- [Jeffrey] Welcome to Healthy Minds.

I'm Dr. Jeff Borenstein.

Everyone is touched by psychiatric conditions, either themselves or a loved one.

Do not suffer in silence.

With help, there is hope.

Today, on Healthy Minds.

- You want to make it clear that, A: you're not alone.

B: we know a lot about these illnesses.

C: they're treatable.

D: you've really gotta get treated.

How could you decrease some of the prejudice and stigma around these illnesses?

One thing is just to be direct and just, and to be aware of how much science there is behind these illnesses.

Not have this kind of big fear factor.

- [Jeffrey] That's today on Healthy Minds.

This program is brought to you in part by the American Psychiatric Association Foundation, and the John and Polly Sparks Foundation.

Welcome to Healthy Minds.

I'm Dr. Jeff Borenstein.

What's it like to live with depression or bipolar disorder?

Today I speak with leading expert, Dr. Kay Redfield Jamison, about both of those conditions.

She has conducted research, has provided clinical care, and has lived with each of those conditions.

She is also the author of a number of books.

Most recently, "Fires in the Dark, Healing the Unquiet Mind."

Kay, thank you for joining us today.

- Absolutely delighted.

Thank you for having me.

- I wanna jump in and ask you to describe the symptoms, the clinical features of bipolar disorder and depression.

- Depression is an illness that's really characterized by inertia, by hopelessness, particularly.

By irritability, less by sadness than a certain morbidity of often a fixation on death and dying.

It's characterized by changes in not only in mood but activity.

So people really slow down.

It's like a hibernating bear.

People who may ordinarily be very active and outgoing and act, you know, involved in their environment and friends start withdrawing more and more and more.

So one of the things that family members notice, for example, is that an adolescent or a young adult is, is not available to them the same way.

They're in their rooms much more, and their friends may notice that as well.

There's a slowing down in every aspect of life.

In terms of thinking, one of the things that's probably not focused enough on, in, in depression is, is the cognitive or the thinking effects of depression that people really can't concentrate in the same ways that they ordinarily do.

They can't think.

They ruminate.

They go over and over the same thoughts and, and again can often start thinking about suicide in a way in which would've been inconceivable to them when well.

So it's, it's a debilitating illness.

It's an illness that at it its extremes can be psychotic and people can be delusional and hallucinate.

That's more unusual.

But I think the most important thing about depression is that it's treatable and that it's a painful illness to go through.

It's a painful illness to be around.

It's very difficult to watch people suffer from depression.

And it's obviously far more difficult for, for people involved who have it.

Mania on the other side, so bipolar illness is characterized by, not only by depression, but by periods of mild to severe mania.

And by mania, it's in many ways the exact opposite of depression.

Not in all ways, but in most ways.

So that instead of slowing down, people speed up, they start thinking far more rapidly than usual.

They're thinking starts speeding to the point that it gets out of control.

They can't control their thinking.

It's impulsive.

People's mood tends to be either very irritable and very paranoid and aggressive or euphoric and expansive and grandiose.

People tend to think that they have powers that they clearly do not have.

They alienate people, they charm people and they alienate people depending on the severity of the illness.

So when people are mildly manic, people tend to be drawn to them because of the high energy, the high voltage, the charm, and so forth.

But as mania progresses and people get more irritable and aggressive and intrusive, people want to withdraw.

But depression is, the poet Robert Lowell once said, "Depression is an illness for yourself, and mania is an illness for your friends."

It's, mania causes you to act upon the world in a impulsive, bad judgment, aggressive, sure of oneself to an excessive degree sort of way.

- Excellent descriptions on, on both.

And I'd like you to speak a little bit about how very common these illnesses are.

How, how many people are affected by both of these conditions?

- So depression is particularly common and is often called the, the common cold of psychiatry.

Exactly because of that.

And so it, it is certainly not limited to being seen by psychiatrists or psychologists.

Many people in internal medicine and general practice and OBGYNs.

I mean it's seen across widely by, by other doctors because it is so common and it affects depending on whose study you're looking at.

In, in the case of women, maybe one woman in five will have an episode of major depression.

In men, less, less than half of that.

But that's very, very common by any kind of public health measure.

It's a very common illness.

Bipolar illness, the classic forms of bipolar illness where you're talking about depression as well as kind of classic mania, not the milder forms.

In about 1% of the population across the world.

And in the milder forms where you're looking at the milder forms of mania, it's about 1-3% addition on top of that.

So again, bipolar illness is, is a common illness.

It's not nearly as common as depression.

But both of these conditions are things that, you know, affect many, many, many people.

And, and if you are, yourself aren't depressed, you are going to know someone who's depressed.

I mean, you know, if you've got your eyes open.

- Every everybody has a friend or loved one who has depression or bipolar or many of the other psychiatric illnesses.

- Right.

Sure.

- It affects all of us.

- Absolutely.

- And, I'd like you to speak about the typical age of onset because this is an important issue as well for both depression and, and bipolar disorder.

- Yeah.

I think in terms of, you know, public awareness and public health awareness, one of the most important things about all of the psychiatric, or almost all of the psychiatric illnesses, is they affect youth.

It's not like dementia, it's not like heart disease.

It's not like cancer, that disproportionately fit, hit older people.

Depression and all the other major psychiatric illnesses first appear young.

So the average age of onset for bipolar illness, 18, 19, 20.

The average age of onset for depression is slightly later than that.

But by anybody's standards, you're talking about illnesses that hit young.

In the case of bipolar illness are recurrent, and will come back again unless they're treated.

Again, the good thing is that they are treatable, but if they aren't treated, they, they will come back again.

So, they're recurrent, they, they tend to come back in a more aggressive form often.

So you've got kids in college who are, you know, kind of at the height of their intellectual functioning in some ways and social functioning and learning and trying to take the, the world in, who get depressed and all of a sudden can't keep up with their classmates, can't keep up with their roommates, fall further and further behind and get deeply frustrated in addition to the pain of depression.

Just the frustration of being around normal people at that age is, is particularly demoralizing.

- And as you said already, this, one of the symptoms is difficulty concentrating.

And when you're in a college or grad school, you need to concentrate and that symptom gets in the way of, of a person's studies and ability to, to learn.

- Yeah.

And I, and I think that's just not mentioned nearly often enough because the mood symptoms of depression are the ones that you feel so intensely.

You know, the, the hopelessness, the despair and, and the sense that you can't do anything.

But if you're trying to function in any kind of world where you're using your brain, which is most of the world, it's really very, very, very bad.

And I think colleges don't tend to put enough of an emphasis on the tremendous disadvantage that these kids have when they're, when they're depressed.

- I want you to share with us, 'cause I know that you speak to college audiences and you speak to medical school audiences, again, young adults.

Share with us what you say about how common the illness is when you speak to that audience.

- Well, I think, yeah, I think what every, everyone wants to do, who's going out and advocating from whatever perspective, whether you're an advocacy group or a doctor or you know, just a, somebody out talking to kids from a mental health perspective, is, is you want to make it clear that, A: you're not alone.

B: we know a lot about these illnesses.

C: they're treatable.

D: you've really gotta get treated.

And so one of the things that we tell our medical students at Johns Hopkins during the psychiatry rotation is, look, a lot of you're gonna get depressed.

That's just the name of life.

I mean, that's what happens.

These are common illnesses.

You're at the age of risk, and we will do everything possible to get you better and have every expectation that you will get better.

But what we can't tolerate is people who don't get treated, who are, we can't have impaired physicians.

We can't have people, you know, not looking after themselves.

One aspect of being a good doctor is looking after your own health, for the sake of your patients and for much, you know, importantly for yourself.

So I think, you know, that, that tends to normalize it in a way.

And, and we also say, you know, keep your eyes out and keep your wing out for your other, your fellow students.

You know, just, just be compassionate, be aware, you know, talk to people.

Always ask people, you know.

I know I'm being intrusive, I hate to ask, but I would, are you feeling down?

Is there anything I can do?

What are you experiencing?

You know, should, how worried should one be?

You know, but all those things, try and try and engage people because it, it's gonna happen.

- I think it's such an important point to make to young people that if they don't get it, a friend of theirs will.

And we all need to be aware of that.

Such an important message.

The, I'd like you to speak a little bit about the genetics of these conditions.

How, how are they inherited?

How, what are the risk factors if somebody has a family member with depression or bipolar disorder?

- What I think people have known for a very long time, that is that the severe mental illnesses run in families.

That doesn't necessarily mean it's heritable, although it turns out in this day and age being able to do that kind of science is that people know that they are heritable, but they, they run in, they run in families.

So that, particularly bipolar illness, schizophrenia, certainly autism.

There are certain of the major mental illnesses that are particularly heritable.

And, you know, again, I think what that boils down to is, from a scientific point of view, is that there are a lot, you know, there are thousands and thousands of really good scientists studying this.

And it's important to recognize how vital research is in looking at these things because where we are now is so different from where we were 20 years ago, and where we will be 20 years from now is gonna be so different from where we are now.

And that's because people are doing genetic studies, studying imaging of the brain and so forth.

I think in terms of, sometimes people feel like if you say it's a genetic illnesses, that means it's inevitable that a child is going to get it.

And it doesn't mean that at all.

In fact, the odds are very much against a child of a parent having bipolar illness.

The odds are the child won't, but the odds are much greater for that child, for that family, that, that they will get bipolar than the general public.

So you know, I think it's from, from my point of view as, as an advocate is I, I think we wanna encourage parents to be blunt and direct with kids.

I mean, what's upsetting is to see parents who have, clearly have bipolar illness in their families.

They know it, and they're afraid if they talk about it with their children, that somehow they're going to cause the symptoms to appear or going to worry them to death or, or whatever.

Whereas I think on the contrary, I think like so much in life, if you're just direct and straightforward and say, look, this, you're unlikely to get this illness, but we have it in the family.

So you just wanna be aware of what the symptoms are, talk about what the early symptoms are.

And if they're going away to college, instead of, you know, going obsessing about the libraries and the playing fields and you know, all the things and how good the food is in, in the co-op, you know, is to say, do some homework.

Get the names of two or three really good specialists in the area and say, look, if you're concerned, call me.

We'll get in touch with somebody who is expert in this and, and just deal with it in a practical manner, in a loving and caring manner instead of a, a kind of a dreaded, when is the other shoe gonna drop.

Because that, that dread passes along to kids.

And it's, it's a form of prejudice against mental illness that, you know, if you had some sort of major disease, a medical disease, other medical disease, running in a family, you would talk about it, you know.

And, and you would say, you know, you've gotta do that because you're gonna save a child's life.

- If there was a history of heart disease, you wouldn't hesitate to make sure.

- Exactly.

- That the person's having a proper diet and controlling blood pressure and other risk factors.

And we should be doing the same for psychiatric conditions as well.

- Exactly.

And just be direct about it.

I think, you know, if you talk about how, how could you decrease some of the prejudice and stigma around these illnesses?

One thing is just to be direct and to, and to be aware of how much science there is behind these illnesses, and be compassionate, but you know, not have this kind of big fear factor.

- One of the important issues in depression and in bipolar is the issue of suicide risk and suicide prevention.

And I'd like you to speak about that.

- Sure.

I think that, again, the reality is that suicide is very much elevated in bipolar illness.

And bipolar illness is probably the, the illness most associated with, with suicide, and certainly depression.

So that those two disorders, the disorders, major disorders of mood are responsible for very disproportionate number of completed suicides.

And these illnesses also, both depression, but particularly bipolar illness, puts you at increased risk for drinking and using drugs as and the combination of having a mood disorder and drinking or using drugs really ratchets up your, your risk of suicide.

So again, I think you wanna always leave a, a wide open highway to ask parents or friends about, or to talk about suicide in a direct sort of way.

And say, you know, this, this is not to put any kind of idea in your head, you know, in the same way that a clinician would.

This is isn't to suggest that you have been feeling this way, but if you have been feeling this way, I really would need to know about it.

We need to do something about it.

And there's a lot we could do about it.

You know, again, always, I think the reasonable extension of hope is one of the things that doctors in the history of medicine and the priesthood have always done is say that laying on of hands, extending hope and faith is very, very important.

What we can do now in this day and age is extend hope in an even more backed up sort of way so that we have the medical, and clinical knowledge that we can say, we can do something about this in a way in which that wasn't true a couple thousand years ago.

- Absolutely.

Absolutely.

I'd like you to speak a little bit about your own experiences with bipolar disorder.

What it was like for you at the beginning and, you know, tell us about when you first were diagnosed.

- Well, I first got sick when I was about 17, and I was a senior in high school and I had never been depressed a minute in my life.

I had never thought about suicide once.

And, and after a period of, of flying high kind of mildly manic, I crashed completely.

And I started thinking about suicide all the time.

I couldn't think, I couldn't concentrate, I couldn't read, I couldn't study.

I was just obsessed with figuring out a way of, of killing myself.

It was so, it varies.

I mean, I used to be always bright-eyed, bushy tailed, couldn't wait to get outta bed, couldn't wait to face the day, you know.

Captain all my teams, I mean outgoing and loving life.

And then all of a sudden I found myself just shut in and unable to function.

So I, I eventually got better in high school as people will, you know, over time, many months later.

And then I, I was up and down through college and, and graduate school with very, period, a lot of periods of flying high and a lot of periods of being suicidally depressed.

And then when I was about in my twenties, I just, after I joined the faculty in, at UCLA in the Department of Psychiatry, I, within about three months of, of signing on as an assistant professor, I was stark ravingly manic, hallucinating, delusional, very disturbed.

And I sought help.

So at that time I was immediately diagnosed.

I got a, I had a very good doctor, still have the same doctor.

I got immediately diagnosed correctly, put on lithium, worked well.

So I, I was very fortunate in that sense to get diagnosed, but still, like many people with bipolar illness, I, it was many years before between the onset of my illness, and the time I got accurately diagnosed.

- Right, from the first symptoms at the end of high school until already post-grad or grad school.

You had these symptoms but did not have a diagnosis.

- About 10 years probably.

Yeah.

Yeah.

Which is actually turns out to be just about the average, and still, between first symptoms and, and diagnosis.

- Could you tell us about the treatment?

What, what was the treatment like for you?

- The most important thing was that I had a doctor who knew what he was doing.

Right.

He knew psychiatry, psychopathology, medicine, psychopharm.

So I was very lucky, and particularly in that day and age, when not everybody was put on medication.

So I was very lucky.

And he diagnosed it correctly.

He was straightforward about it.

He didn't mouse around, he didn't kind of back away from it, or back away from my denial.

He was, I would say, extremely compassionate, but very straightforward, you know, very no nonsense.

And, and said basically, you know, lithium is what you need and you're probably gonna need it for the rest of your life.

And psychotherapy as well.

And so I also was very fortunate in that day and age when people were tending to split off into psychopharmacology over here, psychotherapy over here, to have somebody who wasn't so simple minded, I think, and, and, and who said, you know, he's a humanist, but he also believed that, you know, psychotherapy was necessary and certainly was necessary if for no other reason that my major clinical problem was that I didn't want to take medication.

You can't address that with medication.

You can only address that with psychotherapy.

So, you know, that was a ongoing battle royal in terms of, of, of fighting the idea that I had to take lithium.

But, you know, it was, it was an incredible, you know, from my point of view, I, I was a psychotherapist and a practicing psychotherapist, to actually be mentored, as it were, by, by somebody who was a superb psychotherapist and doctor, and be, have my life depend upon it, was a kind of clinical training.

I mean, that's not what I owe my life to.

I mean, I, you know, but I, as a clinician, I was enormously indebted just to be around somebody, in the presence of somebody, who was tough.

And who was smart, and who was kind, and who believed in me, and who extended hope when I had no hope whatsoever.

I thought I was gonna lose my job.

I thought I was gonna lose my life.

I, I didn't wanna live.

You know, he, and he never bought into that, you know, somehow or another he believed, I don't know why.

- Well, I, he was right, obviously.

And the, you know, I think the point you make is, is so important that the hope, realistic hope, but hope is so important and that with treatment, that hope comes with treatment.

But you pointed out an important issue for many people with bipolar disorder and other psychiatric and medical conditions continuing with medicine, wanting to try to get off the medicine.

Could you speak a little bit about that aspect of, of your treatment and sort of the broader aspect for other people?

- Sure.

I think it's, I think it's the major issue, you know, is, is a major issue, is getting people into treatment and aware that there's treatment and so forth.

And then the other is figuring out the correct treatment and then the chronic problem is keeping people on treatment.

I have this discussion with my husband who, who's a cardiologist at Johns Hopkins, he says, you know, people in psychiatry and psychology blather on about how difficult it is to keep patients on medications and so forth.

He says, try being a cardiologist, you know, try keeping, getting people to exercise, to lose weight, to not smoke, to not drink, to take their medicines.

You know, this is a problem, as you said, in all of medicine.

It is not unique to psychiatry.

I think one of the things that feeds into it is that you're talking about a relatively young age group that's being asked to adhere to, to, to take medications and to do it over the rest of their lives.

(uplifting music) - Please join us next time when I continue my conversation with Dr. Kay Redfield Jamison.

Do not suffer in silence.

With help, there is hope.

This program is brought to you in part by the American Psychiatric Association Foundation and the John and Polly Sparks Foundation.