Brought to you by the Depression Is Real Coalition, The Down & Up Show is dedicated to the reality of depression. Each week 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 #06: Knowing When It's Time to Seek Help

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 KEN DUCKWORTH, MEDICAL DIRECTOR FOR THE NATIONAL ALLIANCE ON MENTAL ILLNESS (NAMI)

Welcome to another episode of Down and Up on depressionisreal.org. Today, we’ll be talking to Dr. Ken Duckworth, Medical Director for the National Alliance on Mental Illness about how to recognize depression and how to find appropriate help. Dr. Duckworth, it’s good to have you on the show today.

DR. ELLEN FRANK / KEN DUCKWORTH

ELLEN FRANK QUESTION:
We know that it can be very hard for people who are depressed to acknowledge or recognize what they’re dealing with. What should we tell people about how to recognize depression?

KEN DUCKWORTH ANSWER:
Well, first of all, I would encourage people to be very sympathetic to the fact that it’s difficult for all of us to sometimes recognize our own mental states. And I think this is particularly true of many of the major psychiatric illnesses where people can slip into a clinical syndrome like depression in an incremental manner over days or weeks and not really be able to appreciate how much their experience has changed.

So I think it’s important to, first of all, to just be humble about the fact that not everybody’s going to pick these things up with some precision. And in fact, part of the process for many people is it’s difficult for them to appreciate them themselves.

ELLEN FRANK QUESTION:
Right. And even people who have multiple episodes of depression sometimes tell me this one snuck up on me.

KEN DUCKWORTH ANSWER:
Yeah, this one snuck up on me. I think one of the interesting things that people need to do is understand their own early warning signs. So for some people, it maybe waking up at 4:00 a.m. For other people, it maybe when their clothes don’t fit and they drop ten pounds.

For other people, more likely teenagers, when they become increasingly irritable and angry. And for elderly people when they get more confused or disorganized, that can really be a piece of the package. Some people in my experience go straight to desperation and suicidality.

But many people do have a pattern of how their depression arrives. And if their loved ones can be part of that conversation, it can really help. Honey, I just noticed you got up at 4:00 a.m. for the third morning in a row. And I know you’re not stressed about a big project at work that might make you anxious. Do you think this could be an episode coming on?

Another thing that’s important is to understand the seasonality or the pattern to the depression. Some people, of course, in a classic setting get depressed in the wintertime when there’s less light and may become more likely to be hypomanic or high energy speedy in the summertime.

So, again, I think a lot of these things can be understood in terms of a pattern. But it is different for every individual in my experience.

ELLEN FRANK QUESTION:
But can’t people have a number of these symptoms and not be clinically depressed?

KEN DUCKWORTH ANSWER:
Well, I think in the context of a death of a spouse, I think you get into the interesting areas of sort of human experience being incredibly stressful and sad. But many people who do lose a spouse or suffer a loss do actually have these clinical symptoms that if they last for more than two weeks and if they impact your functioning in a substantial way are the criteria for clinical or a major depression.

ELLEN FRANK QUESTION:
I think there are people out there who believe that one should fight depression by going out for a jog or working out. How do you respond to that?

KEN DUCKWORTH ANSWER:
Exercise is a great thing. And I think there is fairly good evidence that exercise is a good intervention for mild depression and actually to take the edge off people’s anxiety as they’re worrying about having a depressive episode coming up.

But when you’re talking about more serious depression, exercise is but one piece of the larger puzzle. And I would not prescribe exercise as an intervention for a more serious depression. Medication, psychotherapy and using your supports, building on your strengths, are really the best interventions for those.

ELLEN FRANK QUESTION:
Let’s go back to something we were talking about a moment ago. Is there a good way to differentiate between the normal sadness that we feel when losing a loved one or experiencing a difficult life event and clinical depression?

KEN DUCKWORTH ANSWER:
I think my impression of that is we’ve confused ourselves by using the word depression for sadness. I’m depressed today. What people I think really mean is that they’re sad today. They’re down for some reason. So basically, you don’t want to look at the snapshot. Are they distressed at one moment? Are they crying because they just got bad news?

But you want to look at the movie a little bit, look at their pattern of weeks and see if the symptoms have been persisting for weeks and are impacting their functioning in a number of areas. And remember, these things are not mutually exclusive. You can have lost a loved one and that can trigger a major depressive episode.

ELLEN FRANK QUESTION:
We talk about depression as a biological illness. But can a difficult life event or a difficult life circumstances actually cause depression?

KEN DUCKWORTH ANSWER:
Well, when you say cause, it’s an interesting question. The literature shows us, and my experience is very consistent with this, that some people are vulnerable to becoming depressed. And there’s often a big stressor that precedes it, a big life stressor.

This is also true of people with bipolar illness. But it’s not always true. And the difficulty that we have in really understanding the exact biological underpinnings of depression, you know, relate to this problem. Some people seem to have more pre-existing genetic vulnerability and one stressor, which for another person might not make that big of a difference, really does push them into a clinical depression. So I would say it’s often, but not always, caused by a major life stressor.

ELLEN FRANK QUESTION:
But what you seem to be saying is that probably there needs to be a kind of underlying vulnerability in the first place and then a stressor on top of that?

KEN DUCKWORTH ANSWER:
That’s what most people think. Although, if you think about some of the adolescents I’ve worked with who are discovering that they’re gay and are experiencing tremendous negative social consequences. A lot of them are at increased risk for depression and actually suicidal outcomes.

And it’s hard to know is that biological or are they just vulnerable to shame and humiliation? So there’s a lot of facets to this process which I think we don’t understand. But that’s a good example, you know, a person who’s discovering that they’re gay who experiences a loss who’s a teenager may not have classic full blown depression before they decide to kill themselves.

ELLEN FRANK QUESTION:
So that brings me to a really important point. If someone is experiencing these symptoms, about how long should they wait before seeking outside help?

KEN DUCKWORTH ANSWER:
I would wait as little as possible. These symptoms are actually as serious as untreated major medical problems like diabetes. Like diabetes, depression is treatable, manageable and containable in most situations. And like diabetes, if left unmanaged, it may kill you.

And I think particularly for people who have a history of suicide attempts, have a history of completed suicide in the family, they should be extremely aggressive about getting a good intervention for their depression. They should not be using substances to self-medicate their experience and hope it passes.

My experience with people is get involved with your supports rather quickly, talk to your friends, talk to your doctor, talk to your spouse, get people involved in it. Because I think another one of the kind of tragic compound side effects of depression is that people feel isolated. Then their support network, all the things that bolster us as human beings, social experiences, laughter, love, all those things, can become more limited as well. So the whole process can spiral downward.

ELLEN FRANK QUESTION:
Once you’ve decided that help really is indicated, where should people start?

KEN DUCKWORTH ANSWER:
Well, that’s a great question. Because, of course, many people feel more comfortable talking to their primary care doctor than they do to seeking a mental health professional. And in some parts of the country, particularly in rural areas, there are very few mental health professionals.

Some people are very religious. And they would rather start with a pastoral counselor. Some people find that they would prefer to go to a support group for the stress of a problem which seems to be generating it, for instance, a grief group, a divorce group, that sort of thing.

What I say to people is one of the pieces to the package has to be a medical professional who has the capacity to make a thoughtful diagnosis and consider medication that is appropriate. The spiritual counselors, all those things are terrific for people. And I encourage people to always use whatever resources work for them.

But I think given the strength of the evidence, I think one of the possible interventions is medication for some symptoms some of the time. And I think that this was an important piece of the process. But some of it does depend on what’s available to you in your area.

ELLEN FRANK QUESTION:
So beyond speaking to a pastor, beyond taking anti-depressant medication, are there other treatment options that are effective for depression?

KEN DUCKWORTH ANSWER:
Talk therapy is something that is actually quite robust in its response. Basically, talk therapy has a number of schools within it, but essentially the core elements of talk therapy are you gather support for your experience and in some more structured ones like cognitive behavior therapy, people actually challenge their negative thinking.

The idea behind cognitive behavior therapy is your negative thinking drives negative feelings. So basically, the mode of attack is to look at your negative thoughts. So instead of drawing dire conclusions about yourself and your self worth in the context of this experience, cognitive behavior therapy would encourage you to understand, for instance, what happened at work that was a big stress for you in the context of how you could learn from it in the future as opposed to defining yourself by it.

So, psychotherapy and medications are quite a strong combination. Once you add support, loving relationships and exercise for more mild depression, I think that that’s a pretty strong package. Talking to other people who are depressed and who have been there also a whole growing area.

In groups like NAMI and Depression and Bipolar Support Alliance offer peer supports, people who say I know what this is like. I have been there. We’re going to support you through it.

ELLEN FRANK QUESTION:
Any final thoughts? Anything you want to add here at the end?

KEN DUCKWORTH ANSWER:
I guess I would like to say that untreated depression is also really bad for your heart. Americans are increasingly interested in their overall cardiac well-being. When we think of all sorts of risk factors like smoking and exercise and all that stuff, but I just add to that that untreated depression is actually very bad for your heart and very bad for your body. And can take years off a person’s life.

Not in terms of suicide only, but in terms of the risk of a cardiac event. So I think it’s especially important for people to seek help and to make sure that their mental health is essential to their overall physical health.

What a great place to close. Thanks so much Ken.

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

For the Depression is Real Coalition, I'm Ellen Frank. Join us next time for another episode of the Down & Up Show on depressionisreal.org. [music]

IAN VO CLOSE

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