I don’t love asking for help, but I’m doing it anyway.

This year has been a lot. A lot a lot.

There have been multiple serious health issues in my family, including chronic illness, seizures, a newly discovered neurological condition, and cancer in my immediate family. At the same time, our housing situation has become increasingly difficult, our rent has gone up significantly, healthcare costs continue to climb, and we’ve reached the point where staying where we are no longer makes much sense.

So, we’re moving in October.

The move will put us closer to people we love, better access to medical care, more resources for the kids, and closer to my office. It’s the right move, and I think it will make our lives much more sustainable in the long run.

The problem is getting from here to there.

Because of the health and disability issues in our family, this isn’t really a move we can brute-force ourselves. We need help with movers, hauling away things we can’t take with us, storage while we downsize, and the many other expenses that come with relocating a family. We also have medical debt and ongoing care that has been difficult to access because of cost.

I’ve been struggling with whether to ask for help publicly.

Part of that is pride. Part of it is that I know I’m fortunate in many ways. I’m a psychologist. I make a decent living. I’ve built a career that I’m very grateful for.

And yet, somehow, we are still barely keeping our heads above water right now.

I know we aren’t alone in that. Housing, insurance, healthcare, food, raising kids—everything has gotten incredibly expensive. A level of income that once sounded very comfortable can disappear surprisingly quickly when several major life circumstances hit at the same time.

So I’m trying to get over my discomfort and simply say what is true:

We could use some help.

I’ve been making things on the internet for a long time now. Books, podcasts, videos, articles, answers to questions, and all sorts of other strange little pieces of myself scattered around the world.

If any of that has helped you over the years, and you’re in a position where you’d like to help us now, I would be deeply grateful.

I set up a GoFundMe here:

https://gofund.me/5402853ac

And if you’d rather send something directly through Venmo:

https://account.venmo.com/u/robert-duff-13

Please do not feel guilty if you can’t contribute financially. I mean that sincerely. I know exactly what it feels like to want to help someone and simply not have the money available.

Reading my work, sharing it, sticking around, sending a kind message, or passing the fundraiser along all help too.

Mostly, I’m trying to get my family through a very difficult stretch and into a situation where we have more support around us.

Thank you for being here

A few nights ago, my eight-year-old was being way too cute. They just wanted to write. They started with trying to transcribe a poem from English to Braille, and they ended with writing a graphic novel about Minecraft. It got me thinking about how I have not written for myself in quite a while. Moreso, it got me thinking about my relationship to writing in general.

I’ve always been a writer. When I was young, I wrote countless stories in my notebooks. As a kid, the collection of scribbled paragraphs surely amounted to full novels in my mind. I also had a particular affinity toward writing titles. I can recall writing The Lighthouse of Horror, which is honestly pretty self-explanatory. I also began a science fiction story called Life in Fear of a Black Sun, which I was exceptionally proud of. There were always stories in my head, and at times they felt so real that I got into legitimate shouting matches with my parents about the fact that I was not actually from Mars, and I couldn’t “go home.”

After a while, I started to notice how powerful words could be for impacting other people. I began writing notes to express what I could not verbally or to broach topics I was too anxious to speak out loud. As child and tween, I also found a particular joy in writing cards that were so sweet and thoughtful that it would nearly make adults cry. I recall buying a M*A*S*H commemorative cast photo and writing a whole letter on the back telling my father that I was proud of his accomplishments. I can’t really tell whether this newfound power made me more empathetic or more psychopathic. Still figuring that one out.

Of course, school is also an important venue for writing. I wasn’t a perfect student, but English and language arts were always strengths of mine. Even when I didn’t want to complete a written task, I would try hard to do it well. And of course, I still loved my titles as evidenced by my essay, “Envenom’d Throne: A Critical Analysis of Social Statuses in Jane Eyre.” Thinking critically about source material, bias, and treating all writing as persuasive writing were cores of my writing style that were developed in high school. I also ended up getting a perfect score on our district’s writing examination, which was a fun motivator to keep it up.

In college, I wrote with a much clearer intention: get perfect grades and get into graduate school. Not much to say about that – I was super fortunate and got into my top graduate school choice, and entered into a Ph.D. program at UC Santa Barbara right after graduating from college. During graduate school, I began to bridge the gap between academic writing and writing that featured my own personality. My work was good, but often with a touch of silliness, crassness, or absurdity. After integrating a bit too much humor into my master’s degree capstone presentation, I was told by faculty advisor that I do great work, but I also need to know when to “button up.”

Luckily, I found another avenue to explore my personality and be freer with my writing. By the end of graduate school, I had dipped my toe into blogging, podcasting, YouTube, and developing content on platforms like Instagram. From mixology to interviews to guided meditations, I began to rediscover that ability to impact other human beings through my writing. It wasn’t only intoxicating – it started to make me a little bit of money on the side. Money that I was desperately craving as a full-time student.

For doctoral programs in clinical psychology, the final year is typically spent working as an intern. I moved to San Diego and worked as a full-time psychologist intern at Kaiser Permanente. While that took up a lot of time, I was also exposed to just how bad resources for people struggling with mental health were. I encountered handouts that had been photocopied over and over since the 1970s and “self-help” books that were heavy enough to hammer in a nail.

I wanted to do better and make content that was entertaining and digestible. I wasn’t licensed yet, but when have I ever let something like a degree and official designation stop me? I published the first book in the Hardcore Self-Help series, F**k Anxiety, before I completed by internship. It was off to the races from there. I kept writing books and created an online course for anxiety sufferers. The more I wrote, the more people read – at least for a while.

These days, my writing is skewed in a different way. In my career as a neuropsychologist, I spend what feels like the majority of my day-to-day life writing. However, I’m writing clinical reports designed to educate patients and help fellow providers with their own work. Of course, I have still made blog posts, Substacks, and videos here and there, but if you’ve followed my work over the years, you know that I’m not nearly as prolific as I once was.

Which leads me to now. Who am I as a writer? What do I want to write? What am I good at writing? What do people want to read from me? I’m really not sure. And I feel compelled to figure it out.

I challenged myself to write some terms that characterize my voice. Here’s what I came up with: clear, casual, humorous, intelligent, empathetic, persuasive, sometimes vulgar, critical, and varied.

Where does that leave me and what should I be writing right now? I don’t have an answer for you right now, but I hope you stay tuned while I work it out.

If you’d like to check out my entire “tier list” of cognitive supplements, feel free to watch my video below!

Supplements to Definitely Avoid

Gingko Biloba

Gingko Biloba, also known as maidenhair, is a tree native to China. It has been used for various purposes for literally thousands of years. In the US, it is commonly touted as a supplement to help boost memory through its antioxidant properties and its ability to increase blood flow.

In a large randomized controlled trial (Solomon et al., 2002) showed no benefit to memory functioning in people supplementing with gingko biloba as compared to placebo. Specifically, the study states:

The results of this 6-week study indicate that ginkgo did not facilitate performance on standard neuropsychological tests of learning, memory, attention, and concentration or naming and verbal fluency in elderly adults without cognitive impairment. The ginkgo group also did not differ from the control group in terms of self-reported memory function or global rating by spouses, friends, and relatives.

Aside from the lack of proven cognitive benefit, Gingko has been shown to increase blood flow, which can actually be a bad thing because it also increases risk of bleeding and risk of seizures in individuals with epilepsy. No thanks!

Antioxidants

We know that oxidative stress (damaged caused by imbalanced free radicals) is linked to brain aging and degeneration. Over the years, there have been so many different vitamins, supplements, and superfoods marketed on the fact that they have strong antioxidant properties.

Unfortunately, the research is just not there. In a review of numerous studies on antioxidant vitamins, any impact on cognition was small and inconsistent (Rutjes et al., 2018). Prevention of dementia was also not supported. For some vitamins like beta-carotene and vitamin C, there appeared to be some positive results, but again, the effect sizes were small, and this was after years of supplementation.

Cognitive Supplement Blends

This is the one that makes me the most upset. I’m using Prevagen as the prototypical example of a supposed cognitive health supplement. I often see it marketed during Jeopardy, presumably when people are trying to keep their brains sharp. It’s expensive as hell and sounds flashy because it uses a calcium-binding protein found in jellyfish (apoaequorin). As you may expect, the research does not support the idea that it improves memory. In fact, the FTC took the company behind Prevagen to trial and concluded that their statements about improving memory were unsubstantiated and misleading.

Aside from Prevagen, there are many other culprits. They are frequently guilty of “fairy dusting,” which is where they include very small amounts of potentially helpful substances so that they can include the name on the label. Many supplements also include caffeine or a derivative of caffeine, which is a well-known temporary cognitive booster.

Most of these cognitive blends are not necessarily going to be harmful for you. They are just going to give you very expensive pee without providing a significant benefit for your cognitive abilities.

Vitamins

Okay, this one isn’t necessarily a supplement to avoid. I just wanted to make a quick statement about vitamins. They are absolutely essential for healthy functioning of your brain and body in general. If you are low on B12, you may find yourself with memory problems. If you are low on vitamin D, you can experience lethargy or mood issues.

HOWEVER, vitamins are one of the biggest supplements that I see people wasting money on. If you are deficient in a vitamin, supplementing will absolutely help. But in the vast majority of cases, taking additional vitamins when your levels are already good does not provide an additional benefit beyond your healthy baseline. Your body is actually pretty good at regulating this, so you end up excreting it anyway. There are also some cases in which overdosing a vitamin can be harmful. So, get your levels check if you suspect you have a vitamin deficiency, and then follow your doctor’s (not your TikTok doctor’s) advice.

What Does Work??

So far, I’ve talked about a bunch of over-the-counter supplements that you should probably avoid. That leaves the question of which supplements can actually provide a benefit to your brain health or cognition. I’ll provide a very quick bulleted list here and if you’d like to learn more, you can check out the video I included above.

• Creatine

  • Boosts working memory and processing speed, especially under stressful conditions.

• Caffeine

  • Increases alertness and improves attention, vigilance, and reaction time.

• Omega-3 fatty acids

  • Can slow cognitive decline in people with mild impairment and can improve attention and processing speed in older adults.

• Citicoline

  • Improves attention and memory in older adults with memory problems. Prescribed in some countries for stroke recovery.

• Curcumin

  • Improves memory and attention in older adults without dementia. In animal models, appears to also help reduce Alzheimer’s pathology.

• L-tyrosine

  • Extensively studied by the military - helps maintain working memory and attention when under-rested and over-stressed.

• Bacopa Monnieri

  • Improves memory recall and learning speed in healthy adults. Takes 2-3 months to ramp up.

Since the later months of 2025, I have had this phrase stuck in my head. I mentioned it in my new year podcast episode that was about being determined to make this year a better one for myself. I still hold that intention, but holy shit has 2026 come out swinging. The idea of “no heroes” is basically just that it’s not worth putting people on a pedestal because so often, it’s only a matter of time until you are disappointed by them. Being callous and putting zero faith in other humans isn’t helpful either, but when people become gurus, influencers, and thought leaders, we tend to forget that they are human and a lot of us are deeply fucked up.

In 2025, I had some personal experiences that hit the resonant frequency of the “no heroes” bell in my mind, but with the newest wave of Epstein-related news, that bell is ringing like Quasimoto on coke.

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This is a generated image, but it is quite close to what the actual environment looked like for a recent assessment that I completed. In addition to evaluating people that are sent by their doctors to determine if they may be showing signs of a dementia condition, I also go out into the field to conduct assessments in the homes of individuals that are struggling. This work is done in partnership with my county’s Adult Protective Services. They have an amazing program that allows us to discuss difficult cases and to provide services like nursing and neuropsychological assessment free of charge.

Today, I want to walk you through a recent assessment that I conducted so you can learn a bit more about how to think like a neuropsychologist. This is Volume 2 of The Brain Files (cue eerie music).

Since I am referencing real people and events, I’m going to change a lot of information here to maintain confidentiality. Please keep that in mind as you read through this.

Referral Question

Let’s start from the top. I was asked to come see a man (Bill) in his 60s due to several concerns. The most obvious concern was self-neglect, which was apparent in his home. There was grime, rotten food, paperwork, broken bottles, and other debris strewn throughout his entire house. While I did not go into the bathroom, I was told that it was full of soiled adult diapers. If you’ve ever been in homes like this, you know that the air feels thick and sharp all at once. It can be difficult to breathe and maintain composure. These situations can be tough because you want to treat the human before you with dignity, but you also have your senses of smell, sight, and taste to consider. So, you mask up, grab gloves if you have to, and do your best.

The other concern was related to mismanagement of finances including an unpaid home mortgage, unpaid HOA fees (I care less about those), and reports of no money to for adequate nutrition or personal care.

History

During my interview with Bill, he told me that he was functioning well, living in another state prior to his father falling ill, which prompted him to move across the country to stay with him and help out. Bill’s father was on hospice care, and he said that he was his father’s sole caregiver during the two years prior to his passing. Bill’s father died about a year ago.

Another major difference between typical medical referrals and these types of cases is that I often do not have the same access to medical records and alternative sources of information. So, what I was able to glean from Bill is that he had two strokes at some point, but he did not know when they were. However, he did know that he suffered a serious decline in his functioning after the occurred.

Initial Hypotheses

Before you start the formal evaluation and interpret any data, it is natural to think about what could possibly be going on here. Given Bill’s circumstances, I obviously want to consider changes in his life that could be contributing. The loss of a parent can cause serious grief for some. In some cases, the loss of a parent that was previously supporting the individual or hiding their pre-existing deficits is also an issue, but Bill said he was living independently before his dad fell ill.

So, are emotional difficulties making Bill lack the motivation to pay his bills or help himself? There were also a number of empty liquor bottles on the floor. Maybe substance abuse plays a role here as well.

Bill shared that he has had strokes. These can absolutely cause both cognitive impairment and changes in behavior depending on where the damage occurred. If he is completely forgetting to do things like pay his bills and he lacks the understanding of how he should be managing his money, we may be looking at something different altogether like Alzheimer’s disease.

Let’s continue…

More Information

As I spoke to Bill, a few things became apparent that helped me better conceptualize his situation. For one, even though he had poor hygiene, which was demonstrated in his soiled skin, hair, and nails, he was wearing new-appearing clothes. He also had various Amazon boxes and clearly brand-new books near the entryway to his home.

When I asked about how his home got to the state that we found it in, he had difficulty adequately explaining. He was certainly depressed, but from what I could gather, depression has not been a lifelong issue for him. Rather, he recently just stopped caring about everything. He feels overwhelmed by any responsibilities, and he admitted that he would rather just stop existing. This did not appear to be a grief reaction, as he had no strong feelings about his father passing.

Bill had previously received help getting him home back into a sanitary state, but over time it returned to the hoarded and unsafe environment that I witnessed. While he was open to receiving help, it seemed that Bill had a lot of trouble with follow-through, whether for matters concerning his home or his medical health. Additionally, Bill had another family member that was previously helping him manage his affairs from afar (they lived in another state), but Bill said they had since cut him off due to frustrations about Bill’s poor financial choices.

Updated Hypotheses

Now that I was able to get a better understanding of how Bill saw his own situation, my hypotheses were narrowed down a bit. While he certainly seemed depressed, his depression felt related to his strokes rather than grief from losing his father. Interestingly, about 30% of people that experience a stroke develop the symptom of apathy whether or not they actually have a mood disorder.

Given his poor hygiene, trouble organizing himself, lack of ability to motivate himself to take action, and significant behavioral changes, I was definitely wondering about damage to his frontal lobes at this point. Frontal involvement also jumped out at me because of his decision-making. Rather than bathe, he tended to buy new clothes. Despite having no money for fresh food, he would buy books on Amazon. These impulse control and decision-making issues are hallmarks of frontal lobe damage. If that were the case, I would expect to see some difficulties with executive functioning (higher-level thinking skills) on our evaluation.

Testing

As I mentioned, the home environment was not very friendly to the senses, and we had no place to really conduct a thorough evaluation. Luckily, I spotted a less cluttered area in Bill’s backyard, and he was open to us going out there. When you are in this line of work, you learn to pack some extra supplies, so I went out to my car to grab some folding chairs, and Bill had a little round table (albeit a little wobbly) that we could use for the assessment.

We always begin assessments with the basics. How is the person’s vision? Are they in pain? Do they speak English fluently? All of that stuff. Unfortunately, in Bill’s case, his visual acuity was horrendous despite having glasses. This limited the kinds of assessments that we were able to do. We had to mostly focus on verbal tasks and tasks that had large stimuli that he could make out.

I should also mention at this point that Bill was never some failure-to-launch man that always relied on others. He had a master’s degree and worked as an educator before taking care of his father. We would expect that Bill would have had pretty good cognitive abilities in the past. It’s with that knowledge that we begin interpreting his current performance.

Results

As a reminder, the tests that I administer are based on normative data for the individual’s demographics. That means their age and education level are factored in. If someone is only showing normal signs of aging, that’s great! We are looking for the areas that they may be deviating from the typical issues that arrive in the normal aging process. Unfortunately for Bill, there were several significant areas of impairment.

This chart shows a basic overview of Bill’s performance in each of the domains we looked at. I also did a separate evaluation to look at his understanding of financial and medical matters. For now, we will just focus on the cognitive results above.

First, let’s look at his strengths. None of the cognitive domains were stronger than expected for his age. He did fine on basic attention, which means he is able to hold onto information for a moment, but that doesn’t mean he is necessarily able to remember it later.

Above, I mentioned that for someone that seems to have issues with their frontal lobe, we would expect to see deficits in executive functioning on testing? That was absolutely the case will Bill. He demonstrated essentially no ability to multitask or organize his thoughts. He also struggled majorly on a test that should have come more easily to him. We did a couple tests of “verbal fluency” which simply required him to say as many words of a given letter or as many words from a given category out loud as he could in a minute. Within a minute, Bill was only able to produce one word per trial for letter fluency.

When translating these scores to real life, this means that Bill has an extremely hard time initiating activities, managing multiple demands, and thinking through the potential outcomes of his actions. You can probably see how this might turn into the type of hoarding situation that Bill found himself in. The tough part is that as issues pile up, it becomes even more demanding on executive functioning, which can cause someone like Bill to shut down entirely.

We don’t have to go through every aspect of his cognitive performance, but there is one other nuanced result that I’d like to point out. In the chart, you see that intellectual functioning is intact. That’s not totally true. When you look at reasoning or intellectual functioning, you are essentially talking about IQ. The number that you see for IQ is actually an average made up of several different tests and indices. For Bill, we were only able to do verbal IQ tests. He did great on a test that measured general knowledge, using trivia-style questions, but his performance was weaker than 98% of people his age on a test that required more abstract reasoning. This skill is tied to frontal lobe functioning, which helps bolster the hypothesis that something is amiss there.

Last overt difficulty that I want to draw your attention to is his memory functioning. I wasn’t necessarily expecting to see this, but Bill’s memory was abysmal. His long-term memory was fine, but when he was asked to remember a list or words, a short story, or a picture he had been shown, his performance was quite impaired across the board.

Putting it All Together

Alright, now we have the presenting issue of hoarding, non-payment and self-neglect. We have the known history of strokes. And we have his results of neuropsych testing. But what do we do with all of this for the case of Bill?

Since this is a case that I saw for APS, I look at things a little differently than a straightforward clinical case. Rather than establishing a diagnosis, my primary concern is to determine if this person has capacity to care for themselves and make decisions independently. For Bill, the answer here was a resounding “no.” Not only did he have no insight into how his situation deteriorated to this point, but he also had plan to improve things, and he failed formal measures of independent living ability.

When someone lacks capacity, I typically then go on to fill out a formal government form called a capacity declaration. From there, a family member or a local entity may step in to take conservatorship of the person and help them get into a safer situation.

However, I do try to provide some opinion on potential diagnoses or areas for follow-up, even in these more forensic contexts. The most obvious source of his impairment would be history of strokes with questionable follow up regarding after care. An MRI would probably show extensive damage in his frontal lobes.

The memory issue is curious, though. Certainly, memory impairment can also be caused by strokes. Truly, they can impact any number of cognitive abilities depending on where the stroke occurred. However, given the extent of his memory loss and some trouble with language, we would also want to rule out a progressive illness like Alzheimer’s disease. Unfortunately, there is no magical rule that says you can only have one devastating brain issue. You can absolutely have both, which we would refer to as a mixed dementia.

What Now?

My greatest hope is that this will start Bill on the path to getting some help. He needs someone to step in and stop his money from disappearing. He needs to get adequate medical care, and the source of his cognitive and behavioral issues needs to be looked into by a neurologist. If even a part of this can be treated medically, that would be awesome.

Bill also needs to be placed somewhere that he can be supported. Because of his executive dysfunction, everything feels overwhelming to him, and he has very little ability to manage his impulses.

Bill was a sweet guy, though. And he expressed that he really wanted help, but he simply had no idea what to do. This is a case where I can see him thriving in a supportive environment with someone else to manage his financial and medical care.

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As a neuropsychologist, I am frequently tasked with explaining to patients and their family members that they have Alzheimer’s disease. If you’ve never heard of my job, basically I perform tests to determine if someone is showing memory loss or other cognitive impairment. By examining the pattern of their performance along with other tests done by their doctors, I can help diagnose various conditions including dementia conditions like Alzheimer’s disease.

Most weeks, I end up telling one or more patients that they may have Alzheimer’s disease. During these meetings, there are a few common questions that I get:

1. What can we do about this?

2. How long do I have?

3. What comes next?

If you have ever had personal experience with Alzheimer’s disease, you may already know the answers to these questions. They aren’t pretty.

1. There is currently no cure for Alzheimer’s disease. The available treatments can sometimes increase quality of life or hold off the progression of some symptoms for a while, but they don’t necessarily change the “end point” of the disease.

2. The life expectancy for someone diagnosed with Alzheimer’s can range widely, especially if they are in good physical health with comprehensive caretaking. However, the average is somewhere around 5-8 years.

3. Describing what comes next is probably the hardest thing for patients to hear. In my experience, many people are not scared at the prospect of dying. They are scared about becoming a burden and losing their dignity. The truth is that the later stages of Alzheimer’s are horrible. People inevitably lose their ability to drive safely. They begin to have trouble adequately communicating. And eventually, basic skills like chewing and swallowing start to break down.

So, how the hell do you begin to explain this to folks? There is no perfect way, but I think that I tend to do a pretty good job of it. More often than not, I have families and the patients themselves thanking me sincerely and feeling good that they finally have some answers at the end of a feedback appointment. Let me share some tips.

Involve the Person

This tip will depend on the person’s level of functioning. If you are seeing someone who is already past the point where they can intelligibly communicate, you are obviously going to be more focused on transmitting information to the family or caregivers. However, you can still look at them when you describe symptoms or testing results. Rather than saying, “She had severe impairment on verbal memory tests,” you can say, “We did a few tests looking at your memory, and these gave you a hard time.”

I also like to try to involve the patient in how to approach the conversation. They may not be interested in the nitty gritty of the assessments and instead want you to cut to the chase. In other situations, they want to hear about their strengths and weaknesses because they are curious about their performance. Describing how you usually approach the conversation and asking the person if they have any preferences can go a long way toward making them feel involved in the process.

Get Consent

As I mentioned above, sometimes family members or the patients themselves ask some really heavy questions. Before diving into the gory details, I like to ask the patient if it is okay to be straightforward and honest. For me, this often sounds like, “Yeah, that’s a good question. Well, let me ask you, Mr. Jones. Is this okay to talk about in front of you? Do you want me to be straightforward about it?” Rarely do patients say “no” to this question, but I still think it helps them feel a sense of ownership over the flow of information. And if they do prefer that you avoid talking about a specific subject, you can always respect their decision in the moment and find a way to convey the information at another time, if necessary.

Be a Real Human

This is heavy stuff! It makes such a difference when you do what you can to humanize yourself. Ask about what has been going on since you last saw them. Make sure you are sitting eye to eye with them. Apologize that you aren’t able to give them better news and admit that you wish it wasn’t the case. Just be a real person. Don’t hide behind clinical jargon or vague language.

It’s also important to give space for reactions. If someone seems surprised or emotional, let them have the time to digest what you are telling them. If they start crying, get them some tissue and tell them to take their time because you know it’s hard to hear. Even if your schedule is slammed, don’t act like you are in a rush. Spending a few extra minutes with someone in such a vulnerable state can be very impactful.

Offer to Spend Solo Time

When you are delivering results and information to multiple people such as a patient, their spouse, and their child, it can sometimes be helpful to offer for any of them to speak to you one-on-one. Children of the patient may have questions that they know will upset their parent like how to stop them from driving or when they should consider assisted living. Patients themselves may want to hear the hard facts about their future without needing to soften it for their spouse. Whatever the case may be, if the situation affords it, I love to tell folks that, “I’m happy to also meet with anyone here individually after we are done to address specific questions or concerns.”

Be Firm About Some Things

When you are an empathetic person in a caring profession, it can be tempting to hedge around difficult topics because you don’t want to cause the person pain. However, sometimes there are things that must be said and that you need to be very clear about. For example, I sometimes have to be more firm than I would like to with family members who do not seem to be grasping the severity of the situation.

Recently, I had feedback with a patient that had moderate Alzheimer’s disease who lived on their own. Their son felt like this arrangement was still acceptable, so I told him, “I want to be clear. Someone with this level of impairment should not be living completely on their own.”

Other times, it’s about telling the patient themselves about the limitations that they unfortunately need to accept. Driving is often a huge issue. It’s very symbolic of independence and not being able to drive is such a limiting factor for many people. However, in some cases, I need to be very straightforward about it and say, “I know that it’s not what you want to hear and I wish it weren’t the case, but I don’t think that you should be driving anymore. It’s not that you’ve forgotten how to drive. It’s that the changes in your brain are going to make it unsafe at some point, and we really don’t want you out on the road on the day that happens.”

Set the Stage

I find that by framing the difficult information as something the person has a right to hear, they tend to feel more accepting and grateful for what you end up telling them. Simply saying, “I just want to make sure I give you all of the information because this is your life we are talking about. You have the right to understand what is happening,” can be extremely effective. You can also call out the fact that these kinds of conversations are difficult, and you wish there were a perfect way to convey the information. This goes back to being human and real with people. They deserve it.

By integrating some of these tips, you can turn a scary and isolating conversation into one that is productive and empowering. You don’t have to offer solutions to be reassuring. People will appreciate the honesty and humanity of your approach. People are used to doctors and people in authority positions shrugging them off. It may sound silly, but just making a little bit more of an effort can make a huge difference.

Translating to Other Situations

My tips here were focused around what I encounter in my own career, but I think they hold up in other circumstances as well. I’m going to share a personal example here and talk about a miscarriage, so feel free to skip below if that’s a sensitive area for you.

Before we had our first child, my wife had a miscarriage. It was one of those a where there was no dramatic evidence, but she intuitively new something was off. She turned out to be right. We went to the hospital to get her an exam and ultrasound to check on things. And I’m so glad that I was there with her because the doctor had the absolute worst bedside manner.

My wife was lying down and I was sitting next to her. The doctor came in and did not even sit down. He stood over us and said something to the effect of, “The fetus stopped growing at about X weeks.” Then he sort of just stood their awkwardly while my wife bawled her eyes out and irrationally apologized for what happened.

If I were in that doctor’s position, integrating some of the tips I shared above, here’s how I would have handled it. I would have first sat down and got on the same eye level. I would have said that I unfortunately do not have good news. When the mother started crying, I would have grabbed some tissues and told her that I am sorry and that she can take as much time as she needs. When the sobbing faded, I would ask how much she would like to know about what happened before just diving into the clinical details. If she wanted to hear about the mechanisms and biology behind the miscarriage, I’d provide those details and explain that it’s exceptionally common. That she doesn’t need to feel as though she did something wrong. I would be clear about the next medical steps and what she can expect in the aftermath. And finally, I’d ask if she wanted any additional information about the outlook for further attempts at having a child at that moment or if it would be better to follow up later on down the line.

If you are ever in a position to deliver devastating news like this, I hope that some of these tips help you out. There are always ways to try a little harder to be real and be human. Give the person some ownership of their situation and respect their dignity. There’s no perfect way to deliver bad news, but some ways are certainly better than others.

So, I thought I would…

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I got the following question from a supporter:

Seasonal Affective Disorder is an amazing topic, and one that I have not done a recent literature review on, so thank you for the prompt! In this post, I will define Seasonal Affective Disorder and provide an update on the current research-supported means of coping with it.

Why am I so SAD?

Seasonal Affective Disorder (SAD) refers to depression that follows a pattern in which mood episodes coincide with particular times of the year. Fall and winter are common seasons for SAD to rear its head, but technically, it could be any time of the year that consistently gives you the blues. In the DSM 5, there is not a specific seasonal affective disorder classification, but rather various disorders, such as depression or bipolar can have the specifier: with a seasonal pattern. For the purposes of this post, when I say SAD, I’ll be speaking about major depression with a seasonal pattern.

Another interesting point is that SAD does not apply to cases where there is an identifiable change or stressor outside of the season itself that causes the depression. For example, if you are unemployed every winter, your depressed feelings may simply be an understandable reaction to that hardship. SAD also requires for the mood symptoms to ease up during the other times of the year (e.g., depressed in the winter and much less depressed in the summer).

Last thing I’ll clarify before diving into the causes and treatments is that to qualify for the diagnosis, two major depressive episodes need to have occurred during the specific season over the course of the last two years. Seasonal depressive episodes also must substantially outnumber episodes that have happened outside of that season.

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I was nervous about recording this one. Not because of who I was interviewing, but because I was trying something new. I recorded this conversation on location at a little park near my graduate alma mater UCSB. I came a little early to scout out the location, found a little bench in the middle of the grass, got my two camera (two iphone) set up figure out, and waited anxiously like I was on a blind date.

When my guest came walking up, she yelled, “Welcome to my back yard!” and we had a giant hug that we never got to have the first time we met. I got up both mic’d up, hit record on all the devices, and then we had an amazing conversation. It was so good that we stayed and talked for another hour or so after I stopped recording.

In my most recent episode of the podcast, I interviewed Dr. Amy Andrea Martinez, or Dr. Dre(a) as she is in my phone. I met Dr. Martinez while traveling. We both got stranded in the Denver, CO airport while our flight back to Santa Barbara got delayed multiple times, then we got on a plane, only to pull back in due to a malfunction, then our flight got cancelled entirely. We ended up becoming fast friends and trauma bonding through the experience. We got rooms at the same hotel and vowed to meet up again once we were back in California.

You can listen to or watch the entire interview on YouTube or your favorite podcast player. In this post, I’d like to reflect on a few key takeaways from the interview.

Embodied Culture

One of our elders brought an instructor from Chicago who was very well known and respected in the Dance Azteca community, and he gave us a whole workshop on gauges.

In our conversation, Dr. Martinez talks about how she grew up in Southern California with her parents who were immigrants from Mexico. Even though she was raised in California, she was always aware of her roots, both through the stories her parents told her and from her visits to Mexico to see family throughout her childhood. Interestingly, she talks about how she came to understand her Xicana and indigenous identities more through her experience as an undergraduate at UCSB.

It reminded me a lot of my conversation with Marcia Bonato Warren about embodied culture and code switching. In a way, it seems like Dr. Martinez had a felt-sense awareness of her indigenous roots, even before having the data to back it up. In the interview, she reflect on how she had always been drawn to gauged ears, and it was only later on that she came to learn about the ritual and importance of stretched ears in her indigenous culture.

We Had La Migra Talk

Most black families have to have the police talk with their kids. We had La Migra talk. You know, the ICE talk.

Dr. Martinez reflected on how her roots and her parents’ experiences influence the way she approaches her work as a professor. For example, she includes a service learning component to her courses, which has ruffled some feathers among students and other faculty. But for her, acknowledging the sacrifices her parents made and the reality of her own upbringing leaves her no choice but to be real.

She explained that since her parents were undocumented, they did not travel due to fear of what might happen to them. However, these topics were not discussed openly when she was a child. To this day, she has not gotten the full story, and it’s only through projects from Chicano studies classes that she had the opportunity to interview her family members and learn as much as she has.

Twenty-Five to Life

I’m trying to do this undergraduate degree so that I can get a job and buy my mom that house she deserves… but then arriving here it was like my life got rocked.

When Dr. Martinez was an undergrad, she found out that her younger brother was arrested in connection with an alleged gang-related stabbing, and he was facing the potential of 25-to-life. She explains the dramatic scene of walking into the room, seeing her mother on the ground bawling, and her family all gathered around before she was told by her cousin what had happened. Being pulled down to the ground to hold her own mother while she wailed over the arrest of her son is a memory that is forever etched into Dr. Martinez’s mind.

One thing that stuck out to me about her recounting of this story was just how it’s such a good reminder that you don’t know what the hell is going on behind the scenes for people. She was a great student, and she went back to classes after this. Somehow nobody took the time to ask her what was going on, and she was just expected to carry on her studies at the same exceptional level she had been previously.

I think we have all been there to some extent. Trying to focus on work or school while your world is crumbling in some way in the background. It’s sad to me that there isn’t more space and understanding for the ways in which life can interfere with the ability to play the game of school and work.

It Only Takes One Person

That changed everything because then he opened up to me about being formerly incarcerated in the juvenile hall system in Oakland himself and that he was gang-affiliated. I was like, “Whoa. How the hell did you get here?”

In a time when there is so much huge shit going on in the world, I truly think it’s important to remember the impact that a single person can make. I have heard so many stories where there is one figure in a person’s story that prompted them to change direction. Sometimes it’s a family member or a coach. In the case of Dr. Martinez, it was a professor.

In the interview, she shares an emotional memory in which she was honest with her professor about what was going on with her brother and the struggles she was having trying to stay engaged in school. This prompted him to share his own past as a formerly incarcerated person and his research with Chicano gang members in the community. Eventually, they developed a mentor relationship, and Dr. Martinez started her own line of research as a McNair scholar, which later evolved into her dissertation research.

I Don’t Know if I Want to Be Here Anymore

I loved life, but I didn’t want to feel this way anymore. I was drowning and no one was seeing me.

One of the most vulnerable moments from the interview is Dr. Martinez speaking about her experiences with depression. During her first year of graduate school, the best friend that she had made during college unexpectedly passed away. Dr. Martinez did not have the language to describe what she was going through at the time, but this clearly threw her into a depression.

She described sitting in classes and not being able to pay attention. She got C grades for the first time in her life, and she didn’t care. Nobody could see her. And this is why she tries to make a point to engage with each of her students as a professor. It can be tough to be engaged when there are so many individuals, but she has learned how important it can be to just be seen during your time of need.

Eventually, things got to a breaking point, and Dr. Martinez told her parents that she wasn’t sure she wanted to be alive anymore. The immediately told her to pack her things and come home. Coincidentally, when she got there, she discovered that another person she had known of died by suicide, which was a sobering reminder of the actual impact that someone’s death has on those left behind.

I’m Still Here

They saw that I wrote that, and then they walked up to me and said, “I’m glad you’re still here.”

After Dr. Martinez made the decision to stay, she began to be more open about her struggles with mental health. She explained how her openness invites openness from others, and that she had multiple students open up to her about their own experiences with suicidality.

Recently she decided to participate in an Out of the Darkness walk for people impacted by suicide and suicidality. She chose the color beads that corresponded to her own experience, and she was joined by two of her students. Dr. Martinez shared an amazing experience in which she went to the chalkboard to write a message and without even thinking wrote, “I’m still here.”

And I’m very glad that she is.

There’s So Much More

Dr. Martinez shares many more insights in this interview. Way more than I could write here. For the full experience, make sure you check out the entire thing. Thank you for your time!

It’s been a while since I’ve talked about the podcast. In this post (and the latest episode), I go behind the scenes to talk about why The Hardcore Self Help Podcast went quiet, the big opportunity that almost changed everything, and what’s next for the show as we relaunch.

For the first time in a long while, I feel excited about the future of the podcast, and I want to bring you along for the ride. For the most detail, please watch the video or listen to the podcast episode!

What Happened

Earlier this year, I was in serious talks to sell the podcast to a larger mental health organization. The idea wasn’t that I would walk away, but that I’d sell the rights to the existing content and continue as a host and creative influence under a bigger umbrella with more resources.

For someone who has been running this as a one-person (sometimes two-person) operation, the idea was very appealing. They flew me out, introduced me to their team, and the vibe was very much “we’re excited to work with you.”

But after months of discussion, legal prep, and waiting for clarity, the deal fell through completely. Their explanation was that a larger acquisition on their end left them without the budget to purchase the podcast. To say I was disappointed would be an understatement.

This isn’t the first time I’ve been let down by opportunities in the content creation space, but it still stung. I had allowed myself to think about how this acquisition could change my work and life. And then it was gone.

Processing and Moving Forward

I’ve taken some time to process the whole experience and think about what I want the next chapter of the podcast to look like. The short version:

The Hardcore Self Help Podcast is coming back.

It will look a little different, though. Instead of focusing mostly on Q&A, I want to lean heavily into interviews. Information is everywhere right now. What’s rare is real human connection. I believe one of my biggest strengths as a podcaster is in interviewing people and drawing out insights you don’t normally hear from them.

So moving forward, you’ll hear more interviews with experts, creators, and everyday people who have powerful stories to share. I’ll still do some deep dives when there’s a topic I feel really compelled to talk about, but the heart of the show will be conversation.

What’s Next

• A refreshed look for the podcast, including new cover art

• More interviews, both remote and in-person

• Occasional deep dives into complex mental health topics

• Updates on my projects, including my new audiobook Bipolar Answers

• A realistic release schedule that prioritizes quality over quantity

I’ll be launching with a few episodes ready to go, so we can start strong and consistent.

Get in Touch!

If you’d like to suggest a quest for the show, pitch yourself as a potential guest, or give me a topic to cover, please comment here or shoot me an email at duffthepsych@gmail.com

Hey, it’s Dr. Duff.

I’ve always been fascinated by the idea of inner child work, looking inward to find that younger version of yourself that you can try taking better care of. But as a therapist and psychologist, I was never really trained in it and didn’t integrate it much into my personal approach to therapy. Honestly, I also hadn’t used it a whole lot in my personal life.

That changed a few years ago when I found the book 101 Trauma Informed Interventions by Linda A. Curran. It’s such a great book: straightforward, practical, and full of exercises. It’s perfect for clinicians as well as people who are struggling with trauma or who are simply curious about exploring themselves more deeply.

While these are trauma-informed interventions, they’re not all tied directly to trauma, and I’ve personally gotten a lot out of this book. Today, I want to introduce you to three inner child exercises from it. They’re arranged by level of difficulty and emotional closeness, and I’ll be honest, the last one cracked me wide open.

If you try any of these, be gentle with yourself. Make sure you have space, privacy, and time to reflect.

Exercise 1: Implicit Childhood Messages

If you’ve never done inner child work or reflected much on your upbringing, this is a great place to start. It’s called Implicit Childhood Messages, and it’s usually presented as a worksheet, but you can also talk through it with a therapist or loved one.

Here are the main prompts:

1. What messages or instructions were part of your daily life?

2. What messages did you receive about your body?

3. What messages did you receive about honesty?

4. What messages did you receive about morality?

5. What messages did you receive about sex?

And for reflection:

• Have you freely chosen these instructions as an adult, or are you just living by them without question?

• Do any of these instructions presently warrant review?

When I tried this exercise, I found it harder than expected. For example, I don’t remember a lot of explicit messaging from my parents. That vagueness and wishy-washiness seems to be part of my story.

Take sex as an example. It was a very present thing in my life, partly because my mom was a teenage parent (and the daughter of a teenage parent). So, the message “don’t get someone pregnant as a teenager” was drilled in. But at the same time, there weren’t many direct conversations about sex or sexuality. It was present, normal, motivating, but also something to fear.

When reflecting, I realized that some of these vague or inconsistent messages still deserve review today, especially around honesty, secrecy, and boundaries. Growing up, dishonesty sometimes felt like an “option,” and while I don’t live that way as an adult, the pattern is interesting to notice.

This exercise wasn’t overwhelming, but it was definitely eye-opening.

Exercise 2: Developing a Nurturing Voice

Once you’ve reflected on how you were raised, the next step is to reparent yourself by finding a less critical inner voice. Many of us internalize harsh parental messages that tell us we’re not good enough. This exercise is about developing a nurturing voice that can meet those moments with compassion instead of criticism.

Here’s how it works:

1. Think of someone, real or fictional, who embodies a nurturing quality.

2. Picture them in their nurturing role: singing to a child, cooking, teaching, soothing.

3. Really imagine their tone, words, body language.

4. Then, when you’re being self-critical, switch into that nurturing voice and notice the difference.

When I did this, my first thought was my grandmother, who was kind and supportive, though I didn’t know her well as an adult. Surprisingly, the figure that really worked for me was a character from one of my favorite books (The Name of the Wind by Patrick Rothfuss). There’s a monk who tirelessly takes care of sick and poor children in his community. He is fair, pragmatic, and unconditionally supportive.

When I imagined him speaking to me, his words didn’t feel fake or saccharine. They felt grounded. For instance, when I criticize myself by saying, “You’re never going to make it,” I could imagine him responding:

“Remember where you’ve come from. You’ve come a long way already, and you still have more life ahead of you. Keep taking steps forward.”

That shift from criticism to compassion felt powerful.

Exercise 3: Dialogue with Your Inner Child

This one is intense. It’s a writing exercise where you dialogue directly with your inner child using your dominant and non-dominant hands.

Here’s the setup:

• Divide a page into two columns.

• In the left, with your dominant hand, write questions to your inner child (like “How are you feeling?”).

• In the right, with your non-dominant hand, write their responses.

The idea is that writing with your non-dominant hand helps you tap into a different, less filtered part of yourself, one that can feel younger, more vulnerable, and raw.

The first time I tried this, I wasn’t expecting much. But when I wrote, “Hey kiddo, how are you doing?” with my dominant hand and then responded with my non-dominant hand, I completely broke down crying.

This time, it was still emotional, though not as overwhelming. What surfaced was a sense of confusion from my younger self:

“There are so many people. So many influences. A mother, a father, a stepfather, grandparents, family friends, uncles, aunties… and they’re all so different. I don’t know who I’m supposed to be like, because they all seem so flawed too.”

That feeling of ambiguity and lack of clear direction has been a theme for me in these exercises. It’s not that I didn’t have practical safety and support, but I was left to figure out the deeper stuff largely on my own.

This was easily the most intense of the three activities. It brought up things I’ll continue reflecting on, and I suspect it will be different every time I revisit it.

Closing Thoughts

Inner child work isn’t always easy, but it can be deeply revealing. These three exercises, from simple reflection, to developing a nurturing voice, to dialoguing with your child self, offer a progression of ways to connect with your past and bring healing into your present.

If you try them, go slow. Give yourself space. And if you’d like to dive deeper, I highly recommend checking out 101 Trauma Informed Interventions by Linda Curran.

Have you ever tried inner child work? I’d love to hear your experiences. Comment, send me a message, or email me, whatever feels comfortable.

—Dr. Duff

I want to share with you a few very different situations that I have encountered in my clinical work that are all unified by single diagnosis.

1. I was doing a home visit at the request of a wife who wanted me to assess her husband. He was unwilling to speak to me, so as I was sitting and talking with the wife, he lurked behind me with a pickleball paddle and kept slamming it loudly on the table in an attempt to scare me, saying, “Yeah! How about that, huh?”

2. In another home visit, I had an elderly patient talk about my graying hair and how it reminded me of her of her ex-boyfriend, whose semen she was allergic to. She further went into graphic detail about their sex life and described details about her body that had nothing to do with our appointment.

3. During an office visit, during the pre-test interview, a family informed me that the male patient was no longer allowed at family gatherings because he would tell graphic and horrifying war stories to young children without their parents’ consent.

4. When doing a home visit for Adult Protective Services, law enforcement was present to keep an abusive roommate from interfering. My patient (an elderly woman) was extremely handsy with one of the police officers, touching his arms, grabbing at his vest, and reaching in places that could be extremely risky.

These are just a few real-life examples from my experience working with people that have Frontotemporal Dementia. It is a devastating disorder that not only causes dementia, but it leads to drastic behavioral changes that the person has little to no control over.

If you’ve never had hands-on experience with frontotemporal dementia, it’s difficult to understand just how hard it can be to navigate and cope with as a family member or loved one. That’s why I was fascinated when Emma Heming Willis shared in a recent ABC News interview that their family has made the decision to move her husband and famous actor, Bruce Willis, into another separate home with a 24/7 care team.

As you might suspect, this immediately sparked a ton of backlash from people online who criticized the move as cruel and selfish. As a neuropsychologist, I have a lot of experience working with families and individuals with frontotemporal dementia. There is no perfect way to navigate process, but if someone has the means to work out a situation like what the Willises have, I am all for it. Let me explain why.

They Are Not Who They Were

By nature, any form of dementia is going to be difficult. However, not all dementias are created equal.

As a very quick review, dementia refers to the level of functioning that someone has. When someone is so cognitively impaired that they can no longer functional well in daily life, they are considered to have dementia. This graph shows the breakdown of how prevalent different types of dementia are (in the US):

As you can see from the chart, Alzheimer’s disease is the most common form of dementia at about 60%. That’s why it is the one that most people probably think of when you hear the term dementia. You envision confusion, repetitive questions, getting lost, and maybe some quirky behaviors. Frontotemporal dementia is an entirely different beast.

Frontotemporal dementia (FTD), or frontotemporal lobular degeneration, is a disease process in the brain that is very similar to Alzheimer’s disease in that it is driven by abnormal proteins that stop neurons from functioning properly, which ultimately results in cell death and atrophy of the brain. Technically, the process is driven by different proteins for Alzheimer’s vs FTD, but that’s more than we need to go into here. The most important thing for you to know is that both disorders cause a progressive degeneration of the brain that starts in one area and spreads to eventually encompass a large portion of the brain.

As the name may suggest, frontotemporal dementia begins in the frontal lobes of the brain. This is why it is so different in nature than Alzheimer’s and why it can be such a devastating and confusing illness. The frontal lobes of the brain play a major role in behavioral control and personality. People with damage to the frontal lobe from FTD or from a different source like a brain injury can show drastic changes to their personality. Often, it seems like they are an entirely different person. For example, I have had sweet old ladies that have practically never said a bad word in their life suddenly start screaming expletives when they are upset with their spouse or family.

Frontal lobe issues can also cause a decrease in someone’s inhibitions and social filter. We all have thoughts about others that we keep to ourselves, but someone with frontal lobe damage may comment on someone’s weight to their face or tell someone to “hurry the hell up,” in a grocery line. I have also had people show up to do door naked during a house call because they didn’t think it was important to put on clothes.

The potential changes caused by FTD can range from subtle to extreme and may include:

• Apathy and emotional blunting.

• Disinhibition and impulsivity.

• Loss of empathy.

• Severe mood swings.

• Obsessive and compulsive behaviors.

• Sweets cravings and oral fixations.

• Decrease language functioning.

• Coordination issues and falls.

• Decreased hygiene and self-care.

• Anxiety, irritability, and delusions.

Imagine your closest loved one completely changing their personality and behaviors. If you live with a sweet partner that asks how your day is and tries to make sure you are taken care of, imagine they could not care less about how you are and only make snide comments about how you aren’t cleaning the house to their liking. Imagine your parent used to be trustworthy with your kids, but now they can’t babysit anymore because they let them watch sexually graphic movies. FTD can be completely devastating, and the most difficult part is that the behavior change often happens before you see issues like memory loss, so it’s difficult to know what is going on.

Bruce Willis and FTD

Bruce Willis is a famous American actor known for roles in blockbuster movies like Armageddon, Die Hard, Pulp Fiction, and RED. Given his fame, it’s been extremely interesting to see his progression of symptoms and eventual diagnosis of frontotemporal dementia as part of the news cycle. Here is a general timeline of his journey with this illness:

• 2015-2021: Multiple filmmakers have opened up about struggles that Willis has had on set for his later films. They described that he had trouble remembering his lines and required an ear-piece to have dialogue fed to him. At times, Willis also appeared confused and needed accommodations like shortened shooting days.

• March 2022: A joint family statement posted to Instagram explained that Willis was diagnosed with aphasia (difficult with language - often a symptom of dementia), and he would be stepping away from acting.

• February 2023: The family confirmed a more specific diagnosis of frontotemporal dementia in an update through the Association for Frontotemporal Degeneration (AFTD). In this statement, they described that the communication issues were only one part of a broader syndrome.

• May 2023: Tallulah Willis, the daughter of Bruce Willis and Demi Moore, published a personal essay in Vogue. She shared details about her own psychiatric difficulties and her perspective on her father’s decline. She described “anticipatory grief” when she realized that she wouldn’t get a “father of the bride” moment.

• September 2023: Emma Heming Willis, Bruce’s wife, appeared on TODAY and described dementia as a “family disease.” She also expressed that it is difficult to tell how much insight Bruce has into his illness.

• August 2025: In a feature with Diane Sawyer, Emma Heming Willis explained that she and the family have “made the decision to surround Bruce with professional caregivers in a new home that is safe, quiet, and easier for him to navigate.” Further, she added that Bruce would want their daughters “to be in a home that was more tailored to their needs, not his.”

Backlash

As expected, after explaining that the family has set Bruce up in second home, Emma was the target of intense criticism by people online. She put out a statement on Instagram explaining that she expected this, and that she predicted there would be two camps: people with opinions and people with experience.

While Bruce is living separately, Emma described that he is not isolated. He has round-the-clock care, and the environment is less complicated and more tailored toward his specific needs. Beyond that, she explained that the family and personal friends visit him constantly, which lights up his mood. In the original living situation, there were apparently factors like noise and unpredictability that served as triggers for Bruce’s behaviors, and in the new living situation, there is more control over how much stimulation he gets.

They Didn’t Do Anything Wrong

Now that you have the story, let me give you my take on all of this. I wish more people could make this type of arrangement happen for their loved ones. This is an example of what you can make happen with a great deal of financial resources. It would be amazing if everyone could have this level of support.

While the family has been very open about Willis’s condition, I’m sure there is a lot they also have not shared. People with frontotemporal dementia often struggle with poor personal hygiene, inappropriate social behavior, and even complications like incontinence or moments of violence. If these things are happening in the home environment, it makes total sense for the family to keep that to themselves to preserve his dignity.

The later stages of a degenerative condition like FTD or Alzheimer’s are not pretty. The person ultimately dies from complications like poorly managed physical health, refusing to eat, getting lost, or aspirating food while eating. People with FTD tend to live about 7-13 years after symptoms emerge, and while it’s difficult to estimate a timeline, Willis is probably at least 5 years into his symptom progression. With the higher level of medical care and observation that he has, he will have a better chance of living longer with less medical crises.

For many individuals with FTD, they end up being placed in long-term care facilities. In the early-to-middle stages, assisted living is often appropriate, where there is oversight, but residents are still expected to be somewhat independent. From there, as the disease progresses, people might be placed in memory care, which is a locked unit to prevent wandering with more direct one-on-one care. Essentially, Willis’s family has been able to create their own private memory care unit with intensive care, personal luxuries, and unlimited access to visitors. If only we could all be so lucky!

Metal in the brain is bad right? Not always. In fact, there are some metals that our brain naturally has in it. These are called endogenous metals. There are some that are in significant amounts like iron, zinc, and magnesium. Others are present in trace amounts like cobalt, selenium, and lithium.

That last one, lithium, is the star of our show today. Because there is new research out of Harvard that shows the incredibly important role that lithium plays in the functioning and health of our brains. If this research leads to treatments in humans, we may be looking at our first true treatment for Alzheimer’s disease.

The article is titled Lithium deficiency and the onset of Alzheimer’s disease, published in the peer reviewed journal, Nature on August 6, 2025. The article itself is very dense, especially if you don’t have a background in neurobiology, so here is the TL;DR:

Researchers out of Harvard Medical School, Rush Alzheimer’s Disease Center, and Boston Children’s Hospital sought to understand the role of Lithium brains that were normally aging, had mild cognitive impairment (MCI), or that had Alzheimer’s disease (AD) and found:

• People with MCI and AD had significantly reduced levels of lithium in parts of the brain impacted by AD.

• Lithium was highly concentrated in amyloid plaques (a key feature of AD) and reduced in other areas of the brain, suggesting that amyloid plaques bind up lithium and reduce its availability elsewhere in the brain.

• Decreased lithium in non-plaque areas of the brain correlated with poorer cognitive performance for normal and AD subjects, indicating that lithium is essential for cognitive function.

• Through a series of experiments using genetically modified mice, they strongly confirmed the binding of lithium in amyloid plaques and the reduction of lithium in other regions of the brain. They also saw the same change in cognitive performance as was observed in the human subjects.

• By reducing lithium levels through modifying the mice’s diets, they were able to elevate amyloid and tau (key in AD development) and reduce cognitive performance.

• They discovered that lithium carbonate (the type prescribed for bipolar disorder) tends to bind heavily to amyloid, whereas lithium orotate did not.

• By administering lithium orotate to mice, they were able to prevent build up of amyloid plaque, increase lithium levels in non-plaque parts of the brain, and reduce the amount of amyloid plaque already present in the brain.

• Administering lithium orotate to mice also effectively reversed the memory loss caused by amyloid buildup.

Together, this shows that lithium plays a vital role in brain aging and cognitive performance. Low doses of lithium orotate (not the kind prescribed for psychiatric disorders) can preserve cognitive function, reduce inflammation, and suppress amyloid buildup in mice. This has HUGE implications for potential research on treating humans with Alzheimer’s pathology using lithium orotate.

Background on Alzheimer’s Disease

Alzheimer’s disease (AD) is a neurodegenerative condition, meaning it literally breaks down the cells in your brain. It is progressive in nature and inevitably ends with someone getting dementia (impairment so bad they can’t live independently) from it. Alzheimer’s typically starts with mild short-term memory loss, like forgetting where you put your keys or what you had for breakfast. From there, the impairment increases to more pronounced memory difficulties and often trouble with language. For example, someone with AD may have difficulty remembering what items are called or the name of their favorite restaurant. As the disease progresses, it essentially impacts the whole brain, leading to behavioral changes, loss of personal memories (like names of family members), and even difficulty with simple tasks like dressing or bathing.

We don’t know exactly what causes Alzheimer’s disease. What we do know is that it seems to cause a few hallmark changes in the brain. One of the biggest culprits is the buildup of abnormal proteins. There are sticky clumps of protein called beta-amyloid that collect between neurons, which cause “plaques.” Inside the neurons themselves, there is a protein called tau that starts to twist into (neurofibrillary) tangles that interrupt the flow of nutrients within neurons. Together, these plaques and tangles cause these important cells in the brain to die out, which shrinks the size of important structures like the hippocampus, which is largely responsible for memory functioning.

In addition to that, there is also evidence that AD causes inflammation and changes to how the brain uses energy. The immune system within the brain seems to go into overdrive with AD, damaging healthy brain tissue while trying to fight off the abnormal proteins we talked about.

Basically, Alzheimer’s disease creates a kind of perfect storm of issues in the brain that slowly causes someone to deteriorate and eventually die from complications, often within a decade. Researchers have made huge strides in understanding what’s happening in the brain with AD, but the trigger that sets the cascade in motion is still up for debate. And so far, we have not found any truly effective treatments.

Background on Lithium

Lithium is a naturally occurring mineral (alkali metal), that has been used for many years in psychiatry as a mood stabilizer, commonly in individuals with bipolar disorder. The discovery of lithium is actually pretty fascinating.

As early as the 1800s, doctors began to notice that certain areas with naturally lithium-rich mineral waters had lower reported rates of psychiatric hospitalization and suicide. Doctors ran with this correlation and began adding lithium to things like tonics and even the popular soda 7-Up. In 1949, a Australian psychiatrist, John Cade, dissolved uric acid in lithium salts to experiment on (literal) guinea pigs and noticed that the lithium itself made them calmer. He then tried lithium carbonate on patients with mania and saw dramatic improvements in their symptoms.

Lithium is scary in concept because it can be very toxic at high doses, but throughout the 1960s and 70s, research continued, and it became the first true mood stabilizer on the market. We now have many different options for stabilizing mood, including atypical antipsychotics like quetiapine, but lithium carbonate continues to be an effective treatment for many people with bipolar and related disorders.

History Repeats Itself

Funny enough, the whole “there must be something in the water,” impact of lithium continues in modern times.

In 2017, researchers from Denmark found an inverse correlation between the levels of lithium in drinking water and the incidence of dementia. The study was not perfect, as it was an observational population-level study with various potential confounding factors.

But again, we see a situation where lithium incidentally being in drinking water seems to cause a positive health outcome. This along with some other preliminary research showing the impact of lithium on cognitive abilities led the researchers from the 2025 Harvard study to dig deeper.

A Beautiful Series of Experiments

It’s not often that I am drawn into a scientific peer-reviewed paper like it’s a fiction book, but man this one got me. Rather than one single experiment, the authors carried out a series of studies and lab experiments to explore and investigate their hypotheses. This may sound nerdy, but I just found their study design to be so elegant. It’s a lot to digest, though as you can see from the table of contents for their paper, so I will do my best to summarize the most important parts.

Lithium Deficiency in MCI and AD

The researchers hypothesized that there would be differences in the endogenous (existing naturally within the body) lithium levels between normally aging people and those with AD or mild cognitive impairment (MCI).

They used inductively coupled mass spectrometry (ICP-MS), which is a lab technique used to detect tiny amounts of metals in a sample. It uses super-hot plasma to break the sample into charged particles, then the mass spectrometer separates and identifies the particles based on mass. This lets scientists measure elements at extremely low concentrations like parts per billion.

Using this technique, they looked at lithium levels in the prefrontal cortex, which is typically impacted by AD and the cerebellum, which is much less impacted by AD. They looked at all of the trace metals in these parts of the brain, and only lithium showed significantly reduced level in the prefrontal cortex but not the cerebellum in people with AD or MCI. This means that the development of Alzheimer’s disease seems to mess with the natural levels of lithium in the brain.

As if using super-hot plasma was not enough, they took it a step further and used lasers in a process called laser absorption inductively coupled plasma mass spectrometry (LA-ICP-MS). This lets them analyze tiny spots of solid material without having to dissolve the sample first. This gives very fine detail, almost like creating a chemical map of the brain.

With this more detailed technique, the researchers then looked at the effect of AD pathology (plaques and tangles) impacted the balance of lithium in the brain. They found that there was a significant amount of lithium bound up in the amyloid plaques and a reduced amount of lithium in other regions of the brain that didn’t have plaque. This is a huge finding. It suggests that the amyloid plaques effectively rob the other parts of the brain of its lithium.

A very interesting finding, but what is the practical impact of reduced lithium outside of the plaque-heavy regions? Well, they looked at that too. Lower levels of lithium in the regions of the brain that were not heavy in amyloid plaque led to reduced cognitive testing scores for episodic memory and semantic memory, which are commonly impacted in dementia conditions like Alzheimer’s disease.

The Mice Experiments

The human part of their studies were very interesting, but it’s hard to make conclusions without running true experiments. This is where animal models come in. We can’t exactly give a human Alzheimer’s disease to then test their brains. For better or worse, we can do that with mice. In this study, they used transgenic mice (not transgender mice like Trump thought 🙄), which are mice that have human DNA inserted so that we can use them as a proxy for humans.

For mice that were made to have widespread beta-amyloid in their brain, the researcher found 3-4x higher concentrations of lithium in the regions of the brain with amyloid deposits compared to the non-plaque regions, effectively replicating what was observed in humans. This effect was dependent on age, though. The high concentration of lithium in the amyloid deposits was only present in 12-month-old mice. For the same type of mice, but only at 3 months old, which is before they start to develop significant amyloid build up, their concentration of lithium was about the same as wild-type mice. This indicates that lithium is indeed tied up by amyloid deposits, which makes it less available to the rest of the brain.

Next, they looked at what happens when you remove lithium from the diets of these mice. Again, this gets pretty complex, but they basically made mice that had Alzheimer’s pathology in the form of amyloid (as discussed in the paragraph above), mice that had Alzheimer’s pathology in the form of tau (leading to tangles), and wild-type mice with no pathology. After removing lithium from their diets, they found significant increases in beta-amyloid deposits in the hippocampus (memory center) for both AD and wild-type mice. They also found increased tau tangles in the hippocampi of the tau-driven mice. This means that the intentional reduction of lithium in the diet of these human-analogue mice increased the brain issues associated with Alzheimer’s disease.

After confirming these neurobiological changes, they also tested the cognitive abilities of the mice using a specialized test called the Morris water maze, which measures learning and memory in rodents. The results of this rodent cognitive test mirrored those of the human cognitive tests described above. The lithium-deficient mice had reduced learning and memory. This suggests that the normal balance of lithium in the brain protects against memory loss in both normally aging mice and those with Alzheimer’s pathology.

They also did some wildly complex stuff looking at the complete sets of RNA and proteins in the mice (transcriptome and proteome) to see the impact of lithium. It’s too much to go into the details here, but they found that lithium was involved in many processes that impact the normal healthy functioning of the brain.

Discovering a Treatment

Since they showed that reducing lithium can cause increases in Alzheimer’s pathology and decreases in cognitive ability, the next step was to determine if there is a way to supplement lithium. Seems simple enough, but how can that work when all the lithium gets bound up by the amyloid plaques?

The researchers had the hypothesis that it was the electrostatic interaction of the lithium ion and beta-amyloid deposits that caused them to bind together so much. Further, if they could find a lithium salt with lower ionization, maybe it wouldn’t be as impacted by the presence of amyloid, and it could therefore be more available in other regions of the brain.

The tested the conductivity of 16 different lithium salts. Interestingly, lithium carbonate, which is the type used as a medication for bipolar, had significantly high conductivity (indicating increased ionization). Of the other lithium salts, lithium orotate had the lowest conductance, so it was chosen as the other lithium salt use as a comparison to lithium carbonate. So, we have lithium carbonate (LiC), which is typical therapeutic lithium and lithium orotate (LiO), which is a lower conductivity version of lithium.

They administered LiC and LiO to the mice in drinking water, and the results were amazing. Lithium in general was elevated within the amyloid plaques for both groups, which is not surprising. But for the LiO group only, lithium was also elevated in the other areas of the brain, not taken over by amyloid plaque. When they increased the dose of LiO to a higher level, it almost completely prevented plaque and tangle accumulation, whereas administering LiC or simply sodium orotate (as a control) had no significant effect in reducing plaque or tangle formation.

Even more impressive, they looked at whether supplementing with LiO could reverse pathology in aged mice. For mice with abundant and widespread beta-amyloid deposition, LiO reduced the burden of plaque by about 70% That’s absolutely wild. The effect was also present for cognitive performance. Among mice that had memory loss compared to wild-type mice, the lowest dose of LiO almost completely reversed memory loss according to cognitive testing. It also improved learning and spatial memory in mice with advanced amyloid pathology. As if that wasn’t enough, it also prevented structural changes and inflammatory changes that are known to contribute to Alzheimer’s disease. The cherry on top is that there was no evidence of toxicity from supplementing with lithium orotate.

Implications

I’m trying not to get too excited about these findings. Given my background as a neuropsychologist, I am obviously eager to find an effective treatment or preventative measure for Alzheimer’s disease. Transgenic mice are not humans, and we don’t yet know the impact of using supplementary lithium orotate in humans with Alzheimer’s disease and related pathology. But if the eventual human trials are anything like the results we see here… that will be groundbreaking.

Here’s what we know from this study:

• Lithium in the brain plays an essential role in cognitive functioning, and when it is reduced, it leads to impaired cognitive abilities.

• Beta-amyloid plaques steal lithium from other parts of the brain that need it.

• Lithium carbonate is more attracted to beta-amyloid plaques than other lithium salts like lithium orotate.

• In mice, supplementing with lithium orotate can improve cognitive function and reduce the impact of Alzheimer’s pathology.

While the authors caution against over-extrapolating these results, in the process of preparing this article, I came across various subreddits that have discussed the use of lithium orotate for cognitive supplementation for years. Do not engage in any supplementation without the advice of your doctor, but it’s interesting to know that science and personal experience may be converging here.

There are many ways to journal, but this is a format that I come back to over and over again when I’m not sure where to start.

• Three things I’m proud of myself for.

• Three things I’m grateful for.

• What am I feeling?

• What is contributing to those feelings?

• Is there anything to be done?

Since this is for the premium subscribers, I’ll let you in a little closer and actually let you read my journaling today. Let’s go!

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So… I’ve been feeling depressed lately. For me, the experience has been primarily emotional. That is, I’m not getting a lot of physical symptoms like crushing exhaustion or a lack of pleasure from things. I’ve just felt down, frustrated, dissatisfied, and sad. I’m not sure that I’ve ever had a major depressive episode, but I can sometimes feel that tempting void tickling the edges of my consciousness. Like I want to disconnect and go numb. I want to succumb to just being dark and done with it all. At the same time, I REALLY DONT FUCKING WANT TO FEEL LIKE THAT. So, for me, it’s always about trying to notice the slide and prevent it from taking hold.

That’s where I’m at right now. I think I am on day two of the upswing, and as long as there isn’t a(nother) major disaster, I should be out of the woods when it comes to capital D depression. The first step of being a good little dung beetle and pushing the ball to the other side of the hill is to have a pity party! Let me explain.

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At this point in our timeline, I think most of us agree that therapy is an amazing tool for treating mental health issues and understanding yourself. This has led to greater acceptance and access, which is amazing. However, as much as that person on TikTok would like to tell everyone to go get therapy, it’s not always so easy. Not all therapists are created equal, and it can take some trial and error to find someone that you really work well with. On top of that, I find that many people get bad therapy and never even realize it because without a background in psychotherapy, how the hell would you know? In this post, I’m going to talk about some of the biggest mistakes and bad habits that therapist have, so you can spot them. I’ll also explain the opposite side - what you might see from a competent and skilled therapist.

To gather these, I pulled from my own experience, the experience of numerous clients that I have worked with over the years, and I also went into the comment sections for sites like Reddit and Quora. Let’s dive in!

They Overshare

Self-disclosure is a valid tool in therapy. Once upon a time, therapists thought they had to remain totally mysterious and provide a blank slate for their clients. That meant they had no personal elements in their office, and they did not talk about their personal life at all. Some people with a strictly psychoanalytic approach are still this way. However, for the most part, the field has moved on from that, and consumers enjoy having a therapist that will act like an actual human being. Sometimes that means talking about an aspect of themselves or their personal life.

However, I have heard horror story after horror story about therapists that talk about themselves entirely too much or in ways that are just not appropriate for therapy. For example, someone I know used to tell me that their therapist would take up a significant amount of their session time discussing their own divorce and issues with the father of their child. After a therapy session, I would learn more about her therapist than I would about any actual progress.

There is also a human tendency to always feel like you want to share your own experience in order to relate to someone else. When someone describes something from their life, we may feel compelled to share something from our own life that parallels it. Therapist is not a normal back and forth conversation, though. As a therapist, you are being paid to use the client’s time wisely and for their best interest. That doesn’t mean constantly sharing about yourself.

How to Do It Right

As I said, self-disclosure is totally valid. It can be a great tool for building up the initial rapport and relationship with a client. It can also help them feel comfortable that you are a normal, flawed human just like them. So, as a therapist, when you feel compelled to share something from your own life, take a moment and ask yourself, “Why do I want to share this?” Is it because it may be helpful to the client in some way? Or is it just a knee-jerk reaction.

If you decide that it would be beneficial for you to disclose something, ask the client for consent first. In my own therapy practice, that usually sounds something like, “Okay, so I actually have a personal example that goes with that. It might help to illustrate what we were talking about. Would that be helpful to hear?” And once the client says yes, feel free to share! Just be a bit more intentional about what and when you decide to talk about yourself in therapy because ultimately, it’s not about you.

They are Distracted During Session

Back in the day, being distracted meant your therapist looking at the clock or their watch during session, yawning, or showing other signs of obviously being elsewhere in their mind. These days, it can be even worse. I have heard stories of therapists overtly checking their phone or even giggling at something on their phone during session while the client is talking. I have also seen people describe their therapist pausing session to schedule on the phone with another client and not tacking on the extra time onto the end of the person’s session. So rude.

More recently, many therapists have switched to working in a hybrid manner or entirely online. There are many benefits to online therapy, and it’s how I’ve done all of my therapy for years. But the reality is there are so many extra potential distractors when you have your computer in front of you. This goes for both therapist and client. I can absolutely tell when my client’s eyes glaze over because they are looking at an email or something on their screen and just nodding along to what I am saying.

Horror stories about distracted therapists during online therapy include seeing them playing a game on screen, shopping for clothes, and writing emails, all while trying to conduct a therapy session. It’s reasonable to be distracted at times, but behavior like that is just disrespectful to the client’s time if you ask me.

How to Do It Right

We are all human. Distractions are in inevitable part of life. It’s not a crime to become distracted during session, but it’s important to avoid doing it intentionally. Don’t try to get away with multitasking in session. If there is an urgent text coming in or something in your environment that you need to address, apologize and excuse yourself for a moment. Recently, in a therapy session, I could see on my phone that I was getting a voicemail from my kid’s summer camp telling me that they were having some issue. I simply said, “Oh shoot, can you give me a minute. I need to text about an issue with my kid. Two seconds.” Then I shot off a text to my wife and got back to session probably less than a minute later. I didn’t pretend like I was listening while clearly focusing on something else.

They Give Too Much Advice

Advice has a place in therapy. Sometimes, when you believe you have perspective on a situation in a client’s life, it is totally okay to offer some advice. However, for the most part, therapy isn’t about dispensing advice. That’s what friends are for. Therapy serves many other purposes including challenging the client on their assumptions, helping them explore events from different perspectives, and giving them a platform to feel heard and understood. It’s arrogant to assume that you always have the answers for the person you are working with. But there are many personal accounts of people’s therapist literally talking over them to say, “You should just do ___” or “Why don’t you ___?” Not helpful!

How to Do it Right

If I start to sound like a broken clock here, welcome to what it’s like to be my supervisee! When you want to give a client advice, the first thing you need to ask is why you have the impulse in the first place. Is it because you want to cut off their line of thinking? Is it because you want to show off? Is it because you think that there is an aspect that they are really not considering and they need some specific guidance? Be clear with yourself about that. And then, when you want to offer the advice, frame it that way. Literally, just say, “Can I give a bit of advice about that?” But don’t spend the whole session giving advice. Your client could get that from friends, Reddit, or ChatGPT.

They Treat You Like a Child (Or Parent)

In therapy, there are two interconnected terms that you learn about called transference and countertransference. The idea is that you or the client unconsciously project other significant characters from your life onto each other. A therapist may experience countertransference with a client where they remind them of an ex-partner or a boss that they once had, which generates some automatic emotional reactions in the therapist that don’t have anything to do with the session itself.

Countertransference is normal and expected. But as therapists, we are trained to recognize and work with it so that it doesn’t influence therapy in a problematic way. Unfortunately, it doesn’t always work out this way. I have heard people describe that therapists seemed to treat them like a child and provide feedback that was coddling and motherly only to find out that the therapist lost a child that would have been around the client’s age had they lived. I have also heard about therapists reacting with outright anger toward their clients because they reminded them of an abusive person from their own past. Yikes.

How to Do It Right

Interestingly, analysis of transference and countertransference is actually a vital part of some forms of psychoanalytic and psychodynamic therapy. If there is a little something coming up, as a therapist, you should not ignore it. Instead, take the time to reflect and try to understand what is happening. And then, you can talk about it. Literally call it out in therapy. I can remember sessions where I have said, “When you talk about this, I feel this urge to sweep in and save you. Like I want to jump in and solve the problem instead of letting you do it yourself. What do you make of that?” Rather than letting some invisible force guide my responses to this person in session, calling it out led to a fruitful discussion about how the client was never allowed to have emotions, and how their parents always just jumped in to “solve” their issues instead of allowing them to struggle and grow.

They Operate Outside Their Competence

This one is a pretty big deal and one that personally upsets me quite a bit. Just like the field of medicine, the fields of psychology and psychiatry are broad. You don’t expect your primary care doctor to specialize in oncology, gastroenterology, otolaryngology, and podiatry, do you? So, it’s only reasonable that therapists and psychologists would have some diagnoses and types of clients that they are more specialized in working with.

Continuing the parallel with medicine, you might go to your primary care doctor with the flu, COVID-19, a broken finger, or any other relatively common ailment, and they should be able to help. Similarly, a neurotypical person with mild depression should be able to get help from any number of therapists. However, someone with complex trauma from sexual abuse within the context of a hyper-religious family probably warrants someone that actually understands something about what they have gone through.

There are a few things that can happen when someone operates outside of their comfort zone and area of competence. At the most severe, they can inadvertently cause harm in the person they are trying to treat. For issues that are commonly misunderstood like OCD or trauma, providing the wrong kind of treatment or support can actually exacerbate the problem, leading to worse outcomes for the client. On the less severe side, it is just really freaking annoying to have to educate your therapist about your life or the issues that you are having. A black woman with agoraphobia may feel like she’s speaking an entirely different language than her white therapist with no anxiety issues of her own.

How to Do It Right

There are a few ways to address this. Firstly, continued training and education is an essential part of being a therapist. Not just rapid-fire completion of CEU courses, but actually training in new modalities and ways of providing treatment. If you want to expand your competence as a therapist, you can take classes and get supervision from professionals that are already trained in the work you would like to do.

The other is to call it out in session and decide whether you need to refer out to another therapist. Personally, I have done this with clients that are strongly religious. I am very much not religious, so I will make sure they understand where I stand (self-disclosure), and I will open up a conversation about whether they feel that would be limiting to their ability to make progress in therapy. If the answer is yes, then we talk about finding them someone who can better provide the care they need. There is no shame in it. The fit between therapist and client is so important. It can be tempting to chase the financial security of having another long-term client, but it’s more important to make sure to operate ethically and make sure they are getting the right kind of help.

Moral of the Story

The big takeaway from all of this is that natural human tendencies can sometimes interfere with the therapy process, since it’s inherently different than other types of relationships you would have. That’s not on the client. That’s on the therapist. There are some bad habits and mistakes that are relatively innocuous and others that are more extreme. This article should help you understand a few tendencies that may signal that your therapist isn’t up to snuff. If you feel like it’s worth addressing with your therapist and continuing, please do. It’s also okay to find someone who is a better fit. You are the consumer and the choice is yours.

You have been worried about your mom’s memory. You notice that she has been missing your phone calls more often, and when you go to visit her, you see subtle signs of something being amiss. A little more mail piled up than before, some questionable left-over pills in her pillbox, a full voicemail box when you try to call. However, any attempts to address this with her are met with defensiveness. She’s always been hyper-independent, so this isn’t a surprise. However, given that her mother died from Alzheimer’s disease, it’s hard to not be concerned. Are you being over sensitive because of your own fears or are you seeing early signs of something concerning?

Eventually, you are able to get your mom to agree to see her doctor with you so that you can bring up some of the concerns you have. You see the doctor and explain what you have noticed, all while your mom is shaking her head silently in disagreement. From her perspective, she’s just getting old and there’s nothing to worry about. The doctor says that they can complete a quick assessment called the MOCA to see if there is anything to worry about. However, after being asked to draw a cube, your mom gets annoyed and refuses to continue, stating that she’s never been good at math. Are you out of luck? Perhaps not.

Rather than pushing your mom to complete the cognitive screener with dubious results because of her frustration, they instead pivot. They ask if they can record your mom on a tablet in the office for a few minutes while they simply chat. Rather than asking your mom specific memory questions and having her complete stressful cognitive exercises, they discuss where your mom grew up, what her favorite hobbies are, and whether she is keeping up with her favorite sports team. And that’s it. The doctor says that they will send you a message with some results and follow-up items soon.

The next day, there is a notification in your mom’s electronic health record that says that voice analysis places her risk of mild cognitive impairment at 95%, and they highly suggest follow-up with a neurologist and neuropsychologist to figure out what is going on.

TL;DR: Researchers are using AI tools to analyze short voice recordings and detect early signs of Alzheimer’s disease and mild cognitive impairment with wild accuracy. Right now, some studies are showing 80-95% accuracy, which is on par with traditional cognitive screening tools. There are limitations right now, but this could radically change how we screen for dementia.

A New Tool on the Horizon

Since Alzheimer’s disease and other forms of dementia or mild cognitive impairment often involve subtle changes in language and speech in addition to overt memory loss, researchers have begun to develop tools that can use voice recordings as a non-invasive way to detect cognitive impairment. These can be thought of as a “digital biomarker” akin to taking blood or plasma to look for signs of amyloid plaque. Instead of analyzing the composition of bodily fluids, these tools instead extract and analyze elements of natural speech. Pretty amazing stuff.

While we have been analyzing language with computerized programs for decades, new advances in AI have brought things to an entirely different level. Instead of relying on hand-crafted rules or manually selected speech features like counting pauses or measuring pitch variability, AI models can learn directly from the data. Where older systems might start with a theory and brute-force it with statistics, deep learning flips that on its head. These models can process thousands of features at once and uncover patterns no human would think to look for. Rather than counting words or other specific features of speech, neural networks can detect nuanced relationships between speech timing, word usage, and vocal rhythm in a way that feels eerily close to human intuition. It essentially achieves that sense that “something’s not right,” that comes naturally to the human ear.

How They Work

Today’s most advanced tools typically look at two broad categories of information: Acoustic features and linguistic features.

Acoustic Features - Sounds and rhythms in your voice

• Tools like openSMILE (a widely-used speech analysis software) can automatically extract hundreds of voice-based features from a short recording including things like:

  • Pitch - How high or low your voice sounds.

  • Jitter and Shimmer - Tiny variations in pitch and volume, often linked to vocal strain or neurological changes.

  • Speech Rate - Words per minute.

  • Pause Duration and Frequency - How often and how long you hesitate.

Linguistic Features - The content of what you say.

• AI models have been trained to look at word choices, sentence structure, grammar complexity, and how logically your ideas are connected. They look for things like:

  • Are words repeated frequently?

  • Is vague language used? For example, saying “that thing” rather than “microwave.”

  • Are sentences simpler than they should be?

  • Does the person drift off topic or lose train of thought?

Using these tools, researchers feed the information on acoustic and linguistic patterns into machine learning models, which then identify patterns. The models listen to thousands of voice samples from people with known cognitive profiles like Alzheimer’s, mild cognitive impairment, and normal aging. This allows the model to determine the speech clues that correspond to each of the profiles, thus predicting what cognitive profile someone may fall into with a surprising degree of accuracy.

How Well Do They Work?

There have been several peer-reviewed studies that have looked at how well these models can detect cognitive impairment. Here are some highlights:

Framingham Heart Study - Ding et al., 2024: This study out of the USA analyzed short voice clips from memory testing sessions. Without using any information about the content of the speech (just the sounds themselves), the researchers trained a model that could identify mild cognitive impairment with about 87% accuracy. One of the most telling clues was how often people said “um” or “uh.”

Kuroda et al., 2025: This study out of Japan had people chat with an interviewer for one minute. Using just the audio from that one-minute chat, the researchers’ AI model was able to correctly classify those who had cognitive decline (based on scores from a cognitive screener called the MMSE) with 95% accuracy.

Huang et al., 2024: This study out of China had people respond to a classic picture description task called the “Cookie Theft” picture. Researchers found that word usage was even more helpful than vocal tone, and their model was able to accurately separate healthy from cognitively impaired speakers about 80% of the time.

Why Does This Matter?

So, what’s the big deal about this? Why do we want to be able to detect cognitive impairment through voice recordings? Well, think back to the story that I had you imagine at the start. There are many people that for one reason or another can’t or won’t participate in the more traditional cognitive screeners like the MMSE or MOCA. These typical tasks require people to directly demonstrate their cognitive abilities by doing things like connecting a series of numbers together in order, spelling a word backwards, or remembering a short list of words and recalling them later. Not only is it somewhat time-intensive, but the process can be intimidating and it takes training and practice to administer the tasks.

If instead, all you needed was a minute or two of the person talking to identify whether they might have cognitive impairment, a lot of people could be identified earlier. This could be done in doctor’s offices like in the scenario I described at the start. Or perhaps it could even be integrated into phone apps that could be used by anyone as a quick screener to start the process of looking into someone’s cognitive abilities.

I encounter many family members who didn’t realize that their loved one had declined so much in their cognitive abilities because over the phone, their loved one was able to cover it up pretty well. Meanwhile, the situation continues progressively deteriorating until there is an emergency and the family needs to step in to intervene. What if the family member could record one of those phone calls and be alerted that there is a 90% chance that their loved one has dementia? This could prevent disasters and enable people to get the help that they need.

There is another situation that I often run into though my work with Adult Protective Services in my county. I am asked to go out and evaluate people in the field who have been identified as possibly having cognitive impairment to see if that’s related to their current issues like self-neglect or falling prey to scams. The problem is these people are often defensive (understandably) and don’t want to complete traditional cognitive screeners. If the social workers from APS could instead just record a few minutes of chatting with the person to see whether they are likely to have cognitive impairment, that would enable them to more effectively refer the appropriate people to me for more thorough testing.

What Are the Limitations?

As promising as these AI-based tools are, they are not yet ready to be included in clinical practice or to replace existing screening measures. There are some important caveats to be kept in mind and limitations to overcome.

Limited Diversity

While the research is extremely promising, most of the tools that are currently used have been trained on relatively small and homogeneous datasets. If the model is trained on well-educated, English-speaking participants in quiet rooms with fancy microphones, it may not translate well to the real world.

If someone has an accent, grew up speaking another language, or has a different educational background, the tool might be less accurate. There are models that have been developed in different languages including Mandarin, Spanish, and Japanese, but this limits the generalizability, especially if the goal is to build a universal screening tool.

Real-World Speech is Messy

Many of the existing models are trained on structured tasks, like describing the cookie theft picture as mentioned above. Others might be trained on prompts like “repeat this phrase” or “tell me a story.” However, in our lives, we talk in a less structured and unpredictable way. There’s usually background noise, interruptions, emotional tones, and other forms of variability. So, a tool that was developed on studio-quality audio might make mistakes or lose predictive power when it is used on a Zoom call or over the phone with someone mowing the lawn in the background.

Not Great at Nuance

These tools are trained to do specific tasks like separate those with cognitive impairment from those that appear to be aging normally. What about someone who has depression or a urinary tract infection, which can both cause temporary changes in someone’s cognitive presentation? What about someone who had a brain injury years ago or just got braces, and their words are more slurred now? These speech issues might flag as signs of cognitive impairment, even if the person doesn’t have any. Depending on how heavily these tools are leaned on, false positives and false negatives could be a real concern.

Privacy and Ethical Concerns

Your voice is personal. In recent years, we have already seen growing concern about the capturing of voice data by AI programs like those built into your phone. If an app is analyzing how you talk in order to screen for Alzheimer’s, where do the data go? Who can access them? Could insurers or employers misuse it? Are you allowed to “opt out”?

These tools are not FDA approved for diagnosis or screening for now. Some are being piloted in clinical settings as part of the ongoing research, but there are definitely some issues to work out before they can be launched for full clinical use. Before we start using voice as a “digital biomarker”, we will need established guardrails, transparency, and a consent process.

The Bottom Line

So, where does this leave us? I for one am quite excited. This is an amazing development. Even if it’s still years away from being useful in clinical settings, the implications are huge. To me, this is like if your smart watch could identify that you probably have cancer and give you a notification that you should get follow-up diagnostics from your doctor.

Nothing is going to replace thorough evaluation for dementia, at least not any time soon. People will still need to get brain imaging and comprehensive cognitive testing in order to get a clearer picture of their capabilities and possible diagnoses. The current research is more looking at identifying if someone is likely to have impairment, which allows people to move forward with more comprehensive evaluation. It does not help determine what kind of impairment someone might have.

This path will need to be tread with care and caution, but this could represent a massive step toward more efficient diagnosis and better care for those with cognitive impairment. Let’s see where it goes!

In my latest video, I reacted to a thread on the Threads app, where people talked about their therapist red flags. From DMing a client on Instagram to telling a client that ADHD is not real, there were some crazy responses. Watch the full video above or see the summary below.

Basic red flag. I mean, this is not a deal breaker necessarily. It really depends on you and the therapist. There’s a skill in therapy we call self‑disclosure, and it’s exactly what it sounds like—talking about yourself. The idea is that that’s supposed to be used as a therapeutic skill. Therapy isn’t a two‑sided relationship in the way a friendship is. You are two humans, so there’s some reciprocity, but one person is the client and one person is the therapist. That boundary is part of why therapy works—there’s a lot wrapped up in friendships, familial relationships, and romantic relationships, and that’s why those people can’t be your therapist.

Being a therapist on the outside is actually a good thing. When sessions turn into casual conversation—sharing back and forth, catching up on each other’s lives, shooting the breeze—that’s not really therapy. Self‑disclosure can be very powerful, though. For instance, if a client is struggling with self‑harm or alcoholism, a therapist might say, “There’s something that worked well for me a few years ago. Do you mind if I share that?” Permission‑based sharing can go a long way toward building the relationship and showing that the therapist truly understands.

I always seek consent or buy‑in before I talk about my own experiences. I’ll explain the situation and then ask, “Do you mind if I talk about that? Would it be helpful to you?” Without that check‑in, it can feel like the therapist is in therapy for themselves rather than for the client.

I have to imagine this has become more common during virtual therapy. I’ve done online sessions for a long time—well before COVID—because my dissertation focused on teletherapy. There’s a lot that’s great about virtual work: you can see someone anywhere in your state, opening up scheduling and access.

However, anything happening below camera level is hidden, and I’ve heard stories of clients spotting their therapist scrolling on a phone reflected in glasses. One person even saw their therapist playing a game via the reflection in their eyes. That’s unprofessional. It’s normal if your phone rings and you briefly check for emergencies, but scrolling through Instagram or doom‑scrolling mid‑session is rude. You won’t be fully present for your client if you’re distracted by your phone.

Huge red flag. That could potentially be reported to a licensing board. You’re not supposed to have general friendships with clients, especially romantic ones. You cannot have romantic relationships with your clients. Even if you do down the line, you must wait a specified number of years after therapy concludes—otherwise it’s unethical. There’s a hierarchy in that relationship, a power dynamic with real risks of exploitation, and romance has no place in therapy.

There are situations called dual relationships, however. For example, I once saw someone for neuropsychological testing—no therapy involved—and the family member who brought them in was a former professor of mine and now a colleague. That’s acceptable if you acknowledge the dual relationship up front and ensure it won’t interfere with clinical work. Similarly, in small towns or tight‑knit subcommunities—say you’re a relationship therapist who works with the furry community—you might run into clients at conventions or local events. That’s fine as long as you disclose it and keep it from affecting treatment.

But a therapist DMing one partner about non‑therapy topics during a couples session is red‑flag central. I can’t believe that happened.

Wow. So this person was charging cash. She took the call from bed, which is very unprofessional—unless you have a clear, professional setup in bed. I’ve seen therapists work from home using a futon or bed with a lap desk and a proper backdrop; it can look cozy and still maintain professionalism. This, however, sounds like she was just on her phone in bed.

Then there’s the self‑disclosure issue: she spent twenty minutes talking about her son dying of an overdose—that’s more than a third of the session. Even if it were relevant, it wouldn’t be appropriate to devote that much session time to personal details. And it clearly wasn’t relevant, since the client was working on their relationship with food. Red flag central—I really should have brought a flag to wave around.

See, that is just messed up. Distractions are a normal part of human experience, but you need to do better. You must eliminate distractions in a session—especially when someone is sharing serious trauma. If a client describes abuse and sees you browsing for pants or dresses online, it’s going to feel awful for them.

Worse, it can set them back. Trauma survivors often avoid opening up because it brings up painful emotions. By looking distracted, you may reinforce their worst fears—that they aren’t worthy of help, that their trauma isn’t real, or that they’re overreacting. Don’t hide it better—just don’t do it.

Good. That’s hard to do, but I’m glad she did that. Holy shit.

For a psychiatrist to say everybody has ADHD and it was made up by Big Pharma to push stimulants on kids—that’s so backwards. ADHD is a legitimate neurological issue. You can see differences in functional brain imaging, and there’s a very clear pattern of symptoms. If you’ve ever known someone with ADHD—whether predominantly inattentive, hyperactive, or combined—and it’s persisted beyond childhood, you know it’s not something made up. Many people never go on stimulants and manage it through other means, which is great, but you can still recognize the traits.

Oh my God, I would’ve punched this person in the face. And telling someone they’d feel better if they went vegan and lost weight—what are you even talking about? If there were specific physical health concerns to address, a psychiatrist might refer you to a nutritionist or endocrinologist. But unsolicited weight and diet advice is none of their business. They need to shut their mouth about telling you to lose weight and be vegan. Holy shit.

Right—as if it were that easy. That’s the whole point of going to therapy. If you’re seeking help for trauma, your therapist should understand that the abuse has lodged your memories in a place where they feel active, dangerous, and like it’s happening again. That’s the essence of a traumatic reaction, and it takes careful work to address. If you could just stop thinking about your abuser, you wouldn’t need therapy.

This is why it’s crucial to find a therapist experienced in trauma work. Without proper training, you risk hearing advice like this that does nothing but harm.

Great point. Just because something is labeled “trauma work” or advertised as a safe, therapeutic space doesn’t mean it actually is. When therapists use a blunt‑force approach without regard for where you are in your healing journey—or for how your body is reacting—it’s sad and counterproductive. Ironically, therapy can be unempathetic if we forget to consider who is on the other side of the chair or screen, what they’re experiencing, and how far they’ve come.

Therapy isn’t one‑size‑fits‑all. That’s why it’s important to vet your therapist: message them, ask about their approach, review their website (or note that the absence of one could be a red flag), and pay attention to how well you connect. If it’s not a good fit, switch—no shame in that. I know it can be hard with waiting lists, insurance hurdles, and cost, but nothing is more important than entrusting your mental health to someone who truly has your back.

Thanks!

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I got the following question from a follower in the context of a broader conversation about their concerns, and since it is a common topic that I am asked about, I thought I would include it here.

In this post, I am going to tackle the discussion of antidepressants, especially SSRIs, and whether they cause memory loss or increase risk of dementia. I commonly have people that tell me they stopped taking antidepressants because they didn’t want to lose their memories. But how valid is that concern? Let’s dig into it.

TL;DR:
Many people are concerned that antidepressants (specifically SSRIs) may cause memory loss, cognitive impairment, or increase the risk of dementia. Current research shows that:

• Short-term SSRI use may cause mild, temporary cognitive changes in some individuals.

• Long-term use is not associated with significant memory loss or cognitive decline.

• Most SSRIs have minimal anticholinergic effects and are not linked to increased dementia risk.

• Paroxetine is an exception, with higher anticholinergic activity and more caution advised in older adults.

• Untreated depression poses a greater risk to cognitive health and is a known contributor to long-term decline.

How Antidepressants Work?

For the purposes of this post, I am going to focus on the most common form of antidepressant medication. However, please keep in mind that there are several others, so this research may not apply equally to all of them.

The most common class of antidepressants are Selective Serotonin Reuptake Inhibitors (SSRIs). Common SSRIs include fluoxetine (Prozac), sertraline (Zoloft), citalopram (Celexa), and escitalopram (Lexapro). As the name suggests, SSRIs primarily target serotonin. Serotonin is a neurotransmitter that helps your brain cells communicate. It is involved in mood, emotional regulation, sleep, appetite, and pain perception. In mental health, low serotonin activity is linked to depression and anxiety.

SSRI medications essentially help increase the amount of serotonin that is available in your brain by preventing the “reuptake” of serotonin in the space between neurons. Typically, when a neurotransmitter like serotonin is released into the synapse (space between neurons), it is sucked back up into the neuron that released it. By preventing that from happening, SSRIs allow that serotonin to instead linger around and potentially bind to serotonin receptors, giving you that relief from depression or anxiety that you need. Over time (typically several weeks), this can provide a reduction in mental health difficulties.

SSRIs are widely considered first-line treatments for both depression and anxiety. Clinical research including randomized controlled trials and meta-analyses (large aggregations of data from multiple studies) have consistently shown that they can significantly reduce symptoms of depression and anxiety when compared to placebo. They are especially effective when combined with psychotherapy, and their side effect profiles are generally well-tolerated.

How do SSRIs Impact Cognitive Abilities?

In the field of neurobiology, it is commonly said that “there is no free lunch.” When you have a medication that causes a primary effect, you almost always have other effects as well, which are called side effects. Not all side effects are bad. Sometimes we use medications specifically for their side effects. For example, a lot of people use SSRIs like escitalopram to prevent premature ejaculation during intercourse. Delayed ejaculation is a side effect, but for those that struggle with premature ejaculation, it’s actually helpful.

So, what are the effects of SSRIs on cognition? The answer is not simple and clear cut. Various clinical experiments have shown that a single dose of an SSRI can produce subtle but measurable cognitive changes. Here’s the thing though - they seem to improve some skills like inhibitory control (not impulsively choosing the wrong answer), weaken other skills (more errors when multitasking/set-shifting), and not impact others (Skandali et al., 2018). These studies suggest that increased serotonin can impact cognitive abilities, but they are unlikely to cause broad deficits in the short-term.

How about long-term impacts? The data here are reassuring. In people without underlying cognitive disorders, generally the research shows minimal impairment on cognitive testing for those using SSRIs over longer periods of time. One study looked at performance of individuals that have been on 20mg of escitalopram for 3-6 weeks vs a placebo group. On cognitive tasks that involve little to no emotional component, such as list memory, attention, and executive functioning tasks, there were no significant differences (Langley et al., 2023).

What People Report Feeling on SSRIs

Despite the normal performance on objective cognitive tests, some participants still report subjective cognitive difficulties, often described as “brain fog”. One study looked at 67 patients that had been treated with SSRIs for over six months, and over 20% of them reported cognitive symptoms like poor concentration, mental fatigue, and forgetfulness. In addition to brain fog, some people describe a feeling of emotional blunting or numbness. These effects were not universal. Some people tolerate the experience of being on SSRIs quite well (Popovic et al., 2015).

How do SSRIs Impact Dementia?

When it comes to dementia, there has been a great deal of research looking at the impact of SSRIs on older adults and those who already have dementia.

Positive Effects

Interestingly, there are several potential positive effects from SSRIs due to the downstream effects that they trigger. For example, SSRIs appear to promote neuroplasticity (ability of the brain to change and reorganize networks) and neuroprotection. This is thought to be caused by increasing brain-derived neurotrophic factor (BDNF), which is a protein that plays a role in survival, function, and growth of neurons in the brain. It contributes to neuroplasticity and the formation of new neurons.

In animal models of Alzheimer’s disease (the most common cause of dementia in adult humans), multiple SSRIs have demonstrated the ability to reduce amyloid-beta plaques and tau tangles, which are both believed to play a central role in the development of Alzheimer’s disease. One SSRI (fluoxetine) was also shown to increase the volume of the hippocampus — the brain structure responsible for memory formation and it also activated BDNF signaling.

SSRIs have also demonstrated anti-inflammatory effects in the brain by impacting certain cytokines (small proteins involved in immune responses) that are thought to contribute to degeneration of neurons (Correia & Vale, 2021).

All of this research suggests that SSRIs may have a neuroprotective effect and might slow degenerative processes in the brain.

Negative Effects

Concerning dementia, there have also been some concerns related to negative mechanisms that could potentially increase risk. The most plausible mechanism for this would be through anticholinergic activity. Acetylcholine is another neurotransmitter that plays a major role in memory, learning, attention, and muscle movement.

Certain medications like antihistamines, muscle relaxers, and some antidepressants lower acetylcholine. For something like a medication for overactive bladder, this is the primary effect as reduced acetylcholine will prevent excessive muscle contractions. For antidepressants, it is more of an unwanted side effect.

The problem for older adults is that exposure to anticholinergic medications over time has been demonstrated to potentially cause confusion, memory issues, drowsiness, and increased risk of falls. Cumulative exposure, especially from multiple medications, has also been linked to a higher risk of dementia.

To be clear, most SSRIs have a minimal anticholinergic effect and would not be very likely to cause these side effects. However, paroxetine (Paxil) is a commonly prescribed SSRI that has been shown to have a significant anticholinergic effect, so this should be used with caution. There are also other forms of antidepressants, like tricyclics that are known to have significant anticholinergic effects. These are often avoided if possible in older adults (Richardson et al., 2018).

Studies on Dementia

A large study from the Netherlands that ran from 2018-2024 followed 5,511 dementia-free older adults for up to 16 years. The investigators compared participants who had used antidepressants to those who never did. After adjusting for potential confounding factors, use of any antidepressant (not just SSRIs) was not associated with a higher risk of developing dementia. They also found no evidence of accelerated brain atrophy through MRI imaging among SSRI users vs non-users (Hofe et al., 2024).

On the other side, there have been some observational studies that have demonstrated associations between SSRI use and cognitive decline in specific circumstances. For example, a 2023 study compared older adults with depression who used antidepressants vs psychotherapy alone. Over a two-year follow-up, the antidepressant group showed a small but statistically significant increase in rates of newly diagnosed dementia as compared to the therapy group. However, as a correlational and retrospective study, there are potential confounding factors. For example, those with more severe functional impacts from depression may be more likely to seek out antidepressants, and these same personal factors may also contribute to an increased risk of developing dementia (Wang et al., 2023).

There have also been a couple studies looking at older women that suggest a possible link between SSRI use and cognitive decline. However, these studies are flawed and do not imply a causation. One study had a mean age of 84, which is quite old and features higher cognitive variability in the first place. Then you recognize that those who are on SSRIs seemed to have greater cognitive impairment. There are a lot of potential outside factors influencing that (Leng et al., 2017).

What About Untreated Depression?

Untreated depression on the other hand can significantly impact memory and other cognitive functions in ways that can even mimic dementia. This is a phenomenon we call “pseudodementia.” In particular, it has been shown that working memory, attention, processing speed, and memory retrieval can all be impacted by depression. Physically, depression has been linked to reduced size of brain structures that are essential in memory.

The good news is that when depression is effectively treated or resolves on its own, the cognitive symptoms also improve. One episode of depression is unlikely to cause persistent changes in someone’s cognitive abilities. However, chronic untreated depression over time appears to be a risk factor for later degenerative diseases like dementia.

In Summary

It’s totally normal to be concerned about how medications might impact your cognitive abilities or your risk of developing dementia. In fact, it’s a good thing to consider your overall health profile and make informed choices that align with your personal goals and needs.

Like most things in medicine, it’s all about balance. Untreated depression is itself a risk factor for cognitive decline and it can lead people to self-medicate in risky ways or disengage from life in ways that increase overall health risks. In that context, the potential risks of medication often pale in comparison to the risks of leaving depression unaddressed.

When we look at the research, here’s what stands out:

• Short-term use of SSRIs may cause subtle cognitive shifts - some positive, some negative, but not broad deficits.

• Long-term SSRI use does not appear to impair cognitive functioning based on objective testing.

• In older adults, SSRIs may offer neuroprotective effects, and concerns about increased dementia risk are largely based on flawed or confounded studies.

• Not all antidepressants are the same. Paroxetine, for example, has stronger anticholinergic effects and is typically avoided in older adults.

Overall, SSRIs are considered safe and well-tolerated when it comes to memory and cognitive health. For most people, untreated depression poses a far greater risk to long-term brain health than carefully managed use of these medications. If you’re on antidepressants or considering them, it’s worth having an open conversation with your doctor about how the risks and benefits align with your individual health picture.

Hope this helps! I’d love to hear your thoughts or questions in the comments.