DEPRESSION: Out of the Shadows
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DEPRESSION: Out of the Shadows + TAKE ONE STEP: Caring for Depression, with Jane Pauley  

Watching: DEPRESSION: Out of the Shadows

Chapter 7: The Promise of Treatment [7:09]

Andrew shows his treatment regimen, which includes pills, therapy, and exercise.

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Transcript: Chapter 7 - The Promise of Treatment

NARRATION: (ANDREW SOLOMON WALKING INTO KITCHEN) Most cases of depression are treatable and yet, only about fifty percent of people experiencing depression seek help. For Andrew, a complex mix of medications is one component of his treatment.

ANDREW SOLOMON: (OC, EXPLAINING PILLS) That's Remeron, it's an a-typical anti-depressant, it supplements the affect of other anti-depressant. That's Zoloft, that's my primary anti-depressant , and SSRI. This is Wellbutrin. Wellbutrin is also an anti-depressant, but it's also somewhat stimulating and some of the others are sedating. That's Zyprexa it's an a-typical anti-psychotic which is also useful in controling anxiety associated with depression.

This is Namenda, it's actually an Alzheimer's drug, but it has mild anti-depressant effects and it's sometimes helpful with the cognitive slow down you can get from the Remeron and Zyprexa. That's Remenedine it counter acts the weight gain effects associated with the Remeron and Zyprexa. That's one kind of fish oil. I take two kinds.

That's my morning.

NARRATION: (ANDREW SOLOMON'S MEDICINE CABINET) Antidepressant medications have been around for over 50 years. There are currently about twenty-five approved drugs to choose from, all of which target mood influencing chemicals in the brain.

NARRATION: (ANIMATION OF NEURAL NETWORK #3) In the healthy brain, each of the neurons release chemicals called neurotransmitters that communicate with adjacent cells. They function like an elaborate circuit board.

In the depressed brain, it appears that some neurotransmitters like serotonin, dopamine and norepinephrine stop working properly and communication breaks down. When that happens, symptoms of depression start to manifest themselves.

DR. CHARLES NEMEROFF: (VO, ANIMATION OF NEURAL NETWORK #3) There's not a single neurotransmitter that's

DR. CHARLES NEMEROFF: (OC) responsible for all of those symptoms, namely the fatigue and-- and trouble concentrating and decreased memory and decreased libido and inability to experience pleasure. That's not a single neurotransmitter. But we do know that there is a relative serotonin deficiency in many patients with depression. We know that norepinephrine appears to be dysfunctional in depression. And more recently we've learned that dopamine, which is the neurotransmitter involved in the ability to experience pleasure, is also awry in depression, and other neurotransmitters as well.

NARRATION: (ANIMATION, ZOOM INTO CLOSE UP OF NERVE CELLS AND SYNAPSE #4) Many antidepressants like Zoloft and Prozac work in a similar way, targeting malfunctioning neurotransmitters and restoring communication. This process can take six to eight weeks, a long time for a person seeking relief.


NARRATION: (ANDREW SOLOMON SITTING ON BED PREPARING PILLS) For some people, a single drug isn't enough to restore the brain's balance. It took Andrew nearly six years of trial and error to arrive at the right medications with the fewest side effects.

He believes that he would not need as many pills today if he had started on medication sooner.

ANDREW SOLOMON: (OC, ANDREW SOLOMON SITTING ON BED) Sometime I look at this whole thing of pills and I think over the next month I'll eat all of those pills and just the quantity of them completely overwhelms me, it seems like so much stuff. And I look at them when they're in my hand like that and I think to myself, that's what stands between me and insanity. It's a very unsettling experience.

NARRATION: (ANDREW SOLOMON WALKING DOWN HALLWAY) Finding the right drug is a trial and error process that many patients go through, as Andrew's psychopharmocologist knows only too well.

DR. RICHARD FRIEDMAN: (VO, ANDREW SOLOMON WALKING DOWN HALLWAY) So if you walked in my office and said, "My sister was depressed. And she really did well on Effexor," that would be a reasonable guess

DR. RICHARD FRIEDMAN: (OC) because, you know, you're biologically and genetically related to your sister. But if you walked in my office and said, "No one in my family's ever been depressed. I've never been depressed. It's the first time I've ever had this happen," and you said to me, "How do I pick an antidepressant then?" I could literally flip a coin.

(ANDREW SOLOMON: I was going through a period of feeling a little...)

NARRATION: (ANDREW SOLOMON IN DR. FRIEDMAN'S OFFICE) In addition to regular check-ups with Dr. Friedman, Andrew makes weekly visits to a talk therapist. Talk therapy used in conjunction with medication is seventy to eighty percent effective in most patients.

New evidence shows that the act of talking, like medication,

NARRATION: (ANIMATION - FLAT IMAGE #5) Also produces changes in the brain, impacting a group of regions including the frontal area and the hippocampus, which is associated with learning and memory.

NARRATION: (ANDREW SOLOMON IN DR. FRIEDMAN'S OFFICE) Talk therapy also has the added value of providing patients with concrete skills to challenge negative thoughts and establish healthier ways of thinking.

NARRATION: (ANDREW SOLOMON IN DR. FRIEDMAN'S OFFICE) Early intervention is also critical to the treatment process.

ANDREW SOLOMON: (VO, ANDREW SOLOMON IN DR. FRIEDMAN'S OFFICE) Your first episode is bad, wait till you get to your seventh episode.

ANDREW SOLOMON: (OC) And in the same way that if you had a heart condition you would take medication in order to avoid having persistent heart attacks because those persistent heart attacks would eventually do you in, every time you have a depressive episode, you have lesioning of cells in your brain, you have a breakdown of mental functioning.

NARRATION: (ANDREW SOLOMON IN DR. FRIEDMAN'S OFFICE) Talk therapy is a primary way to reduce stress, a major risk factor in depression.

It is thought that the stress hormone, cortisol, may cause nerve cell death or shrinkage.


DR. CHARLES NEMEROFF: (OC) in the field about whether there's actually neuronal death associated with depression. And there is evidence that stress in the presence of a lot of cortisol, which is the adrenal hormone that's hyper-secreted in depression, can cause shrinkage of neurons and maybe even cell death.

NARRATION: (ANIMATION #6) Illuminating new studies of the brain have shown that the prefrontal cortex and the hippocampus are smaller in some patients with depression. But it appears that antidepressants might actually reverse the damage.

DR. CHARLES NEMEROFF: (VO, ANIMATION #6) In contrast, antidepressants

DR. CHARLES NEMEROFF: (OC) increase the rate in which neurons actually are born and grow. So the idea has been suggested that depression is, in part, a disease where neurons in the hippocampus are degenerating, dying, or shrinking, whereas antidepressant treatment actually reverses that process. And that's a viable hypothesis. It's just not yet proven.

NARRATION: (ANDREW SOLOMON WORKING OUT) What has been proven in animal studies is that exercise stimulates nerve cell growth in the hippocampus, which might explain exercise's positive impact on depressed patients.

For people with mild depression, exercise alone can dramatically reduce the symptoms of depression. For others like Andrew, it has become an essential component of his treatment.

ANDREW SOLOMON: (VO, ANDREW SOLOMON WORKING OUT) I think medication and certain kinds of talk therapy seem to have the most proven record.

ANDREW SOLOMON: (OC) it's not as though there's one thing that works for everyone. But keep questing and keep looking until you get to the point at which you can function again. And try whatever there may be.

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