I think those of us who are mentally healthy assume that people could feel better if they would go out and do the things they once loved?

I've been thinking about this a lot lately, because sometimes if you're someone who doesn't experience depression, you almost have this bias to think like, well, everybody should engage with things in the world the way that I do. That's the normal way to engage with it. But actually, there are some real adaptive benefits to not going out and getting things. One of those is conserving energetic resources. So every decision we make, whether you have depression or not, is actually a kind of balance between conserving your resources, maybe not subjecting yourself to threats out in the world as well, but even just at the very basic, basic level, keeping your calories, keeping your energetic resources versus engaging with something in the world that might be very good, but would undoubtedly expend some of those resources, maybe put you at risk of things in the outside world as well. So there is definitely an argument that it's adaptive in some circumstances, not to always have drive and motivation to somehow achieve more, but in fact, to conserve what you have to stay safe.

We hear so much these days about the importance of gut health without necessarily thinking about why it matters. What have we learned about the communication that takes place between the brain and the gut?

So there have been some really formative animal studies suggesting that the gut microbiome influences behavior, perhaps cognition in the brain. And this means the diversity of the microbiome, which can be affected by so many different things. But it's essentially the kind of bacterial environment that we live in that can then multiply the microbes in this gut. So babies are born without a microbiome as soon as they're born. So if you're born through vaginal birth, then you develop a microbiome immediately. And then throughout your life, you're experiencing changes to your microbiome, often from the foods you eat, but also from other things. Infections, inflammation can change your microbiome. Antibiotics change your microbiome. So lots of things change it. So animal studies seem to show that there's this kind of mysterious link between how diverse the populations of gut bacteria are and behavior. So is the animal showing sort of depression-like behavior, anxiety-like behavior? If their gut microbiome diversity is worse, then so too are these mental health-like symptoms. And this is quite exciting because it accords with big population studies that show that in the population, the same people who experience worse mental health also tend to have worse gut health. So I think this is a really cool field. It's actually a field that I would suggest is missing kind of some key evidence before you go out and buy any kimchi, which is we don't really know if changing the human microbiome for the better for most people will affect their mental health. It might affect their gut health. And maybe if you're somebody whose mental health is worse because you're experiencing gut disturbances, then maybe it could affect your mental health. But is there this direct link in humans? I think the jury's still out. And the reason for that is that these sorts of studies are super, super well controlled in animals. The animals live in a germ-free environment. Their genetics are controlled for it. In the human world, our microbiome is just a mess. It's constantly exposed to different things. Scientifically, would giving someone something that increased the diversity have enough of an effect to really change their mental health? I would love to see a study that suggests that, but we haven't had it yet. We have talked so much about

endogenous brain chemicals and the ones we ingest. What about talk therapy? How could we possibly change the way our brains work by thinking and talking?

So one thing that really frustrates me is that sometimes discussions about mental health either stay entirely in the kind of psychological realm, speaking about talk therapy, speaking about psychological causes, or in the biological realm, speaking about antidepressants, speaking about quote unquote chemical deficits. But in fact, we really need to speak the same language across both causes and also treatments, because that's what our brain does. Our brain responds to things, whether that thing is a drug or a talk therapy. And in some of my own work, I've shown that the brain changes from both antidepressant drug treatment and from psychological therapy, but it's actually slightly different regions of the brain that are changing. So I think of them both as brain-based treatments. It's just that they're doing slightly different things. So

the syndrome you call busy brain is not quite as straightforward as, say, leading a busy life and having a brain. You're talking here about this pattern of neuroinflammation caused by chronic stress. What are some common signs that our brains are being physiologically affected by our mental burdens? Chris,

thank you so much. You're absolutely right. When people hear the word busy, they think of the external factors that are competing for our attention. But this is actually a chronic stress management crisis. We're in a place in a post-pandemic world, nobody wants to be told, Chris, just eat berries and breathe and everything's going to be fine, right? And so as I was researching with all the corporate clients I was working with, there were a few patterns that emerged. Number one, I call it being stuck on the stimulant-sedative cycle, a stimulant like caffeine, or even maybe prescription ADHD medicine like Adderall, which is overprescribed here in the United States. You think there's no way I can focus, let alone tune into my personality without an extra boost of energy drinks or coffee or these stimulant medications. And then you're wired all day and maybe even low key anxious, and you don't know what to focus on. And a simple email like me emailing you after the show and saying, hey, Chris, thanks for reading my book will take me 37 minutes to complete. And I'm still anxious. And then you're wired and you can't leave work behind when you go home. And when you put your head down on the pillow, they're erasing thoughts or what's known as ruminating anxiety, creating insomnia. Or even worse, you wake up somewhere in the middle of the night between two to 4am, you're wide awake, and you can't go back to bed. So you fool yourself to thinking, I'll feel better if I tackle something on my to do list, and you get up and you do a load of laundry before the kids get up. Okay,

so what you're talking about here is all tied to inflammation, which is this immune response that is supposed to help us heal. Why is it that chronic inflammation is bad for us? What

happens in the brain, we know this mechanism of interleukin-1 in the brain gets elevated in other disease states like dementia or neurodegeneration of Parkinson's, or if you have a virus in the brain. But what was shocking as I was doing the research for this book, Chris, was sitting under chronic stress month after month, year after year will create the same response. And it's not just in the limbic system of the acute stress response that a lot of us has heard about. It actually affects a particular part of your brain, what I call the busy brain center, or in clinical neuroscience terms, your hypothalamus, and the SCN nucleus, which governs something known as your circadian rhythm, or your body's biological clock. And just like an airport traffic control tower, that's linking one airport, like in Dallas, to airports all around the world, our hypothalamus is the same way, Chris, it's linked to the memory and attention and mood centers of our brain. But guess what? Also, it's linked to our hormones and our digestion and our respiration. So now this synchrony or symphony that should be happening in your body for all your organs to be working in a 24-hour cycle are completely disrupted, just like a storm coming through DFW airport and canceling all incoming and outgoing flights.

You are writing about this as a physician with years of experience treating neurology patients, but also as a person who has experienced these effects. Would you share just a little bit about your catastrophic run-in with your own busy brain? Yeah,

Chris, it was probably one of the most important reasons I wrote this book. I know what it feels like to be walking the halls of the workplace alone, and it's visible that something is wrong. This happened to me back when I was in neurology at a time where less than 5% of the brain doctors in America were women. And we didn't have terms back then like a mental health crisis or burnout at work. And my patients knew I was struggling and asked if I was okay, but none of my colleagues did. was the loneliest place to be in the world. And I remember it started out as simple chest pain, which was initially diagnosed as just acid reflux. You're too stressed. But it turns out I have a rare medical disorder known as achalasia. And because I was prescribing to that burn and churn special that so many listeners are, I'm just going to churn through the day and burn the midnight oil to get my work done. It caught up with me. And the symptoms became so severe that I was waking up in the middle of the night, choking on my own saliva and vomit and getting pneumonia. We knew something was wrong. And by the time I was correctly diagnosed, I had precancerous lesions and ended up in life-saving surgery. And Chris, I was sitting there in the hospital knowing that nothing I learned in medical school up till this point is going to help me now. So

you came to realize you were caught up in what you call this stress success cycle, which is about what? Believing a certain kind of success is essential regardless of the cost, and then assuming that running around being stressed all the time is a sign to you and everybody else of how committed you are.