunction with antidepressants. In our study, all of the people had failed to recover despite two or more antidepressants, but they were still on an antidepressant. So they could definitely do it along with that. And some people were in psychotherapy and it can be done along with that. The book offers an opportunity to kind of walk through the program and it includes my website, stuarteisendrath.com, where people can go to get the different meditations. There’s audio files that can be downloaded or streamed and they involve a variety of different meditations, and those are available for free. They probably work best in conjunction with the book because the book kind of walks through trying the different meditations. But if a person wants to just test them out, they can go to the website and get the meditation’s there.
Kimberly Snyder: Amazing. And would you say the goal in your work is for people to integrate these practices and to get off medication? Can we say that’s a goal or do you think some people, because of their specific case, because of neurotransmitters and some of the things we were talking about earlier, will still need to use medications longterm?
Stuart’s work goal for people who integrate these practices
Dr. Eisendrath: Well that’s a good question. That’s really an individual issue that they should take up with their doctor about what they’re going to do. There is however evidence about it, and the evidence… For example, there was a very large study in England that took people who had fully recovered from their depression and divided it into two groups. One group continued to receive their medication, which is sort of the standard maintenance treatment. They continued the medicine at the same dosage. The other group received mindfulness based cognitive therapy and then were tapered off of their medication, and then people were followed for two years. At the end of two years, just as many people who had the mindfulness training but were offered medication were free of depression as those who had continued on their antidepressants. So it was a very powerful study showing that there are alternatives to being on medicine indefinitely. But for some people the medicines are maybe important to stay with, so it’s something that they really need to take up with their doctor and if there’s anything like suicidality present, that’s something they should really talk to a mental health professional about.
Kimberly Snyder: Dr. Stuart, finally I want to ask you about in… the world is always changing of course and in the modern day there’s different stressors on people than there were in different generations, particularly social media, which I know can be a source of connection but it could also be a source of FOMO, fear of missing out, and for some people creates anxiety and could actually trigger depression. Have you started to see that in your work recently because it’s just become such an integral part of modern life? Any impact from social media, or any other modern phenomenon that’s different than say when you started your work?
Dr. Eisendrath: Well, I think there’s some evidence that those factors can be present. I myself haven’t investigated down to specifics, but there are a variety of modern stressors and people don’t have the family supports. They have often moved away and they maybe don’t have the actual social supports in terms of family and friends that they had before, and the pace of life and the stressors of modern life can play a significant role in precipitating depression. So most of these can be very important.
Kimberly Snyder: I see. Yeah, sure. I guess maybe it’s indirect if you’re on social media a lot, you may be less connected to the support system or people are less available or whatever. So that makes sense. Dr. Stuart, thank you so much for being on our podcast today and sharing. Also sharing about your personal experience and just the work you’re putting into this issue because I have not personally experienced depression, but I have had family members that have and friends and acquaintances and I know how much suffering it causes, and I love your approach integrating yoga and yoga methods and breathing techniques and mindfulness techniques and I think it’s a really powerful approach. So thank you so much again for your work and for coming on the podcast today.
Dr. Eisendrath: Thank you.
Kimberly Snyder: And beauties, as I mentioned, Dr. Stuart’s book is called “When Antidepressants Aren’t Enough”. It is a very recent book. It’s just come out. We’re going to link to it in the show notes. We’re also going to link to Dr. Stuart’s website which as he mentioned he has some audios and he has some materials which you can also check out at stuarteisendrath.com. So that will be in the show notes, which are over on our website, which is mysolluna.com.
Kimberly Snyder: So again thank you again Dr. Stuart. Thank you beauties so much for tuning in. We appreciate you. We love you. We are so grateful for our community. We’re here to share and support each other, so anything we can do to continue to support you. We have our Q and A Thursdays so you can ask questions directly to me on the website. We also have a positive social media which is @_kimberlysnyder. We also have tons of resources on the site, free meditations, new recipes and so much else, so much other good stuff. So thank you. Thank you. Sending you love. We’ll see you back here Thursday. Until then take care of yourself.