Ken Krogue: Hello everybody, Ken Krogue and Thom Harrison here with Eternal Core. Today we’re with Dr. Jacob Hess, and we’ve got some amazing things to talk about today. I am going to turn the time over to these two because they’re going, like in 30 seconds, they’re going to be over my head and I’m just going to pitch in occasionally. Is that all right? Dig us in, you guys.
Thom Harrison: Well Jacob, I remember very significantly, back in the seventies, when I started my practice, how important relationships were, and how desperate people with mental illness and mental health problems were just trying to find something. I remember so many of my patients coming in and saying, “I will do anything to feel better.” Initially, all we had to offer them was relationship therapy. I was trained in the psychoanalytic method and in the behavioral method. And I found out pretty early, I didn’t like turning people into a bunch of lab rats. So I used cognitive behavioral therapy and found that that was very helpful.
Thom Harrison: Then, I remember in the eighties, about the mid-eighties, (it was about 83 or 84) a big change took place. That’s when pharmaceuticals came in, and when we were all introduced to Prozac*, and that was the beginning of the Serotonin re-uptake inhibitors and people became pretty desirous of getting on that drug, because they wanted to feel better, and they wanted to feel better quick. And that’s what was being touted, that this is going to help you feel better quick. I saw a lot of people moving their dependency onto pharmaceuticals and moving away from that more long-term process of healing through treatment. Do you have anything that you could add to that scenario or help us with from your research?
*Prozac was introduced in 1987.
Jacob Hess: I did interview one person who told me he would cut off his thumb if it would take the pain of his depression away. And another woman told me that it hurts so bad she thought it was going to kill her, just the pain.
Thom Harrison: Well, it feels that way because some people feel like they’re in a hole and there’s no way out.
Jacob Hess: So its understandable that they would want anything that could possibly make the pain go away. And for some people, antidepressants can help, especially in the short term, alleviate some of the pain. My research has focused on long-term outcomes. So, if we’re going to get a clear picture of how they help, we need to focus more than on just the three to six weeks, right? The FDA has approved antidepressants because of short-term studies that have
shown, for some people, it can have a benefit in the short term. When you look long-term, you start to see, “Okay, this gives us more of a clear picture on how to use these tools in a thoughtful way.”
Thom Harrison: Some of these individuals have been on these drugs since the eighties. And it’s my experience that you have to keep adjusting the drug, and you have to add something here, or an anti-psychotic down the road. Then I see a deterioration of their health, not a benefit.
Jacob Hess: Well, that’s really what got me interested is one of my loved ones started treatment with antidepressants for some really painful things. For a while they got feeling better, and then they would fall back into it. And then they would get feeling better for a while and fall back into it. Over the long-term, I started to wonder what research has been done to show a path of more long-term healing, because certainly, she was getting better sometimes, on some days. But on many days it was like, “I’m going to wake up and see how I feel.” And it was just sort of like, “Is the combination of meds working for me today.” And it was excruciating. So, what the research has shown clearly over the long-term is that it’s not a pretty picture long-term if you stay on the meds and it becomes your reliance for the long-term, as a primary solution. Statistically speaking, people are not in a good place long-term compared to those who never go on.
Jacob Hess: Every single one of the studies I have seen, without any exceptions, on antidepressant outcomes, long-term show the same pattern. Short-term, you can find this benefit for some people. And not everyone finds the short-term benefit. But, long-term, you really don’t want to lean on them or put your trust in them as the long-term solution. And The New York Times just recently had a piece about how, even though the FDA has approved them for short-term use, they’re being used in a more long-term basis. People are being told, “You need this long-term. Your brain needs…”
Ken Krogue: I hate to jump in here, the entrepreneur in the mix here. You know, our software, we made software as a surface for recurring cash flow. And I hate to say it, but the model that we tried to drive our customers to was long-term recurring cash flow that we could show to our investors as a pattern that wouldn’t be interrupted. You know, and I hate to say it, but typically a business model will drive the outcome of the business strategy. Is that even a factor here? Is that, I mean, drug companies, they need to make money over time. And is anybody really researching how to heal people and get them off the drugs and into a healed step there?
Jacob Hess: Yes, for sure. There is a former drug representative who went on to study at Yale University and published his experience at how they had been pushed and encouraged, as drug reps, to persuade doctors to get their patients on long-term courses of antidepressants, because it would help the business. It’s pretty clear that the research doesn’t support that. Anti-anxiety drugs, same pattern. Anti-psychotics, same pattern. The long-term studies show people in not a good place.
Jacob Hess: So, if we want empirically based, science-based medicine, we would pay attention to what does thoughtful, selective usage of anti-depressants, anti-anxiety, anti-psychotics look as part of a package for some people. That would include an option of tapering off at some point. Now, unfortunately, the onramp is huge to get on, but to get off, it can be a little tricky. Many people go in and their doctors will say, “Okay, let’s cut your dosage in half.” Now, if you cut your dosage in half, it’s very likely that withdrawal effects will be so severe that you won’t be able to get off. But, if you go in a very gradual, careful way, 10 percent decrements at a time, most people can get off.
Thom Harrison: And those side effects can be really troubling and very difficult. What happens is the majority of the people then get a mindset that, “I guess I really need this medication because look at all the side effects I’m having.” So they interpret that incorrectly. They think, “Oh, this proves that I have a severe chemical dysfunction in my brain and I need this med,” and often that is reinforced with these people.
Jacob Hess: Exactly. In the very moment when you start to taper off, you can tell two stories about that moment. “Okay, I’m feeling a lot more. I’m having all these things. Is it a return of the depression or is it withdrawal effects?” And if you interpreted it as withdrawal effects, you can ride them out. Every drug has withdrawal effects. You could stop drinking coke, and you’re going to have to ride it out. So that’s the good news. And let me say this, in my interviews with folks, many people who’ve told me when they finally taper off an antidepressant, they feel like themselves again. It’s an interesting thing when they get on, and they find some benefit. They can feel themselves again, but if they get off, they can find themselves again. So there’s good news here. This is not an anti-drug message; it’s not an anti-doctor message. There is an important place for thoughtful, selective usage guided by a physician. My concern is that people are being told, “This is your life.”
Jacob Hess: I interviewed one woman who told me that the day her doctor told her that depression will be a lifelong problem, that she would need to be on these meds forever, that’s the day her suicidal thoughts started. So, my concern has been, we’re taking people who are already feeling pain, and we’re telling them things that… I mean, if I told you right now you have an inherent deficiency that is always going to make it hard for you to feel happy, that would probably weigh on you. I found in my research, that story, “You have a chemical imbalance, this is going to be with you for the rest of your life and you’re going to need to lean on this for the rest of your life.”
Jacob Hess: Let me tell you one story. I was giving a presentation to the Rotary Club on depression recovery. A woman came up to me after in tears, and she said that her friend, who was a Mormon mother, had been struggling with depression and had gone to a doctor and gotten on some meds that were influencing her sexual relationship with her husband. As a Latter-Day Saint mother of a couple of kids, she went into a psychiatrist and said, “I need to make a change. This is not sustainable. I can’t do this. I’m not able to connect with my husband.” And the doctors said, “This is what you have. This is going to be your life. You’re going to need to be on this the rest of your life.” She went home, wrote a note to her family, her kids, and her husband, went out, and took her life.
Jacob Hess: Now, I’m pretty sure the doctor didn’t go home and think, “What did I say,” right? He probably went home and said, “Bipolar disorder is just such a hard thing.” What I would love is that we have more awareness as to the impact of these stories that we’re telling people. If that story was scientific, if the science actually confirmed that people have these disorders for good, and they have an enduring chemical imbalance that needs to be corrected, then we should tell them. But you know, as a mental health professional, the latest research on the brain is wildly optimistic. That moment by moment, depending on what we eat… I saw you eat some gummy bears before. You’ve probably sparked some neuroplastic changes connected to gummy bears.
Thom Harrison: I thought it was the “emphasis on plastic.” I thought it was the healthiest thing we had in the basket.
Jacob Hess: I told my sister once, who was suffering with depression, about neuroplasticity, brain changeability, and she said “I can do something.” Previously, she was like, “Well, I just have to wait for something else to determine whether I’m feeling good.” But she started to feel like, “Well, maybe I can learn to meditate, maybe I can get more sunlight.” Right? So that’s the first wildly optimistic thing, but it’s more. There are thousands of studies that document risk factors for depression, for anxiety, for ADHD, things in our environment and our lives that set us up.
Thom Harrison: And also, you know, the commercials set us up. I mean, if you just, if you can watch, if you’ve got the flu and you watch a couple of days of TV, what are we being told by these pharmaceutical companies? We are being told that, “You need this. You need to stay on it.” And there are some strongly deceptive processes in those messages of, “You need this like a diabetic needs insulin, that you will always need this.” So people buy that, because they’re not hearing this. They’re not reading these researches. So they truly believe what they’re being told.
Ken Krogue: This message isn’t getting out.
Jacob Hess: No, it’s not. And I would say, we’re currently suing pharmaceutical companies for opioid deception, right, certainly all over Utah. Why? Well, all over the nation, because we’re suddenly waking up saying, “Wait a minute. All those doctors who were saying that these are the answer, and the marketing were actually inflating the results.” I can tell you, because I’ve studied this for 10 years, the exact same patterns that we have seen in the opioid over-promotion, the exact same patterns have happened with antidepressants. I’m talking about doctors who have been paid to promote them in certain ways and an inflation of results. And some of the results that are unflattering don’t get shared. So I wrote a Salt Lake Tribune Op-Ed on this, just to say, “If we’re paying attention, let’s also, let’s not assume it’s exclusive to opioids. Let’s be careful,” you know. And again, this is not an anti-doctor and anti-meds message. There can be an invaluable place for an opioid.
Ken Krogue: And that’s my world. Doctors do their work, the researchers do their work. But then, they turn it to the marketers who have to make money out of it.
Thom Harrison: I mean, let’s take Oxycontin, and no, that’s not an anti psychotic. The research was if you took it with the coating on the Oxycontin. Oxycontin is a significant pain relieving medication, which initially was only given for people who had terminal cancer. But then, they found out that if you just licked it and you wiped the coating off of it, you had a very different experience. It totally changed the outcome of the person that was taking it.
Thom Harrison: So again, all this research is done on the medication within this small group of individuals. I found that some people did not benefit from them. Some people, it actually made worse. Yes, there were individuals that found a very beneficial process, and it was very important to put them on them initially. But then, to gradually take them off and help them with other therapeutic processes, which would give them value and would help them. But we don’t talk about that. Many people believe, “If I’m on this, I have to be on this forever.” Excuse me for interrupting.
Jacob Hess: Well, look, I would say to somebody who’s on it and has found benefit, “Great. Stay on it and find the benefit.” But, if you are currently on an antidepressant, anti-anxiety, on a number of them, and you’re not feeling well, there are thoughtful ways to help taper down. I have found in my research, a number of people who taper off kind of feel themselves again, but it needs to be done carefully with guidance. You don’t just go cold turkey off stuff, that’s dangerous.
Jacob Hess: And the best news is this: there is a researcher at the University of Kansas who has looked at all the different contributors to depression, right? He has a program where he just teaches people to make adjustments in your diet and your exercise and your stress level to reconnect with meaning, to reconnect with relationships, et cetera. He has found that 100 percent of the people who can start to make adjustments in these nine, I think is it six or seven areas, find their depression lifting to the point that it’s not clinical anymore. They find their wellbeing again, 100 percent, including people who hadn’t found the healing on the meds. So there are lots of reasons to be hopeful.
Jacob Hess: If you can look systematically at all the different areas that influence depression or anxiety or even evidence with ADHD and schizophrenia, you can start to move towards what I would call sustainable healing. We talk about sustainable environmental practices, sustainable development, what does sustainable healing look like? Well, I would argue, it’s paying careful attention to all these risk factors as guideposts. Like, okay, my family has high cancer risk, right? I know families who have high heart disease risk. I can’t do the same things as other people do. There are certain ways of living that set you up for depression, sort of the modern ways of living: going too fast, eating junk, never getting sunlight, stressing ourselves out, not being connected. That sets us up. So, if we recognize that we can do something about it….
Jacob Hess: One quick story. I used to teach a depression recovery class, and in the class they would answer a questionnaire and find out all the areas of vulnerability. One person came up to me at the end and said, “I have nine risk factors for depression!” She was so excited to discover that she had nine risk factors. And I asked her “Why, why are you excited?” Because, for the first time in 15 years of coping with depression and managing it, she was starting to realize that she could make some adjustments in her life that would start to get at the roots of depression. So that’s the hopeful message. The research is full of hope, and I would love for people to know that. Many people don’t. Many people are told that this is just the burden you carry, the cross. And let me just say, I heard a talk by a religious mental health leader. And he said, “One day in the resurrection, we won’t have the depression anymore. People won’t struggle.” And I felt sick to my stomach in that moment, because everything that I had seen in graduate school suggested that that healing doesn’t have to just wait till the resurrection.
Thom Harrison: That someday can be now.
Jacob Hess: We can find a lot more healing, but instead of talking about that, we’re just talking about treatment and managing it. And I want to say, “Okay, let’s manage, let’s treat, but let’s also open the conversation to what will it take to find that long-term, lasting, deep healing.”
Ken Krogue: Well, I’ve got to jump in again because the entrepreneur and the crowd, we’re really practical, you know. We look for solutions. And, as I hear you talk, I’m going to mirror back what I’m hearing if that’s okay, because I’m sort of a simple approach to it. You know, factors, risk factors and how about causes, you know? To me, if we’re going to have lasting healing, let’s solve what’s causing the problem. And I’m not a fan of that I’m wired faultily. That I’m always going to be, you know, having a struggle with depression. And I’ve just been through a massive car accident that I’m bouncing back from three years later. I’ve been through serious depression. It’s been a challenge, but if I have to have the mindset that that’s how it’s always going to be because I’m wired that way. I love where you’re going. You’re saying, “No, here’s 10 things that are probably causing it. Change the 10 things, and the result changes.” It’s like software, ‘If, Then’ statements. If this, then that, you know? I may be too simple here.
Jacob Hess: Beautiful. Look, the only reason I don’t talk about causes is very often people want to find the cause, right? And I haven’t seen in any of this, I mean, traumatic brain injury can be a huge contributor and even a direct cause, but it’s one of 150 I’ve found. I’ve looked at every single study I can find on risk factors for autism. Right? And we talked about autism, and it’s just this big mystery. There are thousands of studies that have documented contributors, and if you look at all of them, you want to know what it looks like? It’s complex. It’s lots of different little things, including like age of parents now having kids. I’m in my thirties, and that has a little influence, and this has little influence. I like it because there’s more
humility to it. It’s like this is something that we ought to look at as a complex thing, and then look at comprehensive solutions. Rather than, “Hey, drink this and it will take it all away” or “Meditate and it will go away.”
Jacob Hess: I’ve even heard stories from people who believe in diet who are like, “Get off all your meds and boost your amino acids and change your nutrition. Your depression will go away.” Uh, no, if you don’t learn to work with painful emotions (I teach mindfulness meditation) if you don’t look at how to connect with a spiritual core deeper than emotion, for instance, good luck facing depression, good luck facing addiction. So it needs to be multifaceted, and it needs to be humble. This is not about anti-this system, right? Everybody’s doing the best they can, including the doctors that are having people come to them in their desperation, and they’re doing what they can.
Thom Harrison: There are as many contributing factors to mental illness as there are people in my experience. And each person has to come to it uniquely and individually and find out what works for them. At EternalCore, God-centered mental health, we find that people that are willing to open themself to all those contributing factors and create a community, see themselves as part of the whole, see themselves as an individual that has been involved in the three-act play, before, now, and what will become, they do better. They function at a higher level.
Thom Harrison: That’s what we’re trying to bring to this community. We’re so pleased that you would come and talk to us. We’d love to have you back and talk a little bit more about any of those factors, which I just brought up, but I’m sorry our time has finished for the day. But Dr. Hess, thank you so much for coming and speaking with us today. This has been a very enlightening and very helpful, very hopeful conversation. So thank you very much for being with us.
Jacob Hess: You’re welcome.