What Causes Depression?

Quinn: [00:00:00] What is depression? And how do the interactions between our genes, our chemistry, and the environment around us affect our odds of developing and being treated for anxiety and depression? That's today's big question, and my guest is Srijan Sen. Srijan is the Francis and Kenneth Eisenberg Professor of Depression and Neurosciences at the University of Michigan and the director of the Francis and Kenneth Eisenberg and Family Depression Center. His research focuses on the interactions between genes and the environment and their effect on stress, anxiety and depression. Now, look, before we get going, I want to make very clear, if it isn't clear already, we're going to be talking about stress and anxiety, depression, some suicide and more today.

It's a very important conversation. That's why we're doing it and an important one to be had, but if any of this could be triggering to you in any [00:01:00] way, please feel free to just skip over this one. Nothing in this conversation should be taken as medical advice. If a treatment or combination of treatments prescribed or recommended by your healthcare provider is working for you, that's great.

Your personal experience with that treatment is much more relevant than anything in this conversation. If you're using a depression medication or other therapy and not getting relief from your depression symptoms, talk with your healthcare provider. And finally, if you are struggling and feeling distress and that you might hurt yourself or if someone you love qualifies in any way here, you can text or call the Suicide and Crisis Lifeline at 988.

That's 988 right now from your phone to get help. And you can even call and press three to speak to a counselor with the Trevor Project, the nonprofit who works and provides wonderful support for LGBTQ folks. Okay, let's get to it. Why are we here? Look, even before COVID, kids, teens, and adults were suffering increasing levels of depression and [00:02:00] loneliness and anxiety and stress.

The symptoms are fairly common to folks who have them. The causes are far less so, which makes treating depression as it were a bit like throwing darts blindfolded at a moving dartboard. You know the dartboard's there, somewhere, but it's moving, and you don't know where, and you don't know why, and you don't know how that might change.

You know, darts stick to dartboards, but you're not sure where to throw it, other than to throw it, and hope that this one sticks. You're welcome. There's more of my poor metaphors further in the feed. Anyways, from genetics to the gut, to brain chemistry, to inflammation, and innumerable possible environmental factors like say, a pandemic, or school shootings, or a loved one passing, or childhood abuse, whatever it might be.

Just lack of sleep can trigger depressive symptoms. Or not. I have suffered through it. Srijan has suffered through it, and so many of you have too. So, with the way the science is progressing rapidly but in myriad ways, I thought it was time to dive in. So [00:03:00] hopefully this is the first of many of these.

Welcome to Important, Not Important. My name is Quinn Emmett, and this is science for people who give a shit. In these weekly conversations, I take a deep dive with an incredible human like Srijan, who's working on the front lines of the future to build a radically better today and tomorrow for everyone.

I hope you enjoy my conversation with Srijan Sen.

Srijan, welcome to the show. Thank you for coming today. Thanks so much for having me. Absolutely. We hope that these conversations are evergreen, but it's October 17th. What is are you in Michigan right now? What are we got snow on the ground yet? What are we talking about?

Srijan Sen: I am in Michigan.

It's the week it's changing, so no snow on the ground, but it’s definitely the first time I wore like a sweater and it's starting to get chilly, but it's a beautiful time. The leaves are changing and lots of football in the air, which is a big deal in Ann Arbor. So yeah, a good time to be in Michigan.

Quinn: I haven't spent too much time in Michigan. I spent some time in the lakes, but I went to school in central New [00:04:00] York to Colgate University and I'm in Virginia now, but I remember getting up there and, I swam and played baseball and so swimming, you had to, you didn't get to leave very much because the season's so long, everybody else goes on these little breaks and we just had to stay.

And I remember sitting in the dining hall on October 4th and watching the snow come down outside. And I was like, what have I done? This is an enormous mistake. Like you said, it's so beautiful. And then it's so cold for so long.

Srijan Sen: I went to college at Cornell in Ithaca, New York. And I remember I did my visit in, in August and it was a beautiful day.

Quinn: It's the most beautiful place in the world.

Srijan Sen: Yeah. And then I don't think I saw the sun for four years.

Quinn: I remember seeing high school students come on the tour, like you said, in like August, September. And you're like, oh, they're all coming. Look at this place. And then you see ones who are actually doing an outside tour in January.

And you're like, what are you doing here? Run for your lives.

Srijan Sen: Yes, yeah. We do interviewing for new graduate students in, it tends to be in, in February and it's the worst time, if those interviews were in August, [00:05:00] it's the bad academic schedule but no it's a great place, a great town.

Quinn: Awesome. Everybody loves fall. That's again, another run of my character things. If you're not into fall, you're out of here. So Srijan, like I said a little bit offline, we like to start with one important question. It sets the tone in that the stakes of the situation, but also it brings a little levity to it.

And we usually get something fun from it. So Srijan, why would you say you are vital to the survival of the species? And again, I encourage you to be bold and honest.

Srijan Sen: Wow. Yeah, that is quite a question. I think my initial reactions, I am not vital to the survival of the species and partially because of the resilience of the species that no individual is, we've survived through, through a lot.

And can survive many things. I think hopefully what I can contribute is this is to improve our understanding of how our mind thinks and how we approach things and be a part of advances in how that relates to when things [00:06:00] go wrong in our mental health. And I think we desperately need to advance.

And I'm hopeful that in the next, 10, 20 years that, that we will understand how we think and do things in a healthier way and I hope I can be a part of that improvement. So I think that's the main thing. I also cheer loudly at Michigan football games and I think influence the world in that way.

Quinn: Sure. Yeah. I mean, cause if you don't do it, I don't know if you're superstitious. I am both like the most evidence-based person, but also like clearly always lined my baseball cleats in the same direction. Because if I didn't that's it.

Srijan Sen: Yes. Yes. I've, yeah. I’ve watched full baseball games backwards through a mirror because we hit a home run that way.

That's the way it works. I'm the same as you. Evidence based in most of life and then ridiculously not in, in some important ones.

Quinn: My poor wife. It's funny you mentioned the resilient thing. I feel like I saw, I'm such a geek for just general history, but way back, going early peoples in certain [00:07:00] continents in the ice ages and all things like that.

And I remember seeing something recently where they were like, yeah, I think at one point we were down to 2000 people in one of the ice ages. And you're like, can you imagine the pressure? Holy shit, man. No, that's like a Battlestar Galactic episode. Like just watching the body count. I've, they probably had a little less self-awareness than we do now, but still oh my God, what a nightmare.

Srijan Sen: Less like real-time body counts on Twitter, but yeah.

Quinn: Correct. I'm probably misnumbering it, but either way, like not great, like in the odds of us getting there. It's, anyways. Yeah. No, thank you. Talk about mental health.

Srijan Sen: We’re at a good time. We have a lot more backups.

Quinn: We know how to wash our hands now. Everything is great. So listen, like we talked about offline a little bit. I expect we're going to bang around a bit, but mental health in general is obviously to use a ridiculous metaphor, very top of mind for everyone, whether they're personally suffering from poor mental health in some way, or a loved one is, or a physician is, or whatever it might be, or a child is. And part of that, I think, is [00:08:00] probably because we're doing a better job recognizing it. Part of that is probably because of COVID and school shootings and phones or whatever it might be. But I want to just really get into this, and hopefully it's the first in a series of these, and you're already invited back.

You're welcome. I want to dig into it, because it's important to have these conversations so people understand that there's folks like you who are working to advance our understanding of the what and the why and then what we might be able to do about that every day because I think that in itself is probably helpful to people to know that they're very much not alone knowing that loneliness is such an issue here.

I thought about this as I was walking in the recording room earlier. To grossly oversimplify depression, the brain, and the gut for a moment, which is probably just a colossal mistake in itself. Just to set the baseline, it seems like, and we can go anywhere from here, the cumulative science and the latest science seems to tell us that depression, as it were, is probably [00:09:00] an individually differentiated set of conditions or condition like cancer. I feel like I saw a reference to a number of places with hopefully some sort of repeatable, identifiable causes that help us maybe treat it in some way like we do a breast cancer or a blood cancer. However, imperfectly, but progressively more effectively. And that any combination of, and I'm going to leave things out here and in no specific order, genetics, white matter, inflammation, the gut, and environmental factors may cause or trigger depression, again, as it were. Does that sum it up? Are we done here? Is that good?

Srijan Sen: We're done!

Quinn: Oh, great. That's okay. Listen, this is so great. All right. So tell me all the places I was wrong there and where you would like to get started with. I don't know if you want to start with sort of the science, like the base layer, like genes or, and work our way up to interventions and treatments or where, what's the best place for people who are listening to go I know people with depression. I would like to understand this better.

Srijan Sen: Hopefully we can cover a lot of ground. [00:10:00] I like the cancer analogy and I think there's others. I think it's important to understand that depression is a really complex disease that manifests differently in different people.

And my hope is that 10 years from now, we don't talk about depression, but we have made advances and are talking about 10, 20, 30 different things. There's generally 10 symptoms that we use to come up with a diagnosis of depression through the DSM, which is our psychiatric Bible.

Quinn: Could you describe those real quick?

Srijan Sen: Sure. Low mood and not having motivation, losing interest in things, having sleep problems, eating problems, low energy, probably most concerning and most serious is thoughts of death and of hurting yourself and suicide is the most tragic consequence of depression. I don't know if I got through all 10 but it's not a magic number.

And there's lots of other things that some people have more irritability, some people have more withdrawing, it can lead to increased use of substances. I think the point I wanted to make on [00:11:00] that is that there's over a thousand combinations of symptoms that can get you a diagnosis of depression and your depression is probably very different from my depression and both in terms of how it manifests in us and the causes.

And we don't have the sort of toolkit to really differentiate at a level that cancer has gotten to. I hope that eventually we do and can really differentiate prostate cancer from breast cancer or cancers due to specific genetic mutations.

Quinn: Which seems so obvious now, right? That we can do that, of course. But depression is however many decades behind.

Srijan Sen: It is and I think we're moving along that pathway and to the way that specific changes genetically in cancers meaningfully predict what treatment would work best. Hopefully we can get there. And really be able to differentiate different types of depression.

I do think and this is going in a different direction, another place the cancer analogy is useful is [00:12:00] that in cancer, there has been real progress that, the chances of you dying of cancer for most of the major cancers is less now than it was at the turn of the century and even less back to 1990 and 1980.

And we have made major advances in our molecular and genetic understanding of what happens in tumors to create malignant cells and how that spreads around the body and advances in immunotherapy and new chemotherapies. From a public health perspective, the major driver of the decrease in cancer mortality has been much more in the prevention realm, which has been understanding and getting people to stop smoking and reducing environmental toxins and sun exposure in different ways. Depression, we don't know nearly as much about the molecular changes in the development of new treatments. We're far behind cancer, but we do know a lot of the primary upstream driving factors in a way that's analogous to smoking.

How social connection triggers [00:13:00] depression, not getting enough sleep, and exercise and work and family interactions, and so those are really important targets for improving our mental health and I think places where we can make progress in the near term in a similar way that, you know, that we've made in cancer with smoking cessation.

Quinn: Let's talk for a moment there about sort of environmental factors, right?

Like you said we have made so much progress because we finally conducted this very kitchen sink approach, as I like to call it of taking on lung cancer, which was primarily smoking and other environmental reasons, of course. And that included lawsuits and marketing and regulation and social pressure and all these different things, right?

And we haven't eliminated it but it is down drastically. In fact, it's so far down there was a headline this week that said that one piece of the puzzle was raising taxes on them. And because smoking has been reduced so much, those taxes, which for the past couple of decades have gone to a variety of children's [00:14:00] programs, that funding is now reduced because there's so few, the volume of taxes collected off them is down. So it's a real like pros and cons situation. It did what it was supposed to do, but now it's like, oh shit. Now we've got to find the money somewhere else.

Srijan Sen: It's hurting the children.

Quinn: Slightly analogous to a gas tax and how EVs aren't paying that.

And so obviously it's great to tax it so gas isn't quite so cheap, but we have to pay for roads somehow. Pros and cons. It's complicated. Like everything here, but let's talk about those environmental factors because obviously, cancer in itself is very complicated. To get into it mildly, my one real bout with it, which I didn't really realize until, with cancer and depression, was one of my best friends died 14 years ago from cancer, very suddenly at 29 and I did not handle it well. It was a lot of drinking, a lot of depressive, a lot of just crying for no reason, very low, all these different things. It definitely lasted a couple of years. It was not great. Never really got real help for it. Just progressively dealt with it.

But, cancer almost cheats in some [00:15:00] cancers, right? It's pretty easy to do a scan and see a large enough tumor and go there it is. Let's make sure it hasn't spread anywhere else, right? Blood cancers are more complicated, even though we've got some tests for that. And now there's much more early testing that's semi-controversial, obviously. There are things like the BRCA gene, which has become very important, but also semi-controversial. The point is these indicators are much more seems like standardized and robust, but often easier as opposed to some of the environmental factors for depression, but at the same time, some of your work seems to have really, especially with medical students, your longitudinal study, seems to have really identified, you were hinting at, both sleep and lack of social connection which again, you don't see on an MRI, right?

So I wonder if you can get into those a little bit and then maybe we'll work back down into whether you are genetically more likely to be predisposed to depression.

Srijan Sen: Yeah, no, I'm sorry you went through that and it's difficult and it's far too common and often, a trigger of a loved [00:16:00] one going through something and there are different triggers, but it manifests and recognizing and getting help and dealing with it in healthy ways is hopefully becomes more norm and easier to do. Thank you for mentioning our work and it's part of a really a broad, hopefully emerging area of looking at these factors and some people have been looking at for a while. A lot of the work I think is getting to backing up common wisdom that probably our parents told us, but I'm hopeful that we can quantify it in a way that's helpful.

So maybe it's worth talking a little bit about that study if that's a good direction to go, we've been studying this group of training physicians, people transitioning from medical school to residency for the past 15, 16 years now. I looked at about 26, 000 of them over the years of folks who are, when we first enroll them are relatively healthy, 3 percent of them are depressed or so. And then in July each year they start [00:17:00] working really long hours, not getting enough sleep, dealing with life and death situations as they're working as residents in the hospital. And a high number of them, about half of them end up getting depressed during that first year of training, under the sort of stressful conditions. And so we've used that model in a bunch of different ways, probably most directly trying to understand what the causes of depression are in that group and work with them, with hospitals, with accrediting agencies to try to counter the negative stressors and reduce the depression and things that go along with it.

But we've also used it to try to understand it's a relatively unusual group. They're healthy when we first see them, and we can follow them as they encounter the stress and many of them get depressed. Most times, in life, we can't predict when stress is going to hit.

Quinn: Sure. But you know the first day of programs. It is such, a very brief segue, one of my best friends is a captain of a [00:18:00] submarine, and, they a few years ago had some sleep scientists come on board because they were running shifts.

Srijan Sen: That's cool a best friend.

Quinn: Yeah, it he thinks he's cooler than he is.

Let's take it easy. It's so cool. I have a podcast. They had some sleep scientists come on board because they're, they were running, what were the shifts? Maybe they were six-hour shifts or something like that. Anyways, after a few days of being out with him, the sleep scientists were like, holy shit, this is really bad.

You guys are effectively drunk the entire time. Everyone's depressed. It's not great. I bring that up because the Navy actually made a structural decision to move them to, I think, and he's going to kill me, I think eight-hour shifts, three eight hour shifts. And how much that actually helped.

As much as you've got this incredible control group of, three percent depressed mirrors the population. You know when they're about to go into the shit. It's a huge variety of people across so many different institutions. But at the same time, again, without jumping over the research itself, I wonder how much structural change can be had to the residency system itself from [00:19:00] understanding the lack of social connection, the sleep stuff and all that. So how do you tie that together?

Srijan Sen: Great. I hope there's progress to be made. And I think both in this group and then in other, certainly in people in submarines, in a lot of factory shift work and air traffic controllers and other things. And it's surprising to me, I didn't realize how much that one component, the shift work, the timing of when you work affects mood, depression, and even physical health in pretty profound ways.

How important our circadian rhythms are and doing things at the same time every day and how much that's set by when the sun's coming out and going down and how much light we're getting. It really does affect us. And I think in, we're just at the beginning of it in medicine, I don't know if this is true, but I saw something that surgery starts ridiculously early in the morning in most hospitals.

What I had read from this history of medicine article is it was, it's set by maximizing the number of hours in the operating theater in [00:20:00] Germany in the 1850s and 60s before electricity was available. And we still haven't really adjusted things. Even though, we have electricity.

Medicine tends to be pretty traditional and stuck in ways, but that has huge effects in ho we still do surgeries way early in the morning and that for many people that doesn't fit their circadian rhythms, both for surgeons and hospital staff and for patients.

And we shift things in non biological or biological friendly ways. Before people used to work, 36, 48 hours in a row, which is bad for them and bad for their attention and bad for patients. We're doing less of that, but still shifting in kind of haphazard ways.

And there are ways our body similar to what your friend experienced in the submarines that shifting forward is often healthier and easier if you're changing from days to nights and shifting backwards. And the length of the shift really matters and how you handle it. And then where you handle the shift and [00:21:00] when you get light after your shift, or before the new shift, makes a difference.

So really having that, the real advances in circadian systems and understanding inform how we organize, how we staff submarines and factories, but also hospitals and how we organize those. I think even though they seem like relatively minor things can have major effects in both our mental health, the mental health of doctors in the work that I'm doing.

But also, the productivity and how that affects the work that they do. Little things and we're talking about the circadian work now, but I think this applies to a broader range of things, can make pretty big differences if we do it correctly. And if we do it wrong, it can have, it can really do damage.

Quinn: It seems to make so much sense. Our parents have been yelling at us to get enough sleep forever. It's just you are further quantifying it and quantifying the myriad internal and external impacts of that, right? We live in relationship to one another, especially physicians, [00:22:00] right? And or nurses and administrators, everyone like that is the entire purpose. It's about the relationship and that is affected just like driving a submarine or flying a plane or working in a factory or being a new parent, right? So, I want to talk, I want to get to physician mental health and again, nurses as well, because they're obviously such a vital piece of the puzzle here, and were so challenged the past few years, but putting a pin in that for a moment. I wonder if we can talk about the intersection of you've left medical school, this place where you were challenged and probably developed some great social bonds, and you are thrust into residency.

Again, you make your list and you have no idea what you're going to get and you go, and you're going into this incredibly both stressful situation. We always say, like, when my kids ask me, is the planets melting and all this? And I'm going to say, I had a podcast. You are going into, you're going to be a doctor or a nurse.

You are, it is life or death, right? But you've lost all those social connections, because one, you are not in person with them, like we were in lockdowns, but also time is pretty zero sum. [00:23:00] You're not standing around. You can't text with these people all day. And the sleep. Tell me how we've been able to really understand and again, quantify what that loss of those social bonds means for the, like you said, half of folks who become depressed over time.

Srijan Sen: It's a shock to the system in the way that you talked about really eloquently it to get, removed from whatever your social support system is, and then moving to a new place and having to adjust all while being thrown into ridiculous work hours and life and death situations.

It is very common to lose social support in different domains of life with that. It affects a lot of people profoundly, and when bad things happen, an error, or a patient dies in the hospital, or family problems, that your normal social net that was there before isn't there anymore. So I think this is, again, not unique to doctors and often, when any of us move or lose social support it can be a [00:24:00] profound both trigger for problems or when something else happens, not realizing that we don't have that support or that net that was there before can really make things snowball and make things worse.

We often hear from our young physicians about their parent gets sick or their sister's getting married and they miss that because of their work. And that sometimes is a trigger for starting a depressed or anxious episode. And again, things can go downhill from there, but that social connection is really important.

And often we don't realize how important it is until it's gone. So that's one of, I think both from a societal level, institutional level, and individuals finding ways to build that, build the social connection, I think is really important and really important from a public health perspective to improving mental health and all the things that flow from it in different ways.

One of the things our work has found in others is that the social [00:25:00] connection, the type of it that's important and how important it is different for different people. And for some people having a large volume of social connections is the most important thing and really is the bedrock and the foundation for their mental health.

For other people, they really do need alone time and I think everyone needs some social connection, but the nature of it and the volume of it is different for different people. So broadly, I think identifying for each individual, both us as physicians and healthcare workers, but also for individuals themselves to try to understand what the most important things are for them.

And then finding ways of prioritizing it is I hope one of the ways we can really make progress in the next, the next period of time and improving our mental health and wellness.

Quinn: Thank you for sharing all that. It seems one of my biggest issues is the folks from quote unquote, hard science jumping on the quote unquote soft science and saying it doesn't matter as much. I'm like look at where we are. And we had on Mark Schultz [00:26:00] recently, who's been running for a long time with Dr. Robert Waldinger, the longitudinal happiness study for a hundred years or whatever, 80 something years.

And it's complicated and only so measurable. But like you, they and their predecessors have used a huge variety of biological and chemical and environmental biomarkers, as it were, to really understand what provides for not just contentment, but a nourished, flourishing, happy life and mental health.

And the number one thing, like the cheat code, is relationships. And like you said, some people, like my wife, who is a butterfly, it's new friends every day. And also a bunch of great friends and I've got my robot vacuum in the other room and this guy and a few like wonderful friends who are ride or die and I'm good, but whatever your preferred version, which can take a while to sort out especially as you move through life. Obviously COVID was pretty hard, whether you were a very small child who didn't get the initial [00:27:00] social exposure, that's so important, didn't get to go to preschool, which is, unaffordable and impossible for a variety of reasons, as it is. Kids are pulled out of school who maybe didn't have attention span issues as well.

So they couldn't even handle the Zoom side of it. Middle schoolers and teenagers who obviously ripped away from friends and missed homecomings and all these things that we've been promising them for so long and day to day interactions, college students. I've got William and Mary is ten feet that way and watching in person how that went down with folks was a fascinating and tough experiment.

But at the same time, we've seen youth mental health dropping before that. And it's been very easy, and probably in some ways true, to throw a lot of it at social media, obviously. But there are some folks who try to take an even further step back and go, this seems to pretty much line up when phones just started coming out, period.

And if you track that again, and again, it's not, it's very imperfect, but [00:28:00] hanging out has gone down, driving licenses has gone down, which, makes it much more difficult to hang out. Screen time has gone up. Kids having sex has gone down. Like all these different markers of, again, not to say our lifestyles were perfect before that by any stretch, but at the same time, these environmental factors, we've introduced things that have never been a part of who we are and how we interact with one another, knowing that relationships are the most important piece of the puzzle. Before we talk about genetics or white matter or any of that shit, what those do to affect them. It's fascinating and it seems so simple, but we seem to keep making it much more difficult for ourselves. It's interesting.

I don't know. It's just, there's a reason I keep coming back to all this, which is I know folks who are struggling with loneliness in a real way, young people and old people and middle and new parents and we just make it difficult. And texting is not the same thing. It's wonderful in some ways, right?

I have friends I text during Liverpool games who live in Australia. I don't, wouldn't otherwise see them. Yeah. It's not the same thing.

Srijan Sen: Yes. Yeah [00:29:00] no. I think that I'm sorry. I was a distracted. I was wondering if you can text the, if he gets to text on the submarine or not.

Quinn: He does not. It's ridiculous.

It's first of all, it's still volunteer only, which is understandable because Holy shit is it claustrophobic. I've gone out with them and I'm not claustrophobic. It was still like, wow. Basically they get plain text emails when they surface, who can know? No, it's a whole different thing.

Srijan Sen: That's interesting too, anyway, yes, I want to study that too.

The environment is so important and it's changed in so many ways from, particularly within the last 20 years. I think one point that I think is important is to try to not, and not that you were doing this, but to oppose biological explanations to environmental explanations.

I think it's, I'd love to get to a place eventually, when our biological sciences have gotten there, that we can put them together. But the only way that screen time is affecting our mental health is through changing our biology in some way.

Quinn: No, not trying to [00:30:00] short that. More, it's just like we're like, we're taking the lowest hanging fruit, the things we do understand and making those more difficult before we even get to, look at how they're reprogramming us.

Srijan Sen: But yes, hopefully we can get to the point where we can understand how it is. Whether it is reprogramming us and in what way, I hope there's pathways to get there, but it's clear the mental health of our, of adolescents, particularly adolescent girls but everyone has been on a decline this, the last 15 to 20 years with anxiety, depression and suicidality and completed suicides in ways that are really tragic and trying to, I think you mentioned a lot of the leading candidates that are driving that.

From my perspective, we still don't know what the answer is and if there is really one driving thing or it's a combination of these things, I am convinced like you are that social connection is a big part of it and the decline in the magnitude of the decline of how much time kids are spending with other [00:31:00] kids and to a lesser extent adults as well.

In person interactions the amount of time on social media with phones, how that's playing a role. Also, this plays into sleep. If you're spending three, four, five, six hours on your phone that tends to or like correlates and probably causes people staying up too late and not getting enough sleep.

Which of these are the driving factors or there's 10 other factors that we haven't discussed but trying to get there and then have markers where we can actually track whether biological or digital or some other markers to catch them early. We can intervene at the earliest possible stage is important.

So like we've been alluding to through the whole conversation, I think, the solutions to the crisis that we're in is going to be at multiple levels. So at a high societal level and policy level of how to increase the interactions we have with policies around phone use and social [00:32:00] media.

I think school start times is a big one. That's also playing a big role, how these are handled at schools and at the family unit levels are important. And then individuals in trying to prevent, like we've been talking about we know a lot more about the things that can prevent mental health problems from starting.

So putting those in place, identifying people early and then getting them help. We haven't even talked about how hard it is to get in to see a psychiatrist or a therapist. And that's a mini-crisis within the larger crisis that we have to deal with. But we need more work in identifying which of these factors that you talked about are the main drivers and how different individuals are affected by the drivers and really work at all those different levels to eliminate or reduce those risks.

Quinn: Base level time is pretty zero sum, right? And look, everyone loves to sit on the toilet and look at their phone, right? Whatever it is, that's a version of multitasking that's probably not quite so harmful. But at the same time, [00:33:00] when it's not on the margins anymore, when it is significant chunks of our wake time or what is supposed to be our sleep time, same with doctor's. I think, I believe I saw one piece of the research was, and this is reminded me so much of the first parenting advice I ever got, which is people are getting up earlier for residency, but they're still going to bed at the same time, which is so logical, but a nightmare, which is the parenting advice I got was you don't get control what time you wake up, but you do get to control what time you go to bed.

And that is like the, I was like, Oh my God, now I go to bed at about 7 45. It's fantastic. It's an exaggeration, but it's the goal. It's the goal. Again, we're not talking about things on the margins anymore, however complicated and nuanced and individualized they may be, right?

We're seeing these broader patterns of just how our lifestyles have changed so much that there has to be some sort of related cause in some way, but not everyone is affected. So let's take a little time and talk about, and obviously this is grossly oversimplified, but the genetic side of how you might be more preconditioned to [00:34:00] experience depression if you are triggered by whatever variety of ways.

And if we have time, which I know could be its own conversation the recent research, which I know has been piling up forever around serotonin and SSRIs and how those work, but maybe we don't know how and for some people and how that's both changed everything and nothing. But let's start with the genetic side, because again, not all of those medical students experience depression.

The number jumps, but not everyone. And not everyone suffered from lockdowns. Many people did and many people didn't. Many students have fallen behind and many did not. Can we talk about that a little bit and what your, most recent understanding is of how that works?

Srijan Sen: Yeah, there's a lot we still don't know.

And one of the exciting things about being in this area is that we're learning a lot and our understanding of how this, how all this stuff works is going to be really different in 10, 20 years.

Quinn: Does that excite you? You seem pumped about that.

Srijan Sen: I am. I am. It's why, no one's, like we're not going to discover like a new chamber in the heart.

Like we pretty much know how it works. And like we have no idea how the brain works. And I think we have the tools to [00:35:00] really understand it much better. So I am pumped about that and the potential there. I think genetics, we, maybe 30 years ago, 20 years ago, thought that there might be a gene for depression, like BRCA for breast cancer, but it's turning out pretty clearly that we do know that there's a genetic component to depression that if your parents are depressed, you're more likely to be depressed.

And that accounts for, some, a third of your risk, but it's not one gene it's spread across, at the latest is, there's at least 300 genes that play a role in depression that we've as a field identified and probably a thousand more with really small effects.

And if you sum them all up, it affects your predisposition and your risk for depression, but it's not any one thing. And as you mentioned in our study and others, that people with, we can now create these things called a polygenic risk score, adding across your whole genome and you can get versions of these on, 23andMe and Ancestry.com and things on how [00:36:00] predisposed you are for losing your hair or getting diabetes or a hundred things. But one of those things is your risk for depression. But these are all probabilistic. So you can have a high score and not get depressed. You can have a low score and get depressed but it has some predictive value there.

One of the interesting things that, that we're starting to make progress in, I think in the next few years, we'll make even more is understanding how the is causing that. And it's not what we've done with social support. What we've alluded to a little bit is that most of these residents lose social support when they move and they start their new training, but not all of them do.

And how that affects people is different. That when people lose a lot of social support, people who have a high polygenic risk score for depression across this whole genome tend to do worse. They are much more likely to get depressed than people with a low polygenic risk score. But we also found that in the situations where people didn't lose their social support or actually gain social support, those same people [00:37:00] who had a high polygenic risk score did better.

They were less depressed and less anxious and generally thriving more than people who had a low polygenic risk score. So it seemed like something in this specific genetic score or combination wasn't really a bad thing. It wasn't that these people are defective in some ways and were struggling.

It was more of a sensitivity to the social environment. So in good social environments, they actually thrived, but in poor environments, they struggled. And so maybe for these people, and it's still early days and I don't think genetics is the answer to this but I think it highlights how, for these people, prioritizing social connection and environment is really important and probably different people have different vulnerabilities. Some people are steady and will be, the same regardless. For some people, the social environment is critical, and prioritizing that is really important. For other people, getting to bed at 745 or 8 is really important. For [00:38:00] others it's, getting in their run every day.

But figuring out what your sensitivity is, and ideally the biology underlying it, and then prioritizing that, I think is really important. Hopefully, we'll have more ways of helping people identify that in the days going forward.

Quinn: There's so much I want to talk about there from exercise, we all see the simplistic headlines of exercise is just as good as an SSRI.

It's okay, let's be nuanced about it. Some people can't exercise in the way defined in the article or whatever it might be. How many hundreds of millions of hourly workers do we have in this country? We have no control over their sleep schedule or their childcare schedule or whatever it may be.

Obviously take all that with enormous, salt mine, but let's go back for a minute to this polygenic score. When did that come about? How far along do you feel like we are in, the easy, lazy, incorrect comparison is an allergy test. You lay there, they prick you a bunch of times, and the doctor comes in and says, looks at all of them and says, blueberries, horses, cats, dust, and you go, oh, I should [00:39:00] avoid dust but I'm fine on chocolate.

It's imperfect, but it has come a long way. Reflux, right? It's easy to do. If you're suffering from it, they can either see you've got an ulcer or whatever it might be, or they can do an elimination diet and you add things back in and you might discover, oh this makes me trigger really quick.

And you can understand that. And it seems like you're alluding to, hopefully, we can get to the point to understand when people are predisposed to really needing those in-person social connections that they can rely on and, or sleep, things like that. But let's talk about that score for a moment.

How did that come about? What is involved? And again, to everyone, like this is not a, do not use it as a diagnosis in any way or anything like that. But whether or wherever it's available, but does that get better at some point what's involved in getting better? What do you need? And how much do you think that is a part of what folks are dealing with?

Srijan Sen: I have envy for other parts of medicine where they're like logging that, but yeah, I don't think we're there yet. It's not [00:40:00] anywhere near an allergy test. It is just one tool that can be helpful. I think it's, and all this is complicated. So, it's not just your genetic predisposition, but other things as well.

We've found and we do a lot of work with wearable stuff. And I think that's a, another part of maybe the path forward, but we give people some of their data back about themselves. All these interns that we're studying where are wearing Fitbits and Apple watches and we're looking at relationships between both sleep and activity and heart rate and light exposure and mood to try to understand things better and one of the things we're finding and trying to get the information back to the individuals is that the state that they're in affects how effective the information is.

So if someone is sleeping poorly or sleeping six hours a night or five and not enough, telling them that and saying you've only slept five and a half hours a night the last week, [00:41:00] you usually sleep seven hours, try to get more sleep. They sleep a little bit more, but if they're sleeping seven hours a night.

You tell them you're sleeping seven hours a night. Good job, keep it up. They tend to sleep worse in the next night. So, in some ways getting, and we don't know the exact mechanism, if it's they feel like they're guilty in some way or don't prioritize it and decide that like oh, it's okay if I follow this Twitter thread at 11 PM and get to sleep a little bit later or whatever it is.

Quinn: Let me see what the neo Nazis are up to tonight.

Srijan Sen: Yes. The same thing in other domains, in exercise and mood, but the state that they're in affects how they, whether the intervention or the micro intervention works, or whether it's positive or negative. Tangent from your question, but it's not just, these are people, the same person, the same genetics, in September might respond positively to a sleep message, but negatively in January.

It's important to get the right prevention, intervention, or treatment, whatever it is, to [00:42:00] the right person at the right time and figuring that out is going to be a challenge, but I think where the answer lies. So genetics is one of these tools, but I think also people understanding themselves in a more day-to-day basis is important.

And I think wearables are one path to this, but not the only one, but trying to understand that each day I do, when I do have dinner with my family, my mood is better that day and the next day, or not, or the exact opposite or when I do get to sleep at night, things get better, and if I do walk in the park and get light exposure, it helps me.

It's impossible for any of us to do all the 30 things that our mother told us, or our doctor tells us to do.

Quinn: Which can provoke anxiety on its own.

Srijan Sen: Exactly. And it can be really counterproductive, but I think figuring out, I think we can and should feel empowered to figure out what the important things are, what the important thing is for me and for you, and then trying to prioritize that as much as possible, as best [00:43:00] as possible. And it's not, no one can go for a six-mile run and then come back and cook a wonderful meal for the family and spend two hours and then get all their work done and then get to bed at eight o'clock.

Quinn: And I've literally never done like half of those things in one day.

Srijan Sen: Yes. If the most important thing for you is to get to sleep early, then deciding to not have a leisurely dinner or not exercise is probably the important thing. So I think figuring out that and a long-winded way of saying that social support and genetics is a part of that, but genetics is not nearly advanced to be the thing that should drive that and much more being conscious about what is important in your life and as much as you can getting data on that from and writing it down in ways can really help us figure out what to prioritize and to help stay healthy and get healthier again when we are in an episode.

Quinn: How much, and hopefully one of these leads to the other, but it's me so doubtful.

How interested in are you, and I wrote a piece about this, [00:44:00] about my conflicting feelings on it. But Apple's rolled out this whole new sort of mental health toolkit, and not all of it's available yet. I think the journaling part is not there yet. At scale, suddenly, at least, a hundred million people or so are able to track and are prompted on the daily to track their mood in any given moment and how they felt today and to program in sort of some preselected and then fill in your own.

I'm feeling this way, irritable, happy, content, whatever it might be because of work, family, health, fitness all those different things in a world where and we've worked on this quite a bit here, clinical trials are so expensive and difficult to run. And I know you've said you've done a lot of wearable stuff.

Do you feel like this can help us make some progress on one front for someone to just understand themselves a little better and have a little more self-awareness for something to show you the math and say, Hey, Like you said, when you eat dinner with your family, you tend to rate a little higher, right?

Or when you go for that run, it tends to be a little better. I know [00:45:00] that works for me, but it took me 35 years to figure that out. And on a macro scale, how impactful do you feel like this might be knowing it started a month ago?

Srijan Sen: Yeah, no I'm really, I'm heartened that they're doing it. Yeah. I'm hopeful.

I think it'll be really interesting to see and we don't know how it's going to affect people. And I'm hopeful it'll be a good thing, but it could be a bad thing. So I think it'll be really, yeah.

Quinn: It's also the most powerful company that's ever existed doing it, like pros and cons.

Srijan Sen: Yeah, yes, exactly. And the data sharing. I think a lot of the sort of domains we're talking about, they are relatively benign, but certainly have some privacy concerns and other ones have even more, the location information, which your phone and your watch know where you are. And that seems to be one of an important factor, people who are home all day, again, it depends on the individual but that can be a sign of worsening mental health or where you're going, but also that's information that people are sensitive about and how to share that is [00:46:00] a challenge. And so, I know Apple thinks about that and hopefully is protecting our privacy, but still allowing, collecting and using this information.

It will be important to again, I've harped on this, but really work on this at the individual level. There's certainly some people where this data can be overwhelming. And as you alluded to, could provoke more anxiety that I only got seven hours and 29 minutes of sleep last night and I'm supposed to get seven and a half hours and this is horrible and that can keep you up the next night, but for some people it can be empowering in understanding every time I do interact with that person, I'm anxious the next three days and I'm in a horrible mood and maybe I should not interact with him so much or seeing that like really going for that run helps me and on days that I have a chance to run through the park things are better. So I think the way Apple gets the data and I haven't fully seen the final [00:47:00] version back to the people and in ways, hopefully, that they can really understand themselves in ways that they didn't before will be one of the important steps and ways that we can advance.

I think also there's more, the phone is collecting more information deeper beyond just steps and sleep that it had before around location and social connections and how many phone calls you're doing, how much time you are on TikTok and on your phone on different apps and finding ways to safely and in a way that secures privacy, but still bring that to bear in helping people understand that you've been on the phone for seven straight hours and how that affected your sleep and in a way that people can receive will be important. So integrating these new domains that are, we know really important for mental health, but how it affects us broadly and individually, we still don't know.

I think it'll be really interesting to see how that plays out. And really, yeah, Apple has a lot of not [00:48:00] control but influence on how this will play out in this next phase, given the, just the size and the reach of that company.

Quinn: That's the conundrum, right? If it's like if young people's mental health has been plummeting since phones came out and now the most valuable company that's ever existed is like we think we figured it out.

We're going to help you have these tools and now your watch can detect how much light you get every day. And we'll fold that in. And we'll see how much TikTok you do on your phone that you pay us for, like all these different things. Again, like it is very complicated and it'll be incredible to see. I'm sure in a month, they've already got enormous data that's hopefully both aggregated and anonymous.

And you can't be identified by the combination of location and time spent and all these different things. But that's also something we've never had before that quickly, that easily. And at that scope. So I hope it becomes useful on the macro and the micro level at the same time. Like it is complicated on just an enormous[00:49:00] number of levels.

Srijan Sen: I think the micro level, I hope, and I think will come first. I think people having the insights in their own life and knowing details that there's no way a phone or a watch can get yet about like personal interactions or things on their schedule and then put that together with some of the mobile data.

I think people we can do right now and do in a useful way right now that I think will be really, people can make changes in their life well before we'll get to the macro level. Hopefully, we can make progress there too, but I think that'll be a little bit down the line.

Quinn: It helps. I think I believe I've seen some science that just the act of self reflection can be helpful, but like you said, you've got to be in the right headspace, which who can know to receive it in some way, just like receiving good news or bad news. Like you can be received differently. My wife talks about, she realized that she's a screenwriter and when she gets notes from the studio, she likes to do it when she's on the treadmill so that she's already got the good chemicals floating and it just works and she just is less stressed about it.[00:50:00]

On the other hand, I decided to make my life's work working on mental health and climate change and public health and things like that. And I have very candidly it's been evident to my family, but, I'm trying to be more open about sharing, like not dealing with it well.

Like just, it's incredibly stressful. Obviously, I'm wildly privileged and I just have a podcast and newsletter and do this consulting stuff. But at the same time, it's all relative when we're talking about physicians and frontline workers and all these different things.

But yes, I try to keep in mind that my experience is my own, but I have been so stressed because of it all. And knowing that I've had back issues, so I haven't been able to run as much as I would like or any exercise in the past year. And over a week I can deal with it. Over a year, it's not great on top of everything else and other things that families are dealing with and this and this.

And I've had some very stressful times recently, and I really started my first, it hasn't gone towards depression, it has gone towards anxiety and stress. And heart's feeling tight and things like that. It's all been [00:51:00] checked out. Started Prozac for the first time, which again I'm aware of it enough, seeing all this recent science, to know that sometimes it works, sometimes it doesn't. There's 20 different versions who can know, and there's going to be side effects. And you just got to go on that ride, but also do the low hanging, relatively low hanging fruit, which is like okay, I do need to prioritize doing the exercise.

I do need to prioritize sleep where I can, and I'm going to have to sacrifice some things to do that. And that's okay. But I do hope that the interaction, like you're saying, all the data that's coming in, hopefully it does help folks on the micro level. Cause again, it took me 40 years to have any sense of self awareness about my life.

So hopefully, especially young people get that sooner. I can't imagine having that sort of knowledge about myself at 19 or 20 or something like that.

Srijan Sen: Yeah. And especially in this sort of emerging field where there is no right answer or we don't know the best way to use all this data. And everyone's integrating it for themselves, but yes, hopefully in the end, it's a good thing.

Quinn: Well, it's the version of control what you can control, right? Where you're saying like, [00:52:00] look, I'm pumped to be in this field because the brain and the gut, it's the metaphor, you pull a string on the sweater. We just keep finding like different sweaters that don't even look like sweaters.

Like it's the wild west. Like you said, no one's finding a new aorta anytime soon, right? If you are suffering from anxiety and stress and depression, you can't do a lot to control that side of it, right? Folks like yourself are doing the work. What you can control is hopefully the things that you notice with self-reflection that can help you feel better, and maybe some of those are more broadly applicable.

Srijan Sen: I think one of the other things we can't control is just the bad news that's out there. You talk about climate change, Gaza and Israel and Ukraine, and that's different than most of human history, where if there was a war going on 3,000, 8,000 miles, we would have no idea, no one knows if the climate's changing, but I think these are all critically important issues and things to deal with, but as individuals, we may have little control over it and not that people shouldn't think about and work on them[00:53:00] but if we find that, I think this also interacts with the, with media and social media that, yeah, negative stories tend to rise to the top and get more attention because of all kinds of biases and tendencies that we have as individuals. So really being conscious of how that's affecting you. And if you're, you are someone who's affected by that, then, limiting the time trying to find, there is a lot of positive news out there that's buried, and trying to bring that in an equal measure can be important again. Some people are not affected by this and it's helpful to know everything out there, other people aren't and so understanding yourself and if you are affected by that the negative activity, both on a local scale that can sometimes happen on TikTok or Instagram, but also at a more news, we're coming into another election cycle than knowing that and limiting your exposure to some of the negative stuff, especially the stuff we can't control.

Quinn: I feel like there's 70 other things and 70 other places I want to go with this, so we might have to have a version two, if you ever are interested in coming [00:54:00] back. I did want to ask one last thing before I ask the last three things I ask everybody, and then I promise we would love for you to go out and go back to solving depression.

Why do you do this work? So this is a question I really like asking people, but it's actually a two-parter because it depends on which word you emphasize here, which is why do you do this work? Why do you feel like you have to do this work? And why do you feel like you have to do this? Does that make sense?

Why does this have to be you, and why do you have to do this?

Srijan Sen: Yeah, I think so. Yeah, really good and thought-provoking questions. I think, I guess for me it's what I naturally think about. I have depression myself, depression in my family, and I've had close friends I've lost to suicide.

And I’m naturally profoundly and emotionally affected by this. I think also I always curious on why people behave or think or act the way that they do and how different people [00:55:00] respond to similar situations or triggers and both from the environmental perspective and in how people respond, but also how that's changing our biology and affects me in a different way that affects you.

So this is, what I would be thinking about even if no one was paying me to do it. And, I came up with the whole ideas on what we what I would do with the submarine crew and ways we would assess their mental health and how they're reacting to not having light and the stress of their own situation.

So I feel really lucky in that I've gotten, I get to spend my days doing things that I wouldn't actually do and hopefully in a way that can help us understand each other better and ultimately, hopefully, help people. I don't know which part of the question…

Quinn: I think you nailed both of it. You did a really nice job walking that line.

You're very intimately, personally affected by this in the most literal way. But like you said, you're just interested in it nonetheless, it seems to have consumed your thinking and you're lucky that someone's paying you [00:56:00] for it, right? It's like being a baseball player.

It's great. Good to go out and play a game every day. At the same time, and I'm sure there are in any field, wonderful people who are contributing to them who aren't directly exposed to these things. But you, bring a personal experience to this and that probably matters for someone who's really looking at this both in the long view, but trying to understand what the latest thing is because you understand it so well.

Srijan Sen: Thank you. Yeah, I hope so. And yeah, I think informing both my own personal experiences and hearing other people's, what they're going through and their experiences is really important and grounding. What I do in the work and yeah, understanding how it's affecting people, but also making sure that we'e're asking questions that really do have a chance of impacting people's lives.

Quinn: That's awesome. Okay. I'm going to get you out of here. Let me ask the last couple of questions I ask everybody and then you can go. Does that sound good? All right. When was the first time in your life when you realized you or a group of your pals, whatever it might be, had the power to[00:57:00] change or the power to affect change in some way?

And some people answer with something from childhood or adulthood or whatever it might be. When was the first time you looked up and realized like, oh shit, look what we can do? Look what I did.

Srijan Sen: That's a good question. I think feelings about all these things change depending on, one of the things about depression and certainly my depression, but broadly is not thinking that you're not making a change or making negative changes.

So I think it's relevant. I'm struggling to think of the first time, but I've been really happy or gratified in some way more recently with this, we talked about this physician, training physician population. And some of the recent data shows that we're making progress there, that the residents starting now are 25 percent less likely to get depressed, get less depressed and anxious than one starting 17 years ago.

And a lot of that is driven by progress, by they're working about eight hours less a week [00:58:00] than they were before and sleeping more and when they get depressed, getting more treatment. So, this is certainly not my work but a broad community of researchers studying this and the residents themselves prioritizing the right things and institutions changing policies, but it's heartening in a broad sense, where depression is more common and worse now than it was in the general population 20 years ago. So, it's heartening to see positive news and that when we do focus intensely on a specific problem and identify some of the root causes in this case, working long hours and not sleeping enough, and really target them, that we can make progress.

It's still depression is way too high in this population, but we've made progress and there's a pathway to make even more progress. So that really made me feel that our work can make a difference and really help people on the ground. So that's heartening. And hopefully, we can do that more broadly with the younger [00:59:00] population, the adolescents that we talked about earlier that we can as a field do the same thing and in all the other people struggling. So that wasn't the first or maybe not the first time it happened, but a recent one that in my old age now, what I can still remember.

Quinn: Yeah. It's fading quick, entire separate conversation. That was awesome. You have drastically contributed to this and to see actual measurable changes is pretty incredible. And obviously it's at scale because it's not just those folks who are being helped again they're getting into a profession to help more people. So there's really an exponential effect of that whole thing.

Who is someone in your life that has been positively impacted your work in the past six months?

Srijan Sen: A lot of different people. I just came from a meeting on the prevention of depression. And so that's really on top of my mind, there's a researcher in Australia called Helen Christensen, who just hearing about the amazing work that they've done there in the school populations, a little bit in this digital [01:00:00] mental health area, but really in a way that's affected, they've gotten policies through in government to improve things has informed some of the work that we're doing. And again, gives hope, but the chances of making change in, at a large scale, at the scale of a country is really impressive.

So yeah, that was heartening to see. And I think it really influenced my work. Again, I'm influenced by what I experienced in the last couple of weeks, there are amazing people doing amazing work all over the place. And it's great to see. For me, it's important to focus on those positive things too.

Cause sometimes I tend to think about the negative things and more so that was one and seeing Helen talk about her work was really enlightening.

Quinn: Awesome. Awesome. Thank you for sharing that. Last one, what is a book you have read this year that has either changed your mind on a topic you haven't considered before, or is actually, or I guess maybe opened your mind to a topic you hadn't considered before or has changed your mind on something [01:01:00] else in all of your free time. We put a whole list up on Bookshop and listeners really love this.

Srijan Sen: David Epstein on Range. I think that it is a really good book and influenced how much that helps, certainly in sports, but also in thinking and in science and how bring, especially now, how much a generalist can help and has influenced me to try to read more broadly and to take in interesting things across fields.

Yeah, a few other ones I found just from my own, reading a lot of non fiction, I used to and sort of high-level fiction is, in the last couple years, I found challenging, and I end up reading mostly popular fiction, so Jack Reacher and things like that, and so that's been most of my reading in the last six months is reading one of those a week, and I find that really relaxing, so less high minded stuff coming out of it, but it's how I wind down.[01:02:00]

Quinn: Yeah, no, I got to turn it all off. And it's, again, it's like literally the same fantasy over and over again. Or same thing. I've been blowing through the Patrick O'Brien 20, there's 20 novels about a sea captain during the Napoleonic wars, a British sea captain, and his best friend, who's the surgeon.

I don't understand half of them because talking about sails and all of these things, who can know? But it is one of the most profound relationships over 20 novels and 40 years in literature. People compare it to, it's like what Kirk and Spock would be if they could be. It's really beautiful.

There's some great historical stuff. And it just really doesn't ask a lot of you on the cognitive sense, it's really great. They're what that movie Master and Commander were based on with Russell Crowe from 10 years ago. Can't recommend them enough.

Srijan Sen: I was looking for a new one to move on to.

Quinn: Don't be put off by like the density of the nautical stuff. You can ignore the bulk of that. In fact, he eventually just makes fun of his surgeon friend for 10 books and not understanding any of it at any point. He's like [01:03:00] how? You've sailed around the world three times. How do you not know how to get into a boat?

Which is great. I appreciate that. But yeah, it's the same thing. I recently, a friend was like, I've got this dark sci fi book for you. I was like, no, thank you. Can't do it right now.

Srijan Sen: Yes. Yeah. Yeah. There a place for that.

Quinn: Yeah. Great. But yeah, I'm so happy for you. No, thank you.

This has been really fantastic. Where can our listeners follow your team's work should they choose to?

Srijan Sen: We have a website where all the new work is they can Google my name and get to it. I can share the website with you. I think that's the best place. I'm on Twitter, under again, my name is Srijan Sen.

I'm not always up to date on that, but I try to keep things up there. But yeah, those are the main places.

Quinn: Awesome. Thank you so much. And I know I kept you quite a bit extra here. I really appreciate it. This is again, I feel like we could keep going on and on about it and there's a million things we didn't get into.

So maybe at some point, thank you for your time. Thank you for this work you're doing. It is so important.

Srijan Sen: Thank you so much. I really appreciate having a chance to talk to you and I really enjoyed the conversation.

Quinn: [01:04:00] Oh I appreciate it. Thank you so much.