AI vs Ayurveda The Truth About Mental Health

Welcome, welcome, welcome, welcome to Nitin Nanda. He's my namesake because I'm Puneet Nanda. And Nitin is not just a very famous psychiatrist, geatric psychiatrist in Los Angeles, California. He also is an entrepreneur. Not just an entrepreneur, he's a serial multiple company maker. He's a rainmaker, to say the least. Nitin, tell us a little bit about yourself.

All right, Punee, well, thank you so much by the way. Great to be on your show. Much accomplished though. You've done so well yourself. So great to be namesake. So delighted to be here. Thank you again. Just from a background standpoint, I'm a trained geriatric psychiatrist trained at Tucson School of Medicine. And yes, I've been fortunate enough to be a serialized more on the mental health space. Much needed topic of health issues that you see mental health. So I have spent all my legacy and my background and life really dedicating to solutions addressing mental health issues. May that be from children, adolescents, adults, geriatric populations. So the whole paradigm. So great to be here.

I almost feel that mental health is becoming a pandemic in United States. Do you feel this has become a bigger issue since COVID since 2020, or has it always been like this and it's just recently become more of a headline news?

You know, very well said. You hit the nail on the head and underscore the enormity of mental health issues. Covid has brought the mental health issues and concerns to the surface. A lot of people who were dealing with mental health issues were still being able to function. It suddenly became to a diagnosable state of mental health issues, which means that that became quite serious for them post Covid. And the genesis of that was the fact that they were worried about all the loss of life that happened. Lot of bereavement, economy, uncertain future for the folks. So that really brought it to a head. And so mental health, which was already there as an issue, stigmatized an epidemic. Then the pandemic came and it really came to the surface. So you hit the nail on the head. Like I said, it has been an issue, but it really came to the surface more with COVID and has ongoing health, you know, concerns since then.

So you and I are both Indians and I see that in United States mental health is more of an issue than in India because we've, we've lived there. We never saw such a pandemic kind of a problem here. I see the moment you start talking to anybody, almost everybody I know is having antidepressants. Like it's Become antidepressants are, have become like candies. Do you think the big pharma is actually benefiting from this and the doctors are being pushed to pedal these antidepressants a lot more here. What is there to say? Or is it the society? What is your opinion on this, Nitin?

Great, great question, Puneet. So I think just the fact you touch upon us as Indians, East Indians and the diversity of cultures we deal with in the US it's, it's truly a melting pot. Every culture handles mental health differently and the level of stigma varies between cultures anywhere from it being mild, moderate, severe and how they deal with it within the four walls of the family versus coming out to the community and seeking help. So to your point, in the U.S. i think the stigma is much less compared to a lot of other cultural entities around the world. That being said, medications have a significant role in treating various mental health states. I call mental health disease states as having angina of the brain similar to having angina of the heart. So a lot of these work very well in treating earlier on with medications, therapy and the combination thereof. Yes, there is definitely a push in certain of the western world in being trigger happy in prescribing medications. Truly what works is a lot of love and affection from the family, the culture itself, the community living, going on with therapy if needed and then as a last resort looking at medication which can be life saving by the way in treating. But again this really varies between different cultures and diversities we deal with. For us example, we as East Indians tend to stigmatize depression, anxiety, suicides and we try not to talk about, we talk about successes but talk about the underlying mental health issues that we deal with on a day to day basis what we call stress or otherwise. So great question. I, I hope I answered that for you.

How do you analyze, for example in India I see that people live in like multiple people live in a household, people talk to each other in the evening, they have dinner together. Here there's a culture of people living with their pets at the most or living alone by themselves. Do you think that is one of the reasons, number two, therapy is very common here? I see a lot of people going for therapy. What is the importance of therapy? Is that kind of replacing that community where people live in India together? Is that, is therapy in a way their way of replacing that family structure? Or am I making things up? What is your opinion, your point on?

So what I would say to that is like I said earlier, it really depends on the cultural background, diversity, various cultures Handle stress mental issues differently. We, as you alluded to in India, In India, a lot of the family gets involved and they tend to provide what we call therapy internally to their kids, to their family members, whether that be husband, wife, sister and whatnot, and try and provide that reassurance, assurance in there within the family itself as one unit, very common. And that helps a lot. That helps tremendously. On the other hand, in certain Western societies, the, you know, the first world, as we call it, a lot of focus is on, hey, once you come of age 18, 21, you got to leave the nest, start your own life. And that can be stressful. And people are driven and striven to do that. And as you do that, you tend to go into this new world where you're away from the family and you gotta be able to handle level of stress and mental health issues that come. Keep in mind, a lot of the mental health issues tend to surface in early to mid 20s through to late 20s. And that goes back to the time when we walk into adulthood, take on our next leap in life, go to a next stage in life, as we call it. And at that point, I think the therapy structure becomes your friends, your work environment. And if that doesn't work, then you seek other aspects of it, which could be getting into therapy, may that be cognitive, may that be supportive therapy, the therapist. And those work tremendously well. But again, seeking help at the right time is critical for your mental well being.

Now a very quick question on what is the role of today's social media? For example, when I watch X, there's very politically charged questions. When I watch Instagram, whatever you watch, TikTok means your mind starts to race. I feel like sometimes my dopamine level is on a roller coaster and I'm getting crashes and I'm getting dopamine. What is your take on it? As a qualified psychiatrist, one of the best in the world, what is your take on it?

Hey, listen, I think you're right onto. You said the right key word, the neurotransmitters called dopamine. So I think there's a release of all kinds of neurotransmitters that happen. There's excitations, there's peaks and drops of that as you look at social media. Social media today unfortunately has contributed to the mental health issues, especially as it pertains to kids, child, adolescent. If you look at the amount of hours and time spent on that, just scrolling through messaging, the bully ism of the social isolation and all that stuff that goes on social media that can be very adversarial to someone. Think of somebody who's already going through depression and is going through this and the negativity and so on that you see on social media. But again, I think there's a lot of proactive effort being made by a lot of these platforms to be mindful of that, to create some kind of eco environment which is friendly and supportive as well. However, the data strongly suggest that the social media has contributed overall to surfacing a lot of the mental health issues. And again, it's the content, it's the time spent, it's all the scrolling. I mean, think about it, how many hours people can spend. Like you said, when you get in there, you want to just scroll and look at messages and whatnot and send messages out. And sometime messaging can be very knee jerk reaction. When you do knee jerk, you may regret later on next you wake up like, why did I do that? Well, that's already out there now and it can a lot of impact on folks and create a lot of the mental health stress for a lot of the people who are on it. So one has to be very mindful of social media.

So tell me one thing, what are the real time physical effects that you see? Because whenever I get into an accident or I hurt myself, I can see bleeding come out. But then if somebody says something wrong to me or if I read something that is unacceptable to me, I probably get a mental cut in my head and it probably is not visible. So what kind of real psychiatric symptoms? How do you determine a patient? Like when you look at a patient, how do you determine that this is a problem because anybody and everybody is stressed today. How do you determine that?

And by the way, you said it very well, Puneet yourself. You know how you had a physical trauma or physical stress, you can see, you can identify it. I call it emotional hurt. So it is essentially a scar or hurt injury that you occur, that occurs from all the media, all the mental health issues, conversations and whatnot that can occur. One has to keep a lot of good mental health hygiene for that. You have to work through it and have the ability to seek help at the right time. That is a critical aspect. A lot of folks just want to internalize it. They want to keep it to themselves. They say, hey, you know what? If I go and seek help, they will think I'm weak. It's not weakness, it is boldness. That is seeking help, talking to your friends who are your co confidence to your family, who you're close to. And if that doesn't work, then seeking the right help outside that's available. The great thing that has happened post Covid is a lot of the treatments have become virtual where real time data of the outcomes are great, even better sometime just because the access is so much there for them. But again, recognizing it, seeking treatment, seeking help, that is a critical aspect. So again, these are all what I call as emotional injuries that occur and can happen for many other things. We also have to be mindful that these are real disease states. Major depression, general anxiety disorder, ocd, schizophrenia, bipolar are real diseases. And I deal with a lot of seniors, for example, they deal with a lot of depression because of isolation, widowhood and also cognitive impairment. When you start losing track of things, losing things, losing your bearings, it can be very depressing. And that is what we call is early dementia or dementia itself. Again, seniors see a lot of that, they under recognize it, they feel a stigma to talk about it. And so again, it's a very vast paradigm but mental health issue under all disease states today.

So I'll tell you my situation. When my dad died, I was very attached to my dad. And for almost a year I literally saw blackness everywhere. I literally could not fathom. I. I felt I'm here, but I'm not here. So for a normal person, this is one of my state that when I realized I need probably to talk to somebody, I need some kind of help or maybe just take a holiday and kind of divert my mind. But for a normal person, how does he recognize that he's got a mental problem? When does. When is it a time to go to see a psychiatrist or a psychologist? Yeah.

A true fear we all go through, including myself. We think about if it were to happen, how one would handle a loss in the family. So what you went through is a process of bereavement. Initially you lost somebody very attached to and you felt that's the end of the world because that happened was so immense for both of you. He was apparently a mentor, of course, being a dad and so on. So again, one has to recognize there's a period of grief and bereavement you go through that typically lasts about three to six months. And if you feel that things are progressing further from that, where you're having, you know, feelings of reproach, feeling depression, isolating yourself, your eating habits change, the social habits change, you are more isolative, you feel like, hey, you know, life is not worth it anymore. I miss him so much, miss him or her so much. That's the time you want to seek help. That's the time you want to seek out to your friends, you want to seek out some professional help and say, you know, maybe I can talk to somebody about this and they can help with doing some, you know, supportive therapy, bereavement therapy, cognitive therapy at that time. And if that doesn't work and if you feel that's going even further, I would even consider trial of, you know, some low dose antidepressants temporarily to see if that will help reverse some of this. There is no point suffering beyond a certain point. Again, grief and bereavement are real thing. People go through the whole reaction for that. And so there's a time period beyond which you feel, as you said, the darkness is coming. Then you want to go and say, you know what, maybe this is a bit too much, I need to seek help. And this is where the people around you come in and step in also because they recognize that and they say, hey Puneet, this is not good. You don't nerd yourself anymore. We know you've been through a loss, but let's see how we can help you and move you forward.

So the next question is interesting because I see on social media everybody's a psychiatrist nowadays. All these young girls will come and guide you and become us your new psychiatrist or psychologist. And then there is a lot of people trying to sell Ashwagandha gummies and saying, oh, you're in mental stress, you're feeling no good, you're feeling this. What do you have to say about that? And we'll come to how Ayurveda is important. But we also want to hear your opinion on these self proclaimed psychiatrists online. And also doubting Ashwagandha to anybody and everybody or some other things. What is your thought process on that? Could this be problematic? Have you seen any patients in real life who've gone through this and have actually worsened or felt better?

Great question. I think very timely. There is definitely a global epidemic and using supplements, you know, supplements which may or may not have real time data. So my two senses and to your point, I do see patients that come to me who are taking these supplements. Sometimes they have benefits, sometimes they don't. Again, we want to go with supplement that have been time tested. They have real evidence based data behind them on their usage. And there's a role of supplements to a certain point. Beyond that they can be detrimental. I'll tell you what, I had a patient who came in who was taking some supplements, not realizing that it was interacting with their anticoagulants, anticoagulants medication which we call blood thinners. So to the point that then the patient came to see me, his lab work was completely whacked out. Taking some supplements that were causing interaction to the liver enzymes. Happens that can be life threatening. We had to send the pain to the er, take the medication, the supplement off and fix that. So there is a role to a certain point as long it is evidence based. And I get concerned when folks get on social media or otherwise claim themselves to have become mental health experts, whatever nomenclature they want to use and start prescribing to folks who are susceptible. One has to be very careful of that. Again, there's a role to a point, but beyond which I think one has to be careful that these can have real time detrimental effect, negative for that matter. And drug interactions which you gotta be very careful about, especially when it comes to older adults or seniors.

Now, as a medical doctor, of course you've been taught to prescribe pills. As somebody who's into natural functional therapy, they want to prescribe natural remedies. What is your honest opinion on things like mindfulness practices? Like people like Deepak Chopra talk about meditation, mindfulness practices, things. And what is your opinion of Ayurveda and which has been around for thousands of years means I would like to understand your honest perspective not just as a physician, but as a human being who understands medicine from different facets.

I will answer that in four words. Strong believer in. I am a strong believer in that. I think there are two aspects you touched upon. One is the spiritual learning and teachings and so on. And I'm a follower of Deepak Chopra myself, you know, great physician, came with a background, trained at Harvard, went on to the whole spiritual aspect of teachings. Very strong with extremely good outcome data. So very strong opponent of that, supportive of that. And again one has to believe in it. And like I said, I follow myself. So very strong supporter of that. Going to Ayurveda. Ayurveda is, hey, listen, goes much longer than allopathic medicine that came around with the medication so on. Ayurveda has a certain role in treatments. Going back to my earlier conversation, I just want to make sure when you take Ayurvedic supplements there is some data, fair evidence based and be cautious of what they are taking otherwise medication wise and treating that. When folks come to me and say, hey, they have had acute gallbladder disease or have, you know, hepatic insufficiency, hepatic issues and you'll be giving Ayurveda, you got to be Careful because it can have issues systemically. Systemically means in the whole body because once you take any of these supplements, they go in, they get absorbed, go to the liver, go to your bloodstream. You want to make sure that the medications have no interaction and detrimental effect. I'm a believer in that as long as there is evidence based backing to it that it works in this and there's some data to it. But again, Ayurveda is on the rise across globally and I believe it.

Is there any specific supplements in Ayurveda that you have used in your practice or have recommended till today? Of course people will have to consult a specialist for that. Secondly, is there any meditation or any mindfulness practice that you have personally prescribed or used in your practice?

So you know, as Ayurveda goes, no, I'm not, I'm not physically prescribed. It's mostly folks coming to me and saying they're taking this and I make sure that I look at any interaction and things like that. So I personally don't prescribe it. I've supported it and have patients continue that and that's fine. You mentioned Ashwagandha. I'm assuming that's in the same nomenclature. If that's the case, people do take it and that's worked. That's something patients have taken. I've supported and done through that making sure that other safety efforts are kept in place. On the meditation side, yes, I think meditation side, you know, I do deep meditation myself, very basic. And that is something by the way we have had in our academics now that has become part and parcel of our treatment solutions. And this is something with my new company Presai, which is, you know, AI and digital, we are supporting that. We have content and meditation. We push that towards our consumers and our patients to do that because it has strong, strong evidence based data showing it works. It's really well. And guess what? It gives you the feeling of Zen. It gives you time out of everything else, including social media. So I think it works wonderfully. But again, everybody has a different prescription for what meditation and whatnot. And it has to come from your heart. You really got to believe in it and do it and but again, Optim data supports itself.

So tell me one thing, number one, explain us about your digital health app that you are developing and walk us very quickly because I know your time is important. Walk us very quickly in next 120 seconds about your journey from UCLA to becoming the psychiatrist for, for all the prisoners through Obamacare, selling your company and then starting another one walk us through it in the next 122nd. Like a quick refresher.

I'll go my Ferrari mode. Okay, so great. Jerry Sakata is my training. So coming out of the training itself, I realized there's a huge need in the community to provide mental health services. And I was able to bring out a very brick and mortar practice that got acquired initially by another big company came back in the market. I realized that there's a huge, huge shortage of providers. We don't have enough psychiatrists, we don't have enough therapists, especially in rural communities, including correction space and whatnot. I started a business called Telemedicine. So we were one of the largest behavioral health telemedicine business. I remember the day that I had to look at the definition of telemedicine telehealth and I would go to medical board and say telehealth is a real science, it's evaluated science and where we deliver mental health services through virtual care. And that grew very nicely and I was able to exit that company very strongly and also participate in IPO at the time, underscoring the fact that it recognized the need of our platform and solution. As I finished that journey, this was just pre Covid. Covid happened and we saw a huge surge in mental illness. And I realized as a legacy for me who touched a lot of these issues in emergency room across the country in the past, I had to do something differently and something different was AI. AI and clinical services. The AI is really based on algorithm to be able to diagnose the consumers before they get depressed, anxious. So early detection and once you detect it, then I got to be able to navigate them for treatment as well. Detection is one thing, hey, you have depression, but what, what are we going to do about it? So we are platform now provides end to end solution from early detection which is all AI driven and then directing at the back end for the right level of care within health plans, health systems. And again, this is the impact I want to have as my legacy to what I've done in the past for the mentally ill or for the mental well being.

So tell me like the more famous apps that I see and I've even downloaded it once in a while. One of them was headspace, another one was calm. And these were more meditation storytelling. And I was surprised when I used the calm app. Actually there were some meditations on there which were guided meditations that you take and you fall asleep. Sleep is an issue that is actually I would say at least ruining a lot of type A Personalities like me and I'm very concerned. But what do you think of sleep?

Sleep?

Is sleep a part of this mental issue ongoing nowadays? Number one, Number two, how is your app different from calm and mind space? And number three, what is the role of insurance with your app? If there is any.

Great, thank you. So first on the question of sleep, the sleep mentally ill or when you have mental illness or stress sleep equals pain in physical, you know, unwell when you're not feeling well. I say sleep and pain are the same, I. E. If you're having lack of sleep sleep issues, start thinking of the mental well being, salting, you know, stress. It's one of the earliest indicators that something is not right. Again, to maintain your circadian rhythm, the sleep, it maintains the balance overall for your brain to shut down and get the rest of. So sleep is a cardinal symptom for every issue that happened mentally. The first question we ask is how's the sleep pattern? Are you sleeping late? Are you sleeping early, are you awake in the middle of the night? Those three things very, very critical and key aspect of your mental well being. So that's sleep analogy, that is to a pain for physical symptom. Number two, what we had developed as an AI platform, this originally came from John Hopkins and whatnot and that's they have a patent on this. Now we are doing all B2B business to business. That is we are mostly working with health plans, health system insurances and hospitals so we don't go to the consumer directly. So our app is prescribed by a primary care doctor, a pediatrician or primary care doctor to the patient. And once it's there with you, it then monitors your overall mental health well being from sleep pattern to what you're journaling, what you're writing in terms of getting depressed, you're getting actually falling off the wagon or substance abuse issues. So our goal is to diagnose this very, very early on so we can then integrate that dashboard at the back end to the clinician. They can see remotely what's going on. And the goal here is to catch somebody falling off the wagon much earlier on and then we navigate them at the back end clinicians for care and treatment. It's all built on one platform. So it's end to end solution for that techspace and calm. Great platforms, fantastic platforms. They are more B2C primarily so they do some work with healthcare health system but they're more, you know, business to consumers. We are exclusively B2B business to business. And yes, our solution has been embraced by number of health plan health systems does cover a lot of the initiative that we have in place. So your out of pocket is minimal.

So nitin, one important little controversial thing like one of my favorite so called influencers was Michael Jackson. He died early at the age of 50. He was taking a lot of medicines, drugs to sleep and simultaneously I personally once in a while take melatonin all the time or I was talking to some of my friends. Like melatonin is becoming an epidemic to the point where kids, three, four year old kids are taking melatonin and it's available over the counter. So I see moms popping in melatonin gummies. Melatonin you call it, drops everything in melatonin from kids to the oldest adults. What is your take on melatonin as a psychiatrist? Or does it not fall in your preview?

No, it does, it does fall in a purview and I think I've used that both in my adult population and my geriatric population. And I see it is effective in that. It's also very effective in jet lag when you're traveling. So it's one of the number one use during jet lag. Essentially the natural melatonin that's produced in our brain controls circadian rhythm, the sleep pattern, the awake and the sleeplessness and all that. The awake sleep cycle, the melatonin 100% right. I think it's been way overused. It's knee jerk reaction just because it is available over the counter and has to be well monitored and it can have negative effects. I mean it can have significant nightmares, proxim sedation and it can also interact with other medications. But yes, this is something one has to be cautious about. It's a sleep aid as we call it. But having said that, it has to be used very prudently, carefully and I go back to say it can have lasting effects. For example, when you take melatonin the next day if you're groggy, don't drive. But it does work. On the contrary. So it does work and I've given it, like I said to my senior population, adults does work for sleep. How long it works to be said, and again the dosage has been monitored and my guidance would be to have your primary provider be informed of that, who can also monitor that because of the medication that you would be taking.

One other important question is see even President Trump talking about this. Fentanyl is becoming an epidemic in our country. And also a lot of drugs means this always been a problem from marijuana, cbd, all kind of Other drugs that are more potent cocaine. So what is your opinion? Why do people get trapped into it and how do they come out of it? What is the main reason that drugs are so popular in America versus the rest of the world or at least was eastern world. World doesn't have that many drugs at least like in America.

That's a billion dollar question. I think you have to understand that what you're talking about and you alluded to Michael Jackson in your previous question, these can have lethal effects. These are profoundly addicting substances like fentanyl and so on. An addiction that is very quick, very common and can lead to very detrimental effect. And again you mentioned fentanyl, cocaine and whatnot. So having said that, it's a real epidemic and you're right, the current administration has made it a top priority in being able to handle it and address it. And the sooner we plug that hole, the better it is. And we are seeing this across the board from a lot of our homeless or what we call houseless folks on the street over to the emergency room which get flooded with a lot of these patients that come in overdose. And number of times it's lethal, it's very difficult to reverse it. The course on these especially again highlighted about the current administration real problem and can have lethal effects. Addiction is the key word to it this bit. I'm a pervy because I don't do substance abuse treatment but it is a real problem again globally, more so in North America.

As a psychiatrist, what is the reason people get into drugs? Like I've never taken drugs and I want to know what induces or incites them to take drugs and go from one to another to another to another. Like what is the main reason according to you as a psychiatrist?

I think one of the key reasons is a lot of our children in their adolescent year want to experiment with things and once they start doing that and you get your dopamine system highlighted and you get the high that kind of starts what we call the spiral downwards. A lot of these folks and the question there is at what point can they get away from it? So again propensity for that is a lot of times people are self feeding depression. We'll be taking this for parties and just getting the regular high and just not being, getting off it. And that's a real problem. So anywhere from self eating a lot of the mental health issues, stress as they may call it, all the way to just having addiction. Propensity towards that is kind of, you know, what caused it. And again it's Being pushed a lot through social media now. So folks sometimes take it accidentally and just say, oh my God, it feels so good. And, you know, suddenly I'm very focused. I can do a lot more. They get what we call manic issues and like, hey, I like this stuff. Let me keep taking it. And next thing what happens is they cross the line between just experimentation and addiction. Once you get into addiction phase, that's where the problem start. And like I said, the key thing is you start spiraling downwards from there.

It's a key point. Cross the line between experimentation and addiction. Love that light. So before I come to the closing point, because it's already more than 36 minutes, I do want to address one other thing. One question. Do you think social media is the new drugs, number one? Number two, I would like to give you 60 seconds to have your shameless plug where you can say a quote, you can advertise your business, you can do whatever you want. That's your 60 seconds. So start with a quote. Is social media the new drugs?

I would not call social media new drugs. I think it's very informative if it's used the right way, if it is misused like any other thing in life, that can again cross the line of addiction and cause a spiral downwards and that can be very detrimental. I think it's a very powerful tool if it used the right way for the right reasons. But beyond that, and that requires a keyword that I use, social media hygiene, which is, hey, keep your time limited, keep it right places and you're going to be okay. So that's one as far as you know, I go. I want to thank you for the opportunity here. I am very proud to be back in workspace starting another company again, mental health initiative. And the goal really is for precise behavioral health to empower the early diagnosis of depression, anxiety. Recognize that and being able to navigate to the right folks, treat it so we can prevent the suicides, the addictions and really provide an eco environment of mental wellness. So thank you, Puneet. This has been amazing. Appreciate it. And again, love the namesake.