After a lecture by my son's headmaster wherein children are regarded by the Catholic Church as divine we say that wonderfully influences expectations of our kids which moulds behaviour and self esteem which is one of the main determinants of success in life. Andy my co presenter related this to his own experiences with Attention Deficit Hyperactivity Disorder. We then segway onto social media which destroys self esteem, social skills , causes depression and dissolves concentration in its frenzy of instant gratification and dopamine hits making us all ADHD. We look at how trauma and behavioural shifts can be passed across generations by epigenetics. We discuss one of the fundamental differences in the thought processes between adults and children. Whereas children combine reality with their imagination and inner self so that anything may seem possible , adults close their minds to reality and stay with their limited set of beliefs and dreams. We summarise that true clarity of mind only exists at two points in life: once when you are born and after you have had good therapy. Enjoy .

Responsibility: Progress in any system is by trial and error. This is how nature works in evolution and how our children grow up through experiences and teaching. Models only work for specific unique situations. Eg laws of gravity , motion etc. in fact many scientific concepts. In fact even those only stay valid until they are disproven or someone comes up with a better concept. The idea that models can be produced for complex systems is not realistic. Yet this is what ‘experts’ are constantly doing in the search for certainty about future predictions of risk or growth. They are almost always invariably wrong. In order to make progress with trial and error there must be room for and consideration of disparate views in order to reach a consensus for going forwards to see if the idea worked or not . Trial and error. It has been known for a long time in the business world that large companies stop being creative. The reason is that they get so large that centralised control from head office is all about homogeneity within the company to maintain its identity and integrity. Anything challenging that is expelled rapidly. At this point the only way they can do more business without new products is to increase market share by monopolisation and by marketing. This is why all companies have a sine wave life. A slow start, an exponential rise , a tailing off and sudden decline as the ‘new idea’ company takes off.  Coca cola , Amazon , Tesla, Apple have no new ideas but are experts at monopolisation and marketing. They also lobby to suppress competition for  new ideas. There has been research looking at the decline of civilisations in the past and all of them collapse after they reach a point of maximal communication within the empire. Ie at their equivalent of globalisation. Wherever there is no progress and suppression of new and or better ideas there is always regress. Now we have social media where the crowd narrative expels, vilifies and suppresses anything that disagrees with that narrative. Unfortunately social media is often manipulated by the powers that be to create a crowd narrative . Additionally, fake news, which is usually more shocking  and more likely to spike the pleasure hormone dopamine, travels through social media six times more rapidly than real news. Humans are hard wired to respond to structure hierarchy and leadership and crowd opinion and to respond to fear stimuli automatically without thinking. Therefore any tool of mass manipulation such as social media in the wrong hands can and has had disastrous consequences . Indeed the psych ops teams used by individual governments to get their citizens to comply with useless and at worst highly damaging measures during the  ‘covid epidemic’  have been legally termed a military weapon. In other words governments used a military weapon against their own people. This was only necessary as the measures used were dictatorial, illogical, inconsistent and dangerous.  Wherever you hear the term ‘we are following the science’ combined with suppression of alternative views -especially suppression of the truth- you know its a scam. For sure.  Of course this is also an example of our leaders not taking any responsibility at all.  Political correctness is another mass media crowd narrative driven by the powers that be to destroy structure within society. It demands compliance no matter how illogical the requirement. It demands equal outcome for all which is often damaging as we are not all the same. We have the same rights but all of us are different.  Compliance is usually effortless and gains approval of the mass media and carries with it no responsibility. This is called virtue signalling. Eg I am wearing a mask. Aren’t I a good citizen? Worse than that is virtue signalling of the minorities which carries with it entitlement eg I am gay or I am LGBT aren't I special just for existing and everyone can and should recognise this talk about me and celebrate me. For doing nothing. Therefore virtue signalling and the entitlement associated with it is the opposite of responsibility and in fact carries something else dangerous which is blame and fault. Eg : You are not complying , you have not employed more gay people , you have not converted half your toilets to LGBT even though we are a tiny minority and the rest of you will have to queue up to use the rest. It is your fault and you must be punished. Being gender fluid is virtue signalling instead of taking responsibility for being the sex that you are.  Men, you are all bad. It is your fault. Take no responsibility and be punished or vilified.  Women: don’t take responsibility for being women, you can now be men so you can sleep with lots of men and women  and you must all be having careers and employers must preferentially employ you even if you are less qualified than your male counterpart. The result? Women who go to university have a 50% chance of hitting their 40s childless and often single or in dysfunctional relationships. Birth rates in the West have dropped off a cliff and now the birth rate is 80% that of the death rate. IIn Norway adult diapers are outselling baby diapers. In developing countries not hit by mass media and political correctness the birth rate is much higher than the death rate.  People confuse fault and responsibility and they are totally different. Fault looks at the past and usually requires punishment. Progress is usually a casualty of this process and in the rare cases there is progress it is accidental. Responsibility is being self aware and admitting when something goes wrong and taking steps to rectify the consequences and to improve future endeavours.. Now you can see that the mass narrative by global communication is purely set up to run on mindless compliance and blame and punishment if you do not comply . Responsibility taking is the trial and error approach in a complicated system which is the only way to progress. It is also the only way to be tribal or what I call tribe compatible behaviour. We are hardwired to be tribal. Our health, both mental and physical, even depends on it.  We take responsibility to function better within the tribe and to collaborate and help others which we are hard wired to do. You can imagine a tribe run by blind compliance and punishment and expulsion of original thinkers would quickly wither and die. This is what is happening to us right now.  Our leaders for decades have been reversing  their leadership style from command and control where everything is centralised and produced and implemented by the government  for the good of the people and has now changed to one of  abrogating all responsibility through the implementation of commissioned and or imported policies and models . In the vacuum which is left comes the chaos of political correctness and global mass media and social media narrative.  It also causes far more corruption amongst politicians. Since they have no responsibility and everything they do is responsibility avoidance it encourages self serving behaviour and entitlement.  Taking responsibility is core to the mental and physical health of the individual . It is a commitment on a daily basis to algorithmically be better than the previous day. As a society it is the same . If our leaders do not go back to this and if social media is not severely restricted and controlled we are being led off the cliff face of our existence virtue signalling as we do so. GetBlueMail for Android

All the great minds including religion tell us that if we are to progress in life we need to shoulder responsibility which involves hard work and pain. They don't make life sound too appetising with the partial exception of religion in which faith is innate . We argue that they miss out one of the key secrets of life which is self esteem. Thanks to Angela who made this a lovely Podcast touching on many issues affecting our lives including narcissism , the universal wage, Dave Mustaine and Socrates.

PTSD first defined in soldiers returning from the Vietnam War and officially recognised since 1980. The distilled essence which you won't find anywhere else is as follows: Similar to phobias there is a processing block causing an emotion logic gap: I know I should not feel like this but I can't help it. This is because we are hard wired to avoid or reduce anxiety so the brain actively suppresses anything causing anxiety so you can't think about it long enough to bring the emotion down to the logic. No amount of sense or education helps here which is in contrast to a real danger where you need tools and education without which just thinking about it will not help at all. There can be minor and major processing blocks. There can also be a processing block from a misperception of an event so here the processing needs to overcome the discomfort of having got it wrong and the consequences of that. It's easy to see how we all have various degrees of emotion logic gap. For instance have you found that no matter how well you explain something to someone they won't change their minds? Even if you know they have understood the logic? It is because it is too painful to do so and they have no reason to go through that pain. Or how many times have you done something knowing it is wrong just because you want to for various reasons? Here again there is a type of processing I teach bit it needs self awareness and motivation. Yet the harm from chronically raised cortisol from even mild processing gaps can be measured by improvement in all aspects of mental and physical health when it is dealt with. It is why I say you only have clarity of mind at two points in your life: 1 when you are borne, 2 after you have had good therapy by a true expert which you pay for. (The payment indicates your motivation versus just turning up). Life time prevalence of PTSD 8% of the population, about 90% are exposed to trauma including unexpected death of a loved one, equating to a lifetime occurrence of 5 separate traumas in men and 4 in females. Women are less likely to be exposed to traumas than men but the traumas they are exposed to are more likely to cause PTSD such as rape and sexual molestation where as males are more likely to be exposed to combat and witnessing trauma to others. About 30% of women view their child birth as traumatic with 30% of those developing PTSD hence about 10% of all mothers have PTSD. About 25% of acute medical problems including ITU have PTSD. Psycholgical sequalae of PTSD: Clinical depression , alchol and drug abuse. Predisoping factor: Clinical depression. Self report questionnaire: PCL-5 Post traumatic stress disorder Check List for DSM 5 20 questions scored 0-4 relating to the previous month. DSM 5:  SIACAD Stressor Intrusion Avoidance Cognition Arousal Distress More than 1 month Can specify whether dissociation or delayed onset. Routine debriefing re living trauma may make it worse CBT 4-5 sessions, EMDR, Reprocessing Live Exposure SSRI SNRI Psychedelics FDA approval pending Transcranial Magnetic Stimulation Atypical Antipsychotic , ECT Important nuances: Chronic loss of control eg bullying or lock-down = Prolonged Duress Stress Disorder Minor trauma still causes processing blocks or impaired processing which needs to be properly processed either with self journaling or with reprocessing therapy. In fact Professor Pennebaker showed that in Yale University students self journaling difficult events reduced cortisol and improved mental and physical health and exam results. Naomi Breslau The Epidemiology of Postraumatic Stress Disorder Jounral of clinical psychology 2001

Stutz Dr Theo I would be fine if I knew what direction to go in I would fly instead I become lazy . We also discussed the first step in therapy which is connecting with your internal energy You do that in 3 steps: 1: Diet exercise and sleep  2: Connecting with others as we are tribal 3: Connecting with yourself your underlying feelings which is self awareness most effectively done by self journaling. The Part X is  that part of you stopping forward progress which could include the Shadow self or the Maze or the Snap Shot or simply the judgmental antisocial part of you. Eg you’ll never be good at that, or who wants to do that , or you are wasting your time trying this. Radical acceptance is a tool to help you get over something bad. Grateful Flow helps deal with negative thoughts and Loss processing deals with loss The key is to understand that for forward progress  and overcome Part X you need to go through a life time of: Uncertainty pain and constant work. It is this process you need to enjoy ie the journey rather than the destination.It is overcoming Part X that leads to growth. Failure pain embarrassment connects you to the universe you are saying I need your help I cannot do this without you. Stutz says confidence is an appetite for uncertainty . I say this is not true because confidence is knowing how to do something which by definition is being certain. Rather self esteem is an appetite for uncertainty because  self esteem is the degree of positivity with which you view yourself and therefore an expectation of positive outcome . If things do not go well self esteem protects you from the negative effects and instead helps you learn and move on and  apply those lessons in your next steps. I am the one who gets to decide and take the next step. It will almost certainly be imperfect but progress is made by taking the steps  aka string of pearls each with a turd in them Indeed research shows that dopamine hits come from achievement and reward in general but it is much greater if the reward is unexpected. Hence watching sport has an element of unpredictability which is why so many people enjoy it.  . Indeed when Formula 1 became too predictable the audience ratings fell so they changed the rules to make it more unpredictable. It is a positive expectation of an outcome that raises dopamine rather than the known outcome itself. The positive outcome will raise dopamine only if is unexpected. This explains how you can enjoy the journey of uncertainty pain and constant work. Your self esteem gives you an expectation of a positive outcome. It is the positive anticipation raising dopamine that makes this process enjoyable. This is especially important because it helps with sense of achievement and growth. The greater the effort the more meaningful the achievement. This then enables the parallel step of balance : Effort and reward must be balanced. Since more of life is effort rather than the result then the mechanism of being able to tolerate the effort is a  positive expectation of success. Once you put in the effort the sense of achievement is fulfilling and makes you grow. Positive self esteem also helps us use failure as a growing opportunity and simply includes  lessons learnt as part of the effort to  the next step all under the umbrella of positive expectation of overall outcome. Snap Shot relates to setting of a goal  eg the perfect wife, the perfect success , the perfect amount of money in the bank which is static concept and has  no depth and does not allow for ongoing progress with pain uncertainty and constant work. There is no perfect nirvana. Goals are illusionary needs and living life like this is one of the worst inventions of the Western World.  When the snap shot does not give you nirvana and cure your inner unhappiness you get much more depressed. The Shadow is the part of yourself you are ashamed of.: This is how I see myself and I felt so much shame that I was denying myself and  and others would no longer see this if i got more successful Visualist a time in your life you felt inferior embarrassed ,rejected, despondent ashamed its a part of yourself that you that you wish you were not and you cannot get rid of How does he feel about you, how you have dealt with him how you have treated him and see what he says Denying and being ashamed of it THe shadow feels hurt angry and upset The shadow wants attention not from the world -does not need an academy award-  but from you The shadow wants to be acknowledged and included and celebrated as a beautiful part of you So in high pressure high stakes situations the goal is not create a faultless performance but to include the shadow self and tolerate whatever happens. Because if I cam content with my true self then other peoples opinions affect him less Ignore the shadow self and he will make you do destructive things. Connecting with your shadow self and having a sense of wholeness means you are happy the way you are, you don’t need to anything else to make you feel better.itis very freeing Maze refers to when someone does an injustice to you and you remain angry seeking or hoping for restitution which usually never comes. Stutz says instead take the love you wanted from the world around you  Active Love - you are unlikely to be paid back by the person so you may as well take it from the universe around you.  by closing your eyes and imagining this is happening then concentrating it in your heart and then sending it and physically feeling it go into the other person so that you become one with love. This is not for their good it is for your own good to free you from the maze. In terms of my coaching this reflects forgiveness but is not as powerful as understanding. For instance you can understand why something happens because it is in someone's nature. That does not need forgiveness.  It requires understanding of reality and what is possible and what you can then do about it. You understand their nature and have expectations according to their nature and act accordingly. For instance you dont put your hand in the mouth of a tiger. You now it will probably bite and you certainly dont get angry. Ask yourself do you want to be right or do you want to create something. Radical acceptance: when something bad happens you don't just think that you will sooner or later recover from it, or stay stuck in a cycle of self pity ,you have to squeeze the juice out of it. Learn your lessons in whatever happens First: dont tell yourself anything negative Second: find something that is positive about it So squeezing the juice out of it suggests that not only do you have the will but also the faith that there is something valuable there If you see all events as having value you are in the zone of tremendous opportunity The Grateful Flow wants to choose the positives. Every thought will affect your mood whether positive or negative.  Part X wants you to have the negative thoughts to just see clouds even though sun is behind the clouds and coming. The grateful flow is not the grateful thoughts but the process. You name 4 things that you are grateful for, the smaller the better as you can connect better then continue in your head. After a while you feel you will create another grateful thought but you dont you block it  so all you feel is the force that would create a grateful thought and as it gets stronger and stronger you  feel taken over by it. You don't just repeat the same grateful thoughts you look for new ones and that process of creating grateful thoughts will change your mood. Gratefulness is a state you want to be in as much as possible. It helps you break through the cloud, What you don't do is argue with negative thoughts. You cant reason with emotion. Loss Processing: The potency of Non attachment . You want to pursue it  and pursue it hard but you are willing not to have it, you are willing to lose Think of something you don't want to lose and imagine grasping it like you are hanging onto the branch of a tree. Then visualise letting go but its not a bad sensation.Its slow and gentle to your surprise. Then you say silently I am willing to lose everything but really feel the intent behind that. Then you imagine you fall into the sun and burn up losing your body (so you lose everything) and instead become part of the suns rays radiating out a very loving giving outflowing sensation and that sun is surrounded by other sons doing the same thing as part of the sun world all saying we are everywhere. All you can do is give you cant take. You cant grasp onto anything. If you have difficulty with that then think of yourself as moving towards non attached. In fact as a human it would not be good if you were totally non attached. If you are moving towards non attachment then no one thing or person leaving you can take away your sense of wholeness. Happiness depends on how you accept that  you cannot completely figure things out and what you do about it.  RAGL The Active Love, Grateful Flow , Loss Acceptance,Radical Acceptance

"Where are you from" is considered a micro aggression. Of course in a harmonious society this is a reasonable question indicative of genuine interest. Indeed in a harmonious society to suggest any other motive would be nonsense. However it has become a problem for two reasons in this age of societal collapse where political correctness has been the latest disintegration stage. The first is people are easily offended because they are unhappy and are insecure about their own identity and feel they have no control apart from the politically correct right to offence for which there is no cost and no responsibility. Of course people should be proud of who they are and pride inspires respect and interest and education. Indeed who you are is simply reality and that is the healthiest thing to deal with. Not edging anxiously round political correctness. The second is that the indigenous population is also feeling unhappy and insecure about their identity as they see it collapsing around them manifested by discussions over whether Christmas should be cancelled or summer school exams moved due to Ramadan. As usual we are all too blinded by the symptom to really address the real problem which is something far more sinister. The real fault lies with our leaders. It is their responsibility to provide leadership including national identity. If someone wants to move to any country it should be clear to them that they will be respected for who they are and where they come from but the priority is to integrate and take on the identity of that country and it's customs. In evolutionary terms if something is familiar it's probably good as it has not already eaten you. If it's not familiar it could be a danger. Hence we dont like people who are different. Studies back this up by showing certain of our brain cells which respond to social queues -mirror neurones- either don't respond or respond less when observing someone of a different skin colour. It can be remedied by education. Hence the phenomenon of racism is a natural phenomenon but the fact it happens is a sign of a badly run society. People don't feel integrated and instead stay close to those they identify with which is why cities become mosaics of different cultures and religions with limited mixing. For instance we all know which cultural groups live in China town, Finchley, Hownslow, Walthamstow, Lambeth -or even large swathes of Birmingham.... Once you have coalescing of cultures each rubbing shoulders with each other then you have friction and strife. Add into that increased immigration recently with no effort or requirement of integration then you have a dry tinder box where small incidents can act as kindling for the underlying problem. For instance the UK is a Christian country. The King of England is the head of the Church of England. At citizenship ceremonies you have to swear allegiance to the King of England. Saudi Arabia is much clearer. It has strict requirements for cohesion to its own culture and religion and forbids public display of other religions. Do you think they would consider moving Ramadan to allow foreign students to study for exams? Who is the stronger more harmonious society? The problem with our leaders is that being a democracy they have to get elected hence they have to please the vast majority of the population who make decisions emotionally on top of which they are misinformed by the media. Therefore logical well infirmed voting is not only a pipe dream but those seeking election just make promises that sound good emotively for quick votes. This is nothing to do with firm fair leadership which will displease the politically correct mass media. Try enforcing British culture, identity, values let alone the Church of England. This general collapse is seeping into every fibre of our society including health, social services police. Everyone avoids responsibility behaves obstructively and destructively rather than constructively and takes offence. It is Marxism with the eradication of the middle and upper class -often and preferably unceremoniously- leaving only the elite and the vast mass of everyone else and this always ends in disaster and revolution.

Gut Immune Body Brain Axis. Dr Gundry: Leaky Gut, gut microbiome and diet Renowned Cardiovascular Surgeon who realised that all he was doing was treating the symptoms so he studied the underlying causes. The lining of the gut is one cell thick As bacteria break down the gut that is when ageing starts Ibuprofen or roundup disastrous the bacteria population Skin is a mirror of the lining of the gut Joints do not naturally wear out. Animal model C Elegans as bacteria begin to break down the wall of the gut that is when ageing starts 105 year old people have a diverse set of bugs identical to a healthy 30 year old. It is not attacking the wall of the gut. Ecermansia musinophilia. Lives in the mucous layer whose job is to trap lectins plant proteins looking for sugar molecules and to protect the wall of the gut from harmful bacteria. Ecermansia musinophilia eats mucus which in turn makes more mucus. Metformin works by increasing mucous and this change in bacteria makes some people have mild diarrhoea as the bacteria change. If we damage this lining eg ibuprofen or food with roundup destroys the bacteria population and gut lining. Glyocosade an antibacterial damages Ecermansia Musinophilia even though it does not directly affect human cells. Antibiotics in food or direct prescription eg ladies who take low dose for UTI have a higher incidence of heart disease. Heart disease is an autoimmune disease starting in the gut. Cholesterol is an innocent bystander which gets sucked into the inflamed wall of a blood vessel. Infants with heart transplants have coronary artery disease with pathology identical with typical coronary artery disease. Lectins which are a foreign protein which can stick to sugar molecules on the surface of blood vessels are the cause of atherosclerosis and removing lectins reduces those markers. Lectins are one of the plant defence systems. Sticky proteins that look for specific sugar molecules to stick to which insights an inflammtory response. Joints do not normally wear out. Usually you can find bacterial particles in the joint fluid of arthritis Because Lectins broke down the wall of the gut. 65% of the immune system is behind the wall of the gut because the gut is where the outside word gets through. A reason why we store fat in the gut is to provide energy to the immune system. Similarly fat on the outside of atherosclerotcic blood vessles correlates with the severity of inflammation. Fat is not the cause . It is there because of the inflammation and the inflammation is there due to the leaky gut. The immune system responds to antigens on bacteria of viruses. Lectins have antigens with cross reactivity with other proteins in the body. Eg thyroid. Nightshade vegetables or peanuts Lectins disrupt the microbiome and break up the lining of the gut allowing entry by lectins and by bacteria or bacterial particles. Hence if you inject a bacterial lipopolysaccharide into a person you can induce septic shock. Alzheimers Parkinsons is neuroinflammation. Most amyloid is produced by bacteria in the gut. Therefore 40 billion dollars invested in antiamyloid drugs has been a waste because amyloid is produced by the amyloid producing bacteria inthe gut fet by western diet. Then the amyloid has to get through the wall of the gut. Once they get through the gut wall and goto the brain it will produce more amyloid. Cholesterol and amyloid coexist in dementia in those with the apoE gene. The apo E gene codes for a carrier molecule because it is less efficient at transporting cholesterol. It cannot get out of the cell after it has been attracted by inflammation. Faecal microbial transplant: 1970s broad spectrum antibiotics came out which made it much quicker to treat infections but it also wiped out the gut bacteria. Normally 10000 species of bacteria. Pseudomembranous colitis was caused by Clostridium Difficile over growing. Initial study done from the faeces of medical students. Faecal enemas treated the pseudomembranous colitis. Meat with animals treated by antibiotics can also cause problems. 60% of faeces is bacteria Oral microbiome and cloud of bacteria around us –Holobiome . This defines our personal space. Kissing is a human and ape characteristic. Exchanging oral microbiome. Bacteria decide whether the other person's bacteria are compatible with them. Women have a gut feeling because they are more capable of listening to their microbiome. We inherit our microbiome from our mother. All of the mitochondria are involved with bacteria inherited from our mother. Bacteria communicate to their ‘sisters ’ie the body’s mitochondria. Autism: kids have a different microbiome than ‘normal’ The placental microbiome is important in educating the foetal immune system. Oral faecal transplants for 6 weeks in autistic kids. Almost immediately 50% autism symptoms reduced. Ecermansia like tubers, mushrooms, -study in Asia find 90% reduction in Alzheimers with two cups of mushrooms a week. Inulin containing compounds eg chicory, radicchio, jerusalem artichoke. Exercise women who exercise routinely from midlife have a 90% reduction in Alzheimers. In those who get AD it happens 11 years later. Housework can be important part of exercise. Meditation and yoga also changes the gut microbiome. Lymph system in the brain in deep sleep -early in the sleep cycle-shrinks by 20% and these bad proteins are squeezed out. You need a 3-4 hour window between sleep and dinner because blood flow diverts to the gut. Olive oil /walnuts / mediterranean low fat diet: first two groups improved memory after 5 years. 3rd group lost memory Those with CVD had a 30% reduction in events, the low fat group continued CVS events. Polyphenos in olive oil grow proteins TMAO is made by gut bacteria primarily from animal protein especially choline eg egg yolk and carnitine . TMAO damages blood vessels. Polyphenols in certain olive oil and red wine balsamic vinegar that paralyse enzyme systems in the bacteria so they do not make TMAO. However the logical error here is that eggs which are high in choline are not associated with increased morbidity. Vitamin D at least 5000 units a day . Almost all cancer patietns and autoimmune pateitns have low vitamin D. HIgher your VItamin D the longer your telomere. Stem cells in the gut are simulated by vitamin D. VItamin C Lectins are present in most plant foods but especially high in: legumes, such as beans, lentils, peas, soybeans, and peanuts nightshade vegetables, such as tomatoes and eggplant dairy products, including milk grains, such as barley, quinoa, and rice The Roll of Inflammation in Depression and Fatigue Frontiers In Immunology: CH Lee 2019: Immune system link to depression first noticed with immunotherapy eg INFa (which activates an inflammatory antiviral response) for Hepatitis C : associated with raised pro inflammatory cytokines and depression and fatigue. 20% of patients treated with INFa developed depression which resolved on discontinuation but also increased the risk of depression in future. Also people with higher IL6 aged 9 were more likely to have depression aged 18 in a dose dependent manner. Innate immune system seems to be lower in depression eg NK cells and also less anti inflammatory regulatory T cells whereas inflammatory monocytes are activated. There is commonality in immune activation from autoimmune disorder such as multiple sclerosis or immune reactions in sepsis. Antidepressants reduce inflammation while a higher baseline level of inflammation predicts a poorer treatment response. People with depression have been shown to have higher inflammatory markers which can be used to predict treatment efficacy and future recurrences of depression. Elevated inflammatory markets eg TNFa after an MI disrupt the blood brain barrier causing depression. Inflammatory changes in the brain with raised TNFa in the hippocampus and striatum precede development of depressive symptoms. Neurogenesis is inhibited by the kynurenine pathway which is rescued by both inhibitors of this pathway and traditional antidepressants. TNFa also increases glutamate release causing exocytotic damage to surroundings neurones. Conditions associated with chronic immune activation such as asthma, atopy, diabetes m MS, RhA, SLE are all associated with raised levels of depression eg 36% of asthma have depression who also had higher TNFa than those who were not depressed. 75% in RhA MS up to 50% risk of depression. Acute inflammation with sepsis also causes depression and raises the risk of depression in future which in animal models can be reduced by using steroid during the acute sepsis. Antidepressants reduce inflammatory markers perhaps SNRI more effective than SSRI and also ECT adds in return to normal of NK activity. Directly reducing the immune response eg anti TNF a or Caspase Inhibitors have been shown to reduce depression. Rituximab which is an antibody that targets and depletes B cells in the treatment of RhA also reduces depression. Aspirin can reduce depression but can also reduce the effect of an SSRI.

Eliot Jacks 1965 Mid-Life Crisis Paradox of prime of life fulfillment in life but seeing it as dated as death is just over the hill National Geographic 2012 Apes Have Midlife Crises, Too—And It May Help Them Middle age ruts may act as natural motivators, scientist says. BYAMANDA FIEGLNATIONAL GEOGRAPHIC NEWS PUBLISHED NOVEMBER 20, 2012 A national survey of Midlife in the United States conducted a poll to determine how many people experience midlife crises. Approximately 26% of the participants reported having a midlife crisis. Most survey participants reported that their midlife crisis occurred before age 40 or after 50, however. That raises the question about whether these crises were truly related to midlife since midlife is typically considered age 45. Out of the one in four people who say they had a midlife crisis, the vast majority say it was brought on by a major event, rather than age. Factors that triggered the crisis included life changes such as divorce, job loss, loss of a loved one, or relocation. Happiness Slump Many studies indicate that happiness is U-shaped. A gradual decline in happiness begins during the late teen years and continues until an individual is in their 40s. Happiness begins increasing again in an individual’s 50s. Data on half a million Americans and Europeans found this trend to be true. Individuals in their 60s reported they’d never been happier, but people in their 40s felt like they were at an all-time low. This U-shaped curve doesn’t appear to be universal, however. It’s more prevalent in high-income nations. A gradual decline in happiness may explain why some people seem to hit a midlife crisis—they’re in a happiness slump. Even though data suggests people become happier again later in life, there’s a pervasive belief that happiness continues to decline as we age. So, some people in their mid-40s may think life is only going to get worse, which may spark a midlife crisis. Some people may experience depression during midlife and refer to their depressive state as their midlife crisis. Women between the ages of 40 and 59 in the United States have the highest rates of depression (12.3%) of any group based on age and gender, according to the Centers for Disease Control and Prevention. Suicide rates are highest during middle age—among white men in particular. People between the ages of 45 and 54 are more likely to kill themselves than any other age group.   A 2016 study published in the International Journal of Behavioral Development found an upside to the midlife crisis—curiosity. Researchers found that people who were experiencing a crisis—whether it was a quarter-life or a midlife crisis—experienced enhanced curiosity about themselves and the wider world around them.1  The distress and uncertainty participants experienced brought about openness to new ideas, which could bring insight and creative solutions. That curiosity could lead to new breakthroughs or new opportunities, which might be the silver lining in the midst of a crisis.   Professor Mark Jackson Royal Society    Psychological: Identity Crisis Biology: Awareness of ageing and deteriorating vigour. Includes women with menopause and empty nest. Middle of 20th Century standardised life course. Ie not just biological but socially prescribed. Time to marry, have children and retire. By the 1950s life expectancy had significantly increased and women had started marrying earlier. Women 20-24. Fewer children clustering them earlier in the marriage. So a longer period of life after childbearing. Men’s life was determined by occupation . Decades in the same job until retirement.  Hence everyone was going through the same changes at the same ages. Ageism started growing with a greater sense of where we should be at certain times of life. Failure to meet expectations. Keeping up with the Jonses started in 1913 in a comic strip. Middle age was sandwiched between adolescent crisis of children and old age of parents. Inheritance happened decades later increasing pressures on couples bringing up children. The extended life course also led to the question ‘is this all there is, do I want to live with the person for the next 30 years’ The realistic prospect of a life long marriage was questioned and the concept of serial marriages was introduced. 1969 the divorce act changed removing the concept of marital offence making it easier to divorce.   Pull to a better life eg Life begins at 40. First used in 1914 by the widow of an army officer  Theodora Parsons, who had trained ladies in physical fitness to keep the mind fit. We do not begin to live until we begin to die. She was addressing middle aged women who were overweight and let themselves go therefore she wanted these ladies to get fitter to aid the war effort.  However that phrase became key in self help literature from the 1930s onwards. Indeed it encouraged older people to enjoy life and work less in order to allow younger people into work during the recession of the 1930s. The American Dream was also sketched out:  the dream of a social order in which each man and woman is able to attain their maximum potential. We could look forward with some hope. After WW2 the collapse of the American Dream was replaced by  the dream of motorcars and high wages as well as human consumption.  Happiness in a hurry.  The idea of life begins at 40 ie life getting better not worse was a sense of narcissistic belief thinking they are due happiness love approval  sex excitement all this is denied me in this stale marriage let me get rid of her. We are aged by our minds our bodies and by history and culture.   Midlife crisis is much more marked in Western than in Eastern cultures.     Barbara Waxman Tedx 2021: People believe their best years are behind them      

Not medical licensed advice . Always consult with your doctor: New Treatments For Obesity BMI: 25-30 : overweight  >30 Obese WHO 2016 40% are over weight and 13% obese slightly higher in females . This is triple that in 1975 UK 2019 House of Commons Library  40% are overweight and 30% obese higher in middle aged and elderly men NHS 2021: Children Obesity has gone up in 12 years from 19% to 25%  The Surprising Link Between Chronic Inflammation & Obesity—Plus What You Can Do About It May 5th 2021 Leptins are hormones produced by adipocytes that communicate with the hypothalamus to reduce eating. If you have too much leptin you become leptin resistant and do not stop eating. High leptin levels are also associated with  chronic inflammation. Conversely losing weight reduces systemic inflammation.  REVIEW article Front. Physiol., 29 January 2020 Sec. Clinical and Translational Physiology Chronic Adipose Tissue Inflammation Linking Obesity to Insulin Resistance and Type 2 Diabetes Frederika Zatteral The key mediator of inflammation in obesity is the innate immune system cell the macrophage that can account for up to 40% of adipose tissue and it differentiates into a pro-inflammatory M1 macrophage setting up chronic inflammation. Obesity and Inflammation: A Vicious Cycle Does obesity cause inflammation or does inflammation lead to obesity? Jun 25, 2020 Jennifer Lutz Obesity causes chronic inflammation via a chronic immune reaction initiated in the adipose tissue but inflammatory cells can go round the body. In addition gut inflammation may be a result also of the poor diet that led to the obesity. We know that obesity has tripled in the last 50 years such that 40% of the western world are obese. In fact 75% are prediabetic. Cardiovascular disease leading to cardiac disease and strokes, diabetes, cancer, depression, osteoarthritis all feed back and make it more likely you will continue to be obese. Higher adiposity and mental health: causal inference using Mendelian randomization  Francesco Casanova,Jessica O’Loughlin,Susan Martin,Robin N Beaumont,Andrew R Wood,Edward R Watkins,Rachel M Freathy,Saskia P Hagenaars,Timothy M Frayling,Hanieh Yaghootkar... Show more Author Notes Human Molecular Genetics, Volume 30, Issue 24, 15 December 2021, Pages 2371–2382,   There is a bidirectional relationship between depression and obesity. Genetic sorting showed that it is obesity per se and not the metabolic unhealthiness due to the obesity such as diabetes that leads to depression. That said diabetes from obesity causes depression although obesity itself causes systemic inflammation which is an independent risk factor for depression and cancer. There are also huge psychosocial effects of obesity on mood. Once-Weekly Semaglutide in Adults with Overweight or Obesity New England Journal Of Medicine March 2021 John P.H. Wilding, Once a week subcutaneous Semaglutide reduced weight by up to 20% Semaglutide is a GLP-1 agonist so suppresses Glucagon and increases insulin hence controlling blood sugar. It also slows gastric emptying  increasing satiety and acts on Receptors in the Arcuate Nucleus in the brain to increase satiety. It is already licensed to treat Type 2 diabetes. It also reduces the risk of cardiovascular complication in Type 2 diabetes and at a cellular level reverses atherogenesis. There is a question on worsening the risk of retinopathy. Other GLP-1 agonists : Liraglutide Setmelanotide. CpdFDA Approved Medication for treating Obesity Phentermine, diethylpropion,benzphetamine, phendimetrazine , Orlistat, Phentermine/topiramate Qsymia, Bupropion/naltrexone, Semaglitide, Liraglutide, setmelanotide Cpd Phentermine-topiramate: First combination drug for obesity Int J Applied Med Res 2015 Singh et al Phentermine is a centrally acting sympathomimetic that reduces appetite and topiramate enhances GABA ergic transmission reducing Dopamine Response to food. This combination causes up to 10% weight loss maintained in 50% for 2 years. The relationship between early weight loss and weight loss maintenance with naltrexone bupropion therapy. THe Lancet Discovery Science 2022 Le Roux et al Naltrexone blocks opiate receptors and bupropion (wellbutrin/zyban) blocks reuptake of dopamine  -reward pathways- .and noradrenaline . Weight loss is maintained at 1 year Both medications enhance each other on feeding and satiety

Depression: The most important thing anyone reading this needs to know is that everyone with depression will get better. The sooner you treat it the quicker and better the results. LIfe time prevalence 4%, in fact in the USA up to 10% struggle with depression. 280 million people world-wide suffer from depression. 20% risk of suicide in untreated depression. Used to be the 5th commonest cause of illness and death, now it is the commonest. It is not because we have all become genetically susceptible to clinical depression, rather we have become more and more unhappy and stressed with modern life. What has risen is social media with the pressure to be perfect compare and online bullying and economic uncertainty as well as recent lockdown and health hysteria and vaccine mandates and most recently Ukraine War and spiralling energy prices. Mental health referrals are at all time highs. Neuroscience New and Research July 2022 Ruairi J Mackenzie: Serotonin theory has been seen for years as an oversimplification. SSRI medications do often work in depression but depression is multifactorial and likely more than one illness.  The Biopsychosocial model of depression is preferred. Even Epicurus 2,500 years ago and before him Buddha both said that seeking of pleasure would cause unhappiness as pleasure is transient and leads to more seeking of it hence is not only meaningless but destructive. Yet as a society that is exactly what we have become: cyclical reflex dopamine seekers especially with social media. Furthermore the teaching of socialisation has been reversed with smart phone hunched pleasure seekers. We are all becoming depressed children with no effective parental supervision apart from the social media CEOs temping us ever further down the rabbit hole of instant gratification.. One of the definitions of the most dysfunctional members of our society namely personality disorders is self obsession as this is not tribe compatible yet the rest of us are rapidly heading that way pulling apart the integrity of our society and even civilisation itself if it continues. Close on the heals of self obsession is loss of boundaries and rules aka political correctness which is a Marxist view of demanding the same outcome for everyone despite the fact that everyone is different. Without boundaries we are lost  because we have evolved to function in tribes with structure hierarchy and leadership. Now we are led by self serving politicians who will say anything that gets them elected which is what they think the voters want but voters are influenced by mass and social media. Add into that that 98% of what we do and think is emotional and not logical which means that currently we are being led by media driven hysteria which the politicians respond to. Even more dangerous is that media controls the masses on a global scale now almost instantly. Diagnosis of clinical depression: Diagnostic and Statistical Manual 5th Edition Americal Psychiatric Association  and International Classification of Diseases 11th Edition 296. And F32 codes respectively: Require are certain number of symptoms for a certain period of time typically 5 symptoms for at least 2 weeks although this can be altered according to severity. Symptoms making up depression include: Low mood typically worse in the morning improving as the day goes on (diurnal mood variation)-  said to be due to raised levels of cortisol in depression with the coritsol peak being in the morning and lowest in the middle of the night-  I have seen severely depressed people walking around the ward at 2am feeling fine. This is one the reasons metyrapone is used with is a cortisol synthesis inhibitor in a resistant depressionL Ted Dinan et al. Disturbed sleep typically waking early in the morning unable to get back to sleep Reduced appetite and weight loss (although people can comfort eat) reduced energy concentration enjoyment motivation confidence libido and suicidal thoughts. Treatment of depression: Firstly there needs to be a risk assessment of suicide . in 2005 1.5% of all deaths were suicide and the commonst cause was depression and it is going up. Investigation: Biological: Thyroid , metabolic, autoimmune, dietary, epileptic , raised indices of inflammation. Females my have hormonal issues including sensitivity to progesterone in oral contraceptives. Psychological: Aristotle argued that virtue is functioning according to you values and beliefs . A blunt knife is not a vrituous knife as knives are designed to cut. A virtuous human being is a human able to function according to their values and beliefs which is socialisation and reproduction. However in todays goal oriented society the pressure is one of endless goal seeking and perfectionism. That alone severely raises stress and cortisol levels but also makes you more unhappy as you not functioning according to your values and beliefs. It also means that if you achieve something at the cost of your values and beliefs you value it less in any case. Hence it is impossible to ever be happy with he result that more and more of us are depressed. Note that chronic sleep deprivation causes clinical depression. Treatment of depression: Classically it is a combination of medication and psychological treatment eg cognitive behaviour therapy. However one third of patients have raised indices of inflammation and those are likely to be resistant to antidepressants and can respond to aspirin. Furthermore for moderate depression regular exercise is as effective as antidepressant. Antidepressants: Currently they all work on a combination of serotonin noradrenaline and dopamine and a couple work additionally on melatonin receptors. None are better than the other although the newer ones have less side effects. The new generation coming through are going to be based on psychedelics and glutamate receptor antagonists . In fact the latter has a drug licensed in the UK for 3rd line treatment of depression s ketamine nasal spray. Treatment resistant depression: Requires a review of diagnosis and physical investigations then switching to a different antidepressant and raising the dose according to plasma levels , combining antidepressants and adding in thyroid hormone, lithium or antipsychotic such as risperidone. -Electro Convulsive Therapy -rTMS daily for 4 weeks. -Neurofeedback can be an alternative to antidepressants. Sleep Deprivation and Depression: National Library of Medicine Jan 2021 Why is ECT becoming a preferred treatment for depression March 2022 Maclean Hospital Harvard Medical School Affiliate Using neurofeedback as a means of reducing self blame in depression: Dr Zahn  Kings College News Centre  Sept 2021 Review of social participation interventions for those with mental health problems Social Psychiatry Psychiatric Epidemiology March 2017 Martin Webber Exercise is an all natural treatment to fight depression: Harvard Health Publishing Dr Miller February 2021 The relationship between excessive internet use and Depression: Morrison Gore Psychopathology 2010 43: 121-126 Treatment Resistant Depression: Web Med:  Dr Bruce  May 2022 Esketamine For Treatment Resistant Depression: BMJ Sept 2019 Jauhar An evidence based approach for augmentation and combination strategies for treatment resistant depression Psychiatry July 2006 Barowski Key differences between Venlafaxine XR and Desvenlafaxine: An analysis of pharmacokinetic and clinical data  Michelle D. Colvard, PharmD Mental Health Clinician (2014) 4 (1): 35–39.   A Popular Theory About Depression Wasn’t "Debunked" by a New Review Published: July 22, 2022   |  Ruairi J Mackenzie A Popular Theory About Depression Wasn’t "Debunked" by a New Review Published: July 22, 2022   |  Ruairi J Mackenzie A Popular Theory About Depression Wasn’t "Debunked" by a New Review Published: July 22, 2022   |  Ruairi J Mackenzie