Brought to you by the Depression Is Real Coalition, The Down & Up Show is dedicated to the reality of depression. Our hosts will talk with some of the world's top experts on depression, as well as people who have been impacted by this illness. The reality of depression is that it is a debilitating and potentially deadly medical condition that affects more than 15 million Americans every year. The other reality of depression is that there is hope.

Down & Up Show #01: Facts & Myths: Depression Is Real

IAN VO DOWN & UP INTRO

The Down & Up Show on Depression Is Real.org. A show dedicated entirely to the subject of depression, and the reality that there is hope for people dealing with this disease. Now, your host, Dr. Ellen Frank.

DR. ELLEN FRANK LAUNCH SHOW INTRO

Welcome to our first episode of the Down and Up Show on depressionisreal.org. I'm Dr. Ellen Frank, Professor of Psychiatry at the University of Pittsburgh Medical Center, and I'm excited to be hosting this show. Depression is a biological disease. I've devoted much of my career to studying depression and how best to treat it.

When the Depression is Real Coalition first approached me to host this show, I happily accepted this opportunity to help people understand what depression is and to encourage people to seek help for themselves or encourage a family member or friend with depression to do so. Depression is a very serious illness, but it is also very treatable.

And that's ultimately good news because people from all walks of life who obtain appropriate treatment can, and do, live successfully with depression.

There's a lot of information out there about depression. Some of it is correct and helpful, some of it is not. This show will go directly to many of the world's top medical research experts on depression.

We will also talk with people who can speak first hand about their experiences with depression. There are many compelling stories to tell about how men and women, young and old have learned to manage and even defeat this illness. Misinformation or maybe I should say disinformation about depression is dangerous, because it continues to fuel stigma and frighten people away from seeking the help they need.

DR. ELLEN FRANK INTROS DR. DARREL REIGER

And that brings me to my very first guest, Dr. Darrel Reiger, a long time friend and colleague. Dr. Reiger is Director of Research for the American Psychiatric Association and Executive Director of the American Psychiatric Institute for Research and Education.

Dr. Reiger will speak with us today about the biological nature of depression and debunk some of the myths surrounding this illness.

DR. ELLEN FRANK / DR. DARREL REIGER INTERVIEW

ELLEN FRANK QUESTION:

DARREL, THANKS SO MUCH FOR JOINING ME TODAY. YOU KNOW IT SEEMS LIKE EVERY DAY WE HEAR ABOUT SOME WELL KNOWN ENTERTAINMENT OR SPORTS STAR OR A POLITICIAN WHO HAS DEPRESSION. JUST HOW COMMON IS IT REALLY?

DARREL REIGER ANSWER:

Well, depression is a very common illness that affects persons from childhood to old age. With a prevalence depending on level of impairment of at least five percent in any given year. And although the most obvious symptoms of depression involve mood and that's why we call it depression, it also affects people's thinking or cognitive abilities, it disrupts normal sleep, it interferes with appetite and generally depletes a person of energy and all zest for life.

And for these reasons alone it clearly can impede school, job, or parenting performance. So it affects people across the whole life span in their critical social and family roles. We also know that mood disorder takes the toll on one's overall health; that is it really is a total body illness rather than just a disease affecting the brain, the brain controls the entire set of systems of the body. Depression can bring on then or worsen other psychiatric and general medical illnesses and ranging from substance abuse to heart disease to diabetes.

And, of course, most critically if it's left untreated it can lead to these profound feelings of hopelessness and persistent thoughts that people often describe as almost thought insertions where they can't stop thinking of death or suicide. And that's what makes it actually a potentially fatal illness.

ELLEN FRANK QUESTION:

DARREL, EVERYONE EXPERIENCES THE BLUES NOW AND THEN, TELL US HOW THAT DIFFERS FROM CLINICAL DEPRESSION.

DARREL REIGER ANSWER:
Well, the body has a limited repertoire of ways of responding to stresses. It can respond with increased heart rate, with blood pressure increases, and it can result in increases in anxiety and depression.

Likewise, most of us have experienced the blues. The death of a spouse or some other trauma can often cause people to feel depressed. At such times we should acknowledge though that a loss, a trauma is an important part of life and we need to support a person's resiliency. And most people can bounce back from this.

But if the intensity and duration of those shifts are prolonged or of a certain level it can really be dangerous to one's health. And certainly in some instances, just like in hypertension we don't really understand what the immediate precipitant of a depression is. The onset can appear seemingly spontaneously. What we're learning now is that there are some genetic vulnerabilities that can interact with stressors that are a part of every day life. And these then seem to make somebody with these particular genetic vulnerabilities much more likely to develop a depression than others.

ELLEN FRANK QUESTION:

BUT YOU SEEM TO BE IMPLYING THAT SOME PEOPLE'S GENETIC VULNERABILITY MIGHT BE SO GREAT THAT EVEN IN THE ABSENCE OF OUTSIDE STRESSORS THEY MIGHT EXPERIENCE AN EPISODE OF DEPRESS.

DARREL REIGER ANSWER:

That's exactly right. And that's why we need to think of it in the same sense as hypertension because in many cases you don't have an adrenal tumor or you don't have something else that is a clear cause of hypertension and yet it just simply spontaneously seems to develop. We have the same kind of understanding of depression at this time.

ELLEN FRANK QUESTION:

BUT WE ALSO KNOW THAT LOTS OF PEOPLE WHO REACH THAT POINT DON'T SEEK TREATMENT. AND ONE BIG OBSTACLE SEEMS TO BE STIGMA. I THINK SOME PEOPLE STILL FEEL SHAME AT HAVING A MENTAL ILLNESS THEMSELVES OR IN THEIR FAMILY AND ON TOP OF THAT WE SEE VERY FAMOUS PEOPLE WHO CLAIM THAT MENTAL ILLNESSES AREN'T REAL, THAT PSYCHIATRY IS PSEUDO SCIENCE. WHAT AFFECT DO YOU THINK THESE PRONOUNCEMENTS HAVE ON WHETHER PEOPLE GET APPROPRIATE TREATMENT?

DARREL REIGER ANSWER:

It's really unfortunate for anybody to have to undergo the experience of having depression.
However, when some very famous people have done it, have gone through this and have acknowledged it. It's been of tremendous help to the rest of us who find it much easier to respond to the need for treatment in the same way that we would for any other debilitating or treatable illness. So it's been kind of a mixed experience where you have some very famous politicians and entertainment figures who have readily acknowledged depression and continue to help to normalize it.

And, yes, there are some people in organizations who really deny the existence of mental illness of an ideology or belief system. And it's really tragic when a member of a family that is in one of these groups actually is affected by a severe mental illness.

To paraphrase a popular movie title you might call mental illness in this type of situation as an inconvenient truth for the ideology. Such groups however tend to be on the margins of society.

ELLEN FRANK QUESTION:

CAN YOU TELL US A LITTLE BIT MORE ABOUT THE BIOLOGICAL COMPONENT OF DEPRESSION?

DARREL REIGER ANSWER:

Well, depression is expressed through the brain which is the main control organ for the entire body. It certainly is another organ just like the heart or kidneys, but it's just a lot more complex in both its structure and function. And just during the time that I've been a physician we've learned an immense amount about neurotransmitters or chemical messengers in the brain that become out of sync in depression and about the influence of the brain over hormones that are associated with depression that these are circulating messengers throughout the body, such as cortisol.

And using new brain imaging technology, such as the functional MRI we can identify actually specific brain regions that function abnormally in the presence of depression. And what's more we can see those differences in a single given patient when he's in a depressed state in contrast to when the depression is in remission. And we're seeing again the promising consequences of this research in terms of helping to get greater specificity in the treatments we have for people.

ELLEN FRANK QUESTION:

SO I CAN UNDERSTAND HOW ANTI-DEPRESSANT MEDICATIONS THAT SPECIFICALLY TARGET THESE OUT OF SYNC NEUROTRANSMITTERS MIGHT WORK, BUT HOW DOES TALK THERAPY, HOW DOES PSYCHO THERAPIES CHANGE THE BIOLOGICAL ASPECTS OF DEPRESSION? OR DON'T THEY?

DARREL REIGER ANSWER:

One of the really exciting aspects of neuroscience most recently is the finding that psychotherapy and the anti-depressant medications seem to affect different areas of the brain that can be identified in some of these functional magnetic resonance imaging studies.

And what's been fascinating about this is that although the talk therapy and the anti-depressants seem to affect different areas of the brain they do seem to have a common final affect of reducing the depressive symptoms.

And I think what's very interesting is the fact that we know that medications can help to re-establish a balance in brain chemicals and even in the wiring of nerve cells in the brain. But interestingly these imaging studies show that our experiences including talk therapy can also result in rewiring of the brain as well, which is an important breakthrough I think in our ability to try to better understand what the path of physiology of depression is and how each of these treatments can work.

ELLEN FRANK QUESTION:

ONE LAST QUESTION, WHAT DO YOU THINK, WHAT'S THE FUTURE. WHAT ARE WE GOING TO SEE IN TERMS OF THE STUDY AND TREATMENT OF DEPRESSION IN THE NEXT DECADE OR SO?

DARREL REIGER ANSWER:

Advances in molecular genetics are giving us the capability to get a unique fingerprint as it were of a person's biology as dictated by his or her genes. And that knowledge opens up a way to tailoring treatments to a single individual patient. This is an area called, with medications, pharmaco-genomics. And we've seen this kind of breakthrough in breast cancer treatment where the genetics of a particular woman can determine, you know, if a given medication is likely to have a dramatic affect on this cancer.

And we're certainly looking forward to that opportunity in the area of mental disorders as well. We're also learning that treating depression in the mother of a newborn can have a dramatic measurable affect in preventing depression in that child, now and in later life. So you can see that this is a very exciting and promising time in research.

ELLEN FRANK QUESTION:

THANK YOU SO MUCH FOR YOUR TIME TODAY, DARREL.

DARREL REIGER ANSWER:

Thank you, it's a pleasure.

DR. ELLEN FRANK OUTRO (Music up half way through)

I think the takeaway point here is that as the sponsors of this show would say, depression is real and we have to treat it with the same urgency and the same compassion that we treat other serious illnesses, just as we do cancer, heart disease or diabetes.

The good news is that with the right treatment people can and do get better. In fact, the national institutes of health reports that more than 80 percent of people with depressive disorders improve when they receive appropriate treatment. So there is help and hope. Please visit depressionisreal.org for more information about depression.

IAN VO CLOSE

Thanks for listening to the Down & Up Show. For more information, log onto, www.depressionisreal.org. You can find us there, and at iTunes, and remember - stay subscribed.

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