Frontiers in Psychiatry: Heat, Cold, and Psychotherapy

In part 2 of this interview, Charles Raison, MD, a psychiatry professor at the University of Wisconsin — Madison, discusses his recent study “Association of plasma cytokines and antidepressant response following mild-intensity whole-body hyperthermia in major depressive disorder" and what further research he'd like to see in the field. Dr Raison examines his remaining questions, supplementary studies he's working on, and how he hopes his results will shape depression treatment going forward.

Catch up on part 1 of this interview with Dr Raison: Using Hyperthermia as Antidepressant Treatment

Read the Transcript: 

DepressionCare 360: What further research in hyperthermia treatment do you feel is needed? How do you hope your research impacts treatment in the short term? 

Chuck Raison, MD: Research has been done that shows that heat is an antidepressant. We call it hyperthermia or whole body hyperthermia. But a lot of these things, we've done some initial studies and the studies open up as many questions as they answer. There are a number of really fascinating questions that remain to be answered about how to optimally use something like hyperthermia as a treatment for depression. So one question is can you combine hyperthermia with regular antidepressants? We don't know. We did a very small study where there were a few people on antidepressants and they did not get any benefit from the hyperthermia.

This is obviously a hugely important question because if we can add hyperthermia to ongoing antidepressant treatment, that's going to make it much more attractive as an actual treatment modality than if I have to say to somebody, listen, you got to get off your SSRI if you want to do this. So that's an unanswered question. We are getting ready to begin to try to answer that in a large study that we're going to be running in Vail, Colorado, interestingly of all places. So that's a question.

Another question is, can you combine hyperthermia with other things that might kind of increase its effectiveness? I have a colleague at UCSF who is combining hyperthermia with cognitive behavioral therapy and has some really, really interesting findings suggesting that there may be a synergistic effect there. One of the things we noticed early on in our hyperthermia studies was that when people were being acutely heated up, they often became very kind of emotionally open and disclosing, and they would just spontaneously start talking about what was wrong in their lives. And so it gave us this idea that, wow, maybe we could pair hyperthermia with psychotherapy, that it could kind of activate people emotionally so that they would get more out of their psychotherapy.

And then maybe my favorite, and this is another thing that we're going to do in this large study in Vail, Colorado, is the question of what would happen if we added cold to the heat. It's famous, like the people in Scandinavia that are always going into sort of saunas, they tend to go out and jump in the ice cold river afterwards, and there's a whole thing now with cold. This guy, Wim Hof, they call the iceman, who teaches people how to jump into the lake in the middle of winter. A lot of people swear by cold as an antidepressant, anti-anxiety modality. It's a lot less studied, but it's really interesting.

We had this sort of thing of that maybe cold has antidepressant effects, the Scandinavians since time immemorial, hot, cold, hot, cold. Nobody has ever actually studied that. So we're gearing up to do a study where some people are going to just get the heat and other people are going to get heat, and then afterwards we're going to stick them in a cold plunge, and we're going to be able to look and see. If it augments it, then that's a way then to even make the hyperthermia more effective. So stay tuned. If you're interested in this area, we're going to have a lot more information within the next two to three years on how this treatment might be optimized.

Charles Raison, MD, is a Mary Sue and Mike Shannon Chair for Healthy Minds and a Professor in the Department of Psychiatry at the University of Wisconsin – Madison. Dr Raison received his medical degree from Washington University in St Louis, Missouri, where he was elected to Alpha Omega Alpha and won the Missouri State Medical Association Award. He completed residency training at the UCLA Neuropsychiatric Institute and Hospital in Los Angeles. In addition to his medical training, Dr Raison obtained his Masters of English from the University of Denver.