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 #50: Dr. Ellen Frank Returns for the 50th Episode
DR. REEF KARIM:
Okay, welcome to the Down and Up Show on DepressionIsReal.org, I'm
your host Dr. Reef Karim, psychiatrist, addiction specialist and
relationship therapist. Today is the 50th Down and Up Show, that's
right, the 50th. To mark this event we've invited Dr. Ellen Frank
to join us.
Dr. Frank served as the host when we launched the show in April
of last year and she's a professor psychiatry and psychology at
the University of Pittsburgh School of Medicine and an expert in
mood disorders and their treatment. So we wanted to take this opportunity
to catch up with her and of course, celebrate the success of this
pod cast.
So welcome back to the show, Dr. Ellen Frank.
DR. ELLEN FRANK
Well thank you.
DR. REEF KARIM
So let me ask you a question, when you launched this, it was more
then a year ago, you had the opportunity interview a number of guests
including authors, policymakers, researchers and journalists. Is
there one guest that you would point out...
You know, we always ask this, if you... if you could... if you were
stranded on a desert island and you had one thing you could bring
with you, so we're going to go with the guest thing, if there's
one guest you would point out as having really delivered an important
message to the millions of people who have depression, who would
it be?
DR. ELLEN FRANK
Well I'd be hard pressed to point to one, but I think the messages
that moved me the most were the messages from... not us researchers,
not us clinicians, but from people who actually... were suffering
from depression themselves and particularly those people who... provided...
insights into how they overcame the challenges that depression provided
in their lives.
DR. REEF KARIM
Especially as they can discuss what the researchers and clinicians...
are doing. You know it's... it's one thing to just have a researcher
come in and say, hey we did this study within a population of 100
people that did this, this, and this. But if you don't really apply
the actual nature of what's happening from a patient perspective,
you kind of miss out on it.
So I agree with you and... and I'm here at the APA and looking at
a couple of these lectures, when patients actually talk to us about
what's going on, it's so much more impactful.
DR. ELLEN FRANK
I couldn't agree more.
DR. REEF KARIM
Yeah, well you spoke to a number of researchers like yourself about
their work, but never got an opportunity to speak about your own
research. So let's talk about your... your research. What are you
currently working on?
DR. ELLEN FRANK
Well let's see, I'm working on a couple of things... I've just finished
a study in which we...were trying to understand if it's possible to
predict ahead of time which depressed patients will respond to pharmacotherapy
and which depressed patients will respond to psychotherapy.
So in this study, we... used our random assignment technique, the
toss of the coin, and... half the patients received... a standard... SSRI,
selective serotonin reuptake inhibitor medication and half of the
patients received interpersonal psychotherapy.
And what we're trying to understand now, is... are there clues that
we had... at the beginning of treatment, before treatment even started,
that would have helped us to identify those people who really are...
their best shot is going to be psychotherapy and how are they different
from the people whose best shot is going to be pharmacotherapy?
Cause right now, we have very few guidelines. When a patient comes
across our threshold with pretty much ordinary, garden variety,
non-psychotic major depression, we really don't have good... clues
as to who's most likely to benefit from each of those treatments.
We know that for patients who don't respond to either pharmacotherapy
or psychotherapy, the next best step is probably to add the other
treatment, not to change the pharmacotherapy or the psychotherapy.
In... in our... research program in... two or three different studies
now, we've seen that if we... add pharmacotherapy to those patients
who have not had a complete remission with psychotherapy, we get
complete remission rates of about 80 percent.
And the opposite is also true, if we add psychotherapy to the treatment
of those patients who've not had a complete remission with pharmacotherapy,
again we get about 80 percent of patients experiencing a complete
remission of their symptoms. So in that sense, the combination is
a really wonderful tool for people who've had an incomplete response.
DR. REEF KARIM
Well I should tell our listeners we're conducting today's show in
the backdrop of the 161st Annual American Psychiatric Association
Meeting being held right here in Washington, DC. So why don't you
tell us about some of the research that's happening right now?
DR. ELLEN FRANK
Well... to be honest, I think the stuff that's most impressed me as
I've been around the meeting, has actually been again, the information
provided from consumers. For example, I attended the Depression
and Bi-Polar Support Alliance... scientific advisory board meeting
at which they... showed us their... new web based materials.
That really were just so remarkable, an entire new... web program
or package of programs, called "Facing Us" that... in which individuals
who suffer from depression and bi-polar disorder tell their stories.
And to be honest, that impressed me more then any of the research
I've seen so far.
DR. REEF KARIM
And... and from your experience of studying depression, talking to
many people who have been impacted by depression, looking at the
research on depression, what do you think's the hardest part about
managing this illness?
DR. ELLEN FRANK
I think the... in some respects, the hardest part about managing this
illness is how insidious onset can be and how even the best intentioned...
most determined patient can miss a new onset until they're really
almost... until he or she's almost really incapacitated, so we as
clinicians are completely dependent on the report of patient as
to how they're doing.
And... I think the fact that depression can come on so gradually and
kind of... creep up behind you without you're really realizing it...
makes the... the management of... of depression a real challenge for
clinicians. I think that's probably my... my number one concern.
DR. REEF KARIM
Okay, yeah and the education of people in understanding what depression
is will help them, you know, whether they have it or they don't,
will help them to... to seek help if and when that time comes with...
DR. ELLEN FRANK
Well and I do think, I mean we have a substantial amount of data
to suggest, that there are individual patterns in onsets so that
the early warning signs... for Cathy are not the same as the early
warning signs for Jane. The early warning signs for Jim may not
be the same as the early warning signs for... Joe.
And... when someone has had three or four episodes of depression,
spending some time to really think about what those early warning
signs are for this particular person, I think can be extremely helpful.
DR. REEF KARIM
Yeah... as you know one of the goals of the Depression is Real Coalition
is to erase the stigma surrounding depression. In your opinion,
what more do you think we have to do to make that a reality?
DR. ELLEN FRANK
Huh... well you know I actually think we've made tremendous progress...
among the... we're always...
Among the real benefits of... the... move to ad... to do direct, to consumer
advertising about... pharmaceutical compounds, which we could argue
whether that's a good thing or a bad thing. But certainly a very
good aspect of direct to consumer advertising regarding antidepressants,
has been to put depression in everyone's face.
And to make it like any other problem you might have, allergies,
diabetes, high blood pressure, you name it and I think putting depression
treatment... you know on this... on a par within the same magazine advertisement,
in the same television spots with all of these other common diseases,
as gone a long way to de-stigmatize depression.
I think many of those advertisements have also... explained a lot
about depression and... and in that way helped to de-stigmatize it.
Our American... our American society is very much one that values
independence and independent initiative, so needing to ask for help
for something like depression, I think is particularly hard for
Americans.
But I... I believe we've made a lot of progress in the 25 or 30 years
since I've been working in this field.
DR. ELLEN FRANK
A particular place where I've seen a change is in the willingness
of men to come forward when they have depression. The National Institute
of Mental Health... did a wonderful public service campaign called
"Real Men, Real Depression" and I'll be the first one to admit,
I kind of thought... this isn't going to change anything.
Well don't you know that the first study that we did after that
campaign ended... brought in probably three times the number of men
that we have ever had in a study of depression in the... quarter century
I've been doing this work. So I think, you know, particular... that's
just one more piece of evidence that things really are changing.
DR. REEF KARIM
Is there anything else you'd like to share with our listeners today?
DR. ELLEN FRANK
No I... I think... we've... we've... covered a lot, we've highlighted some
of the interesting things that are going on here at the... Annual
Convention of the American Psychiatric Association. And... I think
we've... you know, pretty much covered the waterfront.
DR. REEF KARIM
Alright, great, well thank you so much for spending time with us
today Dr. Frank.
DR. ELLEN FRANK
You're very welcome, I hope the rest of your day and the rest of
your convention is a good one.
DR. REEF KARIM
Thank you, you too, it really is a pleasure...
DR. ELLEN FRANK
Take care, bye-bye.
DR. REEF KARIM
Bye. Join us next week for another segment of the Down and Up Show
on Depression is Real dot org, I'm Dr. Reef Karim.
