Meet the Producers: Larkin McPhee
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What inspired you to make a film about depression?
I had recently produced "Dying to Be Thin," a film on eating disorders for the NOVA Science Series, and saw what a positive impact that film had on people's lives, motivating them to seek treatment. When I read Andrew Solomon's bestselling, seminal work The Noonday Demon: An Atlas of Depression, I immediately recognized an even greater opportunity to help people, since the illness of depression is highly prevalent, afflicting people of all ages, race and socioeconomic status. And, unlike any other major medical illness, depression often strikes early, between the ages of 15-34 years old and can significantly derail a person's life, if not properly diagnosed and treated.
You chose an interesting title with DEPRESSION: Out of the Shadows. Can you talk about the stigma surrounding the disease?
We are on the threshold of being able to visualize depression with the advent of brain imaging. But these images are not yet as tangible as pointing to a broken leg or clogged artery. So it is easy to understand how depressed people, to varying degrees, perceive themselves as weak or lazy when in fact, it is the illness that is the real culprit.
Depression can so seamlessly afflict both the mind and the brain. The brain really functions like our master organ, and when it is compromised by depression, there is a ripple effect on both the mind and body that can overwhelm our sense of self. The more we can do to "medicalize" this disorder of the brain, the more we can reduce stigma. And the less stigma surrounding the disease, the more likely it is that people will seek treatment.
And that's news to some people: depression is treatable. About eighty percent of people who seek treatment find relief. Depression can be managed like many other chronic illnesses. But although it's one of the world's most costly and debilitating disorders, it is surprisingly under-diagnosed and under-treated. And this is tragic because depression can compromise careers and relationships, rob people of their dreams, or worst of all, lead to suicide.
How did you strive to make DEPRESSION: Out of the Shadows different from any other film on the topic?
It was imperative to me to integrate the science of depression with the personal stories we tell in the film as a way to emphasize the importance of treatment and prevention. Not only is the disease disruptive to people's day-to-day lives, but it is also utterly destructive to the body. An episode of depression can potentially ravage the brain, shrinking or altering critical regions involved in thought and memory. Additionally, depression raises the risk for many other illnesses including heart disease, diabetes, stroke and osteoporosis.
If left untreated, depression can become a progressive, chronic illness, just like heart disease or diabetes. Most of us would never dream of letting those disorders go untreated. So we need to acknowledge and manage depression, usually with a panoply of treatments that might include medication and talk therapy. Also, it is important for people to realize that the brain is an organ, just like the heart, and thus, is highly sensitive to its environment. For the brain to work optimally, it depends upon a healthy diet, regular exercise, and plenty of rest.
The people you profile in the film are a diverse group, and their depression presents in a variety of ways. Which person's story surprised or moved you the most?
Everybody's story moved me, but the story that took me by surprise was that of our postpartum mom, Ellie Zuehlke. During her ordeal with postpartum depression, Ellie experienced what are called "intrusive thoughts" about hurting her baby. Apparently, intrusive thoughts are common in mothers experiencing postpartum depression; acting them out is rare. In Ellie's case, she was reluctant to seek help because she feared a child protection agency would take her baby from her. Such fear and shame prevent many people from seeking help. Fortunately, Ellie had a wonderful support network, including a friend who got her into the care of a postpartum expert where she received excellent treatment.
I was greatly impressed by Ellie's willingness to share the fact that she had intrusive thoughts. How many women have enough courage to go on national television and make such a frightening admission? Ellie clearly wants to help women recognize the signs and symptoms of postpartum depression, and not feel so alone. Her candor will hopefully encourage many women to seek treatment without fear of consequence.
What was your greatest challenge in making the film?
The greatest challenge was building trust with the participants. Their personal stories are filled with pain and shame and matters of life and death. I have spent a lot of time working closely with all the participants, making sure that I clearly understand the nuances of their stories and only report details that they have approved.
Research around depression is yielding some incredible therapies. Which do you find most promising, in terms of treating and/or living with depression?
The story we include about an experimental, fast-acting drug called ketamine is exciting because so many patients with depression experience excruciating physical pain and mental anguish and are in need of immediate relief. Current treatments can take up to six to eight weeks for patients to experience an improvement in symptoms. Can you imagine being sleep deprived or overwhelmingly anxious for that long? More work needs to be done on the safety of ketamine, but this experimental medication offers a potentially revolutionary new approach for drug therapies; it targets a totally different chemical system in the brain.
Deep brain stimulation (DBS) is another area of promise because its preliminary success offers the research community a new paradigm for treating depression. Traditionally, the brain has been viewed as a bowl of "chemical soup," with all elements combined. But, neurologist Dr. Helen Mayberg describes the brain more like a circuit board. In this view, the depressed person's brain is seen like software in a bad loop; the emotions are stuck, and the sadness is repetitive and unbreakable. DBS, and the perspective surrounding such a therapy, encourages researchers to zero in on very specific regions or "circuits," rather than tackling the brain as a whole.
With all of the current research on the brain, do you think that depression will ever be accepted or acknowledged as a physical disorder that one simply treats, and not a character flaw or moral deficiency?
I think society is already moving toward acceptance of depression as an illness. For example, the Houston Texans are the first NFL team to have mental health parity because their Vice Chairman, Philip Burguieres, insisted on it. Philip personally experienced depression, as one of America's most accomplished CEO's, and has become a frontrunner in "medicalizing" the disorder within the corporate community. As Philip says in the film, "If you're gonna take care of the whole person, you have to take care of their brain also." Currently, America loses an estimated $50 billion in work productivity. As we learn in the film, it pays to treat depression, and hopefully, more and more health insurance companies will embrace this fact.
When you were working with the film's psychiatric and neurological experts, did you uncover a lot of interest in "mental hygiene?" In other words, are researchers searching for preventive measures, so we can avoid getting the disease in the first place?
Prevention is certainly the Holy Grail for treating any major medical illness, including depression. Research already shows that the most basic preventative measures include a healthy diet, exercise and proper rest. But perhaps the most important risk factor to minimize is stress, since it often triggers first episodes of depression.
In the case of adolescents, anxiety most often precedes a first episode of depression. So, in the near future, scientists hope to use brain imaging to identify biological markers in kids' brains. This technology would help earmark these at-risk children, and allow their caretakers and physicians to intervene early, and potentially ward off the symptoms of depression altogether.
What was the most striking thing you learned about depression?
I already knew that depression robs a person of their drive and energy and will to live, but I also learned that it can be physically painful. Depression is a perplexing illness that affects a bewildering array of chemicals in the brain. There are over a hundred billion neurons in the brain, and over five hundred trillion connections or synapses. The breakdown in communication between some of these neurons can wreak havoc on many systems in the brain, including those that regulate sleep, appetite, motivation and drive. No wonder there is no magic cure for depression.
As we learn in the film, it can take patients as long as six years to figure out the right cocktail of medications, therapy and exercise to restore optimal communication within the brain. The "moonshot" for science now is to continue to map and understand the universe of the brain, and help people find effective, efficient relief for this devastating illness.