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138. Dr. Steve Ilardi | Depression and CrossFit

138. Dr. Steve Ilardi | Depression and CrossFit

 On today’s episode, Ackerman talks to Dr IIardi about the benefits of exercise when it comes to depression. Dr Stephen Ilardi is a professor of clinical psychology and the author of The Depression Cure: The 6-Step Program to Beat Depression Without Drugs. Earlier on in his career, Dr Ilard found the depression epidemic was getting worse and traditional forms of treatment aren’t working. He was a correlation between the epiphany and of the 21-century lifestyle of being sedentary, indoors and a heavy fast-food debit that was creating the problem. Dr Ilard examples how exercise is more beneficial than any other anti-depression medication on the market. They cover a wide host of topics in today episode such as symptom and activity has this impact too, the more critical discussion how you as box owner can help a member who comes to about their depression. As it will happen at some point, and probably already has.

Timestamps:

(2:02) The increase in depression
(4:51) Symptoms of depression
(9:14) Why regular physical activity is so important?
(16:56) How long does it take for it to take effect?
(20:36) Principles to be aware of
(26:34) Metal illness and physical illnesses
(29:58) Addicted to activity
(33:43) Coming off Meds
(36:37) When you can’t work out as much

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Ackerman:
All right, welcome back to Best Hour of their Day. We have another very special guest. We have Steve Ilardi p_h_d_. Dr. Steve from the University of Kansas. And we’re going to talk all about the benefits of exercise when it comes to depression and. More than that, I’m going to let you talk a little bit about that, Steve. To kick it off, because I don’t know that I’ll do it justice. So can you give your self a little 30 second elevator pitch of who you are? For the listeners out there.

Dr Steve Ilardi:
Absolutely. Hey, Jason. So, I mean, as you mentioned, I’m a professor of Clinical Psychology University, Kansas. I trained at Duke University, where I spent five years, got my p._h._d.

Dr Steve Ilardi:
And most of my focus for my whole career has been clinical depression. And for the first probably 10 years or so of my career, I was really like a deep lab, science bent science neuroscience guy, publishing articles that probably 100 people in the entire world might read or care about. And I was happy as a clam. But over time, I got increasingly frustrated with the fact that we have an epidemic of depressive illness and our current regimen of treatments, whether they be medication or traditional talk therapy. That regimen is not getting the job done. The epidemic is getting worse and worse. And I had an epiphany that much of that epidemic is driven by the way we live, and in particular, the fact that we were just never designed for the sedentary, socially isolated, sleep deprived, fast food laden indoor just frenzied pace of 21st century life. And it’s taking a tremendous toll on our bodies and brains and our minds. And so I switched gears and began researching a lifestyle based approach to treating depression and witnessed some really remarkable results. So that’s who I am. That’s what I do.

Ackerman:
Well, I appreciate that. Yeah, I agree with you, Steve. Correct me if I’m wrong, but it seems like there the trend or there’s some sort of upswing or hockey stick, if you will, of people being diagnosed with depression. Do you think. It’s because of the way we’re living this day and age. Or was it just not being diagnosed often enough? You know, back in the 50s, the 60s, the 70s.

Dr Steve Ilardi:
Yeah, that’s a great question. So it’s really that I think the first question any thoughtful person should have come to mind when they hear that the rate of depressive illness has been skyrocketing. Is it just basically, if I can paraphrase, is it just an artifact or awareness now or the way in which we’re thinking about? And the answer is no. How do we know?

Dr Steve Ilardi:
Well, because we’re using exactly the same methodology to it’s basically and I don’t want to go too deep into the weeds, but it’s an epidemiological approach where researchers going back for many, many decades have canvassed. They’ve done random samples of the population, kind of like pollsters would do, except a much bigger sample. Thousands and thousands of Americans across a wide swath, a big cross-section of the country. And we’re not asking people, hey, have you ever had depression? Hey, have you ever been diagnosed? Hey, have you ever been treated? We’re asking them very specific questions about symptoms and then using the diagnostic formulas that we have. Some listeners probably have heard of the DSM, which is our diagnostic handbook, kind of a Bible, as it were, for how to make diagnoses. And what I can say is applying exactly the same algorithm or Formula Two, exactly the same answers to the same questions. What we’re seeing is a huge uptick in the rate of depressive illness. And it tracks with disability claims that we’re seeing it tracks with a large spike, sadly and tragically, a large spike in suicide and particularly suicide rates. Both completed suicide, fatal suicide attempts among young people. They’ve been skyrocketing since really about the last 25 years or so.

Ackerman:
Well, yes. And as a you know, I have a masters in psychology, some quite familiar with the DSM. I had the DSM 4. Is that so? What their honor is it progressed to the five.

Dr Steve Ilardi:
Now, I believe it or not, we’re on the five. In fact, 2013 was when the five came out and the new edition appears roughly I’d say about every fifteen, eighteen years. So if we sit tight for another decade or so, we’ll see another one.

Dr Steve Ilardi:
Certainly, well, the criteria don’t change that much from one edition to the next. And when it comes to depression, they’re almost identical.

Ackerman:
Well, that’s what I was going to ask. You know, people listening, let’s let’s kind of establish what we’re referring to. Can you give us. What are the major symptoms, what should people be looking out for? Whether it’s within themselves, family, friends, when. When it comes to diagnosing depression?

Dr Steve Ilardi:
Yeah, I’m really, really glad you brought that up because there’s so much tragic misunderstanding around the word depression. You know, in a lot of people hear that word. You know, maybe just in casual conversation, they’ll hear some. They say, oh, I’m really depressed today. And what that often means, just an everyday conversation is that, you know, the person’s feeling down, they’re feeling sad. Maybe something upsetting happened. You know, the slings and arrows of outrageous fortune. They’ve had a setback, a disappointment, a loss, a failure. And that’s, by the way, a normal part of the human condition. We’re hardwired to feel sad when something hasn’t gone our way. And it’s not typically something that is of any clinical concern as long as it resolves and as it typically does in a short period of time. But here’s the problem. We in the clinical community use the word depression, the same exact word. We use it as a shorthand for a really debilitating illness. In the DSM parlance, we called major depressive disorder. I prefer depressive illness because I think it captures much better the fact that now we’re talking about this debilitating condition that often robs people of their ability to to think clearly.

Dr Steve Ilardi:
It robs them of their energy, it robs them of their focus, it robs them of their ability to love and work and play. And in many instances, probably the majority. It actually robs people of their very will to go on living. Depressive illness, lights up the brain’s pain circuitry. So the person who suffers from it is actually in a state of agony. It’s partly emotional and in many cases it’s also physical because the brain’s emotional pain circuitry sits right next door to the physical pain circuit. So they’ll talk about this sort of un clear, vague sense of physical distress. And many people, because of the negative thinking that accompanies the negative mood, they’ll begin to get hopeless. They’ll begin to feel like there’s no possible escape. And many will begin looking at death as a potential means of escape. And of course, we know all too tragically because depressive illness is completely treatable in the majority of cases. But that’s the distinction. When we in the business talk about depression, we’re not talking about just everyday run of the mill sadness.

Ackerman:
Well, and I want to really relate this to fitness and box owners, coaches and even some athletes, you know, members of boxers, because you know, what percentage of. America will eventually be impacted by this.

Dr Steve Ilardi:
Yeah, well, again, you’re asking such great questions. The latest epidemiological evidence we have suggests that at least 30 percent of Americans at some point in their lives will be hit by depressive illness. And what this means is depressive illness is now the single leading cause of disability for all Americans. It causes more disability, more days lost, more years lost than heart disease, cancer, anything else. It is now truly become an epidemic. And by the way, that’s despite a 400 percent increase in antidepressant medication use just since 1990. In other words, one out of every eight Americans is currently taking an antidepressant that every day. And it has not moved the needle one bit in terms of stemming the tide of this epidemic.

Ackerman:
Well, when you say 30 percent of Americans, when I really hear is 100 percent well, at some point be impacted in their lives, because whether they deal with depression or not, they’re gonna have a friend or family member or a member of their boxer or one of their athletes be dealing with this so that you know that we know how to deal with it. From that perspective,.

Dr Steve Ilardi:
Absolutely. And you know it. I mean, one of the I guess if I can can put a silver lining on this. We know that regular physical activity and being a part of a community such as a Crossfit, community, both of those things are enormously protective. Not completely. Not 100 percent. I don’t want to give any any sort of false assurances. But what I can tell you with absolute certainty is that the rate of clinical depression among people who participate in Crossfit, is going to be lower than that in the population and not just slightly lower, but a lot lower.

Ackerman:
So when you say that, is that Crossfit, specific or is that all activity?

Dr Steve Ilardi:
Yeah. No, it’s not. It’s not specific. Although I’ll tell you a couple of things that I love about Crossfit, that I do think maybe set it apart a little bit. But know what the research that I’m referring to primarily is that that looks specifically at the antidepressant impact of regular physical activity. I mean, as I mentioned or sort of alluded to a little bit earlier, our bodies are not designed to be sedentary. And, you know, there’s there’s a kind of pithy little saying making the rounds. You may have heard of it sitting is the new smoking. And, you know, the more we learn about what our bodies are designed to be doing, the more we learn that they’re I mean, they’re really not designed to be sitting around. And our ancestors, if we look all the way back to the Paleolithic, to the Pleistocene, our ancestors, judging from contemporary Aboriginal groups, are living pretty similar lives. They were moving most of the day and engaged in pretty vigorous activity, probably up to four hours a day. And we said that moderate intensity. And so what we’re learning is that when we get up and move and particularly when we’re getting close to the aerobics range of activity, it has profound antidepressant impact on the brain. It it changes brain function. And this is going to really surprise a lot of people, but I’m gonna say it. So there’s my spoiler. It changes the brain more dramatically in more different ways than any current medication that we could give someone. So if we could take the brain changing effects of physical activity, of exercise and put them in a pill, it would become the most effective pill that we could possibly give someone with depression.

Ackerman:
Well, I’ve said that often, you know, getting up at 5am to hit the 5:30 or 6 a.m. class is a terrible feeling when that alarm goes off that you feel great. Ask her. And I said, if they can just bottle up how I’ll feel after it. Be easier for me to wake up in the morning. And I’m sure it’s a similar effect when it comes to depression. You know, we we have to be able to get these people to the gym. So let’s let’s start there.

Dr Steve Ilardi:
Absolutely. Yeah. No, that’s. I mean, it’s it’s a wonderful point. And, you know, it’s something in our research here. The universe of Kansas, one of the very first things we found. OK. So we’ve got a a a lifestyle based treatment program. The centerpiece of it is getting people moving. And by the way, it’s not at high doses. It’s much, much less. It turns out, than to have clinically significant effect than you get at Crossfit,. So this, again, may surprise some people, but the best research suggests that you start to see an antidepressant effect with brisk walking for a half an hour in the Arabic zone. Three times a week. So basically 90 minutes of a walking three times a week has been tested head to head against his all off against an antidepressant medication in a couple of different trials and found to be equally effective in the short term. More effective in the long term. And again, that’s a really low dose. But the question is, how do you get people to do it? And so when we started piloting that, what we found was a lot of patients when we just, laid that out for them and said, here’s the goal, here’s how you can do it. Let’s structure it. And, you know, let’s meet in a week and we’ll talk about it. What we found was only about half of our depressed patients were able to put that into practice on their own.

Ackerman:
And it makes me think of two things. It’s one, you know, it’s that first step, right? It’s how do we get them to take that first step and actually feel it? But secondly, I think you’re probably considered a much more progressive doctor. You know, how do we get doctors to not prescribe drugs where they probably make money on and saying, hey, we’ve got this better alternative, it’s actually free and it’s going to make you feel even better?

Dr Steve Ilardi:
Yeah. Well, you know, here’s the interesting thing is when our research started to get some traction and publicity locally and, you know, we got a nice feature story on the front page of the law External World, which is our local paper and a community of about a hundred thousand. A lot of the doctors in town started writing out on a sheet of paper, a list of lifestyle changes, including this, you know, regular brisk walking.

Dr Steve Ilardi:
And they would hand it to their patients and say, here, this will help you. And here’s the problem. People with clinical depression, because of the illness, they lose a lot of their energy and they lose a lot of their initiative. And I don’t want to get too deep into the weeds on the neuroscience, but basically the circuits in our brain that allow us to translate our intention into action. Think of it as sort of the executive function of like being able to pull the trigger. And we want to do those circuits go off line when people are clinically depressed, they reside in the left frontal cortex. And so what we ended up basically having to say to our patients is, look, we want to set you up for success. We’re not just going to hand you a list of things, including, you know, exercising and tell you, hey, good luck with that. You know, put that into practice as best you can. Instead, we’re going to partner with you. We’re going to give you that little spark of initiative. So what do we do? Well, we got a personal trainer for every single one of our patients after we had had such poor results and our pilot group on adherence to exercise. So we’re like, OK, well, Mrs. Jones, we want to introduce you to Beth. He’s gonna be your personal trainer. He’s gonna meet with you now. You’re gonna put three blocks of time in your schedule for the week ahead.

Dr Steve Ilardi:
And then he’s gonna give you, if it’s okay with you, give you a little prompt, a little tickler, a half hour in advance. And what we found it was really remarkable was most of our depressed patients, they would tell us, look, I was sitting there, I was dreading the workout. Like you were talking about, you know, waking up at 5:30 in the morning is like, oh, God, I got to go do this thing. And they’d be dreading it, but they would get a little reminder. And that would be enough to get them up off the couch, get their shoes on, get them out the door. And then once they started moving, once they started actually getting involved in, they’re like, oh, why was this so hard? This is this is really helping. And so, you know, a lot of people who are experts in treating depression. So or just, you know, a lot of physicians who see a lot of depression in their routine practice. They get really cynical and they’re like, okay, well, yeah, sure, exercise might help depression, but nobody who’s depressed is gonna be able to do it. And what I tell them in response is no. Most people with depression are not going to be able to initiate it. But if you’re willing to partner with them, we can help them do it. And once we have them moving, it’s going to profoundly change their life.

Ackerman:
Have you found kind of a tipping point in number of days or weeks or even months? And it takes for them to realize, OK, this is what’s helping me feel better?

Dr Steve Ilardi:
Yeah, that’s that’s a really wonderful question. It varies, of course, a little bit from person to person. But I would say just ball parking on average, probably about two months. You know, there’s there’s a saying you might have even encountered it in your master’s program that once any activity, anything at all becomes a habit, it becomes self-reinforcing. In other words, you know, somebody has a habit of flossing their teeth every night. We’re just grabbing that piece of dental floss, gives them a little dopamine spark in their brains, reward circuitry. It’s like, oh, this is what we do as a habit. This is great. And it becomes self-reinforcing. There is a saying that it takes. Somewhere between about 10 and fifteen repetitions for something to become a new habit. Unfortunately, with physical activity, it looks like it takes a little more. And there’s there’s some evidence at least that for. For many people, it can take 20 to 30 repetitions before a particular workout routine becomes completely self-reinforcing.

Ackerman:
Yeah, probably has to do with the fact that working out some tiny bit harder than flossing your teeth.

Dr Steve Ilardi:
Yapper for most of us, I would say for sure. Yeah. And you know, it’s a lot of exertion, you know, and if I could pivot back just to something we’re talking about earlier. I mean, I think part of the genius of the Crossfit, system is that by including a very strong component of social connection, social accountability and social encouragement, I think it gives people a little bit of that same spark of initiative that we’ve been doing in our program here. So in other words, I can imagine someone and I’ve actually talked to a couple patients that were part of a Crossfit, community and that, you know, that’s something they joined as part of their recovery. And they said that, you know, there were certainly times where they were feeling that really low motivation, energy initiative and just the thought of seeing their comrades, seeing their, you know, the members of their community there. That was enough to get them out of bed, to get them moving, to get them to the gym. And, you know, it’s something I mean, I know I don’t need to tell you this, but so many Americans, not only are they sedentary, but they really just crave a sense of belonging to something bigger than themselves, some sense of deep connection with other people. You know, basically, they’re looking for their tribe. And I think Crossfit, really, really fills an important niche there for a lot of people like.

Ackerman:
It’s like Coach Glassman says the magic is in the community, and I’m not sure that B is, you know, battling depression or just looking to be healthier and fitter, I know for me there’s been plenty of times. The last thing I want to do is work out. Just like you said, none of my friends are gonna be there. My tribe, if you will, motivates me to get off my couch or put down the computer and actually get to working out. Now from the affiliate level, you for a coach or for a box owner? What are some things we need to be aware of? If someone comes in and tells us they are battling dealing with depression, but they are using exercise as a means of overcoming it.

Dr Steve Ilardi:
Yeah, well, a couple of principles right away. I mean, number one, I think it’s important to approach this illness with a strong sense of humility, to understand it is really treacherous. And there is no one size fits all solution in the sense that I mean, if you look at the full array of outcomes, clinical outcomes for someone with depression, let’s say I mean, let’s just take the standard array of treatments. Right. I mean, you think of like if somebody with clinical depression goes to see a psychiatrist, what’s going to happen? Well, they’re probably going to be put on an antidepressant med. What’s the likelihood that that med is going to help them into a complete recovery over the next, let’s say, three months? The answer may surprise you. It’s about 30 percent or so. We’ll experience complete recovery. About half the patients who take that med are going to get really trivial to no benefit. About half the people, the man is not going help at all. What if they instead do traditional psychotherapy? It’s gonna be about the same ratio. What if they instead start exercising? It’s gonna be a little better depending on the level of activity and what else is happening. But you know, that’s still not going to lead everyone to complete remission. It turns out in clinical depression. There are about seven to 10 different interlocking neurological physiological kinds of disregulation. In other words, there are lots of different systems in the brain, in the body that are malfunctioning when a person is clinically depressed and we talk on a few of them with exercise and that’s enough to get many people in a complete recovery.

Dr Steve Ilardi:
But there are lots of others that we may need to address as well. So that’s why I mentioned we have six different elements in our protocol. Exercise is just one of them. What else could be going on while they might have a circadian rhythm dysregulation, which a lot of people get at this time of the year in the winter because they’re light deficient. So we might want to start using the therapeutic lightbox for them as well. We might need to work on their their habits of sleep. We may need to look at their levels of inflammation, may need to add anti-inflammatory, high dose fish oil or some other kind of anti-inflammatory regimen. So, you know, if I circle back around to your question, I think it’s really important for box owners to hold in a kind of dialectical tension. The idea that on the one hand, what they’re providing can have a true antidepressant effect about as great as the medication for people who come in who are depressed. And yet what that means is there are going to be people who still need more. And so, you know, they don’t want to be too cavalier in thinking, oh, this is a replacement for seeing a trained mental health professional like no. If some was clinically depressed, I would encourage every box owner listen to this, to encourage that individual like, yes, please keep coming. But also, please consider seeing a professional to make sure that you’ve got a trained set of eyes on you to make sure that we’re not missing anything else that we could be doing to help.

Ackerman:
Well, on a couple of things, you mentioned there being you know, I think what most people have thrown in as sad seasonal affective disorder. Right. Were inflammation, sleep. Those are all things that we should be talking about at the box level as well. So the physical activity is going to benefit them. But also these other things that we should be discussing, such as nutrition, sleep, etc. now.

Dr Steve Ilardi:
Absolutely. Yeah. I would say that, you know, that’s that’s a really wonderful point. And I’m just sort of sifting in my head through the major elements. And our by the way, for the listeners who are interested, we are protocol is called Therapeutic Lifestyle Change or TLC and the six elements. The only one that really probably doesn’t perfectly easily fit within the Crossfit, zeitgeisty is that rumination strategies. So basically, you know, one at one of the big problems we see in depression is people who are depressed really get stuck in their heads. They get they get locked in a vicious cycle of negative thinking where they just can’t shake these relentless negative thoughts about themselves, about others, about the future, about the world. And people with depression often spend literally hours every day caught in their own vortex of negative thinking. And, you know, it turns out that we can do all of these other anti-depressant things for them, like exercise and lightbox and omega 3s and everything else. But if they’re still ruminating all the time, we’re not going to get them completely well. Well, we’ll certainly be able to reduce the severity of their symptoms, get them more functional. But that that’s the sort of thing that very often a good trained clinical psychologist or other mental health professional can help them learn to identify when they’re ruminating and redirect, redeploy their attention elsewhere, something that, you know, probably some listeners have gotten into mindfulness techniques or mindfulness meditation. And it’s very difficult for people to pick up meditation while they’re depressed. But if they’ve ever had that practice before, that’s something that they can deploy often and successfully kind of put an end to that ruminative cascade.

Ackerman:
And I’m thinking as a coach, though, what we can do is celebrate these small wins, be it, you know, first pull up a PR and the list, you know, just completing a workout. And hopefully, you know, lots of small wins will lead to a better mindset long term. And they can hopefully have methods and ways to improve their own mindset when they’re not at the box.

Dr Steve Ilardi:
Yeah, absolutely. That’s a that’s a great point. Hey, one other thing I would mention for the box owners and for any other listeners out there, and that is depression. Unlike most other forms of mental illness, it can commonly be caused by undetected, undiagnosed physical illnesses. And a huge array of different physical illnesses can initially manifest as clinical depression. So, for example, in some, you know, you may be familiar with if somebody has sleep apnea. So they’re waking themselves up hundreds of times every night because their airways collapsing and they’re literally star for oxygen. Sleep apnea very often presents initially as clinical depression. So if a person has a medical illness like that, that’s causing their depression and we can treat it with everything we have. You know, we can get them exercising. All those things are gonna be helpful, but we’re not going to cure them until we actually figure out what’s what’s driving it underneath that medically. So this is particularly useful to keep in mind when the person presents where they’re otherwise, like, you know, psychologically, they’re in a good space, they’re healthy, they’re balance. And they’ll say, you know, I don’t know what’s wrong. It just came on out of the blue. It’s like nothing particular was going on in my life. I just like this thing just hit me like a ton of bricks. Whenever we see something like that, we really, really want to urge the individual to get a complete medical workup to rule out any of these kinds of underlying biological drivers that might be undetected.

Ackerman:
Well, I’m sure that’s something we should address as well. If someone comes see your box or, you know, approaches you as a coach and says, hey, I have depression and I’m trying to deal with it. Probably the first thing you should do is ask them if they’ve spoken to a doctor.

Dr Steve Ilardi:
Absolutely, yeah. And not just, you know, a lot of times people will hear that and think, oh, you mean like a therapist? And I mean what you’re really saying, at least what I’m saying and I think we both are is. Well, no, we want you to have you know, we want you to have a medical workup, because in probably about a third of cases of clinical depression, there’s some underlying medical illness or just to throw another little wrinkle and some other substance that the person is using regularly. That could be pushing the brain in that depressive state. So, for example, there’s a subset of people, if they’re abusing alcohol, it will have a central nervous system depressant effect. There is a subset of people, believe it or not, that marijuana can also make them clinically anxious and or depressed. There is a subset of people that, ironically, are taking a class of drugs called benzodiazepines that include Xanax and out-of-hand Klonopin. Those drugs, while they can reduce anxiety, they also tend to push the brain away from the most restorative phase of sleep. We call it slow wave or delta wave sleep. And, you know, ironically, anti-anxiety drugs like those can sometimes actually cause clinical depression. So there are all kinds of things that we need to keep in mind that really only a trained professional is going to going gonna be able to make that catch. And sadly, it pains me to say this. Sometimes the professionals miss these things and then they’re pretty low-hanging fruit.

Ackerman:
Is there a concern that someone that’s using physical activity to battle depression will become addicted to the activity?

Dr Steve Ilardi:
Yeah, I hope they do actually.

Ackerman:
Could it get to be too much of a good thing and so be too much, you know, especially in the Crossfit, space. You know, too much training can lead to overtraining injuries, etc.. Yeah. How do we handle that?

Dr Steve Ilardi:
Yeah. Yeah. I like where you’re going with that. Yeah. So obviously, you know, overtraining is is a concern for some dude. I’ll be honest, it hasn’t been a huge high prevalence sort of thing that I’ve seen in my practice because, you know, most people just don’t push themselves that hard. But in the Crossfit, space, I could see it. I mean, you know, the biggest tell at least that I’ve learned to look for and please tell me if it’s different in your experience. But for me, the biggest tell is if somebody feels worse after a workout than they did when they started. If somebody feels physically sick after a workout, somebody feels lower energy after their workout, that’s probably a sign that they’re overtraining. There’s also just some good empirical research that suggests that, you know, there’s diminishing returns in terms of benefit to the brain with any workout lasting longer than about 45 minutes to an hour. So if somebody is, you know, pushing way beyond that, that’s probably not helpful. From the same point of their depression. But just in general, yeah. I mean, if somebody is definitely suffering physically or otherwise as a result of their, quote, addiction exercise, then we want to keep an eye on that and want to help them make a course correction.

Ackerman:
Yeah, I like to refer to that quote as, you know, no one has ever said they regret that workout where, you know, I regret that workout said no one ever. And I think you’re absolutely right. Yes. If you’re done with your workout and you are regretting it or feel worse, you’re probably overdoing it. And I. My entire life always kind of abided by the five minute rule. Just get to the gym. Give me five minutes if you’re not feeling better. You can go. And I don’t think I’ve ever actually left after five months.

Dr Steve Ilardi:
I think. Yeah, that’s that’s wonderful. Well, I can tell you, you know, here at the University of Kansas, I end up teaching. I teach a lot of classes. My abnormal psych class right now, I’ve got two hundred and seventy two students. And one of things that means that I teach a lot of our division one athlete. So these are scholars of athletes across probably over two dozen different sports. And, you know, people think, oh, well, if you’re a division one athlete, then you’re getting so much beneficial activity that surely you’re more or less immune from depression. It turns out to be quite the opposite, because a lot of times these elite level athletes are being pushed to overtrained and they’re under a lot of competitive stress. And one of the things that will push somebody in the direction of depression is the brain’s runaway stress response. And so if somebody is in an enormously stressful situation and they’re overtraining and they’re getting sleep deprived and the ruminating about their competition, their performance, all that, it’s like a perfect storm for pushing somebody to depression. So, you know, we athletes, we’re not immune. We you know, we have to be wise about what we’re doing.

Ackerman:
Talk to me about this. Someone is listening to this podcast or they feel better. Due to exercise and they decide to completely just come off the medication. Yes, I know. How did we get there?

Dr Steve Ilardi:
I would say that should only ever be done under medical supervision. One of the things we’ve learned about the medications is that they have very often a pretty difficult withdrawal syndrome. Now, I I don’t say that to discourage anyone. I’ve worked with literally hundreds of patients with clinical depression. I’ve worked with dozens of patients who started off in treatment while they were on a medication, got better and tapered successfully off the mat. But what I can tell you is, as somebody just, you know, decides on their own, as many of the folks that I’ve known over the years have done. They just decide on their own. Yeah, I’m going to quit taking it. They can go through really rough, turbulent withdrawal symptoms that can make them feel like they have the flu, that can make them feel really, really agitated. Can make them feel. Excuse me, emotionally. I’m getting choked up just talking about it. I feel emotionally volatile and they really need to be under careful medical supervision and do what we would regard as a gradual or slow taper off the Med.

Ackerman:
What percentage of the people that you’ve dealt with? You know, the hundreds of clients that fully come off of medication.

Dr Steve Ilardi:
And I would say, well, in in our in our work with with this TLC program, we’ve I think we’ve run about 150 through the protocol so far, and roughly half of them were on a med. Roughly half we’re not. By the way, what that means is. I mean, think about it. Lots and lots and lots of folks were completely fully syndrome, really depressed while taking the meds. That’s a very common outcome. So if anybody is listening to this and they’re like, well, what the hell is wrong with me? I’m on this antidepressant and I’m still depressed. That is common. It’s not something that’s advertised, but it is quite common. So, anyway, of those who came in on the medication, what I always tell them is, look, let’s not make any change. Let you know because we don’t want to put you through withdrawal on top of everything else. Let’s put these lifestyle changes in place. Get your brain healthy, get your body healthy, get your mind healthy, and then we can see what we’re dealing with after you’re in recovery. Then we can talk to your prescriber and we can can help you set up a slow, gradual taper. I would say probably about half of those who’ve gone through that process have decided, yeah, I really want off this med and I want officers. I can. And then probably about half are just like now it’s not broke. What? Why? You know, why mess with it. And they’re just kind of resigned to like I’ll probably take this med for the rest of my life.

Ackerman:
So if someone’s using fitness as a way of dealing with depression and then life gets in the way and we all have work and family and life obligations. What? What should they do in those moments? Because they won’t have that endorphin and Delta means spike that you’ll get from exercise. How can they handle and manage depression when they’re not working out as often?

Dr Steve Ilardi:
Yeah, well, I mean, I think a lot is going to depend on exactly what’s interfering. So, for example, it is just they’ve gotten really, really busy. Then there are all kinds of little micro workouts so they can do. And probably this is something you and I both discovered on our own. Right. I mean, you can just like. Okay. Well, I’ll just throw out one hundred burpees right now. I got ten minutes to spare. And you know, that’s not bad. But in other words, we can do something that’s come to be known as high intensity interval training or hit where we can get like a really intense workout in a very short period of time. Now, if it’s illness or injury, then that’s not going to be an option. And by the way, I’m just assuming that, you know, as long as we’re not ill or injured, we always can carve out five or ten minutes for high intensity workout. Right to get.

Ackerman:
I tend to agree with you. I’m sure there’s some listeners that that don’t. But you’re right. You know, you only need four by area to do 100 buprees.

Dr Steve Ilardi:
Exactly. And by the way, that 10 minutes that you’re going to lose, you’re gonna more than make up for it in better productivity, greater concentration ability, mental acuity. I mean, it’s like you’re not going to lose anything. So if I had to choose between like, okay, well, it’s going to cost me ten minutes of sleep, ten minutes a work, ten minutes of I’m going to knock out on suburbia’s. I mean, you know, the last thing you want to do, a sacrifice, the physical activity. I’d rather sacrifice the ten minutes of sleep anyway. But you know what? If I’m injured, what if I you know, I’ve had the flu and I just can’t work out for a while? Yeah, I would say in that case, even there are a lot of times it’s possible to just do something really light and easy. And I’d like to try to do it in nature.

Dr Steve Ilardi:
I think that many of us are are sort of if I can use this term nature deprive nature deficient and even in an urban area. I mean, I was in New York City on vacation a few years ago and I was getting really antsy after a couple days. And, you know, so I just went out to Central Park and it just snowed. And I’m just like traipsing around, you know, and finally running around Central Park and like, this is freakin beautiful. It’s, you know, right in the middle of the most urbanized spot probably in the entire continent. Get out in nature. Get out in sunlight if you can. It’s going to be really beneficial and move as much as you can, even if it’s just like a light stroll. It’s still going to be beneficial to the brain, to the body, to the mind.

Ackerman:
Yeah. I think for me and for most of our listeners, we’re kind of equating fitness and activity with Crossfit, in high intensity where like you said at the beginning of this episode, we’re just talking three 30 minute walks a week is all you need to really feel these positive changes.

Dr Steve Ilardi:
Well, yeah. The only actress I’d put on that is that these studies with brisk walking have been primarily with with as most people who are clinically depressed, they’re really sedentary. So it was enough to get them into the aerobic range. So to get their heart rate up to, you know, like seventy five percent of their heart rate reserve, which would basically be, you know, let’s just say pick an average 30 year old like you’re getting them up. Pulse rate over 150. There’s no way you or I are gonna get our pulse up to 150 just by doing a brisk walk.

Ackerman:
I was I was excited to no longer have to do these hard workouts, but actually, I get it.

Dr Steve Ilardi:
So. Yeah, so. So for a sedentary, middle aged adult, brisk walking like they’re, you know, late for the bus or something, you know, running late for their flight at the airport, 30 minutes of that. That’s plenty. But you know, what we’re really talking about is 30 minutes in the aerobics zone. And if somebody doesn’t have a heart rate monitor, they don’t want to go to the trouble of doing all that. I mean, basically a good heuristic, a good proxy is like you’re breathing hard. You’re probably perspiring a bit. You can carry on a conversation with some difficulty. You can’t sing if you’re in the aerobics zone. Right. You can’t at least you can’t sing like a continuous tune if you can. You need to step it up because it’s not aerobics.

Ackerman:
But, yeah. Reference. I’ve never I’ve never heard that before. We often say used to carry a conversation and that’s another good kind of parameter. Hey, you should only talk when not saying.

Dr Steve Ilardi:
Yeah. No. Absolutely. And the other thing about the conversation is, you know, it’s it’s with its labored. So you’re not even able to get out complete sentences. You’re able to get out short phrases followed, you know, interspersed with breaths. Because why? Because, you know, your oxygen needs are so great, you can’t get out a full sentence like this. And if you cannot, it’s not arobot.

Ackerman:
Gotcha. We’ve lived you know, we’ve covered quite a bit when it comes to this depression, when it comes to the benefits of activity. Is there anything we missed? I mean, I want people to check you out. You can. You can. I will link your TEDTalk, which is pretty awesome. They’ve got a TED talk. Depression is a disease of civilization and tons of other information when they Google you. But is there anything else that you can really? Tell the listeners that they should be aware of when it comes to depression and it comes to Crossfit, and overall sickness.

Dr Steve Ilardi:
Yeah, I would just say that, you know, the treasurer of Crossfit,, aside from, you know, obviously getting people moving and getting them fit is the connection. And, you know, as much as possible, I would encourage people when they’re part of that community to use it as a springboard for deeper bonding, deeper connection with people getting together, maybe outside of Crossfit,. It’s been discovered. And I don’t know why this was shocking to anybody, but it turns out that to actually make a deep friendship, the single rate limiting variable is the amount of time that we spend with the person. And it turns out that if we have just a few deep friends, emotionally supportive confidence, when life hits us with something hard, you know, if we lose a loved one or, you know, we face it a setback, we get fired. You know, whatever the thing is, life is gonna throw something hard at all of us at some point. And we need to have that social capital. And I think Crossfit, provides a good platform for that. But I think many people who are part of a Crossfit, community still would benefit from going deeper from from spending. It takes about one to two hundred hours of time with somebody 100 to 200 hours to make that person a deep friend. So I would encourage listeners to think about putting in that time.

Ackerman:
That’s really awesome to hear. I think like you said a few times, it’s it’s really encouraging to find that Crossfit, is helping on so many levels. I think when most people join their their local affiliate or I just simply want to look better naked. And then it turns out there’s all these other positive changes and impact that we get from this community and, you know, send those hundred-year 200 hours. I mean, that’s a year of training at the box. And then that year you’re going to look better naked. Your number one goal, the dress are going to have some great friends and hopefully have a better headspace to go along with all of that.

Dr Steve Ilardi:
Absolutely. Yeah. I think it’s it’s it’s one of the most I mean, as a clinician, Crossfit, is one of the most positive beneficial social movements that I’ve seen. And so I’m really happy with the work you’re doing.

Ackerman:
Well, thank you, Doctor Steve. Let me give you the platform right here. If there’s anything that we miss or anything you want the listeners to learn about you or or what you’re doing. Please feel free to let him know right now.

Dr Steve Ilardi:
Sure. Well, I guess, you know, this person comes to mind is if any of us listen to this and they’re like, hey, I really want to go deeper. There’s a loved one that I have that’s battling depression. Or I think maybe I am. I’ve got a book. It’s called The Depression Cure the Six Step Program to Beat Depression Without Drugs. And it’s available anywhere. Books are sold. You can find it easily online if you want to watch a fairly detailed YouTube lecture that I gave a few years ago. It’s like a one year now. It’s like an hour and a half. Pretty detailed content, but it’s a lot of actionable stuff. Just look for me on YouTube, put my last name, Clardy ILADS in the search box and you’ll you’ll find a lot of hopefully useful content. I’m also about to launch a YouTube channel. And again, if you just search on my last name, you’ll you’ll find some good content with that as well.

Ackerman:
Yeah. And we’ll put all those links in the podcast. No, it’s for those of you that are listening to this while you’re out for your brisk walk or while you’re driving your car, don’t go Googling and driving. But we’ll put that up there. And like like Steve said, I Googled his name earlier. And the first thing that popped up was your TED talk. And right below it is that YouTube video. And you’re also featured in CARM, an app that I’ve used for meditation. And your book is available there as well. So we’ll make sure to cover all of that. And we’d love to continue this talk with you in the future. It’s really been awesome. Be here. You know, nothing gets me more excited than to hear professionals and really smart people. Discuss the benefits of fitness and specifically the benefits of Crossfit,.

Dr Steve Ilardi:
Adolescences, it’s been my pleasure and I’d be more than happy to come back anytime.

Ackerman:
So let’s say you were right. I said let’s stop for 20. It’s been nearly an hour. So you were absolutely right about that. Thank you so much for coming on. You really opened up my eyes and I hope you’ve really helped a lot of listeners out there. Like Steve said, 30 percent of the people out there are dealing with depression. Just because you’re not one of them doesn’t mean you’re not seeing them every day at the box. And how you treat them at the box, you know, that just goes to being a good person, being nice, being being the kind of person you’d want your your grandmother to be around at the box and you never know who you’re talking to. You never know what kind of day they’ve had. Treat them nicely. And you and you’re probably doing a whole lot more good than you realize.

Dr Steve Ilardi:
I couldn’t I couldn’t put it any better myself. So thank you for that.

Ackerman:
Well, thanks, Steve. It doesn’t take a PHC to be, you know, to to realize, hey, just be nice to people. But it but it does take aphc day to do all that research you’ve done, and we’re going to benefit from it. X again for being on this hour of their day.

Dr Steve Ilardi:
It’s it’s been really, truly my pleasure. And again, I’m happy to come back anytime. So thanks again and best wishes to you and all your listeners.

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