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 #26: Dr. Reef Karim: A Medical Messenger in a Pop Culture World

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, Terry Williams.

TERRIE WILLIAMS QUESTION:
Welcome to the Down and Up Show on depressionisreal.org. I'm your host Terry Williams. Today we will speak with a very interesting figure in the mental health field, Dr. Reef Karim. Dr. Karim is not only a psychiatrist at the prestigious UCLA Neuropsychiatric Institute, but he's also probably the only psychiatrist who has ever been voted one of People Magazine's sexiest men alive.

He's been called a medical messenger in a pop culture world and has been featured as an expert on the Today Show, CNN, CBS, Fox, and the other news media discussing mental health issues in the celebrity community. You may have seen him recently on CNN's Larry King Live talking about depression among celebrities.

In addition to his practicing duties, Dr. Karim traveled to India to advise a group of physicians on post traumatic stress disorder due to a natural disaster. Dr. Reef has also assisted the Pakistani consulate after the Pakistan earthquake and he worked with the Red Cross after 9/11 in disaster medicine. Welcome Dr. Karim, we are so excited about having you today.

DR. REEF KARIM ANSWER::
Thank you, thank you so much, it's good to be here.

TERRIE WILLIAMS QUESTION:
So we know that depression can impact anyone but would you mind sharing with us your specific insights on depression and celebrity, you know, ala so much of what we're witnessing with regard to you know Britney Spears and Lindsey Lohan, and there have been so many before. But would you share something on that?

DR. REEF KARIM ANSWER::
Yeah, I mean, when we talk about depression first off somebody's brain definitely is changed. There is some kind of chemical change in someone's brain when they're depressed. So when we were learning about things like depression as well as addiction, for a while it was kind of like well, what's wrong with you, you know, pull yourself up by your bootstraps, and I hate that expression, and just be better, what's wrong with you?

And then we realized over time, wow, there is actual, a chemical change in the brain that's happening. So in looking at that you have to realize that somebody could be homeless, on the street, in a corner, living in a cardboard box, or they could be the biggest celebrity known to man, it doesn't matter, because there could be a chemical change in either of their brains or anybody in between.
So when you look at depression you look at somebody has a depressed mood for at least a couple hours every day, they have a loss of interest and pleasure in activities that they normally like, sleep problems, eating problems, they might feel like hurting themselves, they could feel fatigued, feeling of worthlessness, helplessness, hopelessness. It's just a really debilitating disease that a lot of people have.

TERRIE WILLIAMS QUESTION:
It is. It definitely knows no barriers. How do you think that we can get across to the public at large the notion that it has no barriers? Because I remember when Owen Wilson had a situation a few, like a couple of months ago and people would say things like he had everything, he has everything. Is there anything that you think that we can do or say more to try to get people to understand that?

DR. REEF KARIM ANSWER::
Yeah, it's a great question. I think the more we include depression and mental health disorders as these are true disease processes. Diabetes is a disease. A cardiovascular problem is a disease. High blood pressure is a É you know these are medical things. Well, guess what your brain changes when you have a mental health problem.
And whether it's a structural, functional, chemical, whatever you want to call it, there is a change there which is a body, a physiological change. So you have to look at mental health issues as a specific disease process.

If it's categorized that way I think people will accept it more and realize there's very good treatment, somebody just has this disease process that could be chronic, it could be something that they get over over time. But irrespective it's taken, it's got to be taken very, very seriously. And the more medical it is I think the more we're going to look at it as not this fringe thing, but a real problem that can be worked on and treated.

TERRIE WILLIAMS QUESTION:
Yeah. Thank you for that. How would you counsel someone who is living in a fish bowl, under the intense public scrutiny and pressure to get help for their depression?

DR. REEF KARIM ANSWER::
When you're a celebrity É I use the metaphor, well, the example, depression can hit anybody from a homeless person to a celebrity. Fine. But they have different life circumstances. I mean, a homeless person is sitting on survival; they just want to get food to eat, find a place to sleep and be safe. Now that's a survival instinct, that person's own acute stress.

Celebrity seems to have it all, has a manager, a publicist, a team, probably attractive, can do whatever they want and has lots of money and seems like everything's great. But their brain doesn't get all the É a brain's a brain. It's just the way it is. And they may have some kind of underlying problem. The difference is the homeless person if they go to a, I used to work at a free health clinic and I still sub (ph.) at different ones.

When they come to a free health clinic they're like hey, just give me some food and a little medication or a little therapy and a bus token and I'm doing good. With a celebrity everybody's watching what's going on. There is no period of restoration, there is no period of okay, I'm just going to check out for a little while and go like hang out and have nobody bother me for a while, just to relax and not think about anything.

And that doesn't happen very often. So the hardest thing about a celebrity with depression is you've got to get them away from their pressure. And celebrities are created, I mean, you might come from a celebrity family, but there's a machinery behind Hollywood and behind the political, the political machinery to create somebody.

And there's a lot of people that are basing their existence, their monetary means, their finances off of you as a celebrity. So there's an incredible amount of pressure and the machinery has to understand the person's health is a big part of this as well.

TERRIE WILLIAMS QUESTION:
Yeah. I was going to comment on that matter. As a public relations professional I've represented many celebrities over the years and what I have found is that so often because people's meal tickets are attached to them, they don't always care about the person as much as they should.

DR. REEF KARIM ANSWER::
Right, you're totally right.

TERRIE WILLIAMS QUESTION:
Yeah. I wanted to É well, what do you think É you've actually really spoken to that, so let me just switch gears for a moment. I know that you've done a lot of important work abroad to help people with post traumatic stress disorder or it's commonly called PTSD caused by natural disaster.
Can you tell us a little bit about your work there and then I also wonder, there's a part two to that, I think that a lot of people don't understand that the gang violence, so much of the gang violence that we see that a lot of gang members really do suffer from severe depression, suicidal tendencies, and PTSD because of the violence they have committed or witnessed, and I wonder if you might have any thoughts on that as well, as the part two of that.

DR. REEF KARIM ANSWER::
Yes, so let's talk about trauma, right. When you have a traumatic event happen to you or you're a part of or there was at some point you felt like fear, helplessness or horror from witnessing an event that was to you or around you, and there was well being, your well being or another person's well being was impacted. You take in that memory.

And different people are prepared or not prepared for having a memory like that; you encode that memory into your brain and it kind of sits there. And depending on your body and your mental response to that memory you may encounter something, initially it's called an acute stress disorder, which means within the first month of a traumatic experience you have whatÉ

There's really three factors, you re-experience something, like you could have nightmares, you could have you know day dreams or visions or thoughts about something, you avoid things, anything related to any possibility of that threat ever happening again, anyone who looks like that person, it might be a place, and you have hyper arousal.

And hyper arousal is you're jittery, you're on edge, you're constantly like a noise really freaks you out. And those three things really, kind of combined, are also part of post traumatic stress disorder which happens a month after the traumatic event. Now what I did is I went to Indian during the Tsunami time. I consulted with the Pakistani consulate because they called me to talk to them about the earthquake.

And then when 9/11 happened I worked with the Red Cross briefly about, really a lot of it is education, because people will freak out at a traumatic event, not know what to do with it and just completely take it in. And this is what I see in all my patients. When something, when a traumatic event is sitting inside you, guess what it doesn't come out.

A lot of times it grows, a lot of times it É it just doesn't disappear over time. It comes out through therapy. It comes out through talking to your friends. It comes out through you needing to get it out. But if it just sits in there and you just keep it in there, guess that it's going to stay in.

TERRIE WILLIAMS QUESTION:
Yes, yes. You know you just mentioned, I wonder, I sometimes often like to ask people this because I think it helps to just demystify and remove the stigma, but at any point in your lifetime did you ever have any particular challenges with depression or anyone in your family. What led you to this calling?

DR. REEF KARIM ANSWER::
Yeah, you know, it's a great question. I get asked a lot why psychiatry? My parents, I have a very, I guess my background is a little interesting I might just say that real quick. I was very much more of the artistic guy. I played in a lot of bands, I was the music guy, I was a Latin dancer, you know, I was doing the whole dance scene in my vanity. I had done some Bollywood films.

I was very much the performer who then ended up having an intervention on me essentially by my strict Indian parents who basically stated you're going to medical school, you're our eldest son, you have good grades, you need to go to med school, don't waste your time on all this performing stuff.

And at the time I was pretty upset about that, who wants to be intervened on, with a career intervention. But it worked out incredibly well, because the performing part of me, and I don't even call it performing, I call it just be comfortable with the media, with being onstage, with whatever, combined with hopefully the opportunity which I am so thankful for, that I've had to be able to go through all the training and education that I've had, has really set me up to be able to get out there and talk to people and help people and work in the media.

So I'm very, very happy with that. I think for me playing in all those bands a lot of the guys that I either played with or came across were addicted to something. So that really got my interest in addiction.

And then family wise I've had some family history of some people who have had some real difficulties with various, you know, mental health things along the way. I've had friends, families, I've had teachers. There are all sorts of people that you'll come across because the reality is if you look at anxiety disorders and you look at depression the numbers are so much higher than we realize.

It's just because of the stigma that people tend to keep it within their families or keep it hidden so that they're not as much out there. And I really applaud people that are out there talking about it.

TERRIE WILLIAMS QUESTION:
Yeah, I think that just people, you know, they walk around with their game face on, just kind of passing for normal and just dying inside. It's just very, very sad to me.

DR. REEF KARIM ANSWER::
Yeah, I mean, don't forget that one of the cardinal responses when you have depression is really isolation. So when you're depressed you're not the kind of person that wants to go out there and talk about your depression all day. You're the person who wants to hang out in your room, close the door, lay on your bed, and try to sleep it off all day or just lay there and do nothing or watch TV.

I know we're going to be wrapping up shortly, but I wanted to get back just very briefly to your work in India and Pakistan. Was there a stigma attached with depression and PTSD there? Or were there any particular treatment options that were available that you could apply here in the states?

DR. REEF KARIM ANSWER::
Yeah, trauma is trauma whether it's in India or it's here. So the first thing is a lot of people didn't understand that there was going to be definitive mental health issues associated with trauma. Whether we're talking about 9/11 or we're talking about the Tsunami people need to realize that, yes, the first thing about disaster medicine is survival with far and away look let's just make sure people have water, let's just make people have food, let's just make sure people have shelter. Far away that is what we have to focus on.

But what I was there to do was to try to really help people to understand look there could be life changing events mentally that are going on because of this natural disaster. And the earlier we can address it, the earlier people can talk about it, the earlier we can employ structure in helping people to deal with what they just saw or experience the better off these people are going to be from a mental health standpoint.

Additionally, what we're doing is there's beta blockers or medications, like one of them is called perpanalal (ph.) that we've been using with different results. Some people really, really think it works well. Some people are not quite as about it, depending on their research. But in some of my patients I found that giving somebody who's had a traumatic event early on in their trauma this medication can help to delay or change the way it's encoded as a memory in your brain.

So if you can kind of alter the way that the traumatic memory is really set inside your brain you may be able to alter the way that you experience that memory or the way that you may avoid or have hyper arousal about that traumatic response. So anything we can do to interrupt the encoding of that scary trauma the better.

And so when I went over there a lot of it was education on how mentally we deal with natural disasters. A lot of it was to see what kind of structure was out there. A lot of it was just me helping people out, you know, and then talking about the way that we can employ medication as it's needed in addition to the therapy.

TERRIE WILLIAMS QUESTION:
Do you ever experience, I guess what can be called caregiver fatigue because you are so intimately involved in painful episodes of people's lives?

DR. REEF KARIM ANSWER::
It's tough. And I have to do it on a time limited basis. I can't surround everything that I do in my life with É I guess people ask this all the time, when's your down time. And I'll tell you what if you are a mental health provider or you work in the field of addiction or even forensics, because you're seeing those kinds of people as well, you got to have down time, you can't É I think the hardest part is a, not taking it home and b, not having drama in your social life. (LAUGHTER)

Because if I go home and I just had the craziest day and you know a girlfriend and I end up having a ton of drama at the end, you know, when I get home, I'm like I can't, I can't take it, I can't take it. And I think the hardest part is you're so wiped out emotionally during the day that you want to just vegetate you know at night, you don't want to really do anything.

TERRIE WILLIAMS QUESTION:
Well, I really, on a personal note I think that you really are a light force in the universe and again I mean, I have psychiatrist and psychologist friends and sometimes you ask them a question or I remember just asking for some comments on something and I when I got them back it was like could you say this in English. (LAUGHTER) Do you know?

And you're very accessible and so that really is a blessing to so many people. Do you have any closing thoughts that you'd like to share?

DR. REEF KARIM ANSWER::
Yeah, I mean, basically I'd just like to share that I think this is great, we're just talking about this, you know. And depression has been stigmatized in the past, I think it's getting better; I think we still have a long way to go. There's a lot of great groups out there that, I know you're a part of some, that are doing a lot of work just with their primary focus is on teaching people mental health is okay.
I mean, mental health is a good thing. We use the word mental like it's scary, but mental health basically means the brain and behavior.

TERRIE WILLIAMS QUESTION:
Yes.

TERRIE WILLIAMS QUESTION:
Well, thank you so very much Dr. Karim for your time and for speaking with us today and just for being a light force in the world. For the Depression Is Real coalition I'm Terry Williams. Please join us next time for another addition of the Down and Up Show on depressionisreal.org. Stay strong. (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)
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