Dr. Nicholas Fabiano
Appearances
Dhru Purohit Show
Is Exercise the Miracle Drug We’ve Been Waiting For? The Number One Way to Strengthen Your Mind and Fight Depression with Dr. Nicholas Fabiano
you're either lifestyle or you're either the regular path of medications and therapy, where the reality is the benefit lies best with everything that you can do that the patient's wanting to do that works for them. So looking at it, not at these separate camps, but that these are all first-line interventions that can go together, I think is a better way of framing it for patients.
Dhru Purohit Show
Is Exercise the Miracle Drug We’ve Been Waiting For? The Number One Way to Strengthen Your Mind and Fight Depression with Dr. Nicholas Fabiano
Because an example there would be, say the patient comes in, they want to start an antidepressant medication, and that's something that I would fully support. But at the same time, that doesn't now block off the area of also having exercises intervention at the same time, starting at the same time, or maybe even a staggered approach.
Dhru Purohit Show
Is Exercise the Miracle Drug We’ve Been Waiting For? The Number One Way to Strengthen Your Mind and Fight Depression with Dr. Nicholas Fabiano
And I think being comfortable discussing these interventions at the same time is important to receive proper care as well, because there's not a whole lot of data. But when someone is on an antidepressant, oftentimes, even when that depressive episode resolves, you remain on it for varying amounts of time, depending on the number of episodes that you've had before.
Dhru Purohit Show
Is Exercise the Miracle Drug We’ve Been Waiting For? The Number One Way to Strengthen Your Mind and Fight Depression with Dr. Nicholas Fabiano
But it would be interesting to see for those that adopt a lifestyle change, such as exercise or diet, perhaps you need to stay on that medication for less. And I don't have the data to support what that interval looks like. However, it would be interesting to see if we can see changes in how these interventions may interact with one another.
Dhru Purohit Show
Is Exercise the Miracle Drug We’ve Been Waiting For? The Number One Way to Strengthen Your Mind and Fight Depression with Dr. Nicholas Fabiano
Because right now, even in the research space, we often see them in isolation. which goes back to your main point where it's hard for the provider to make a decision of what to do best if these interventions aren't often used together in the research world, now applying it to the clinical setting or the patient in front of you.
Dhru Purohit Show
Is Exercise the Miracle Drug We’ve Been Waiting For? The Number One Way to Strengthen Your Mind and Fight Depression with Dr. Nicholas Fabiano
Yeah, for medication side effects, specifically within psychiatry when we're looking at the treatment of depression, It's easy to look at these two broad classes of medications that we use. So there's obviously the antidepressant medications, and these can have side effects that we turn to be metabolic side effects. And by that, I mean they can be associated with things like weight gain.
Dhru Purohit Show
Is Exercise the Miracle Drug We’ve Been Waiting For? The Number One Way to Strengthen Your Mind and Fight Depression with Dr. Nicholas Fabiano
They can be associated with changes in your heart rate. They can change your blood pressure sometimes. And we know that exercise can counteract a lot of these side effects. And another thing that people don't know is sometimes for people that are on one antidepressant and you see a partial response, sometimes you get your treatment augmented with another medication.
Dhru Purohit Show
Is Exercise the Miracle Drug We’ve Been Waiting For? The Number One Way to Strengthen Your Mind and Fight Depression with Dr. Nicholas Fabiano
Research has shown at a family or primary care physician level that, as you mentioned, people that are exercising more, so the providers, are more likely to have that discussion with their patients. And that extends to things like depression. And that's important.
Dhru Purohit Show
Is Exercise the Miracle Drug We’ve Been Waiting For? The Number One Way to Strengthen Your Mind and Fight Depression with Dr. Nicholas Fabiano
And oftentimes these are in the antipsychotic class of medications. And it sounds like a misnomer, but we use these classes of medications to augment the antidepressant effect. But these antipsychotics have even more of that metabolic burden. So much more weight gain associated than antidepressants. And what this does is you can imagine anyone taking these, having these side effects and
Dhru Purohit Show
Is Exercise the Miracle Drug We’ve Been Waiting For? The Number One Way to Strengthen Your Mind and Fight Depression with Dr. Nicholas Fabiano
that would limit your adherence or wanting to continue taking this if you're experiencing it because it alters your life and can influence your depression directly as well too. So where exercise comes in is if someone's on these medications and experiencing things like weight gain or any of these other metabolic side effects, exercise can help counteract these.
Dhru Purohit Show
Is Exercise the Miracle Drug We’ve Been Waiting For? The Number One Way to Strengthen Your Mind and Fight Depression with Dr. Nicholas Fabiano
So whether you're weight training, whether you're running, whether you're doing something like yoga, it can help combat those side effects. And you might even see an improvement beyond what those side effects are having just from having that active lifestyle.
Dhru Purohit Show
Is Exercise the Miracle Drug We’ve Been Waiting For? The Number One Way to Strengthen Your Mind and Fight Depression with Dr. Nicholas Fabiano
So I think for the whole picture, it's important if you're starting someone on these medications, even if it's a small exercise regimen, to at least present it as an option to help counteract that. Because I think it only makes sense if you're starting something where you know it's going to have side effects to be proactive rather than reactive.
Dhru Purohit Show
Is Exercise the Miracle Drug We’ve Been Waiting For? The Number One Way to Strengthen Your Mind and Fight Depression with Dr. Nicholas Fabiano
Because that can really taint someone's next experience with an antidepressant and say, hey, I don't want to do that again because I had XYZ side effects. Whereas if you're a physician being proactive and honest about those side effects, that may lead to more rapport with your patient and may lead to better outcomes as well too.
Dhru Purohit Show
Is Exercise the Miracle Drug We’ve Been Waiting For? The Number One Way to Strengthen Your Mind and Fight Depression with Dr. Nicholas Fabiano
As you mentioned, when you're looking for a doctor, if that's something you want to talk about, it's hard if the physician that you're speaking with isn't open to that discussion. So there's that disconnect there. But the other part stems even deeper beyond people that have their own experience with exercise and want to prescribe it.
Dhru Purohit Show
Is Exercise the Miracle Drug We’ve Been Waiting For? The Number One Way to Strengthen Your Mind and Fight Depression with Dr. Nicholas Fabiano
We frame it in a way like this. If you go to see your doctor for a medication that you're being prescribed, you wouldn't just be told, take medication, and then the doctor closes the door and walks out. You would be left thinking, what do I do with that? But the parallel being, as we discussed before,
Dhru Purohit Show
Is Exercise the Miracle Drug We’ve Been Waiting For? The Number One Way to Strengthen Your Mind and Fight Depression with Dr. Nicholas Fabiano
People often, when they're discussing exercise with their physician, are told just exercise and that's the end of the conversation. So the idea for the FIT principle comes to make a similar prescription as one would have for a medication as the same as you would have for exercise. So with a medication, you have the type of medication, you have the route you take it. So is it oral?
Dhru Purohit Show
Is Exercise the Miracle Drug We’ve Been Waiting For? The Number One Way to Strengthen Your Mind and Fight Depression with Dr. Nicholas Fabiano
Is it an injection? You have the dose, you have how often you take it. So all of these important variables that go into the prescription. So with the exercise prescription, there's the FITT principle. So it's F-I-T-T. That stands for frequency, intensity, type, and time. And to break down some of those variables, frequency essentially refers to how often is someone exercising throughout the week.
Dhru Purohit Show
Is Exercise the Miracle Drug We’ve Been Waiting For? The Number One Way to Strengthen Your Mind and Fight Depression with Dr. Nicholas Fabiano
I think fundamentally the system fails us when we're being trained. And I can only speak to my own experience and also having spoke to a lot of other residents and physicians. That throughout medical school, throughout residency, we're taught of all of these benefits of exercise. It's brought up for a physical health, mental health sort of thing.
Dhru Purohit Show
Is Exercise the Miracle Drug We’ve Been Waiting For? The Number One Way to Strengthen Your Mind and Fight Depression with Dr. Nicholas Fabiano
So that can vary from multiple times a day to maybe once a week or even less than that. And that's okay. But having that benchmark as a prescription, and we usually see the most benefit at around three to five sessions per week. With I, so that's the intensity of exercise, we break that down into low intensity, moderate or vigorous intensity.
Dhru Purohit Show
Is Exercise the Miracle Drug We’ve Been Waiting For? The Number One Way to Strengthen Your Mind and Fight Depression with Dr. Nicholas Fabiano
And the general idea is the higher the intensity of exercise, the greater the antidepressant effect, of course, with nuances for different patient populations. And a simple way to see what kind of exercise intensity you're working at is doing something called the talk test.
Dhru Purohit Show
Is Exercise the Miracle Drug We’ve Been Waiting For? The Number One Way to Strengthen Your Mind and Fight Depression with Dr. Nicholas Fabiano
So if you're able to sing, you're able to talk fully while you're doing your exercise, you're probably at a low intensity exercise. If you're able to talk with your friend, maybe, but you're not able to full sing and you don't have that much air in your lungs, you're probably approaching more of the moderate intensity.
Dhru Purohit Show
Is Exercise the Miracle Drug We’ve Been Waiting For? The Number One Way to Strengthen Your Mind and Fight Depression with Dr. Nicholas Fabiano
But if you're exercising and you need to just focus on exercising because it's so intense you can't even get a word in, that's probably more of the vigorous side of things. And then the next T is the time. So how long are your exercise sessions? Again, can vary very broadly depending on what you're doing and how sustainable that is.
Dhru Purohit Show
Is Exercise the Miracle Drug We’ve Been Waiting For? The Number One Way to Strengthen Your Mind and Fight Depression with Dr. Nicholas Fabiano
But we usually aim for around 45 to 60 minutes per session to see the maximum benefits from that end. And for the last T, it's the type of exercise. So broadly, we break them up into three different classes. So there's aerobic, which an example would be something like running. There's resistance training. So an example would be weightlifting. And then there's mind-body.
Dhru Purohit Show
Is Exercise the Miracle Drug We’ve Been Waiting For? The Number One Way to Strengthen Your Mind and Fight Depression with Dr. Nicholas Fabiano
So an example would be yoga. And of course, you can imagine between that, there's a lot of different mixed type of exercises where maybe you're running, but also doing some resistance. Or maybe there's a mind-body aspect, but also some resistance or aerobic activities as well too. So It's just a framework to kind of delineate what type of exercise you're doing.
Dhru Purohit Show
Is Exercise the Miracle Drug We’ve Been Waiting For? The Number One Way to Strengthen Your Mind and Fight Depression with Dr. Nicholas Fabiano
And the important thing is there's not necessarily one clear winner in terms of the type. The largest body of evidence is in aerobic exercise just because it's easy to do in trials for walking or running from a safety perspective. But that doesn't mean that that is necessarily better, which is an important point to make.
Dhru Purohit Show
Is Exercise the Miracle Drug We’ve Been Waiting For? The Number One Way to Strengthen Your Mind and Fight Depression with Dr. Nicholas Fabiano
When talking with the patient, the most important thing is figuring out what they like to pick that type rather than saying, oh, on this one study, this is the best thing you need to do that. It's not very feasible. It's better to kind of work that in and have a discussion. So the hope is with the FIT principle,
Dhru Purohit Show
Is Exercise the Miracle Drug We’ve Been Waiting For? The Number One Way to Strengthen Your Mind and Fight Depression with Dr. Nicholas Fabiano
You can, when speaking with a patient about prescribing exercise, you can prescribe it akin to how you would prescribe a medication. And that also allows for follow-up.
Dhru Purohit Show
Is Exercise the Miracle Drug We’ve Been Waiting For? The Number One Way to Strengthen Your Mind and Fight Depression with Dr. Nicholas Fabiano
So at appointment, to draw the parallel again, when you start a medication, oftentimes with measurement-based care, we'll measure severity of depression on scales and see how you respond to different doses and see what side effects there may be. The same thing you can do for exercise. If you have that fit outline of what the person has been doing for the last
Dhru Purohit Show
Is Exercise the Miracle Drug We’ve Been Waiting For? The Number One Way to Strengthen Your Mind and Fight Depression with Dr. Nicholas Fabiano
But we're not formally taught how to talk about it, how to prescribe it, how to follow up with it. The same way we're taught about medications. So I think there's that degree of uncomfortability for people that don't have that personal experience with it, which again, it stems down to education, being able to talk to people so that you're able to have that discussion with your patient.
Dhru Purohit Show
Is Exercise the Miracle Drug We’ve Been Waiting For? The Number One Way to Strengthen Your Mind and Fight Depression with Dr. Nicholas Fabiano
few weeks you can see what effect did that have on someone's depression scores and maybe what side effects that they have and was it feasible and from there you and the patient can kind of come to a decision of what may work and then the important point that i like to make with the fit principle too is that it's not about reaching those ideals right away that can be very discouraging for a patient and that's why i'm always hesitant to discuss the quote-unquote optimal amount of exercise for depression because number one it varies for individual people
Dhru Purohit Show
Is Exercise the Miracle Drug We’ve Been Waiting For? The Number One Way to Strengthen Your Mind and Fight Depression with Dr. Nicholas Fabiano
But number two, sometimes when you have these optimal levels, it can be very off-putting for someone who's already feeling in a state of no motivation to get started. So I think starting it off by setting lower goals that are easily attainable and building it up from there using the fit principle is the best way to really apply that.
Dhru Purohit Show
Is Exercise the Miracle Drug We’ve Been Waiting For? The Number One Way to Strengthen Your Mind and Fight Depression with Dr. Nicholas Fabiano
Because again, as a physician, your role is to provide information to the patient in front of you so that they can make an educated and informed choice. And with exercise being one of the first line treatment options for depression, it's only fair to have someone that's able to have that discussion and and facilitate follow-up and make sure that you, the patient, has the most success too.
Dhru Purohit Show
Is Exercise the Miracle Drug We’ve Been Waiting For? The Number One Way to Strengthen Your Mind and Fight Depression with Dr. Nicholas Fabiano
I think it's an important point you make too in terms of getting into it. And I think reframing that discussion too, because you said sometimes maybe you need a little push to kind of get into things. And I think it's helpful to reframe sometimes how we look at exercise or some of these prescriptions. So sometimes people will argue that, you know, whether it's motivation or time or
Dhru Purohit Show
Is Exercise the Miracle Drug We’ve Been Waiting For? The Number One Way to Strengthen Your Mind and Fight Depression with Dr. Nicholas Fabiano
Because going to the gym or making this a whole activity might be hard to do as a first step. But I think reframing different things where maybe you would take the elevator at work and maybe it's one floor up. Maybe this time you could take the stairs instead. Or maybe when you go to do groceries, it's not too far away and you're able to walk there instead and walk back.
Dhru Purohit Show
Is Exercise the Miracle Drug We’ve Been Waiting For? The Number One Way to Strengthen Your Mind and Fight Depression with Dr. Nicholas Fabiano
and get some sunlight exposure as well too, and maybe socialize with someone on the way too. So these little things that you're able to do at the beginning is so important for the point that I mentioned before about the momentum of once you start doing it, it also gives people this locus of control over their own health and their own mind. Whereas sometimes when someone is
Dhru Purohit Show
Is Exercise the Miracle Drug We’ve Been Waiting For? The Number One Way to Strengthen Your Mind and Fight Depression with Dr. Nicholas Fabiano
starting medications and they feel that they're relying on these medications to be themselves, which isn't the case, but that's a sense that patients often have came to me with saying, I need this because I feel broken and without it, I'm not. Whereas with exercise, a lot of people will say that I now feel in control of my health I'm choosing to go for a run.
Dhru Purohit Show
Is Exercise the Miracle Drug We’ve Been Waiting For? The Number One Way to Strengthen Your Mind and Fight Depression with Dr. Nicholas Fabiano
I'm choosing to go for a walk and I feel better because of that. And I think that's a very important point that we need to look at too, to make sure that the person in front of us that we're helping get out of that depression feels that they're in the driver's seat of it and they're not just being pushed along. And again, as I mentioned, that can start with very little things.
Dhru Purohit Show
Is Exercise the Miracle Drug We’ve Been Waiting For? The Number One Way to Strengthen Your Mind and Fight Depression with Dr. Nicholas Fabiano
And we know from the research, too, when we look at dose response curves in terms of amount of physical activity and antidepressant effects, the biggest gains are seen for people that are sedentary, so not moving at all, going from just a little amount of physical activity and then a little bit more. And it keeps going up from there.
Dhru Purohit Show
Is Exercise the Miracle Drug We’ve Been Waiting For? The Number One Way to Strengthen Your Mind and Fight Depression with Dr. Nicholas Fabiano
And of course, you're going to have diminishing returns as you get to higher and higher levels. But I think it shows the importance of for those people that right now are struggling to even get just a little bit active. Those little amounts of physical activity can go a long way from both an antidepressant perspective, but from a moment of perspective and to help get into other things.
Dhru Purohit Show
Is Exercise the Miracle Drug We’ve Been Waiting For? The Number One Way to Strengthen Your Mind and Fight Depression with Dr. Nicholas Fabiano
And maybe that doesn't lead to more exercise, but maybe that leads to engagement in therapy. Maybe that leads to less side effects in the medication that they're having. And overall, it's this whole picture as the person. And maybe that leads to improvements to that individual rather than just looking at it through the lens of depression.
Dhru Purohit Show
Is Exercise the Miracle Drug We’ve Been Waiting For? The Number One Way to Strengthen Your Mind and Fight Depression with Dr. Nicholas Fabiano
So that would be my advice there. You know, as you mentioned, people that do exercise more often, the physicians are likely to have that discussion. But I hope to see a future where even people that maybe aren't are able to still facilitate that and have a conversation with the patient in front of them.
Dhru Purohit Show
Is Exercise the Miracle Drug We’ve Been Waiting For? The Number One Way to Strengthen Your Mind and Fight Depression with Dr. Nicholas Fabiano
Yeah, no, I think in terms of how you're framing it, I think also when we lump these exercise groups into these umbrella terms of aerobic resistance, like I mentioned before, there's so much gray area in between. So even how you go about your resistance training can have more of that aerobic approach where
Dhru Purohit Show
Is Exercise the Miracle Drug We’ve Been Waiting For? The Number One Way to Strengthen Your Mind and Fight Depression with Dr. Nicholas Fabiano
depending on how you do it, if you're doing this more HIIT sort of resistance training where you're doing these high intensity intervals or different things of that sort, you might notice more changes in your heart rate. And the important point is that maybe while you're doing the activity, you have these spikes in heart rate and different changes there.
Dhru Purohit Show
Is Exercise the Miracle Drug We’ve Been Waiting For? The Number One Way to Strengthen Your Mind and Fight Depression with Dr. Nicholas Fabiano
But the evidence has shown that when we're looking at heart rate and heart rate variability, the associations with mental illness is usually at your baseline heart rate variability or baseline heart rate.
Dhru Purohit Show
Is Exercise the Miracle Drug We’ve Been Waiting For? The Number One Way to Strengthen Your Mind and Fight Depression with Dr. Nicholas Fabiano
So by essentially revving your heart up when you're resistance training, when you're running, it's to help bring it back down to a level that's that lower heart rate variability or sorry, higher heart rate variability and lower heart rate variability. where you have those lower associations with things like depression and anxiety.
Dhru Purohit Show
Is Exercise the Miracle Drug We’ve Been Waiting For? The Number One Way to Strengthen Your Mind and Fight Depression with Dr. Nicholas Fabiano
But I think your approach makes sense too, where it's good to have a mixture between the two where, you know, as you mentioned, maybe you like resistance training more and the biggest part of exercise and being adherent to it.
Dhru Purohit Show
Is Exercise the Miracle Drug We’ve Been Waiting For? The Number One Way to Strengthen Your Mind and Fight Depression with Dr. Nicholas Fabiano
And same thing with diet is doing something that you like and enjoy because you can prescribe someone the most optimal regimen from a physical perspective, from a mental perspective, and maybe you adhere to it for a week or a month. But over time, if you're not enjoying that, it will become something that you resent and you don't end up doing to your full capacity.
Dhru Purohit Show
Is Exercise the Miracle Drug We’ve Been Waiting For? The Number One Way to Strengthen Your Mind and Fight Depression with Dr. Nicholas Fabiano
So an example would be resistance training. If you really enjoy and you're set on hitting a specific number or you're really just invested in getting your squat to a specific level or your bench to a specific level, you're going to work that much harder at it, whether you consciously know it or not. And then that feeds into what I spoke about from exercise intensity and antidepressant effects.
Dhru Purohit Show
Is Exercise the Miracle Drug We’ve Been Waiting For? The Number One Way to Strengthen Your Mind and Fight Depression with Dr. Nicholas Fabiano
where whether you know it or not, as I mentioned, you're going to be having that higher intensity that you bring to each of those sessions, which will lead to those greater benefits. So like I said, although we put them into categories of aerobic resistance and mind body, oftentimes these exercises, they can really be used interchangeably. There's gray areas between them.
Dhru Purohit Show
Is Exercise the Miracle Drug We’ve Been Waiting For? The Number One Way to Strengthen Your Mind and Fight Depression with Dr. Nicholas Fabiano
And I think it's best to do the one that you find the most benefit from and you find the most enjoyable.
Dhru Purohit Show
Is Exercise the Miracle Drug We’ve Been Waiting For? The Number One Way to Strengthen Your Mind and Fight Depression with Dr. Nicholas Fabiano
Yeah. So creatine, as you mentioned, is a substance that's been around for a long time, especially within the fitness industry. And I always, whenever I talk about it, I like to make the disclaimer that it's not a steroid supplement. Some people have that misconception.
Dhru Purohit Show
Is Exercise the Miracle Drug We’ve Been Waiting For? The Number One Way to Strengthen Your Mind and Fight Depression with Dr. Nicholas Fabiano
But as I mentioned before, creatine, when used, it's traditionally more viewed as something that can be helped to, for someone who's lifting weights or running, to increase the amount of reps you can do, to maybe allow you to run a little bit further.
Dhru Purohit Show
Is Exercise the Miracle Drug We’ve Been Waiting For? The Number One Way to Strengthen Your Mind and Fight Depression with Dr. Nicholas Fabiano
And how it works without getting too much into the complexities is when you take creatine, you essentially allow your body to store more of that creatine in your muscles. So phosphocreatine is how it's stored. And when you're exercising, you're using up the currency of energy in your body, which is called ATP. And creatine essentially helps you recycle that more efficiently.
Dhru Purohit Show
Is Exercise the Miracle Drug We’ve Been Waiting For? The Number One Way to Strengthen Your Mind and Fight Depression with Dr. Nicholas Fabiano
So you can imagine if you're able to recycle your energy more efficiently, then you're able to exercise more. So you can imagine from a pure performance perspective, if you're able to do this more efficiently, you're going to have better outcomes from strength, you're gonna have better outcomes from muscle mass and all these different variables.
Dhru Purohit Show
Is Exercise the Miracle Drug We’ve Been Waiting For? The Number One Way to Strengthen Your Mind and Fight Depression with Dr. Nicholas Fabiano
And that will also likely coincide with your ability to have more intense workouts and more antidepressant effects. And Where the research has been for this recently has been with pairing creatine to these first-line measures for depression.
Dhru Purohit Show
Is Exercise the Miracle Drug We’ve Been Waiting For? The Number One Way to Strengthen Your Mind and Fight Depression with Dr. Nicholas Fabiano
So there's been a few trials around pairing creatine with antidepressants as a treatment for depression versus the other arm just being the antidepressant alone. And what these trials have shown has been that creatine results in a faster antidepressant response, so as soon as two weeks. and a better response in the long term as well too.
Dhru Purohit Show
Is Exercise the Miracle Drug We’ve Been Waiting For? The Number One Way to Strengthen Your Mind and Fight Depression with Dr. Nicholas Fabiano
Traditionally, we viewed exercise as a treatment for many different things, more so in the physical realm. So you often hear your doctor talking to you about these things for diabetes or weight loss and stuff of that sort.
Dhru Purohit Show
Is Exercise the Miracle Drug We’ve Been Waiting For? The Number One Way to Strengthen Your Mind and Fight Depression with Dr. Nicholas Fabiano
And then a recent trial within the last few months came out pairing it with cognitive behavioral therapy. So that's a therapy that we use to treat depression. And it found the same thing where there were benefits to the response from a cognitive behavioral therapy. And we know beyond the physical aspects of creatine, there's cognitive benefits too.
Dhru Purohit Show
Is Exercise the Miracle Drug We’ve Been Waiting For? The Number One Way to Strengthen Your Mind and Fight Depression with Dr. Nicholas Fabiano
So the creatine has direct benefits to your cognition, your memory, and all these different things. So that may allow someone to engage more in therapy. Where I think it's interesting, and it gets a little bit more complex here, is an increasing view of mental disorders is from what we look at from a bioenergetic perspective.
Dhru Purohit Show
Is Exercise the Miracle Drug We’ve Been Waiting For? The Number One Way to Strengthen Your Mind and Fight Depression with Dr. Nicholas Fabiano
So as we discussed before, the traditional view of mental disorders is looking at it from neurotransmitters like serotonin and all these different things. However, the more recent view has been conceptualizing it from energy. So as I discussed before... Creatine is stored in the muscles as something called phosphocreatine. But what I didn't talk about was it's also stored in the brain.
Dhru Purohit Show
Is Exercise the Miracle Drug We’ve Been Waiting For? The Number One Way to Strengthen Your Mind and Fight Depression with Dr. Nicholas Fabiano
So about 95% is stored in your muscles. The remaining five is around in your brain. And it also stores itself as phosphocreatine. And without getting into too much of the complexities here, the...
Dhru Purohit Show
Is Exercise the Miracle Drug We’ve Been Waiting For? The Number One Way to Strengthen Your Mind and Fight Depression with Dr. Nicholas Fabiano
How your body, when stuff is working in a healthy state, so a non-depressed state, is your body uses this process called oxidative phosphorylation to regenerate the ATP molecule and allow your brain to also have energy. However, we know that when people are experiencing a depression, the brain itself is not able to do this process of oxidative phosphorylation as well. So it's slower.
Dhru Purohit Show
Is Exercise the Miracle Drug We’ve Been Waiting For? The Number One Way to Strengthen Your Mind and Fight Depression with Dr. Nicholas Fabiano
It's not efficient. It's a time of increased metabolic demand on the brain. And what the brain is able to do is tap into some of these creatine stores that you have to use that as a shortcut to replenish the ATP. But you can imagine that if this goes on for days, for weeks, for months, for years, that creatine store that you have in your brain is slowly going to be depleted.
Dhru Purohit Show
Is Exercise the Miracle Drug We’ve Been Waiting For? The Number One Way to Strengthen Your Mind and Fight Depression with Dr. Nicholas Fabiano
So now there's no longer that shortcut. And the usual way that you're making the ATP is not as efficient either, which can lead to this prolonged state of depression. And that's where some of the hypothesis lies. So where creatine comes in is, again, you can get it from your diet, but oftentimes when we're talking about creatine in the fitness industry, it's from supplementation.
Dhru Purohit Show
Is Exercise the Miracle Drug We’ve Been Waiting For? The Number One Way to Strengthen Your Mind and Fight Depression with Dr. Nicholas Fabiano
So people take it in their scoops, they put it in their water, put it in their coffee. And creatine by this, the thought is that it can replace both the muscle creatine stores, but also the brain creatine stores to help the brain essentially get out of that where there's that increased metabolic demand.
Dhru Purohit Show
Is Exercise the Miracle Drug We’ve Been Waiting For? The Number One Way to Strengthen Your Mind and Fight Depression with Dr. Nicholas Fabiano
So that's the complex thoughts between or behind how creatine might help depression and how it may even facilitate exercise and depression. And the interesting part is in the paper that we wrote, we summarized some of the evidence around creatine with therapy and medications, but there's actually no study comparing creatine
Dhru Purohit Show
Is Exercise the Miracle Drug We’ve Been Waiting For? The Number One Way to Strengthen Your Mind and Fight Depression with Dr. Nicholas Fabiano
creatine and combining it with exercise to see its effects on depression, because that makes the most sense, right? The majority of people that are taking creatine are people that are exercising. And in a real world setting, that's where we would be most interested in the outcome.
Dhru Purohit Show
Is Exercise the Miracle Drug We’ve Been Waiting For? The Number One Way to Strengthen Your Mind and Fight Depression with Dr. Nicholas Fabiano
So we would hope to see studies in the area soon to see what the antidepressant effect of exercise plus creatine is, because we know from both that bioenergetic perspective, but also from the performance perspective of creatine, that there should be benefits. But we don't have that clinical data yet, but it is so relevant. And I'm hoping to see that soon.
Dhru Purohit Show
Is Exercise the Miracle Drug We’ve Been Waiting For? The Number One Way to Strengthen Your Mind and Fight Depression with Dr. Nicholas Fabiano
Yeah, I think the important caveat, as you mentioned, is before starting any supplement, you want to speak with your doctor. But as you mentioned before, creatine is a very well-researched substance with very minimal side effects compared to a lot of other medications or other substances in the fitness industry.
Dhru Purohit Show
Is Exercise the Miracle Drug We’ve Been Waiting For? The Number One Way to Strengthen Your Mind and Fight Depression with Dr. Nicholas Fabiano
And there have been alarms around different side effects that didn't really substantiate. So just to bring up a few that are commonly brought up in terms of side effects that I've seen people ask me about is The concept of renal impairment or kidney impairment has been brought up in terms of what happens for creatine as a side effect.
Dhru Purohit Show
Is Exercise the Miracle Drug We’ve Been Waiting For? The Number One Way to Strengthen Your Mind and Fight Depression with Dr. Nicholas Fabiano
And that was based on a very small case study of an individual who was actually restricting their diet, so limiting their fluid intake while taking high doses of creatine, so an athlete. And they saw rises in their creatinine levels, which makes sense, but
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Is Exercise the Miracle Drug We’ve Been Waiting For? The Number One Way to Strengthen Your Mind and Fight Depression with Dr. Nicholas Fabiano
Apart from that, in the literature where they've done meta-analysis combining all these studies together, there's no evidence of renal dysfunction. And the caveat that I will add though is for those that have pre-existing renal dysfunction, that's maybe something you would want to speak about your doctor and make sure everything is okay before supplementing.
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Is Exercise the Miracle Drug We’ve Been Waiting For? The Number One Way to Strengthen Your Mind and Fight Depression with Dr. Nicholas Fabiano
But for the general public, from a kidney perspective, stuff is generally safe. Another concern that's often brought up by people is hair loss in creatine. And I see that a lot whenever I write about creatine. People always say, but that causes hair loss.
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Is Exercise the Miracle Drug We’ve Been Waiting For? The Number One Way to Strengthen Your Mind and Fight Depression with Dr. Nicholas Fabiano
And to give some background for that as well, too, that came from a very small study as well, I think about 20 years ago, where they looked at rugby players and they supplemented creatine and they found an increase in something called DHT. And DHT is a hormone that's related to hair loss. But it's interesting to show that with that, that's been really one of the only studies to show that.
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Is Exercise the Miracle Drug We’ve Been Waiting For? The Number One Way to Strengthen Your Mind and Fight Depression with Dr. Nicholas Fabiano
There are no changes in testosterone level or any of these other hormones. And there's no studies to show that creatine actually results in hair loss. So no clinical trials to support that data. So Although there's that study from a while ago to show maybe concern around DHT levels, we know it's much more complicated from that perspective. So just another thing to talk about.
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Is Exercise the Miracle Drug We’ve Been Waiting For? The Number One Way to Strengthen Your Mind and Fight Depression with Dr. Nicholas Fabiano
So those are some of the common things that when I talk to people about creatine that come up. But overall, in a general sense, it's relatively safe for someone that would want to start at those lower doses.
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Is Exercise the Miracle Drug We’ve Been Waiting For? The Number One Way to Strengthen Your Mind and Fight Depression with Dr. Nicholas Fabiano
And as you mentioned, if you are experiencing some of those GI side effects, either having a lower dose or breaking up that dose to morning and night rather than taking it in one dose can be helpful. But again, caveat being always, I'm not your doctor, so you want to make sure that you speak with your physician about it. But it is generally a safe supplement to take.
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Is Exercise the Miracle Drug We’ve Been Waiting For? The Number One Way to Strengthen Your Mind and Fight Depression with Dr. Nicholas Fabiano
And I think another point from that too is the form of creatine. So the most studied form of creatine is creatine monohydrate. So that's creatine essentially paired with water. And that's what I would recommend most of the time just because that's where most of the evidence lies. However, there's other forms too.
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Is Exercise the Miracle Drug We’ve Been Waiting For? The Number One Way to Strengthen Your Mind and Fight Depression with Dr. Nicholas Fabiano
So you mentioned, you know, the different formation of creatine, but also things like creatine paired with HCL. So creatine HCL or hydrochloric acid. Sometimes that's easier on someone's stomach. It's a little bit more expensive. However, there's arguments to be made that it's easier digested. You actually need a lower dose because of that as well too.
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Is Exercise the Miracle Drug We’ve Been Waiting For? The Number One Way to Strengthen Your Mind and Fight Depression with Dr. Nicholas Fabiano
And then one that's not as commonly heard is creatine nitrate. So that's comparing it with a nitrate group. And that takes advantage of some of those vasodilatory effects where in the gym terms, you get a pump more. when you go to the gym. So some people like to take creatine nitrate before the gym to kind of have both of those things at the same time.
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Is Exercise the Miracle Drug We’ve Been Waiting For? The Number One Way to Strengthen Your Mind and Fight Depression with Dr. Nicholas Fabiano
So just being aware of the different ones out there. But to say that most of the research and when I'm discussing these different things, it's around creatine monohydrate, just because it's the one that's been around for so long.
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Is Exercise the Miracle Drug We’ve Been Waiting For? The Number One Way to Strengthen Your Mind and Fight Depression with Dr. Nicholas Fabiano
To reframe that even a little bit, there's a lot of controversy over what causes depression, what causes it to continue on, and what changes that has on your brain. Different discussions about serotonin levels, different brain physical changes in your brain that occur with depression, and we're not even sure from that lens.
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Is Exercise the Miracle Drug We’ve Been Waiting For? The Number One Way to Strengthen Your Mind and Fight Depression with Dr. Nicholas Fabiano
First off, if you have your suspicion that someone may be experiencing depression, making sure that they have that professional help around them. But from having a discussion around exercise, I think it is really important to frame it in that way, as I discussed before, where
Dhru Purohit Show
Is Exercise the Miracle Drug We’ve Been Waiting For? The Number One Way to Strengthen Your Mind and Fight Depression with Dr. Nicholas Fabiano
you're not coming from this stance of the lack of activity or diet or something is necessarily causing their depression because that can be very off-putting for the patient and make them feel that they don't want to exercise and it's almost a resistance to doing it. I think if someone's coming to you with that and saying, you know, what should I do from an exercise perspective?
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Is Exercise the Miracle Drug We’ve Been Waiting For? The Number One Way to Strengthen Your Mind and Fight Depression with Dr. Nicholas Fabiano
I think just helping them do the small things. So whether that's going for a walk, whether that's, as I mentioned, taking some of those more passive modes of activity before and making it active, is a good step in the right direction and working with them.
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Is Exercise the Miracle Drug We’ve Been Waiting For? The Number One Way to Strengthen Your Mind and Fight Depression with Dr. Nicholas Fabiano
And if you're able to, if it's someone that's close to you, maybe doing some of those activities together, maybe if they want to go on a walk together, if you wanted to go to the gym together, because getting into fitness, and I can speak from my own personal experience too, I was someone who I played soccer my whole life and I was comfortable with that.
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Is Exercise the Miracle Drug We’ve Been Waiting For? The Number One Way to Strengthen Your Mind and Fight Depression with Dr. Nicholas Fabiano
But when I started getting into the weights in the gym, it was very overwhelming. So at that time, someone told me, hey, you just need to go to the gym. I was already scared enough to go to the gym and see all these muscular people and stuff. And I was 100 pounds, probably soaking wet.
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Is Exercise the Miracle Drug We’ve Been Waiting For? The Number One Way to Strengthen Your Mind and Fight Depression with Dr. Nicholas Fabiano
So I think being able to be with someone in that moment and help them do that, especially if it's something that you enjoy. And if you're that person that people see as having knowledge in fitness or different things, then maybe taking them to the gym or taking them for a run because it can be overwhelming and even simple things like running.
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Is Exercise the Miracle Drug We’ve Been Waiting For? The Number One Way to Strengthen Your Mind and Fight Depression with Dr. Nicholas Fabiano
There's so many different terms and things that come up zone two. And for someone who's not interested in running or wanting to get into it, it can be overwhelming and off-putting. So my suggestion would be just to be there for them and to help them walk through these different things and help facilitate their interest.
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Is Exercise the Miracle Drug We’ve Been Waiting For? The Number One Way to Strengthen Your Mind and Fight Depression with Dr. Nicholas Fabiano
So maybe they don't like weightlifting like you, maybe they don't like running like you, but maybe there is something that you can find that they do like and helping them adhere to that because that's where you'll find the most success.
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Is Exercise the Miracle Drug We’ve Been Waiting For? The Number One Way to Strengthen Your Mind and Fight Depression with Dr. Nicholas Fabiano
So I think it's helpful to really break it down into three different prongs in terms of when we look at what does exercise do to your brain, and it's to break it down into the biopsychosocial lens. So when I say bio, I mean biologically, what does exercise do to your brain? So we know that exercise, it increases the levels of different neurotransmitters.
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Is Exercise the Miracle Drug We’ve Been Waiting For? The Number One Way to Strengthen Your Mind and Fight Depression with Dr. Nicholas Fabiano
I think it's a great point. Like you said, making it something that's fun to do and not seem like a chore and also extending that hand for someone that maybe wants to do something or is hesitant to learn something new, but willing to and being able to be that bridge to have that conversation, I think is so important.
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Is Exercise the Miracle Drug We’ve Been Waiting For? The Number One Way to Strengthen Your Mind and Fight Depression with Dr. Nicholas Fabiano
To reverse kind of the things I would do, how I view kind of the fundamental pillars of your health are your exercise, your diet, and your sleep patterns. So if we're to flip those upside down and want to induce a depression, for exercise, I would say, you know, remain completely sedentary. Don't even get off the couch. Just Uber eat stuff straight to your couch.
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Is Exercise the Miracle Drug We’ve Been Waiting For? The Number One Way to Strengthen Your Mind and Fight Depression with Dr. Nicholas Fabiano
And what you're eating too, that leads to the next point, is purely ultra-processed foods. So just eating the most processed stuff you can have. So whether that's fast food, stuff with maximum amount of calories packed into small amounts of food, that would be kind of the exercise diet.
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Is Exercise the Miracle Drug We’ve Been Waiting For? The Number One Way to Strengthen Your Mind and Fight Depression with Dr. Nicholas Fabiano
And then sleep wise, I would say completely have no schedule to your sleep, kind of fall asleep whenever, try to stay up during the day and have your circadian rhythm be all messed up.
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Is Exercise the Miracle Drug We’ve Been Waiting For? The Number One Way to Strengthen Your Mind and Fight Depression with Dr. Nicholas Fabiano
And with those three things, and the reason why I say this is as a resident physician, some of these things happen to us indirectly sometimes where we're on a 24-hour shift, we haven't eaten, we haven't had the chance to exercise in a week because it's so busy. And again, not to say and discredit someone that's experienced a depression, but in these states, It's so hard.
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Is Exercise the Miracle Drug We’ve Been Waiting For? The Number One Way to Strengthen Your Mind and Fight Depression with Dr. Nicholas Fabiano
You feel that mental burden on you, especially if it's prolonged for a period of time, that I can imagine how if someone's lifestyle was like this day after day, week after week, year after year, how it would be almost impossible not to develop symptoms of depression or an overt clinical depressive symptom.
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Is Exercise the Miracle Drug We’ve Been Waiting For? The Number One Way to Strengthen Your Mind and Fight Depression with Dr. Nicholas Fabiano
And that's why I think beyond just the medication therapy and what our standard is, we need to make sure that we have these fundamentals in check because it's hard to... piece someone back together if you don't have that foundation there.
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Is Exercise the Miracle Drug We’ve Been Waiting For? The Number One Way to Strengthen Your Mind and Fight Depression with Dr. Nicholas Fabiano
And that's why it's so important, not necessarily to perfect it, but to at least restore some balance to it and not just have this bandage approach of, oh, here's a medication. This will make stuff better. And maybe it translating will, but it won't solve that foundation and prevent relapse and different things of that sort.
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Is Exercise the Miracle Drug We’ve Been Waiting For? The Number One Way to Strengthen Your Mind and Fight Depression with Dr. Nicholas Fabiano
So things like serotonin, norepinephrine, dopamine, and these are neurotransmitters that are implicated in, you know, the alleviation of depression and what some of these medications aim to actually increase. So that's a positive thing. Another thing that exercise does is it also increases levels of what we call brain-derived neurotrophic factor, or BDNF.
Dhru Purohit Show
Is Exercise the Miracle Drug We’ve Been Waiting For? The Number One Way to Strengthen Your Mind and Fight Depression with Dr. Nicholas Fabiano
But it's been more mainstream recently as the research just came out to show that exercise, just similar to, as you mentioned, therapy or even antidepressant medications, can have similar antidepressant effects if prescribed correctly. So I think this notion for some people is received very well, for others, maybe not so well.
Dhru Purohit Show
Is Exercise the Miracle Drug We’ve Been Waiting For? The Number One Way to Strengthen Your Mind and Fight Depression with Dr. Nicholas Fabiano
Yeah, no, I completely agree because at one level, it seems so obvious that these fundamentals even need to be communicated or that the research needs to be done to solidify this. And I think it falls down to that educational level and actually implementing it. So making sure, so at a physician level,
Dhru Purohit Show
Is Exercise the Miracle Drug We’ve Been Waiting For? The Number One Way to Strengthen Your Mind and Fight Depression with Dr. Nicholas Fabiano
And that is essentially miracle growth for the brain. It's such an important thing from a neuroplasticity standpoint, and it helps prevent cognitive decline and all these beneficial things, which we think has a role in depression. And then to speak about the physical changes within the brain,
Dhru Purohit Show
Is Exercise the Miracle Drug We’ve Been Waiting For? The Number One Way to Strengthen Your Mind and Fight Depression with Dr. Nicholas Fabiano
being able to discuss these important things with your patients, because oftentimes how patients view an interaction with their physician is, I see the doctor, I get my medication adjusted, I leave, I follow up. And the lifestyle measure has kind of fallen out of practice as a commonplace beyond, as we mentioned before, that vague, oh, go exercise without clear instructions.
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Is Exercise the Miracle Drug We’ve Been Waiting For? The Number One Way to Strengthen Your Mind and Fight Depression with Dr. Nicholas Fabiano
And then I think from an incentive perspective as well too, when we're looking at research that is done or reimbursements, oftentimes how the medical model is set up now is for trials to be done on antidepressants or drugs. You're going to have that financial backing from these different companies because there's incentive for that to be done.
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Is Exercise the Miracle Drug We’ve Been Waiting For? The Number One Way to Strengthen Your Mind and Fight Depression with Dr. Nicholas Fabiano
Whereas right now, I think for a lot of the lifestyle measures, so whether it's optimizing your exercise, whether it's optimizing your diet or sleep, there's not those same incentives that exist from a superficial level. So there's not that immediate return to someone who's going to be funding X research or different things.
Dhru Purohit Show
Is Exercise the Miracle Drug We’ve Been Waiting For? The Number One Way to Strengthen Your Mind and Fight Depression with Dr. Nicholas Fabiano
So I think we need to really restructure how we approach different disorders. And it comes down to how we perceive these disorders. Because this comes to one of the other things that I come up with in medicine is we often see this divide between mental and physical health. And I don't think it's useful to separate the two because then we try to treat them in isolation.
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Is Exercise the Miracle Drug We’ve Been Waiting For? The Number One Way to Strengthen Your Mind and Fight Depression with Dr. Nicholas Fabiano
And in doing so, we have approaches by saying, you know, we should just do therapy or we should just do medications. And we ignore the physical side of it with the caveat being that the physical side directly influences that mental side as well, too.
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Is Exercise the Miracle Drug We’ve Been Waiting For? The Number One Way to Strengthen Your Mind and Fight Depression with Dr. Nicholas Fabiano
And I think that's where the disconnect lies as well, too, in how we're taught, how we look at mental disorders and how we even look at physical disorders where we're treating these conditions in isolation rather than looking at the unifying treatment of them both.
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Is Exercise the Miracle Drug We’ve Been Waiting For? The Number One Way to Strengthen Your Mind and Fight Depression with Dr. Nicholas Fabiano
So I think the medical model in society, we need to kind of restructure how we view these conditions so that we can see a better way to both treat and then beyond that, be proactive and prevent. Because a lot of this discussion today has been about treating depression with exercise. But there's also a large body of literature to show that we can prevent depression with exercise.
Dhru Purohit Show
Is Exercise the Miracle Drug We’ve Been Waiting For? The Number One Way to Strengthen Your Mind and Fight Depression with Dr. Nicholas Fabiano
We can prevent depression with dietary measures. We can prevent depression with sleep. So how our system is set up now is treatment. We treat what is currently happening. And it's almost like the sinking ship where there's rising levels of depression. There's rising levels of anxiety. And we're trying to develop the next best drug to reduce those levels.
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Is Exercise the Miracle Drug We’ve Been Waiting For? The Number One Way to Strengthen Your Mind and Fight Depression with Dr. Nicholas Fabiano
We know that people that exercise have larger brain volumes, specifically in areas like the hippocampus, which is important for your cognition and memory. So those are some of the brain changes that we know that happen. And there's a lot of other things that are in the research area, but those are some of the major areas.
Dhru Purohit Show
Is Exercise the Miracle Drug We’ve Been Waiting For? The Number One Way to Strengthen Your Mind and Fight Depression with Dr. Nicholas Fabiano
But in reality, we can look at it from a different way and say, is there a way to prevent the new cases of depression and anxiety? And oftentimes lifestyle measures, again, as I mentioned, are that fundamental aspect to treating them.
Dhru Purohit Show
Is Exercise the Miracle Drug We’ve Been Waiting For? The Number One Way to Strengthen Your Mind and Fight Depression with Dr. Nicholas Fabiano
So I think that was a long winded way just to say that we need to kind of restructure how we view these mental disorders, but also how we treat and place more emphasis on prevention and being proactive.
Dhru Purohit Show
Is Exercise the Miracle Drug We’ve Been Waiting For? The Number One Way to Strengthen Your Mind and Fight Depression with Dr. Nicholas Fabiano
Yeah, so I think that's a great question in terms of what can be done. I think there's two levels where we can look at where there could be intervention. So I've spoken about the first a lot is from the educational perspective. So I do think that there's room, whether it's a third party intervention, whether it's directly into the curriculum.
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Is Exercise the Miracle Drug We’ve Been Waiting For? The Number One Way to Strengthen Your Mind and Fight Depression with Dr. Nicholas Fabiano
to provide educations or extra certification to physicians to be able to have these discussions with patients and feel well-equipped. And perhaps that there's some sort of incentive as well for physicians to want to know this so that it can become ingrained within the culture of medicine. The second is more from a supply-demand issue.
Dhru Purohit Show
Is Exercise the Miracle Drug We’ve Been Waiting For? The Number One Way to Strengthen Your Mind and Fight Depression with Dr. Nicholas Fabiano
So lots of people perhaps want to get involved with exercise for depression. They want to have that one-to-one support. And number one, there's not that expertise to have that discussion a lot.
Dhru Purohit Show
Is Exercise the Miracle Drug We’ve Been Waiting For? The Number One Way to Strengthen Your Mind and Fight Depression with Dr. Nicholas Fabiano
There's personal trainers, there's different things of that sort for more of that physical standpoint, but perhaps adapting it from the mental standpoint, there's not as many people that you can talk to compared to a therapist or more of your traditional routes.
Dhru Purohit Show
Is Exercise the Miracle Drug We’ve Been Waiting For? The Number One Way to Strengthen Your Mind and Fight Depression with Dr. Nicholas Fabiano
So there may be avenues for someone to develop almost a systematic approach to exercise for depression, similar to something like cognitive behavioral therapy, which is, again, it's a very systematic therapy that we do, but the same thing for depression.
Dhru Purohit Show
Is Exercise the Miracle Drug We’ve Been Waiting For? The Number One Way to Strengthen Your Mind and Fight Depression with Dr. Nicholas Fabiano
And with AI and all these different tools that we have available, there may be something that, again, maybe it's not as perfect as a human coach that you could have going to these sessions with you, but perhaps having a routine made for you having this agent that can kind of adapt to what you're doing, track depression scores and see how you're doing over time.
Dhru Purohit Show
Is Exercise the Miracle Drug We’ve Been Waiting For? The Number One Way to Strengthen Your Mind and Fight Depression with Dr. Nicholas Fabiano
And then when we break it down further, if we want to look at the psychological lens of this three-pronged approach,
Dhru Purohit Show
Is Exercise the Miracle Drug We’ve Been Waiting For? The Number One Way to Strengthen Your Mind and Fight Depression with Dr. Nicholas Fabiano
And having that as something that you could present to your doctor and say, you know, I have this, this is what I've been doing. This is the numerical score that I have because of this. What do you think? And maybe that could be something that's commonplace and facilitate these exercise interventions at a more realistic level.
Dhru Purohit Show
Is Exercise the Miracle Drug We’ve Been Waiting For? The Number One Way to Strengthen Your Mind and Fight Depression with Dr. Nicholas Fabiano
Because I do acknowledge that when we tell patients to exercise, and even if we're telling them to go to a gym and get a personal trainer, that's not maybe well versed from the mental health realm. Even just having a personal trainer, some of these things can be very expensive and time consuming. So perhaps there's room to make this more accessible for more people.
Dhru Purohit Show
Is Exercise the Miracle Drug We’ve Been Waiting For? The Number One Way to Strengthen Your Mind and Fight Depression with Dr. Nicholas Fabiano
You can imagine when you exercise and people have probably all have this experience where after you have a good session at the gym or if you go for a run or if you go climbing with friends or some sort of sport, immediately after you have this sense of, you know, increased drive, motivation, those stresses that you were worrying about maybe aren't there anymore.
Dhru Purohit Show
Is Exercise the Miracle Drug We’ve Been Waiting For? The Number One Way to Strengthen Your Mind and Fight Depression with Dr. Nicholas Fabiano
Again, not as perfect as having that person in front of you. but in a structured approach to engaging in this. And again, the big thing is getting that ball rolling and starting that momentum. So I think that could be two areas for intervention.
Dhru Purohit Show
Is Exercise the Miracle Drug We’ve Been Waiting For? The Number One Way to Strengthen Your Mind and Fight Depression with Dr. Nicholas Fabiano
Yeah. So as you mentioned, right now I'm in my psychiatry residency and I've always been someone that's been active throughout my life. So in my early years, I played competitive soccer and that was my main thing. Did some track here and there. However, when I got to medical school, it wasn't as feasible to have that because it was more of this time-based thing.
Dhru Purohit Show
Is Exercise the Miracle Drug We’ve Been Waiting For? The Number One Way to Strengthen Your Mind and Fight Depression with Dr. Nicholas Fabiano
I didn't have as much time that I can allocate to these things. I needed to do something where I had more freedom that I could exercise in my own time. So I started picking up weight training more. And something funny happened, actually. In my first year of medical school, I was arm wrestling someone, and I broke my humerus. And I'll show you the scar here. Oh, wow.
Dhru Purohit Show
Is Exercise the Miracle Drug We’ve Been Waiting For? The Number One Way to Strengthen Your Mind and Fight Depression with Dr. Nicholas Fabiano
So I broke my dominant arm. I needed to have a plate with screws placed in there. And in that moment, I think I realized how important my... Physical health was for my mental health because my whole life I took for granted being able to go to soccer practice, to go to these tournaments, to be able to run, be able to sprint. And now I was just getting into the gym, having a lot of fun with it.
Dhru Purohit Show
Is Exercise the Miracle Drug We’ve Been Waiting For? The Number One Way to Strengthen Your Mind and Fight Depression with Dr. Nicholas Fabiano
My mood was great. And then I went to just break my dominant arm. And I was like, wow, I can't do the things that I want to enjoy now. Like I can't even really go for a run because I was in a sling. I just had a surgery. And there were weeks and months where I was almost not completely immobile, but I wasn't doing the things that I liked. And I saw the direct impacts that that had in my life.
Dhru Purohit Show
Is Exercise the Miracle Drug We’ve Been Waiting For? The Number One Way to Strengthen Your Mind and Fight Depression with Dr. Nicholas Fabiano
And that was probably one of the lower parts of my life. And After that, I had this newfound motivation where the second I was out of my sling and my cast, I was doing my physiotherapy. They told me it was going to take 12 weeks and I wouldn't regain full range of motion in my arm. But I said no to that.
Dhru Purohit Show
Is Exercise the Miracle Drug We’ve Been Waiting For? The Number One Way to Strengthen Your Mind and Fight Depression with Dr. Nicholas Fabiano
And I essentially held a 30 pound weight as I was studying just to straighten my arm the whole time. And I regained full range of motion and From there, I had this newfound motivation where I was just getting back into things. I wanted to succeed from that front.
Dhru Purohit Show
Is Exercise the Miracle Drug We’ve Been Waiting For? The Number One Way to Strengthen Your Mind and Fight Depression with Dr. Nicholas Fabiano
And I found the immediate switch from being in this state of, again, was never formally diagnosed with depression or started on a medication. But I was, you know, in retrospect, looking at it, it was not a good time. And to do a complete 180, which paralleled with the benefits to my physical health, I really saw those changes.
Dhru Purohit Show
Is Exercise the Miracle Drug We’ve Been Waiting For? The Number One Way to Strengthen Your Mind and Fight Depression with Dr. Nicholas Fabiano
And from there, I continued to adapt different things like my diet and then focusing more on my own sleeping patterns. as much as you can within residency. And I saw those benefits and even things like creatine and having that as a supplement. A lot of my research that I'm doing now stems from my own experiences with different things that I've had.
Dhru Purohit Show
Is Exercise the Miracle Drug We’ve Been Waiting For? The Number One Way to Strengthen Your Mind and Fight Depression with Dr. Nicholas Fabiano
So whether it be exercise, the injury, the creatine, all these things I've noticed benefits in myself, but I wanted to... quantify it and see how it could be applied elsewhere. So yeah, and then from there, I've continued to do that. And I've continued to adapt different regimens from what I'm reading and different things of that sort.
Dhru Purohit Show
Is Exercise the Miracle Drug We’ve Been Waiting For? The Number One Way to Strengthen Your Mind and Fight Depression with Dr. Nicholas Fabiano
And that's important as well, too, because that can provide you with the momentum to continue to maybe get that task done you've been waiting and holding off on or even to look forward to that next session. So that psychological aspect is important too.
Dhru Purohit Show
Is Exercise the Miracle Drug We’ve Been Waiting For? The Number One Way to Strengthen Your Mind and Fight Depression with Dr. Nicholas Fabiano
So it really stemmed from my lifelong pattern of being active, that being disrupted from my broken arm and then getting back and but noticing those stark contrasts in those periods of time.
Dhru Purohit Show
Is Exercise the Miracle Drug We’ve Been Waiting For? The Number One Way to Strengthen Your Mind and Fight Depression with Dr. Nicholas Fabiano
And then an often forgotten part of exercise too is the social part or the social aspect of that three-pronged approach where particularly in populations that are more prone to being isolated or alone, particularly during the COVID pandemic or older populations, exercise may be the only time where people are in a group setting doing something.
Dhru Purohit Show
Is Exercise the Miracle Drug We’ve Been Waiting For? The Number One Way to Strengthen Your Mind and Fight Depression with Dr. Nicholas Fabiano
Yeah, I think the last message that I'll leave is with exercise, just framing it as both that preventative and treatment aspect. And for people wanting to get into it, anything really counts. Don't let these numbers be off-putting and you have to hit this threshold or... compare yourself to another person in your life, because that's easy to demotivate yourself.
Dhru Purohit Show
Is Exercise the Miracle Drug We’ve Been Waiting For? The Number One Way to Strengthen Your Mind and Fight Depression with Dr. Nicholas Fabiano
I think if you have that motivation to just even go for a walk or do these little things, that will take you so much further and you'll notice that momentum build. So that's kind of the last piece that I wanted to add there. But For people that are interested in hearing more about myself or some of the work that I do, the place that I'm most active is probably on X or Twitter.
Dhru Purohit Show
Is Exercise the Miracle Drug We’ve Been Waiting For? The Number One Way to Strengthen Your Mind and Fight Depression with Dr. Nicholas Fabiano
There I either post my own research, stuff about exercise, or I try to summarize usually one scientific paper a day. And I usually do that in the form of threads. So my Twitter is at NTFabiano. But yeah, thank you again for having me. It was a pleasure to have a chat. I look forward to future discussions.
Dhru Purohit Show
Is Exercise the Miracle Drug We’ve Been Waiting For? The Number One Way to Strengthen Your Mind and Fight Depression with Dr. Nicholas Fabiano
Likewise. Thank you for having me.
Dhru Purohit Show
Is Exercise the Miracle Drug We’ve Been Waiting For? The Number One Way to Strengthen Your Mind and Fight Depression with Dr. Nicholas Fabiano
So whether again, that's at the gym, just talking to other people. whether you're on a sports team talking to other people. And we know that this social connection as well, too, has antidepressant effects, too, because loneliness in itself has been perceived to be a disease and increased the risk of dementia and cognitive decline and even depression.
Dhru Purohit Show
Is Exercise the Miracle Drug We’ve Been Waiting For? The Number One Way to Strengthen Your Mind and Fight Depression with Dr. Nicholas Fabiano
So looking at these three different lenses, we really see how exercise can fit in and may alleviate someone's depression, even without knowing the full scope of what causes depression per se.
Dhru Purohit Show
Is Exercise the Miracle Drug We’ve Been Waiting For? The Number One Way to Strengthen Your Mind and Fight Depression with Dr. Nicholas Fabiano
But even for providers, for instance, in Canada here, it's one of the first line treatment options that we have in our guidelines. But many people aren't aware of that. So I think with that, we have the evidence for it. We know its benefits. The next part is really educating people and also the providers about how to do that. And that's where that disconnect really lies.
Dhru Purohit Show
Is Exercise the Miracle Drug We’ve Been Waiting For? The Number One Way to Strengthen Your Mind and Fight Depression with Dr. Nicholas Fabiano
Like you said, as physicians... With our training, a lot of our formal teaching and comfortability comes with medications. So you have someone with depression, the two-pronged simple approach is therapy, medications, maybe both. And that's where maybe that comfort level comes in. I think the other part too with exercise and sometimes people wanting this quick fix is
Dhru Purohit Show
Is Exercise the Miracle Drug We’ve Been Waiting For? The Number One Way to Strengthen Your Mind and Fight Depression with Dr. Nicholas Fabiano
Sometimes there's this misperception because in depression, innately, there's this amotivation. A lot of people experience that.
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Is Exercise the Miracle Drug We’ve Been Waiting For? The Number One Way to Strengthen Your Mind and Fight Depression with Dr. Nicholas Fabiano
So sometimes the provider kind of rather than speaking with the patient in front of them and seeing what might work for them, just automatically kind of assumes that and jumps to the other treatment options rather than entertaining that discussion, which I think is an important barrier as well, too.
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Is Exercise the Miracle Drug We’ve Been Waiting For? The Number One Way to Strengthen Your Mind and Fight Depression with Dr. Nicholas Fabiano
Which is important to really make sure, you know, is this patient wanting to talk to me about exercise? And then that brings up the other point of the severity level of depression too. So as a provider, you have a responsibility, you have different treatments to offer, but exercise and where most of the research lies is in people that have a mild or moderate depression.
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Is Exercise the Miracle Drug We’ve Been Waiting For? The Number One Way to Strengthen Your Mind and Fight Depression with Dr. Nicholas Fabiano
Versus someone that has a severe depression. And to give a picture of what that looks like, someone with a severe depression is someone that is completely bedbound. They're not able to do their activities of daily living. Stuff is really, really hard.
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Is Exercise the Miracle Drug We’ve Been Waiting For? The Number One Way to Strengthen Your Mind and Fight Depression with Dr. Nicholas Fabiano
And offering exercise to someone in that setting maybe isn't inappropriate, but perhaps it can be kind of this bridged approach where maybe other interventions can be offered first and then having that discussion about exercise.
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Is Exercise the Miracle Drug We’ve Been Waiting For? The Number One Way to Strengthen Your Mind and Fight Depression with Dr. Nicholas Fabiano
But I think before you go into that discussion with a patient, I think you also need to understand that, as you alluded to before, people have probably had poor experiences with other physicians, whether it be a psychiatrist, whether it be a primary care doctor, surrounding exercise. So if you came in with a physical ailment and you were told just go exercise,
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Is Exercise the Miracle Drug We’ve Been Waiting For? The Number One Way to Strengthen Your Mind and Fight Depression with Dr. Nicholas Fabiano
that's not very actionable and it can feel that a finger is being pointed at you if you're the patient, that you're being blamed for this condition. So the patient already walking into this encounter with you, the psychiatrist, can already have that view of exercise or lifestyle metrics in general. So it's important to kind of Presented in a way that it's not confrontational.
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Is Exercise the Miracle Drug We’ve Been Waiting For? The Number One Way to Strengthen Your Mind and Fight Depression with Dr. Nicholas Fabiano
You're not blaming someone for having depression or something because of their diet or because of their exercise regimen or lack thereof. More so framing it in an educational view and feeling if the patient seems interested at this moment.
Dhru Purohit Show
Is Exercise the Miracle Drug We’ve Been Waiting For? The Number One Way to Strengthen Your Mind and Fight Depression with Dr. Nicholas Fabiano
And again, as I mentioned, even if this moment, if they're not able to engage or not wanting to, it doesn't mean that it can't be an option for future discussion as well too. And I think that's where some of that disconnect lies between the patient and the physician and having or facilitating that discussion.
Dhru Purohit Show
Is Exercise the Miracle Drug We’ve Been Waiting For? The Number One Way to Strengthen Your Mind and Fight Depression with Dr. Nicholas Fabiano
No, that's fair. And I think to that point, too, like you mentioned, it distorts the view from both the provider and patient perspective. So it looks like that is the quick fix. And where the disconnect lies, too, is with exercise and different interventions.
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Is Exercise the Miracle Drug We’ve Been Waiting For? The Number One Way to Strengthen Your Mind and Fight Depression with Dr. Nicholas Fabiano
These trials have sometimes shown that exercise actually has a faster antidepressant response than some of the medications, because we typically speak to patients about from a depression perspective that sometimes medications can take four to even eight weeks to start having that immediate effect or a noticeable effect.
Dhru Purohit Show
Is Exercise the Miracle Drug We’ve Been Waiting For? The Number One Way to Strengthen Your Mind and Fight Depression with Dr. Nicholas Fabiano
can be a long time for someone that's experiencing severe depression or anxiety even if the exercise intervention within the first few weeks isn't meeting meeting its maximal effects i think it's something that providers need to be aware of that it could be something to help bridge that and this is to another point that's important is sometimes when we discuss lifestyle interventions so exercise diet sleep we artificially create these two camps where