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 #20: Understanding the Stigma Surrounding Depression

The Down and Up Show on Depressionisreal.org. A talk show dedicated entirely to the subject of depression and the reality that there is hope for people living with this disease. Now your host Terrie Williams.

TERRIE WILLIAMS INTRO:

Welcome to the Down and Up Show on Depressionisreal.org. I'm Terrie Williams your guest host filling in for Dr. Ellen Frank. Today we will be talking with the amazing Dr. James Potash (ph.). Dr. Potash received his medical degree from the Johns Hopkins School of Medicine. He's currently an associate professor in the Department of Psychiatry and Behavioral Sciences where he is co director of the Mood Disorders program.

His research centers on the genetics of mood disorders and he frequently writes for abcnews.com. In recent articles Dr. Potash has discussed a stigma that surrounds depression and the treatment options available, a most compelling topic. I would guess that I would like to call you a freedom fighter in many ways Dr. Potash. Thank you for being with us today.

DR. JAMES POTASH ANSWER:

Thanks. I'm pleased to have the chance to be here.

TERRIE WILLIAMS QUESTION:

Yes. Stigma is a very, very, very serious issue surrounding all mental illnesses. In your recent article Depression Stigma, Sometimes Deadly, you've discussed the prevalence of stigma surrounding depression. Can you explain this to our listeners? And what is it that keeps us literally from being free to be who we are?

DR. JAMES POTASH ANSWER:

Sure. I think when people are psychiatrically ill it's clear that a lot of people out there don't want to talk about it. There are a lot of people who don't want to see a psychiatrist if they have a psychiatric problem, because they don't want a psychiatric visit to show up on their insurance, they may not want to have their employer hear about it because it's fear of repercussions.

And then there are also people who do come to see a psychiatrist but who don't want to go on medication, because they may feel like that would be a sign of weakness. So I think there are a whole lot of ways in which we see evidence of stigma continuing to create problems for people who need to get treatment.

TERRIE WILLIAMS QUESTION:

Yes. I'm just, words kind of are difficult for me to express in terms of what the stigma does, I mean, because there are just millions and millions of people who are suffering on some level.

And so we have an opportunity to deal with people in a healing way to lift them up or in a fragmenting way. But I find that it's just keeping so many people from getting the help that they need. What do we do? I mean, one of the things, and I'm sorry to just kind of go on and one, but part of the reason that I decided to speak out about my own depression was because I just saw people everywhere suffering, they told me, but best friends didn't know and family members didn't know. What do we do?

DR. JAMES POTASH ANSWER:

Well, I think one of the important ways to fight stigma is through education. For example, there are more and more books appearing that help explain depression. There's, I know you have a book coming out in a couple of months about depression, there are two that I often recommend to patients, one's called Understanding Depression by Raymond DePaulo (ph.) and another book is called Depression, the Mood Disease by Francis Mondamore (ph.).

TERRIE WILLIAMS QUESTION:

So would you say that men harbor the stigma of depression much more than women do?

DR. JAMES POTASH ANSWER:

I think so. I think so. We have a study of the genetics of depression that we're doing here at Johns Hopkins in collaboration with five other academic medical centers around the country. And we found that it's relatively hard to get men into the study. It's much easier to get women into the study. And, of course, women have depression twice as often as men, but even accounting for that it's still relatively hard.

Yeah, I think a lot of men feel like it's important to project strength.

TERRIE WILLIAMS QUESTION:

Yes.

DR. JAMES POTASH ANSWER:

I think plenty of strong men have suffered with depression just like everybody else, that includes successful businessmen, policemen and athletes.

TERRIE WILLIAMS QUESTION:

Yes.

DR. JAMES POTASH ANSWER:

And, of course, treatment helps them just as much as it helps everybody else.

TERRIE WILLIAMS QUESTION:

Can you, for those who might not know about serotonin working and not working, can you just say a little bit about that?

DR. JAMES POTASH ANSWER:

Yeah, sure. So serotonin is a neurotransmitter. Neurotransmitters are chemicals that communicate between brain cells. And we know that serotonin is a neurotransmitter that is critical in depression. And there's another one called neuroephanapherin (ph.). Serotonin and neuroephanapherin have been known to be important for many years now in depression.

When these two neurotransmitters are depleted they can trigger depression, and when their levels are increased as they are by most of the antidepressant medications, people typically recover from their depression.

TERRIE WILLIAMS QUESTION:

What would you say are the common forms of depression treatment and in your experience what are most effective? I know I would like to almost just make sure that our readers, listeners, I'm sorry, that our listeners know that there can be chronic depression but it can also be something that you deal with based on life transitions, you know, circumstances, episodes in one's life. Could you speak a little bit about that?

DR. JAMES POTASH ANSWER:

That's okay. Well, no, you're right. You're right that most people have depressions which occur in episodes. So most people get depressed and then they get well. Typically the getting well process takes five or six months on average. But there is a subset of people; there are a group of people who do stay depressed to some degree or other most of the time.

We actually published a paper about a year ago in the American Journal of Psychiatry saying that about 30 percent of people in our study did report that they are chronically depressed, a minority, obviously not a small minority. But in terms of the treatments there are really three major kinds of treatment. The first one is electroconvulsive therapy or ECT for short.

I say first one, it's actually the first modern therapy in psychiatry. It was invented in 1938 in Italy. It's been used around the world since about 1940. And it may come to a surprise to some people, that ECT is actually the single most effective treatment for people with severe depression. It works about 80 percent of the time. And it's very safe.

The other, the second major form of treatment is antidepressant medication. And that, any given antidepressant, the first one that's tried for someone, works on average about 60 percent of the time.

TERRIE WILLIAMS QUESTION:

That's interesting.

DR. JAMES POTASH ANSWER:

Now there are a lot of them. There are 24 of them on the market. Now if a patient is one of the 40 percent of people who don't respond to the first antidepressant they try, we typically try one of the many others that are available. And often the second one we try does the trick. If the second one doesn't work we try the third.

Now the other major form of treatment is psychotherapy. Psychotherapy is a crucial component to any treatment of depression really, because everyone needs support to some degree or other in dealing with depression. They need to hear that they're not a bad person. They need to hear they don't deserve to feel this way.

They need to hear there are strategies that can help them in dealing with the difficulties created by depression, difficulties in relation to their spouse, their friends, their boss. So those are É

TERRIE WILLIAMS QUESTION:

Let me ask you, given your background, how do you weigh in on alternative methods? What if somebody is, such as faith or just alternative methods, exercise, how does that fit into the mix from your point of view?

DR. JAMES POTASH ANSWER:

Well, I mean, when I'm taking care of someone I'm always very much heartened when they are a person of faith, because I think that the support of, the spiritual support of faith as well as the communal support of a congregation are things that can be incredibly helpful as a person tries to get through depression.

I mean, one of the great challenges that is a lot of people with depression wind up getting into, wind up losing some of the support that can be so important in getting them through. In other words, sometimes depression can cause a marriage to break up and then a person may have lost their best support, a spouse.

TERRIE WILLIAMS QUESTION:

That's right.

DR. JAMES POTASH ANSWER:

So I think the support of faith is extremely important. I think exercise certainly is also something that I always feel is enormously positive when someone is involved in it. In general exercise makes anyone feel better to some extent, I think. And even more important in someone with depression that so many of our medicines cause people to gain weight. I think exercise takes on even greater importance because it can be valuable in preventing that side effect.

TERRIE WILLIAMS QUESTION:

Yes, no doubt. I mean, I know that some of my most difficult moments I had to really force myself to, but just when you get those endorphins going it helps.

DR. JAMES POTASH ANSWER:

Yeah.

TERRIE WILLIAMS QUESTION:

You know as a mood changer. We've been hearing at least the last few days about the reported attempted suicide by the actor Owen Wilson.

Do you have any comments on that? And I just want to say being wealthy and famous does not preclude you from, you knowÉ

DR. JAMES POTASH ANSWER:

Yeah, Terrie I'm glad you asked that question. That's a very É that's a question that É I feel very strongly about that issue.

TERRIE WILLIAMS QUESTION:

Yeah.

DR. JAMES POTASH ANSWER:

Because that really speaks to the misunderstanding that people have about suicidal behavior. The misunderstanding is that there must always be a reason that you can pinpoint in a person's life situation for them to act that way. And the fact of the matter is that while that can happen, it can be that life circumstances can drive it very often, probably more often than not, it's not a matter of life circumstance, or at least not that alone.

The majority of the time people who make an attempt to kill themselves have a serious depression, and the serious depression is typically something that unfolds in the brain for reasons that we don't yet understand but that have to do essentially with brain chemistry. Suicide is typically the result of a diseases process. And a person who has everything going for them can get a disease just like a person who has everything going for them can get cancer, or can develop diabetes or can develop asthma, the same way a person who has everything going for them can develop a severe depression because of the way the brain chemistry unfolds.

I guess, yeah, I think people, I think some people continue to find it hard to understand that depression is a disease process.

TERRIE WILLIAMS QUESTION:

Uh-hmm. I'd like to ask you just for a moment was there anything in your life or just your experiences that led you to this field?

DR. JAMES POTASH ANSWER:

Well, there's at least one big thing, and that is that my father is a psychiatrist. So I suppose I'm genetically predisposed to becoming a psychiatrist. My father trained as a psychiatrist here at Johns Hopkins from 1959 to 1962 and I was born at the end of his psychiatry training here at Johns Hopkins.

TERRIE WILLIAMS QUESTION:

Oh, is that right?

DR. JAMES POTASH ANSWER:

So I'm sure that has an awful lot to do with it. And I also have depression in my family, as well. So I'm sure that also had something to do with it.

TERRIE WILLIAMS QUESTION:

Yeah. Well, there is a question that I'd like to ask you before we begin to wrap up. But I know that your research focuses a lot on the genetic predisposition of mood disorders. Can you explain how a mood disorder is defined and in fact detected?

DR. JAMES POTASH ANSWER:

Yeah, so the term mood disorders refers essentially to depression and bipolar disorder. So people with depression have just depression whereas people with bipolar disorder have both depression É

TERRIE WILLIAMS QUESTION:

Can you explain for our listeners the difference?

DR. JAMES POTASH ANSWER:

Yes, so people who, depression refers to of course to very low moods along with a lot of other symptoms, like trouble sleeping, poor energy and changes in appetite and feeling badly about oneself and feeling slowed down and feeling guilty. People who have depression have just those kinds of moods.

People with bipolar disorder have both those depressions and also high moods which when they're very high are called mania and when they are less high are called hypomania. If you have manias then you have what's bipolar type one disorder. If you have hypomanias you have what's called bipolar type two disorder.

The important thing to keep in mind is in making those diagnoses relies strictly on the clinical picture, meaning the symptoms that the patient reports and the signs which are what other people can see. There are not any blood tests or any other kind of physical tests to guide us at this point.

TERRIE WILLIAMS QUESTION:

We know that there are millions and millions of us who are without health insurance and I wonder if you would have any words for anyone who might find themselves in the position where they feel as if something might be wrong what alternative there might be for someone like that.

DR. JAMES POTASH ANSWER:

Well, the thing to do for someone like that would be to seek out the nearest community mental health center. Community mental health centers were set up nationally roughly 40 years ago or so now at the time of the revamping of the mental health system, public mental health system. Community mental health centers are government funded and are really, do provide a place where anybody ought to be able to get treatment.

TERRIE WILLIAMS QUESTION:

Okay. Are there any other thoughts that you might like to share with our listeners, any parting thoughts?

DR. JAMES POTASH ANSWER:

Well, I suppose I should tell people a little bit about what we do in trying to understand the genetic basis of depression. We actually do have ongoing studies where we're recruiting people with depression and with bipolar disorder to try to figure out which of the 20,000 or so human genes are responsible for conferring risk for these illnesses.

TERRIE WILLIAMS QUESTION:

Do you pay people?

DR. JAMES POTASH ANSWER:

People get a relatively small amount of money for participating. Actually if anyone hears this and goes to our Johns Hopkins Mood Disorder website they'll see more information.

TERRIE WILLIAMS QUESTION:

And your website is what?

DR. JAMES POTASH ANSWER:

www.johnshopkins.org/moods.

I do think using these kinds of tools is likely to bring us closer to a fundamental understanding of the way the illnesses unfold in the brain. And having that understanding I think is going to give us the ability to interrupt the disease process with new medications in a way that we haven't been able to before.

TERRIE WILLIAMS QUESTION:

That's very, very encouraging. Well, I thank you Dr. Potash for talking with us today and just really shedding some light on stigma and those things that we can do to break down those barriers, just most important work. Well, thank you again for that.

DR. JAMES POTASH ANSWER:

Sure, my pleasure.

TERRIE WILLIAMS QUESTION:

For the Depression is Real coalition, I'm Terrie Williams, join us next time for another addition of the Down and Up Show on Depressionisreal.org. (Music)

Thanks for listening to the Down and Up Show. For more information, log onto www.depressionisreal.org. You can find us there and at i-tunes. And remember stay subscribed. (Music)