JuQgJxYriYI.srt

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So the question is,
how do you differentiate the utility of 

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behavioral slash psychotherapeutic 
treatments for conditions like 

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depression versus medical treatments?
Okay,

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so the first thing I would say is don't 
underestimate the utility of medical 

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interventions.
Depression is a catastrophe.

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It carries with it a very high suicide 
rate and it also levels people out and 

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it's really hard on their families and 
so and it and it's physiologically 

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extraordinarily damaging.
And so if you're in a depressive state 

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and it's severe,
you can try an antidepressant.

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You'll know in a month if it works,
if it works well,

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maybe it'll help you get your life 
together.

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Like we could say,
well maybe you're depressed because your

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life isn't very well together.
Could be.

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Sometimes people are depressed,
their life is just,

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it isn't fine because no one's life is 
fine.

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Everyone's life is a tragedy.
But sometimes people have their lives in

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order,
as much as you could expect anyone to 

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have.

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They have friends,
they have an intimate relationship,

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they have a career that they like,
you know,

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they're,
they're qualified industrious people 

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working hard on what they're doing.
And,

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and,
and really playing a minimum number of 

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games with themselves and they're 
terribly depressed,

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antidepressant man that sometimes that 
will just fix it.

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And so hooray,
you were biological entity.

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If,
if there's something out there that can 

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help you strengthen yourself so that you
can prevail.

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Great.
And you know,

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people,
you hear,

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everyone takes antidepressants,
you know,

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everyone's taking them.
It's like no one takes those bloody 

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things without serious consideration.
Half the time I spend with my clients 

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who are depressed is often the two years
long attempt to get them to tentatively 

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try an antidepressant because there are 
so guilty that they're relying on an 

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external crutch to sort out their lives 
that they can't even tolerate it.

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But you know,
I say,

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well look man,
what if you had diabetes,

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you know are going to take your insulin.
It's like you got stressed,

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you blew out at your weakest point.
That's what happens when you get 

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stressed.
If there's something out there that 

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might help you,
it's like try it for God's sake.

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You'll know in a month and you'd just 
stop if it doesn't work.

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Now,
having said that,

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you want to do a multidimensional 
analysis,

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it's like,
well,

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do you have any friends?
Do you have an intimate relationship?

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Are you pursuing one?
Do you have a reasonable career?

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Are you as educated as you are?
Intelligent?

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You have something useful to do with 
your time outside of work?

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Do you have a drug or alcohol problem?
Are there other behavioral issues like 

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sleep dysregulation and lack of eating 
that are contributing to the pathology?

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You want to differentiate all of that 
and wherever you can make a behavioral 

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intervention so much the better,
but sometimes too,

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you're dealing with people whose lives 
are so that they don't even know where 

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to start.

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They're different than the ones who have
everything in order.

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See,
and you say,

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well,
try this man.

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Maybe you won't cut your throat in the 
next month because if your dad,

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it's going to be hard to work with you,
and so,

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so medical interventions,
anything.

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If you're sick,
you do what's necessary to get better 

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and you your pride behind.
If you.

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If you have to,
and that says nothing about the utility 

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of the behavioral interventions,
you want to hit the problem with 

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everything you have at your disposal,
but some antidepressants especially,

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especially for people whose lives are 
together and who are depressed,

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antidepressants can be absolutely 
miraculous.

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So you know when you hear about the 
clinical evidence in their favor being 

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iffy,
and that's partly because the diagnosis 

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of depression isn't very well 
formulated,

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that it's very different to have a 
terrible life than to be depressed and 

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antidepressants can only help you so 
much if you have a terrible life.

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So yeah.