WEBVTT

NOTE duration: "00:03:33.162"


NOTE Confidence: 0.9949938

00:00:07.919 --> 00:00:09.780
The current standard of care

NOTE Confidence: 0.9853596

00:00:10.400 --> 00:00:12.420
for the treatment of depression

NOTE Confidence: 0.9853596

00:00:12.639 --> 00:00:13.785
is based on what we

NOTE Confidence: 0.9853596

00:00:13.785 --> 00:00:14.764
call the monoamine

NOTE Confidence: 0.92236924

00:00:15.144 --> 00:00:16.364
deficiency hypothesis.

NOTE Confidence: 0.89875174

00:00:17.465 --> 00:00:18.605
Essentially presuming

NOTE Confidence: 0.99219114

00:00:19.145 --> 00:00:20.765
that one of three neurotransmitters

NOTE Confidence: 0.9689531

00:00:21.145 --> 00:00:22.605
in the brain is deficient

NOTE Confidence: 0.9689531

00:00:22.744 --> 00:00:24.904
or under active. Neurotransmitters can

NOTE Confidence: 0.9689531

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be thought of as the

NOTE Confidence: 0.9689531

00:00:25.785 --> 00:00:27.680
chemical messengers within the brain.

NOTE Confidence: 0.9689531

00:00:27.680 --> 00:00:28.880
It's what helps one cell

NOTE Confidence: 0.9689531

00:00:28.880 --> 00:00:30.080
in the brain communicate with

NOTE Confidence: 0.9689531

00:00:30.080 --> 00:00:31.680
another to pass that message

NOTE Confidence: 0.9689531

00:00:31.680 --> 00:00:33.120
along. But the reality is

NOTE Confidence: 0.9689531

00:00:33.120 --> 00:00:33.920
there are more than a

NOTE Confidence: 0.9689531

00:00:33.920 --> 00:00:34.820
hundred neurotransmitters

NOTE Confidence: 0.96063924

00:00:35.200 --> 00:00:36.900
in the brain and billions

NOTE Confidence: 0.96063924

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of connections between neurons.

NOTE Confidence: 0.98944396

00:00:39.445 --> 00:00:41.364
So we know that that's

NOTE Confidence: 0.98944396

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a limited hypothesis.

NOTE Confidence: 0.81806546

00:00:47.925 --> 00:00:48.825
For decades,

NOTE Confidence: 0.9977783

00:00:49.445 --> 00:00:51.305
we thought that the primary

NOTE Confidence: 0.94607097

00:00:51.930 --> 00:00:53.370
pathology, the primary cause of

NOTE Confidence: 0.94607097

00:00:53.370 --> 00:00:55.050
depression was some abnormality in

NOTE Confidence: 0.94607097

00:00:55.050 --> 00:00:55.789
these neurotransmitters,

NOTE Confidence: 0.947881

00:00:56.250 --> 00:00:58.190
specifically serotonin or norepinephrine.

NOTE Confidence: 0.99139637

00:00:58.809 --> 00:01:00.109
However, norepinephrine

NOTE Confidence: 0.99921584

00:01:00.570 --> 00:01:01.309
and serotonin

NOTE Confidence: 0.9972424

00:01:02.089 --> 00:01:03.050
did not seem to be

NOTE Confidence: 0.9972424

00:01:03.050 --> 00:01:05.085
able to account for the

NOTE Confidence: 0.9972424

00:01:05.085 --> 00:01:06.605
symptoms of depression in people

NOTE Confidence: 0.9972424

00:01:06.605 --> 00:01:07.905
who had major depression.

NOTE Confidence: 0.99011517

00:01:08.765 --> 00:01:09.265
Instead,

NOTE Confidence: 0.9996078

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the chemical messengers

NOTE Confidence: 0.9898932

00:01:11.965 --> 00:01:13.645
between the nerve cells in

NOTE Confidence: 0.9898932

00:01:13.645 --> 00:01:14.925
the higher centers of the

NOTE Confidence: 0.9898932

00:01:14.925 --> 00:01:16.625
brain involved in

NOTE Confidence: 0.98202014

00:01:17.240 --> 00:01:19.560
regulating mood and emotion, which

NOTE Confidence: 0.98202014

00:01:19.560 --> 00:01:21.420
include glutamate and GABA,

NOTE Confidence: 0.96880084

00:01:21.880 --> 00:01:22.380
were

NOTE Confidence: 0.9993185

00:01:22.760 --> 00:01:23.260
possibilities

NOTE Confidence: 0.9948621

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as alternative causes

NOTE Confidence: 0.998946

00:01:25.720 --> 00:01:27.260
for the symptoms of depression.

NOTE Confidence: 0.9914207

00:01:28.280 --> 00:01:29.640
We know that these two,

NOTE Confidence: 0.9914207

00:01:29.640 --> 00:01:31.420
which are the most ubiquitous

NOTE Confidence: 0.9914207

00:01:31.479 --> 00:01:32.140
and abundant

NOTE Confidence: 0.98139346

00:01:32.525 --> 00:01:33.905
neurotransmitters in the brain,

NOTE Confidence: 0.9971725

00:01:34.685 --> 00:01:35.905
actually regulate

NOTE Confidence: 0.99951625

00:01:36.444 --> 00:01:37.825
how the brain is

NOTE Confidence: 0.99306345

00:01:38.205 --> 00:01:39.905
changing over time and adapting.

NOTE Confidence: 0.97727877

00:01:40.285 --> 00:01:41.565
When you are exposed to

NOTE Confidence: 0.97727877

00:01:41.565 --> 00:01:43.405
severe and chronic stress, like

NOTE Confidence: 0.97727877

00:01:43.405 --> 00:01:44.925
people experience when they have

NOTE Confidence: 0.97727877

00:01:44.925 --> 00:01:45.425
depression,

NOTE Confidence: 0.93703365

00:01:46.229 --> 00:01:47.770
you lose some of the

NOTE Confidence: 0.93703365

00:01:47.829 --> 00:01:49.689
connections between the nerve cells.

NOTE Confidence: 0.9981577

00:01:49.990 --> 00:01:51.930
And the communication in these

NOTE Confidence: 0.9981577

00:01:52.070 --> 00:01:52.570
circuits

NOTE Confidence: 0.9972775

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becomes inefficient

NOTE Confidence: 0.8631372

00:01:55.189 --> 00:01:56.009
and noisy.

NOTE Confidence: 0.99747676

00:01:56.549 --> 00:01:57.770
Because of the

NOTE Confidence: 0.9962541

00:01:58.070 --> 00:01:59.210
noisy communication

NOTE Confidence: 0.99747926

00:02:00.070 --> 00:02:01.575
in the circuits involved

NOTE Confidence: 0.9789317

00:02:02.454 --> 00:02:04.634
in regulating mood and emotion.

NOTE Confidence: 0.9961215

00:02:05.414 --> 00:02:07.094
We think that the loss

NOTE Confidence: 0.9961215

00:02:07.094 --> 00:02:09.194
of these synaptic connections

NOTE Confidence: 0.99807

00:02:10.694 --> 00:02:12.375
contributes to the biology of

NOTE Confidence: 0.99807

00:02:12.375 --> 00:02:12.875
depression.

NOTE Confidence: 0.9972985

00:02:19.400 --> 00:02:20.840
It's critical to understand the

NOTE Confidence: 0.9972985

00:02:20.840 --> 00:02:21.340
neurobiology

NOTE Confidence: 0.9903181

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of depression and how the

NOTE Confidence: 0.9903181

00:02:23.720 --> 00:02:25.160
brain plays a role in

NOTE Confidence: 0.9903181

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that for two main reasons.

NOTE Confidence: 0.9903181

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One, it helps us understand

NOTE Confidence: 0.9903181

00:02:28.519 --> 00:02:29.419
how the disease

NOTE Confidence: 0.995989

00:02:29.775 --> 00:02:30.995
develops and progresses

NOTE Confidence: 0.93593514

00:02:31.855 --> 00:02:32.815
and we can start to

NOTE Confidence: 0.93593514

00:02:32.815 --> 00:02:34.514
target treatments based on that.

NOTE Confidence: 0.9733093

00:02:35.055 --> 00:02:36.975
There are clear differences between

NOTE Confidence: 0.9733093

00:02:36.975 --> 00:02:38.014
a healthy brain and a

NOTE Confidence: 0.9733093

00:02:38.014 --> 00:02:39.935
depressed brain. And the exciting

NOTE Confidence: 0.9733093

00:02:39.935 --> 00:02:41.455
thing is when you treat

NOTE Confidence: 0.9733093

00:02:41.455 --> 00:02:42.195
that depression

NOTE Confidence: 0.8240439

00:02:43.560 --> 00:02:44.060
effectively,

NOTE Confidence: 0.9726094

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the brain goes back to

NOTE Confidence: 0.9726094

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looking like a healthy brain.

NOTE Confidence: 0.9726094

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We recognize that the treatment

NOTE Confidence: 0.9726094

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for depression is a long

NOTE Confidence: 0.9726094

00:02:50.200 --> 00:02:51.960
term process because for many

NOTE Confidence: 0.9726094

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people depression is a long

NOTE Confidence: 0.9726094

00:02:53.560 --> 00:02:54.700
term disorder.

NOTE Confidence: 0.98611706

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So we need new treatments.

NOTE Confidence: 0.996671

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We've needed new ways to

NOTE Confidence: 0.996671

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approach depression

NOTE Confidence: 0.9893214

00:03:01.815 --> 00:03:03.835
for people that haven't responded

NOTE Confidence: 0.9893214

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well to their prior treatments.

NOTE Confidence: 0.9838158

00:03:06.215 --> 00:03:07.115
We are

NOTE Confidence: 0.9529343

00:03:07.415 --> 00:03:09.095
in a new era of

NOTE Confidence: 0.9529343

00:03:09.095 --> 00:03:10.569
psychiatry. Psychiatry. This is a

NOTE Confidence: 0.9529343

00:03:10.569 --> 00:03:11.629
paradigm shift

NOTE Confidence: 0.71403617

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away from

NOTE Confidence: 0.91190445

00:03:14.970 --> 00:03:17.069
a model of monoamaminergic

NOTE Confidence: 0.99161196

00:03:17.930 --> 00:03:18.430
deficiency

NOTE Confidence: 0.9467005

00:03:19.290 --> 00:03:19.790
to

NOTE Confidence: 0.9985506

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a fuller understanding

NOTE Confidence: 0.99820477

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of the brain as a

NOTE Confidence: 0.99820477

00:03:23.450 --> 00:03:23.950
complex

NOTE Confidence: 0.99591416

00:03:24.747 --> 00:03:25.247
neurochemical

NOTE Confidence: 0.99535906

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organ.