2_3 Ishrat Husain: Science with Relentless Curiosity, Understanding Depression Across Cultures, and Canada's Leadership in Psychedelic Research

Today my guest is Dr. Ishrat Husain who is Head of the Clinical Trials Unit and Lead of the Mood Disorders Service at Center for Addiction and Mental Health. He is also an Associate Professor in the Department of Psychiatry at the University of Toronto. He holds a Tier 2 Canada Research Chair in Treatment Innovation in Mood Disorders. Dr. Husain's research program focusses on advancing the understanding and treatment of mood disorders across populations through biomarker-driven clinical trials of emerging pharmacological and psychosocial interventions including psychedelic therapies.

You can follow Dr. Ishrat Husain at:
https://twitter.com/IshratHusain_

Transcript

[00:00:00] Raad Seraj: Welcome to Minority Trip Report. MTR is a podcast spotlighting stories of personal transformation and underrepresented leaders in mental health, psychedelics and consciousness. I'm your host, Raad Seraj. If you're learning from or enjoying Minority Trip Report, please subscribe to MTR on YouTube at Minority Trip Report and follow us on Instagram at Minority Trip.

[00:00:18] Raad Seraj: Thank you and enjoy the episode.

[00:00:20] Raad Seraj: Today my guest is Dr. Ishrat Husain, who is the head of the clinical Trials Unit and lead of the Mood Disorder Service at the Center for Addictions and Mental Health. He's also an associate professor in the Department of Psychiatry at the University of Toronto. He holds a Tier two Canada research chair in treatment innovation in mood disorders.

[00:00:35] Raad Seraj: Dr. Husain's research program focuses on advancing the understanding and treatment of mood disorders across populations through biomarker driven clinical trials of emerging pharmacological and psychological interventions, including psychedelic therapies.

[00:00:48] Raad Seraj: Ishrat welcome.

[00:00:49] Ishrat Husain: thanks for having me, Raad. 

[00:00:51] Raad Seraj: I already warn you, I'm gonna start in a very philosophical bend here. Normally we go to how somebody grew up right away, but I think this is a good place to start because maybe it'll tell us a little bit about why you chose psychiatry as the discipline that you're committing your life to. Your bio says you're the head of clinical trials unit and lead of the mood disorders service at cam. Now I find the word disorder really interesting because in order to know what a disorder is, you have to define what order is in the realm of psychiatry and mental health. How do you define order? And from that, what is a disorder or a mood disorder? 

[00:01:26] Ishrat Husain: I think it's a great question. And I don't think it's one that's ever been posed to me in that way, but I'll do my best to try and answer it. So I think when it comes to understanding what order is I think I tie it in to a lot of it, into somebody's functioning.

[00:01:43] Ishrat Husain: I think to me, order equals functioning whether that's occupational functioning, whether you're able to do your job or not. Whether it's academic, you're able to go to school, do your assignments, things like that, whether it's social functioning i e are you able to, interact with friends, family members as to what you would usually be able to do?

[00:02:02] Ishrat Husain: So there's a baseline level of order and functioning that. Any individual person has, and it's very personal to that particular individual. And you could take that definition of order to, I think even physical order. So whether it's physical or mental I think it's re to me it's very much tied into one's functioning.

[00:02:23] Ishrat Husain: And when I then think of disorder, it would be an impact on fu functioning. So anything That affects your ability to do your job, go to school, see your friends, be with your loved ones in the way that you would usually be. To me, that is a disorder. If we bring it specific to mental health I think it's important that, every hu most human beings, 99% of people have a spectrum of human emotions.

[00:02:52] Ishrat Husain: And it's totally Non-pathological to experience everything along that spectrum of emotions. I think when any of those emotions begins to affect the order or the functioning of your life for a sustained period, it becomes a disorder. An example would be, the term depression, which people, these days in particular throw around a lot like.

[00:03:16] Ishrat Husain: I'm depressed. Or like even the term O C D, I'm, so O c D, that has become very common speak or therapy talk as a, as it therapy speak. But actually I think it's misused because these sort of definitions are, they are characterizing disorders and one is supposed to have a major depressive disorder when their low mood and associated symptoms.

[00:03:40] Ishrat Husain: Are impacting their function in various domains of their life for a sustained period of time. So that's my roundabout way of telling you what I think a disorder is. And it's very, it's very, it's actually a very nuanced way to see it as an opposite to the order in your life.

[00:03:59] Ishrat Husain: Yeah, no that, that's my view on it. 

[00:04:01] Raad Seraj: You said it was the first time you heard that question, but I think you answered it really well. One, one of the reasons why I really wanted you on the podcast cuz you do have a very nuanced way of articulating these subtle, but also I think deeply ingrained from what you just said, I think.

[00:04:15] Raad Seraj: Why do you think it's so much easier to almost propagate misconceptions about mental health? And things like, like you said, major depressive disorder and saying somebody thinks somebody's depressed is very different from being what is clinically depressed. Cuz somebody could say on one hand I think mental health treatment has, is behind many decades.

[00:04:38] Raad Seraj: I don't think anybody could argue that on the other hand. You are right? Because of prevalence of social media and like everybody having an outlet, whether it's, legitimate or not. Why do you think it's so much easier to have pop culture psychology rather than, let's say you can't, there's not something as pop culture physics because you have to ultimately build bridges.

[00:04:59] Ishrat Husain: I think a part of it is to do with society and the time we're living in. I think it's, there's just a lot more awareness of mental wellbeing and the importance of that, which I am very pleased about. I think that it's, things have come a long way. People are, feel more ready as, soci, particularly western society.

[00:05:21] Ishrat Husain: More willing and able. To speak about their emotions and their emotional challenges. It's in a way gone the other way where actually it's encouraged to talk about your emotions and what you're going through. I think that has then, infiltrated into social media, as you mentioned, mainstream media. And I think. It's, it's in, it's in the TV shows we watch. It's in the songs that we listen to. 

[00:05:47] Raad Seraj: Sorry, Ishrat, you were saying that you're very encouraged by the fact that people are much more open or encouraged to talk about mental health openly, or the challenges and so on. 

[00:05:56] Ishrat Husain: Yeah, and I think that's a function of the society that we live in. I think it's being encouraged more and more.

[00:06:01] Ishrat Husain: It's it's something that we see in television shows, we see it in, we hear it in the songs that are on the radio about people's, struggles sometimes with emotional, psychological challenges. So I think it's, that's why it's seeping through more in general conversations that we have with others around us.

[00:06:21] Ishrat Husain: I don't necessarily think there's anything negative with that. I th I just think that. We also have a role particularly somebody, for instance in my position when I'm, coming onto shows like this or speaking to media to educate the public as well about the differences between what is a non-pathological change in your emotional being to what is actually pathological.

[00:06:43] Ishrat Husain: And it's important to have that dis distinction because it really informs. The approach to how to, to how you overcome these challenges. 

[00:06:51] Raad Seraj: I really agree with you. I think it's, I think it's not the fact that people talk all about it more, even if it's, loosely based on diagnosis. I think the fact that everybody's talking about it's really good cause everybody's suffering on one way or another.

[00:07:05] Raad Seraj: I think to your point, what we have to do is have a draw that distinction by through education. Yeah. To say there's the. Really far end of the spectrum of pain and existential suffering that, medical science focuses on, but everybody else should be talking about how do we maintain a sense of wellbeing in our relationship, in our day-to-day life.

[00:07:25] Ishrat Husain: Yeah, absolutely. I think that actually I think that we should be educating our children on this, like early on is I think it should be part of their curriculum. And I think that would be a huge step forward. 

[00:07:37] Raad Seraj: How do you speak with your children about this? How do they see the work that you're doing?

[00:07:43] Ishrat Husain: Yeah, so I have a seven year old and a six-year-old. And they're quite curious. Children in general are curious. They ask me, they know I'm a doctor. They know I'm a doctor of the mind. And the mind is a very abstract concept because I don't say I'm a brain doctor, say I'm a doctor of the mind, because I think there is a difference between the brain and the mind and For them, it's, because they're so young, the whole concept of mind is very abstract still.

[00:08:10] Ishrat Husain: So I try to explain them to them that, it's sometimes people go through difficulties with sadness, with articulating their thoughts, their feelings, and that my role is to try and help them through that. I'm not sure they fully understand that concept at this point, but, I, what I do generally, my sort of way of, I really wanna facilitate communication with my children.

[00:08:33] Ishrat Husain: I want them to be in very, be very able to communicate their feelings. I think that's a really important thing. And it's not an easy thing to do actually. So that, that's one thing that I'm working on with them. 

[00:08:45] Raad Seraj: It's certainly a lifelong mission to talk about mental. I don't, adults don't do it well, nevermind talking to children about it.

[00:08:52] Raad Seraj: Yeah. Being know people who are closest in your life. 

[00:08:55] Raad Seraj: Okay, so Ishrat, let's go to your upbringing. Tell me a little bit, you've had a quite an expansive upbringing in terms of like many continents, many countries very diverse upbringing, I imagine. Tell me a little bit about how you grew up. Tell me about your parents all the different places you've been Pakistan, UK and now Canada.

[00:09:13] Ishrat Husain: Yeah, so I was born in Pakistan. I'm a pRaaduct of two physicians. I'm in fact a third generation psychiatrist, which is, whoa, pretty astounding when you hear about it. My, so I grew up part of, my, my upbringing was across three continents, as you mentioned. When I was young, we moved from Pakistan to.

[00:09:35] Ishrat Husain: The US where my father completed some postgraduate training from the us. We moved to the uk. First spent a few years there, then we moved back to Pakistan at formative time of my life. Element late elementary, early middle school years and then moved to Canada as a teenager.

[00:09:59] Ishrat Husain: Spent a few years here before moving back to the UK for medical school in my post-grad training and PhD. And then eventually returning to what I call, what I always referred to as home in a strange way Toronto. And that was about five years ago. So truly have considered myself a global citizen and have had, I've had the real sort of.

[00:10:24] Ishrat Husain: I think luxury and gift of being able to have connections personal relationships with people across the world. I have friends in three continents which is, it's great. And I think it's really informed my worldview, in terms of having that diversity of experience.

[00:10:42] Ishrat Husain: So yeah, that, that was my upbringing and I I really have an outward looking view on the world. I think, it's it's something that I think is I'm glad that my parents, I had that sort of viewpoint because I, it's made me very adaptable as well, I think.

[00:10:58] Ishrat Husain: And very comfortable with meeting and speaking to people from, all. Levels of society, all parts of the world, any type of culture. I'm very comfortable and qui and inquisitive to meet people from all backgrounds. 

[00:11:11] Ishrat Husain: I wanna dig into what it's like to be in a third, to be a third generation psychiatrist.

[00:11:17] Ishrat Husain: Cause I don't think I've spoken with anybody with that sort of lineage going that far back. More so in a Pakistani family or in, south Asian diaspora. But before that I think it's, it feels certainly more important to have a diverse perspective on life and lived experience in psychiatry versus, let's say, again, maybe in being an architect.

[00:11:35] Ishrat Husain: I think having a diverse perspective on life is useful and great, enriches your life regardless, but it feels particularly important in the realm of psychiatry or in the realm of the mind. Can you speak a little bit about why, how that's informed you? Yeah. 

[00:11:51] Ishrat Husain: It's psychiatry. The art of psychiatry is is being able to communicate and form a therapeutic rapport and alliance with the individual that you're trying to help.

[00:12:06] Ishrat Husain: That is the key. And I think that having diversity of experience gives you. Strengthening, being able to communicate with an individual no matter where they're from or what their background is. For me, I see people and I fun. Part of the function of that is because I live in Toronto, which is a melting pot, I, in any given day, I will see people from 10 or 11 different backgrounds and cultures.

[00:12:32] Ishrat Husain: And, I feel that I'm still able to do a an effective job because of, yeah, I think, my experience, my background I think that's been an asset really. So I think in psychiatry it's very important. It's also it's really important because mental disorders, as we mentioned, a lot of them have a cultural, context or aspect to it.

[00:12:52] Ishrat Husain: So somebody with, let's just take. Major depressive disorder as an example from, a South Asian community or background will often present their symptoms in a very different way than somebody from a Western society. Oftentimes an example of this would be that those from South Asian backgrounds express their emotional distress.

[00:13:15] Ishrat Husain: Through physical or somatic type symptoms. It's very common that, somebody with depression will really focus on physical type symptoms like headaches or dizziness or chronic pain type things. And that's just a function of the culture because that's how they have been raised that, that.

[00:13:36] Ishrat Husain: Emotional distress can come out through physical ways, and it's important to be able to recognize that sometimes as well. So I'm very aware of those things. And 

[00:13:46] Raad Seraj: do you mean that people in different cultures so I refer to South Asia because I'm South Asian and I'm know exactly what you're talking about.

[00:13:53] Raad Seraj: Are you referring to the fact that people only express their distress only when they have emotional sorry, physical pain or? Is it, emotional pain manifests as physical pain if if you, it's underdressed. 

[00:14:09] Ishrat Husain: I think it's the latter. So I think that people feel, when they're going through emotional pain, expressing it as something that's manifesting physically.

[00:14:17] Ishrat Husain: An example is that I have lots of South Asian patients and they have anxiety and we know that anxiety can be. Associated with somatic physical symptoms like your heart racing, feeling dizzy, feeling restless, feeling rigid and or tense. And I have a lot of my South Asian patients when I tell them, how's the medicine working?

[00:14:38] Ishrat Husain: How's the treatment going? They always tell me, yeah, it's good. It's good. It's my dizziness has stopped and like my restlessness has come down. It's not, they don't focus so much on perhaps the psychological experience that they're having or the benefits of the treatment that they're getting.

[00:14:53] Ishrat Husain: And, but I know because that, Physical expression is a manifestation of underlying psychological issues that, that they're getting better in other ways as well. You have to take a very person-centered approach in, in mental health. I think that's the way that, that we're really gonna move the needle and improve outcomes for people is that, that, I don't think it's a one size fits all approach.

[00:15:15] Ishrat Husain: And I think that we have to take in somebody's background, cultural context. Spiritual context into it as well, because it, it's such a, as I mentioned earlier, the mind is such a complex organ that all of these factors play into it. And then also when one's experiencing a mental disorder they are involved in the manifestation of that disorder.

[00:15:37] Raad Seraj: And then of course, you add on top of that language, one of my last guys John Lou were talking about how, and he talks a lot about the use of psychedelics or mind altering substances, like even tea or herbs. In ancient China, the word psychedelic is a modern invention, particularly in the west in the sixties, but we've been able to alter our minds and address different.

[00:16:05] Raad Seraj: Alter states or enter different alter states even through things like prayer. And I think the lang, when you add language on top of existential suffering and mood disorder and things like that, we forget that it's not, like you said, all one size fits all. You have to keep in mind the context.

[00:16:19] Raad Seraj: Let's go back to what I wanted to touch on, which is what is it like to be a third generation? Psychiatrist and raised by two other psychiatrists who were then raised by other psychiatrists. Yeah. So why do you think you have such a deep pedigree, and I'd imagine at some point were you always, did you always know you wanted be a psychiatrist?

[00:16:40] Ishrat Husain: No. I felt, I honestly, I, it, it was, I fell into it or I would say I was. It came to me in a way, so I, I went to medical school. I always, I wanted to be a physician. I wanted to help people because I found that dedicating a career to easing people's suffering was a nice thing to do.

[00:16:59] Ishrat Husain: So I was very drawn to medicine and because I think the rebel in me had parents that were psychiatrists and a grandfather that was a psychiatrist, I decided I didn't want to do that, and I shunned it in medical school. I, I didn't really pay much attention to it. But then when I got in the uk when we trained you, you get exposure.

[00:17:20] Ishrat Husain: You're basically, after you finish medical school, you get the opportunity to suddenly intern, intern in various medical specialties. And you work and you get paid to be an intern in those specialties. So I did. I did all sorts of different things and I just couldn't find something that I really connected with that it just, for me I was checking in and checking out and I was speaking to my dad one day and I was like, look, I don't know if I wanna do this.

[00:17:42] Ishrat Husain: Maybe I'll leave medicine or do something else. And he was like, look, why don't you just give psychiatry a go in one of these intern slots and if you don't like it, go to financial consulting, whatever you wanna do. And and. I was hooked. I was working, I was I found it fascinating hearing people's stories.

[00:18:01] Ishrat Husain: I found it like incredibly a very diverse and rich experience in the variety of, peoples and you saw, and stories you heard and the various manifestations of mental health issues. And what really drew me to it was that how little we still know about the mind. And I felt that there was real opportunity to grow, to learn more to, apply science, to do research, to understand some questions that we still didn't have answers to.

[00:18:34] Ishrat Husain: So I think the scientist in me and the curious mind in me was really drawn to psychiatry for that reason. And I signed up and never looked back. 

[00:18:43] Raad Seraj: But your parents were like so relieved. Or maybe they played that game all along. It's oh, we know what's happening. Come back. Tell me a little bit of what you said you were rebel, the rebel in you.

[00:18:55] Raad Seraj: I think leaders are often a couple of things. Like you said, curious, open-minded, I think deeply passionate, but in some way rebellious. Tell me a little bit what, the rebellious Isra is was like, where did that come from growing up? 

[00:19:11] Ishrat Husain: I don't think I was ever as rebellious as probably some of my peers or my friends in school.

[00:19:16] Ishrat Husain: I was still, pretty disciplined and hard work in certain aspects. But I, for me I. I I don't want, I don't like to take the conventional route all the time. I think that's probably the rebel in me. So an example would be, when I was doing my training, Somebody would say to me, look, you have to leave your clinical training to go out and do like higher research training if you really want to be a clinician scientist or a researcher.

[00:19:47] Ishrat Husain: And if you really wanna be taken seriously to do that. And I felt like I didn't wanna do that. I said, look, I really enjoy my clinical training. I like seeing patients. And I think I can do my research alongside that. And I think I can do my PhD alongside that. So I did something unconventional, which was to do my doctorate or my higher research training alongside my my clinical training.

[00:20:10] Ishrat Husain: And that wasn't the conventional route. It took, it took a lot of work, a lot of sacrifice, but I was able to do it and. And, lo and behold, I was still able to have a satisfying and fulfilling clinical research career. Like that is the approach I like to take.

[00:20:24] Ishrat Husain: I like to, I do like to do high risk, high reward projects as well even in my science. I think that's probably the more, the most rebellious I can be. 

[00:20:36] Raad Seraj: Let me pose this to you. I think, obviously being rebellious, people have different mental models for what that looks like.

[00:20:44] Raad Seraj: Do you think part of it is, has to do with also how you grew up and again, growing from different places? I find identity is very attached to, this rebellion. When I say rebellion, I actually mean like pushier against the convention. Pushier is conventional ideas or convent conformity in some ways.

[00:21:00] Ishrat Husain: I was growing up. When I, my, the context of me growing up is I'm the eldest son of the only son of my grandchildren out of, I think he had six sisters and he was like the only son. And growing up in patriarchal society like Pakistan as then being his first son I was always told.

[00:21:21] Ishrat Husain: Growing up that, that, I could achieve whatever I wanted, or I could, in a way I could, the world was my oyster in the sense that, you go ahead and do what you want. And I think that really struck I, I've never had boundaries for myself or like limits for myself. I've always felt that, if I put my mind to something and I work hard enough, I can go out and, we get the results that I am seeking.

[00:21:47] Ishrat Husain: I also was, grew up with a lot of love. And I was always nurtured and felt like, and I think that really helped build a lot of confidence in me. Like my, I was always like I was always told, like I was always, it was never like a home where, we were given really, critical type approaches.

[00:22:07] Ishrat Husain: Like we were obviously told when we're not doing the right thing, but. We were always nurtured and given a lot of confidence. And I think that's really informed my view on pushing boundaries taking risks, obviously sensible risks. But, that type of I think that's really informed my sort of, my view on on, on that, that these aspects 

[00:22:29] Raad Seraj: talk about sensible risks.

[00:22:32] Raad Seraj: Tell me about your thoughts or experiences with psychedelics, because I think it's gonna, it really inform a lot of the conversation we're gonna have. You touched on a lot of things Al already. I think, having this idea of anything is possible, having that upbringing and I think a lot of mood disorders and let's say depression and things like that.

[00:22:51] Raad Seraj: What feels to me. Is like a poverty of the mind in the sense of the imagination, knowing what is possible. We'll come to that, but, I want to flip us a little bit and orient to surround your work with psychedelics, but first asking the obvious question, which is, what are your experiences or thoughts about psychedelics as substances that people take?

[00:23:13] Ishrat Husain: Yeah my. Exposure to psychedelics probably started pretty late in my life, to be quite frank. And it was through work, it was through the research and the science it was probably around six years ago, so 2017 when I was doing research already in trying to understand and trying to develop new treatments for depression in particular.

[00:23:35] Ishrat Husain: And compass Pathways approached me in London when I was living there to about this study that they were going to do psilocybin for treatment resistant depression. And I'd obviously read Robin Carhartt Harris's paper, and I was just fascinated by how. Large the sort of antidepressant effect was in these pretty chronically unwell, depressed people.

[00:24:03] Ishrat Husain: And I was really curious and thought, okay, like I would love to be a part of this study to be able to, to under, to see whether it actually works in a large group. And that was my first really exposure to psychedelics and their potential. Benefits and so on. I'd actually not been exposed even in a recreational sense to psychedelics prior to that.

[00:24:27] Ishrat Husain: I don't think it was something that the crowd that I hung out with at university or even afterwards really part partook in. That was my first exposure to it and really from there on in, I dove into the world of. Of psychedelic science more than anything.

[00:24:43] Ishrat Husain: And obviously I've heard subjective experiences from so many different people, from so many different walks and avenues in life around how they've found benefit from using, substances like. Psilocybin or MDMA. Now, there's also a group of people who told me it's like super fun to to roll on M dmma while they're at a rave as well.

[00:25:06] Ishrat Husain: That's a different side of it. I think that becomes like recreational use. When people go and they have drinks when they go out and stuff like that. But for me, my exposure has been honestly, primarily through my work about it and I think. For us in mental health, because there's just been very few new treatment approaches to help people with particularly common illnesses like depression or anxiety.

[00:25:32] Ishrat Husain: I was really keen to take it forward. And then when I moved to Toronto compass approached me here as well. We were that site for that large study got involved in that. That led one thing led to another. We've now. Got this huge psychedelic science research program, over 10 studies in various clinical populations looking at psilocybin and its potential therapeutic benefits at camh, which is really exciting.

[00:25:57] Ishrat Husain: But to your, to answer your question my, my own personal exposure to it has been limited to my sort of scientific work. And that was a conscious decision as well, by the way, which I'm happy to explain to you if you would. Yeah, please. I'd love to know. One of, one of the things that once you're in the psychedelic science, even community people sort of mention is that have you never had your own journey or your own?

[00:26:22] Ishrat Husain: And I've said no, it was really. It was really interesting to me when people ask me that question, because they've never asked me about anything else. They've never said 

[00:26:32] Ishrat Husain: no truth. Have you ever taken an antipsychotic? Have you ever taken like Olanzapine? And I'm like, no, I haven't.

[00:26:39] Ishrat Husain: Have you ever taken Zoloft or sertraline or for that? And nobody's ever asked me that, but they would always ask me about the PIL side bin and things like that. And I found it really fascinating that people were asking me, And I felt that actually consciously, I did not want to, because I actually did feel that it would affect my objectivity of my research.

[00:27:05] Ishrat Husain: I, I actually feel that, and I don't know if it's true or not, I haven't tested it, but I feel that as a researcher, I should be somewhat removed from it. And try and be as objective as possible. There is this concept, I don't know if you've heard of it, of allegiance bias where, if you have a treatment or yourself that, and it works for you or gives you, a particular positive feeling that you then take that bias into your research or into future studies and so on.

[00:27:41] Ishrat Husain: So my view was that, I'll try and do it without having that experience. Now, I'm not involved in the data. I'm not the therapist who's sitting with the participants in our research studies. And a reason for that is that I'm not allowed to be a therapist, actually, because apparently that intRaaduces bias as well into clinical trials.

[00:28:01] Ishrat Husain: So my role is limited to being the, The scientific investigator with a medical background that provides oversight to people in these studies and then to reliably assess the results on safety and effectiveness at the end of it. So my, my, my rationale for not having my own experience has been that so far, maybe when I'm out of these, out of the research, And I've moved on to other things.

[00:28:24] Ishrat Husain: I'll have my own... 

[00:28:25] Raad Seraj: maybe part of the part of the, so it's really fascinating. It's such an interesting conversation here because on one hand I was just about to say maybe this is why psychotherapists feel much more inclined in. In fact, some people feel that it's required almost as a frame of reference if you're gonna treat somebody on the influence of psychedelics to know what they're going through in some way, in some, perhaps some emotional resonance or frame of reference Again, Psychiatrist, on the other hand, feels like you have a free pass.

[00:28:55] Raad Seraj: But other hand, when people ask you, I also feel that maybe, and speaking for personal experience, I feel like the benefits, go beyond just let's say alleviating existential suffering, to touch on the day to day, enhancing life under being present, and so on. Those, do those sort of aspects resonate with you and do you find, because I understand totally where you're coming from cause it can bias you cause you're like, oh, this is great, so why wouldn't it be great in everything that I do, the science that I'm doing?

[00:29:25] Raad Seraj: But I think that's probably why people ask how I would've asked. It's the same thing. 

[00:29:29] Ishrat Husain: Yeah. And I totally understand that by the way. I've had, I have friends who, who've said to me that it's. And they're not people who suffer necessarily from the disorders that we've talked about so far.

[00:29:42] Ishrat Husain: They're, they're high functioning and have no, health issues to say, but they find that it enhances their life to an extent. I don't think anything in this world no is a panacea or cure all or anything like that. But I think that a lot of people have said that.

[00:29:59] Ishrat Husain: You know it, that they find real benefit from it. And this is not like micRaadosing. This is, I think people actually taking the full experience. There's certainly something there. And I'm just really fascinated about and what is happening. It's just incredible that These compounds have such powerful effects on, on the human experience.

[00:30:25] Ishrat Husain: I'm trying to understand that I have to be a little bit mindful that I am dealing with also very vulnerable people though, right? Within our Trial participants. We have, people that haven't gotten better with four or five, six different types of treatments, long, long histories of really severe mental health issues, childhood trauma, often a part of that.

[00:30:47] Ishrat Husain: And so it, for me it's also important to temper the hype a little bit because. A lot of these people come into these trials thinking, hearing a lot from maybe their peers or the media about the powerful impacts of these or the potential benefits of these. And then they come in and they expect that it's gonna be transformational or, gonna turn their life around.

[00:31:10] Ishrat Husain: And it's not always the case. Even if you look at the studies, yes, there's powerful effects, but there's still, a proportion sometimes a third or up to 40% of people that don't get better. It's important to note that as well. 

[00:31:24] Raad Seraj: I think that's absolutely true.

[00:31:26] Raad Seraj: And, part of me I don't like to valorize psychedelics as in all kind of hype is damaged. It's like particularly in this particular setting cuz because, expectant expectancy is an issue. And secondly, I was listening to the the latest Huberman podcast with Robin Carter Harris, and he was saying that in some of the clinical trials that he is run.

[00:31:44] Raad Seraj: A patient may be in part of the first one, but because it's still a, controlled substance that's illegal, they may not have access to the second trial, and so they might have felt good for a little while, but because they can get subsequent treatments, I can only imagine what that might feel for somebody.

[00:32:01] Raad Seraj: And now they have to go to the underground to access that medicine perhaps in a very unsafe kind of way. So it's a very complex area, so you can't just take say you gonna eat mushrooms and everything's better. 

[00:32:12] Ishrat Husain: Yeah. Exactly. Exactly. And I heard that podcast as well. I thought Robin was very good on it.

[00:32:18] Ishrat Husain: I think he gave a very balanced, assessment of the current state of play. And I think, yeah, it's important to note that, these are still controlled substances even in our studies. People may. Get better, but then to access it again, it's going to be a challenge.

[00:32:33] Ishrat Husain: It's going to be a challenge. Managing that is, is something that, that we have to deal with. 

[00:32:39] Raad Seraj: Do you talk to your parents about this sort of emerging treatment? 

[00:32:42] Ishrat Husain: I do using Second House. What do they think? They're obviously, they're, they trained 30 years before me. Their view is that, they've seen a lot of things come and go.

[00:32:54] Ishrat Husain: So I think they, they're optimistic, but at the same time, some slightly skeptical it's going to be transformational. I think that's their view on it. But I think most people in psychiatry are actually really intrigued by the potential of these substances. There are still quite a lot of skeptics out there though, as well, because I think there's still this generation of psychiatrists actually that were there in the seventies, sixties and seventies when some of the trials were going on.

[00:33:24] Ishrat Husain: And some of them have reported that, there was also some challenging. Experiences. Like they, they would say that, we've seen patients, for instance, with L S D psychosis and that was a huge issue at Cam h or at the Clark, what it used to be called that used to be coming in into our emergency department and so on.

[00:33:41] Ishrat Husain: I think it's healthy to have a little bit of skepticism too, though. I think it's important, absolutely critical eye and that we critically appraise anything that we're doing. 

[00:33:49] Raad Seraj: I think especially now because it's so easy to be polarized because again, social media and personal propaganda is everywhere, so there's, there was always an agenda.

[00:33:59] Raad Seraj: And I think having skepticism as just a way to discern good from the bad, good information, from the bad information, whether you're a scientist, whether you're, just a civilian just a citizen. I think it's really important to maintain that sort of critical eye on things.

[00:34:14] Raad Seraj: Cause ultimately, Domain of the mind, everyone has vulnerable. And particularly I think psycho is not going to solve everything. It's also not for everyone. It's very important to understand. It could really cause a lot of harm in the wrong setting, but also for the wrong, people with predisposed conditions that they may or may not know of.

[00:34:34] Raad Seraj: So I think that's really important. Let's let's switch gears a little bit. I think let's talk a little bit more about. Your line of work and I wanna start in the the area of what depression is. Now to your point, there's the etymological sort of definition or the cultural definition, the colloquial definition of depression.

[00:34:55] Raad Seraj: But in your mind, what is depression? What do we know of depression today that we did not know, let's say even 10 years ago? And I have some thoughts around, I think the better understanding of how the mind versus the brain works. This modular versus a network circuit, a vast circuit of brain circuit rather than like discrete modular parts.

[00:35:19] Raad Seraj: But let's go, let's start there. How do you define depression? And let's talk about what we know today versus. 10 years ago. 

[00:35:26] Ishrat Husain: Yeah. So I would define depression as a mental health condition, which is characterized by a couple of core symptoms. So sadness would be one of them. Loss of interest or loss of enjoyment, anhedonia is another.

[00:35:43] Ishrat Husain: And then that is associated with a number of other symptoms that, could affect. Your sleep, your appetite, energy levels, motivation, various things. But it's not just momentary with depression from, with depression, it needs to be sadness And all of these symptoms that are persistent for, several days, at least a couple of weeks.

[00:36:06] Ishrat Husain: And it's affecting your functioning. And your ability to do your job, go to school, et cetera. See friends, all of that. So that is my view of depression, how it manifests varies on the individual. And what triggers can be a combination of things as well. Sometimes it can be something that you can't even identify.

[00:36:29] Ishrat Husain: So for me that, that is my sort of broad definition of what depression is. In terms of what we know now compared to what we knew 10 years ago? I think the main thing that we know is that it's not a homogenous condition. It's not something that's due to, the chemical imbalance in your brain.

[00:36:52] Ishrat Husain: It's not because you have a depleted serotonin level that people are having depression. I think it's. Very multifactorial. Like many mental illnesses, there's biological, psychological, cultural, spiritual aspects to, to depression. And I think that's what makes it so challenging to treat because it affects everybody in such a different way.

[00:37:19] Ishrat Husain: And that, that's why, that's what I believe we are very clear on. Now, we perhaps weren't as clear on 10 years ago when it was really very much considered this sort of chemical imbalance that if you took an antidepressant sri, that it would boost your serotonin and you're good.

[00:37:37] Ishrat Husain: So that, that's my understanding of where things are now. 

[00:37:41] Raad Seraj: What changed? Because I think that serotonin. I don't know if it's actually serotonin syndrome or not, but the fact that s there's a serotonin hormonal balance in your brain and that causes depression, it still feels very prevalent.

[00:37:55] Raad Seraj: What changed from going from that very simplistic answer, and I've read many articles about that this is actually politically motivated from one, one, incomplete study and then the big pharma. Bought into it and pushed it, pushed that agenda. What is it better tools? Is it not having more people are sick or more people are struggling despite having SSRIs and so on?

[00:38:19] Ishrat Husain: I think it's, I think it's that. I think it's the fact that, despite the sort of very widespread rampant prescription of antidepressant, That people continue to suffer, right? I think that only, half of people would respond to an antidepressant if they're depressed for the first time.

[00:38:44] Ishrat Husain: And I think that the field has moved beyond that and is now looking, has over the last 10, 15 years, has been doing a lot of work to try and understand. The pathophysiology of depression and has come to the sort of realization that it's not just one pathological model that can explain it.

[00:39:03] Ishrat Husain: And I think it's, that's been driven by the fact that a lot of people don't get better with biological type treat, like SSRI antidepressants.

[00:39:11] Raad Seraj: That's interesting. Let's talk about multi multifactorial aspects of depression. What are they in your mind right now? What are people, what are we finding? 

[00:39:21] Ishrat Husain: Honestly it's so varies on the individual that you see, but I think that, generally, in the context of current modern society, I think my experience is that childhood adversity.

[00:39:33] Ishrat Husain: Is one of the biggest drivers of at least refractory depression. That's the depression. That doesn't get better with the treatments that we have. So people having childhood trauma invalidating environments growing up during their formative years, I think really makes them vulnerable to having mental health problems, and particularly issues like depression, anxiety that, are.

[00:39:59] Ishrat Husain: Are quite pervasive throughout their life. That's one aspect. And then I think loneliness the feeling of lack of connection as well in modern society, which was compounded by the pandemic for a lot of people is really also playing a role in in, in depression that I see and treat.

[00:40:18] Raad Seraj: Do you see a particular, like a further stressors. Going back to your comments about, let's say people in particular marginalized communities, south Asian communities, for example, childhood adversity I imagine exist in across the world in all cultures and all people. Are there particular ways that cultural components further layer on top of that and add further stress?

[00:40:44] Raad Seraj: Let's just, let's talk about maybe income levels. Let's talk about household, demographics and things like that. 

[00:40:49] Ishrat Husain: Yeah, for sure. We know from like replicating evidence that those from, more lower socioeconomic backgrounds are more likely to experience severe mental health problems and mental health problems like depression and anxiety.

[00:41:04] Ishrat Husain: We know that certain cultures as well, they're the prevalence of these illnesses are higher in certain cultural contexts. I do a lot of work with the South Asian community. We found that rates of depression are actually much higher in that community. And access to treatment is harder because there's a stigma associated with mental health problems in these communities.

[00:41:26] Ishrat Husain: There's this whole concept of in in, it's called isk or honor which basically means that you can't bring that shame on the family. If you're going out and seeking help for mental distress or emotional issues, which means that the com the problem compounds itself because you've got higher rates of a of a particular problem, or whether that's due to socioeconomic factors, social isolation, lack of opportunities, childhood adversity, whatnot.

[00:41:56] Ishrat Husain: And then you've got barriers to treatment and stigma, which means that people aren't getting help. Absolutely. It does play a role in the cultural context. 

[00:42:04] Raad Seraj: Do you see that further at complexity? Do you see that play out differently in men versus women? Because I understand our role. The idea is that we have that in, Bangladesh across South Asia.

[00:42:15] Raad Seraj: Really? Yeah. The sense of honor. And I do feel like men and women carry that differently. I'm not saying better or worse, I'm gonna saying 

[00:42:23] Raad Seraj: different. 

[00:42:24] Ishrat Husain: Absolutely they do, they do definitely carry it differently. We've done work with south Asian women in the uk. We're looking at rates of self-harm in that population and we found that actually they were really high.

[00:42:38] Ishrat Husain: And one of the reasons That they were hire, that was expressed by the peop, the women that we were working with was that, this concept of is it, and the fact that, the men in their family would have real issue with it. So I think it does express itself differently.

[00:42:56] Ishrat Husain: I think with men it's more an issue with regards to gender roles oftentimes. A man within certain communities, particularly South Asian communities, seen as like the breadwinner who's role is to support the family and any sign of weakness in that can affect that concept of honor or whatnot.

[00:43:16] Ishrat Husain: I think it does express itself differently, but I think they probably both have to deal with it.

[00:43:22] Ishrat Husain: I know we are running short of time so there's so much more to discuss, but I kinda wanna like move us to final segment of the podcast. And this is, I think where, talk about, leadership in this particular time and in this particular space. There's so much going on. You are leading the first federally funded study on South Sabin and it use or Sal Sabin as a way to treat depression.

[00:43:48] Ishrat Husain: You are leading that clinical study. It's the first one that has been funded by the Canadian government through C I H R. Tell us a little bit about that at that study and then we'll go into other aspects of leadership in this space at this time. 

[00:44:01] Ishrat Husain: Yeah, we were very pleased that The Canadian government is now putting funds to support work in this area.

[00:44:08] Ishrat Husain: I think it's putting Canada at the forefront of research in in psychedelics as potential therapeutics. And we we took a very novel approach to trying to understand a key question, which is an assumption in the field, which is, I can understand why it's an assumption.

[00:44:25] Ishrat Husain: Is that about. The role of the psychedelic experience itself in the therapeutic outcomes. And I just found it very interesting scientifically to design a study to a address that question is whether the psychedelic effects are what are directly leading to therapeutic benefits in people with depression.

[00:44:51] Ishrat Husain: So what we're doing is, We've designed this three arm study in which one arm is receiving the full, psychedelic experience with psilocybin. The second arm is receiving psilocybin, but alongside it, a blocker of the psychedelic experience. And the third arm is a placebo arm. And we're trying to compare, first of all the psychedelic effects in each arm, but then also antidepressant effects to really understand whether it is.

[00:45:19] Ishrat Husain: The agonism or the activation of the serotonin two A receptor, which we know causes a psychedelic effects, whether that's also causing the antidepressant effects as well. It's assumed that it is, and because they're such powerful experiences, but nobody's actually tested that scientifically.

[00:45:37] Ishrat Husain: And I think that's what got us over the line with the funding was that it was it was a novel approach to psychedelic research. And we were, we're underway. We're doing the study now. Not, we're fully blinded. We don't know what's going on. We don't know which per person's receiving what, so we don't have the results yet.

[00:45:56] Ishrat Husain: But a lot of interest in this work. A lot of patients have put themselves forward to to take part in it, which kind of speaks to the need for new treatments as well, because everybody just wants to be able to access a new way to treat their depression. 

[00:46:10] Raad Seraj: What do you think is the follow on from this study?

[00:46:13] Raad Seraj: Let say this study is revealing, I might not say successful or unsuccessful. I don't know what that means, but rather revealing and very insightful. What is the next step after this study? 

[00:46:23] Ishrat Husain: I think it really depends on what the results show. I think if we, and I'm not expecting this, I think that if we found that psilocybin in combination with a blocker of the psychedelic effects, still had some antidepressant properties, I think that it would we would have a responsibility to take that forward and test that in a larger population against a placebo to see whether, that's something that could be integrated into our current treatment protocols.

[00:46:54] Ishrat Husain: If we show that psilocybin actually needs its psychedelic effects to have depression, then that's great. Then we know how we can integrate. This treatment into our current care pathways. So I think that's where we would want to take it, depending on what the results show us. We're doing work alongside this as well, looking at really interesting things like, how many doses of psilocybin do you need for a sustained effect?

[00:47:22] Ishrat Husain: What is the role of the psychological support do you. Is that needed? Is that what's key? So there's so many it's a very complex intervention. If you think about psychedelic therapy, there's which makes it very fascinating and interesting to study because there's multiple facets to it.

[00:47:37] Ishrat Husain: You've got the biological drug piece, you've got the psychotherapy piece. They're probably all convalescing together to have the therapeutic effect, but it's really interesting to be able to tease out one thing at a time to see what's leading to benefit. 

[00:47:52] Raad Seraj: Fantastic. I really hope the study is useful.

[00:47:56] Raad Seraj: Either outcome is good because we know now something more about the use of psychedelics in this context than we did before. Whether the psychoactive component is important or not, we still further the science and I think hence how it's going to be used. Last question to you is, To aspiring scientists, and there's lots and laws to people who are very interested in this space because they've had personal experiences or not.

[00:48:20] Raad Seraj: But I think because of how rigorous science can really help move the needle in terms of better treatments out there. How do you, how would you define good leadership in terms of and good science at this time? There's a lot of uncertainties. A lot of unknowns. Definitely social urgency, critical need for care.

[00:48:41] Raad Seraj: How do you define a good, good leadership at this time? And what advice would you give to those aspiring scientists? 

[00:48:47] Ishrat Husain: I think good leadership encompasses really people having the ability to inspire those, alongside them working under their supervision to really act to the best of their abilities, go above and beyond what they, the limits they've set for themselves.

[00:49:05] Ishrat Husain: To me, that's just a broad definition of a good leader, specific to psychedelic research. Anybody who's interested, I would just encourage them to to be as objective as possible when trying to answer any particular scientific question. Be responsible. At the end of the day, the work that we're doing matters the outcomes matter and it's imperative that we are responsible, conscientious, robust in the studies that we are designing, and then the way that we're conducting them, because, it would be a shame if everything falls down or breaks down because of.

[00:49:47] Ishrat Husain: Irresponsible or inpro inappropriate science. I think that, that would be really unfortunate, most of all, for patients and research participants who really, want and need access to some of this stuff. I would just encourage people to be. To really, be thoughtful in their approach.

[00:50:06] Ishrat Husain: And that, if you're going to enter this space, you have a responsibility. And that responsibility is to do robust work. And I think that as long as we're all singing from the same hinge hym sheet with that, then I think that things are heading in the right direction. 

[00:50:20] Raad Seraj: Amazing leadership is being responsible and that's, that is being a big part of it and being audacious.

[00:50:25] Raad Seraj: Astra, thank you so much. This has been a fantastic conversation. There's, again, lots of things I couldn't touch on, but this has been very educational and inspiring for me. Thank you very much for spending the time with us. 

[00:50:35] Ishrat Husain: Thanks for having me, Raad. 

[00:50:38] Ishrat Husain: This podcast was brought to life with the help of Carolyn Tripp on art and design. Thanks so much for listening to Minority Trip Report. If you're learning from or enjoying the podcast, please subscribe to MTR on YouTube at Minority Trip Report and follow us on Instagram at Minority Trip. It's a zero cost way to support us and help us spread the word.

[00:50:55] Ishrat Husain: Please also sign up with your email for new episode announcements, events, as well as our forthcoming newsletter. I'm your host, Raad Seraj. See you next time.