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 #11: Depression and the Retired Athlete

IAN VO DOWN & UP INTRO

The Down & Up Show on Depression Is Real.org. A talk 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 INTROS Dr. Thomas Schwenk and Eric Hipple of the University of Michigan Depression Center

Welcome to the Down and Up Show on Depressionisreal.org. This week's episode, Depression and the Retired Athlete is about the toll being a professional athlete can take on mental health. While physical pain might be expected as a result of years of playing sports for a living there is growing evidence that there may be a psychological consequence as well in the form of depression or drug and alcohol abuse.

And then we're going to move onto talk a little bit about a general connection between depression and pain. Dr. Thomas Schwenk, Associate Director of the University of Michigan Depression Center and retired Detroit Lions quarterback Eric Hipple join me today to discuss a recent study they published on the relationship between chronic pain and depression, in particular with former NFL players.

Eric's story has recently been featured on ESPN's Outside the Lines. They'll share information about the work that they are doing with the depression center and how they're helping to de-stigmatize depression among a group of people who may be at higher risk for the disease, male athletes. Welcome and thanks to you both for joining me today.

DR. ELLEN FRANK / DR. THOMAS SCHWENK & ERIC HIPPLE

DR. SCHWENK & ERIC HIPPLE ANSWER:
Happy to be here.

Thank you.

ELLEN FRANK QUESTION:
Dr. Schwenk can you tell our listeners just briefly about your findings relating to chronic pain and depression in retired football players?

DR. SCHWENK & ERIC HIPPLE ANSWER:
Well, I think the short version is that with regard to depression retired NFL players are people too; that they have roughly the same risks for moderate to severe depression as would be the case in the general population. What they have that's different is an incredibly high pain burden. So about 50 percent of the people we surveyed had very high levels of chronic pain, and the chronic pain and the depression interacted to be associated with a very high level of life difficulty, life misery, lots of aspects of life that were of low quality.

ELLEN FRANK QUESTION:
Maybe this is a question that both of you should try to address. What do you think are the specific health issues that athletes who are transitioning into retirement have to face? Eric, why don't you start?

DR. SCHWENK & ERIC HIPPLE ANSWER:
Well, as far as general health issues you're talking about a young person who's leaving, it's I think not so much the health issues as it is the psychological issues, the fact that all of a sudden their support structure has been taken away from them, the ones that they have been used to. They're facing an early retirement issue that many people don't face until their later years. And so I think that's a big issue as far as that goes.

Health wise, yes, there are a lot of guys that leave the game because of injury, about one-third of our respondents to the survey responded to the fact that they left the game because of injury itself. And so I think, those health issues as far as that goes I think has a lot to do with the pain that they feel.

But on the other side of a two edged sword is the fact that it was also been given, you know been taught very well on how to overcome pain and have built up a resilient factor and has not recognized it and pushing through it.

ELLEN FRANK QUESTION:
So I'm not sure you've been taught so well to overcome pain as to ignore it or deny it.

DR. SCHWENK & ERIC HIPPLE ANSWER:
Or deal with it, correct, yes. Yeah, you really can't overcome it, that's true. But you are taught to deal with it and to try to ignore it and to push through it. And I think that exasperates itself to the point where because you don't treat it or you don't deal with it, you don't find it until it becomes a really, really big issue, because all of a sudden it really exasperates itself.

ELLEN FRANK QUESTION:
And how would you answer that question Tom? What do you think are the challenges for professional athletes, particularly football players?

DR. SCHWENK & ERIC HIPPLE ANSWER:
I think Eric mentioned the issue of injuries and handled that quite well. I think the other issue we saw with the respondents in the survey was a lot of concern about their fitness, weight gain, the loss of fitness, the loss of the ability to exercise. I mean, these are people who for maybe 15 years have lived through physical performance and lived through a very high level of elite athletic performance and they now can't do that nor do they have any real structure to do that.

And so I think they're susceptible to a lot of the same things that affect the general population, but it hits hard and it hits fairly suddenly and it hits somewhat unexpectedly.

ELLEN FRANK QUESTION:
Eric are these issues, these general issues consistent with what you personally faced and with what your particular close teammates faced?

DR. SCHWENK & ERIC HIPPLE ANSWER:
Yes, in fact I think that Dr. Schwenk had a great point when he said that all of a sudden they face issues of weight gain, which I went through. I found not much of a reason to exercise any more because that purpose was taken away. And so you would think that you would have a pattern of wanting to exercise and keep going, but all of a sudden when the purpose is gone the idea of exercising kind of goes away. And so you lose that aspect of it. And all of a sudden your eating habits don't change, maybe they become worse.

Certainly you know in the exercise that helps with those issues, you know, burning off fat, burning off and keeping you fit. And then you throw in the effects of your habits you know that you might have, you know, alcohol habits where they have all of a sudden they become playing into a part of it as well. Then you get diabetes, you have heart issues and stuff like that. I think all of that has a part to play with it.

ELLEN FRANK QUESTION:
Why do you think that professional football players and male athletes in general maybe reluctant to seek treatment, either for pain or for depression?

DR. SCHWENK & ERIC HIPPLE ANSWER:
Well, I think the same stigma is here that has been true in the general population. But I think it may be somewhat more retrenched here. It's improving I would say in the general population, here I think there still is a sense of stigma, a sense of weakness, we certainly saw that in our survey that retired players thought that they should handle this themselves or they should talk through it with family members or spiritual counselors. They didn't see it as a medical problem.

But I think there is also the issue of not wanting to compromise their status. Now as a retired player that's not so much of an issue, but they're so trained I think to not show any weakness or any possibility that they can't perform because that may jeopardize their role that may jeopardize their starting position. There's a lot of pressure to perform here.

ELLEN FRANK QUESTION:
Eric I understand that you struggled with depression after a particularly painful life event. But do you think your athletic background compounded that depression?

DR. SCHWENK & ERIC HIPPLE ANSWER:
Actually I think more important, certainly I suffered after my son died. But I think if you look at the family history it probably plays more of an important part than what the athletic portion did, in the fact that you know depression ran in my family. And at some point in time I think football actually gave me a desire and a drive you know to proceed, to push through things.

And then you know of course like I said it's taken away the ups and downs of that life gives you, but you still have a little bit of that fight that keeps you kind of pushing through things. And I will say this, the lack of education of actually what is going wrong with you is probably the biggest downfall is because all of a sudden you don't feel well, continuous pain issues are coming up. I can understand the pain, but you know I was used fighting through it.

But all of a sudden the other things that cycle through depression start happening to you and you don't realize what it is because that lack of education is there. And then, of course, when you get to the point when I lost my son that was the one that was, I just couldn't get past, and I think it led to a crash that become a severe depression.

ELLEN FRANK QUESTION:
Dr. Schwenk you think that female athletes are at similar or even higher risk for depression since women in general are at higher risk for depression?

DR. SCHWENK & ERIC HIPPLE ANSWER:
Yeah, that's an interesting question, as you say in the general population women are at greater risk. I don't think we know much of anything about elite female athletes and we don't really have a corresponding model to professional football, but that area is certainly crying for research. I think we'd certainly want to start to tap into elite female athlete populations to explore that.

My assumption would be that it would be roughly the same as the general population in terms of a slightly higher risk. But it's possible that sports and sports performance is such a dominant part of the lives of both men and women that maybe it kind of equalizes things out. I don't think we know.

ELLEN FRANK QUESTION:
The University of Michigan Depression Center has a new initiative focused on men and depression, can you tell us a little bit more about the work you're doing with that?

DR. SCHWENK & ERIC HIPPLE ANSWER:
I think right now it's in the consciousness raising stage. I think that we really want to make clear that men suffer from depression that this is a real problem, sort of the real men get depression kind of approach and really raise awareness about this, as well as to begin to understand a bit more about what's different about men with depression compared to women. But Eric I think maybe is closer to this project a bit.

ELLEN FRANK QUESTION:
So Eric you want to tell us a little bit more about it?

DR. SCHWENK & ERIC HIPPLE ANSWER:

Yeah, one of the aspects of course is first initializing and looking at the idea of men being I guess if you want to look at the macho level of what we're talking about you know real men, real depression, but also athletes you know as being looked at, well, this is the epitome of a men, you know, certainly of the macho type.

And let's tackle that issue because I saw what was happening there and some things that Dr. Schwenk and his colleagues as far as getting involved and putting forth the programs that facilitated to bringing actual, of bringing a retired player through the depression center and doing a work up and doing a diagnosis and follow up treatment and then it has continued to follow up in the general well being in his health and has watched it get better with depression over time.

ELLEN FRANK QUESTION:
That sounds like a wonderful program.

DR. SCHWENK & ERIC HIPPLE ANSWER:
Then of course the Depression Center also has been involved with a documentary that will come out next year, January I believe, that Men Get Depression. And that focuses on four or five different aspects of life in men's history, young, middle aged. I think I'm the middle aged guy. (LAUGHTER)

ELLEN FRANK QUESTION:
You hope you're the middle aged guy.

DR. SCHWENK & ERIC HIPPLE ANSWER:
So then also different levels of É a CEO of a company, and myself as being a retired athlete and just different variations. And so just bringing across the point that yes, this is an important piece, and it's a piece that is out there.

ELLEN FRANK QUESTION:
You know I think this is É

DR. SCHWENK & ERIC HIPPLE ANSWER:
The awareness stage also É

Okay, the awareness stage of where we're at right now. But I think we've also done a step further and actually have gotten into some hands on with the study itself and also with bringing a player in and going in and piloting a program that way.

ELLEN FRANK QUESTION:
I think we can't underestimate the importance of this kind of public information strategy. I know at the University of Pittsburg Medical Center in our depression work since NIMH took on the real men, real depression campaign we've seen enormous increase in the number of women É excuse me, the number of men who are willing to present for treatment of depression. Our studies used to be all women and now it's probably about 60/40, and that's a huge change.

DR. SCHWENK & ERIC HIPPLE ANSWER:
Yeah, that is a huge change.

ELLEN FRANK QUESTION:
And I think it really is thanks to men like Eric being willing to come forward and tell their stories. Let's talk for one last minute about the depression pain connection in the general population, not necessarily people who are elite athletes, but just aging Americans who have chronic lower back pain or chronic knee pain. What do we know about that connection, Dr. Schwenk?

DR. SCHWENK & ERIC HIPPLE ANSWER:
Well, the literature suggests that the pain comes friend, and I don't know that that's always the case. We know that depression is a very important concomitant with a variety of chronic diseases, including heart disease and diabetes. So it maybe that depression and chronic pain of various sorts come things. But there's also a suggestion that the pain comes first and then the functional limitations and the sleep disturbance and possible self medication with alcohol and drugs may lead to depressive symptoms.

I think the important point is that both problems are important, both deserve treatment. It doesn't really matter which one came first or if one causes the other, the fact is they're both critical and they both should cause the patient to really think that this is an important problem that deserves attention.

ELLEN FRANK QUESTION:
But you can see how it might be a kind of vicious circle in which they depression makes the individual reluctant to try to do the things that will actually relieve the pain and then the increasing pain makes the depression worse.

DR. SCHWENK & ERIC HIPPLE ANSWER:
Absolutely. And we think that may be true in the retired NFL players who are used to such a high level of exercise and athletic activity and the pain inhibits that. And we know that exercise is a very important buffer and even a possible treatment for mild depression, so there may be an important activity connection there.

ELLEN FRANK QUESTION:
And that certain kinds of exercise are an important treatment for pain.

DR. SCHWENK & ERIC HIPPLE ANSWER:
Absolutely.

ELLEN FRANK QUESTION:
So in closing what advice would the two of you give to retiring athletes who are experiencing this difficult combination of chronic pain and symptoms of depression? And what advice would you give to just ordinary guys who are experiencing that combination? Eric, why don't you go first?

DR. SCHWENK & ERIC HIPPLE ANSWER:
Well, I would say first of all get educated and learn when you aren't feeling well why you're not feeling well instead of trying to blame certain things, it must be's, it must be that. No, this might not exactly fit. It is a full body experience you know. We know that we have pain, okay, but that pain gets a certain degree and all of a sudden you can't get out of bed anymore, you don't feel like getting out of bed. And it starts spinning into that vicious cycle.

Let's not wait until it gets to that point. So don't be afraid to ask for help for one. I think education helps with that. But don't wait until it gets too É Don't use those skills that were given to you, to you know play through it and get through it, go ahead and seek help a lot earlier and the treatment is a lot more effective the earlier it's given.

ELLEN FRANK QUESTION:
Excellent advice. And you Tom, what would you add to that?

DR. SCHWENK & ERIC HIPPLE ANSWER:
I think it's like we say to everyone, the way to make depression special and to cause people to seek care is to make it normal to help people understand that this is a district like any other, it's treatable like any other, it's important like any other, and to just make it a normal part of one's pursuit of health and medical care as Eric points out.

If we could just get it into that category of this is a problem, I know that it can be treated, I'm going to seek care for it, that would do wonders for the whole field.

ELLEN FRANK CLOSE:
Well, I just want to thank you both so much for taking time to talk with us today, I think this has been a fascinating series of issues. It's particularly important because of the stigma men have faced in terms of mental health and especially for athletes. And that we often don't recognize the particular challenges they face as they leave the limelight and move into retirement.

So thank you for your research on this topic and thanks so much for taking time to talk with us. For the Depression is Real Coalition, I'm Ellen Frank. Join us next time for another segment of The Down and Up Show from Depressionisreal.org.

IAN VO CLOSE

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