DEPRESSION: Out of the Shadows
Take One Step: A PBS Health Campaign
DEPRESSION: Out of the Shadows + TAKE ONE STEP: Caring for Depression, with Jane Pauley  

Watching: TAKE ONE STEP: Caring for Depression, with Jane Pauley

Chapter 1: Who is Vulnerable? [5:55]

Jane Pauley talks about her bipolar diagnosis and introduces the panel experts. Is everyone vulnerable to depression?

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Transcript: Chapter 1 - Who is Vulnerable?

JANE PAULEY: Welcome to Take One Step: Caring for Depression. Hello, I'm Jane Pauley. Well, you've probably learned a lot from the documentary, Depression: Out of the Shadows. It may feel like the more you know about depression and the many forms it can take, the more questions you have. That's how I feel. When I was diagnosed with bipolar disorder the year I turned 50, it was certainly a shock. But as a journalist, knowing a little bit about a lot of things, I didn't suffer the misconception that depression was all in my head or a mark of poor character. I knew it was a disease, and, like all diseases, was treatable.

But experience does not make me an expert. Let me introduce the knowledgeable members of our panel. Dr. Dennis Charney, the dean of the Mt. Sinai School of Medicine in New York has directed research programs at Yale University and the National Institutes of Mental Health in the science of depression, bipolar, and anxiety, and the drugs used in their treatment.

JANE PAULEY: Dr. Annelle Primm is the director of minority and national affairs at the American Psychiatric Association and an associate professor at the Johns Hopkins School of Medicine. Medically underserved communities are Dr. Primm's special focus. And she's an expert on the relationship between mental health and substance abuse.

And Dr. Ken Duckworth is a noted psychiatrist in private practice, and particularly in community health, and a member of the faculty at Harvard Medical School. But as medical director of the National Alliance on Mental Illness, NAMI, his mission is to help people outside the medical community, like you and me, better understand mental illness. Thank you all for being here, and welcome.

(Thank you)

A 90-minute documentary barely scratched the surface, but it's obvious that depression comes in so many different variations. And the symptoms are pretty various as well. Dr. Primm, is there any underlying, uh, continuity, any common denominator among those symptoms?

DR. ANNELLE PRIMM: Well, the common denominator that I see is that in all of these individuals, they experienced a change from their normal selves, from their baseline in the context of depression, where their mood changed or their sense of self changed or their outlook on life, their activity level. So very important to focus on the way that change affects the person and the way they express depression.

JANE PAULEY: I'll insert just a brief personal experience. Before I was ever diagnosed with depression, the depression was going to become significant in my life, I had a period where I didn't feel right. And after a period of months, I think, I went to my husband one evening and I said, "I think something's wrong with me." And he said, essentially, "Funny you should mention it. Because," and he ticked off my five best friends, "...have all asked, is Jane okay?" Friends and family, will recognize this change, will they not?

DR. ANNELLE PRIMM: They will recognize it. And that's why we often look to what we call collateral informants, the people around an individual, their family, their friends, even their beautician to find out if this person has changed in some way when we are trying to fill out the history and understand how the depression came about.

JANE PAULEY: How does it come about? Let's talk about vulnerability. Is everybody vulnerable? And I know everybody is not equally vulnerable. Dr. Charney?

DR. DENNIS CHARNEY: That's the point. Everybody to a degree is vulnerable, but it's not equal. And there are several reasons we can say that. One is, we have found that depression and bipolar disorder is in part genetic. So because of your genes-- and many genes may relate to depression and bipolar disorder-- uh, that gives you an extra vulnerability. And if you add to that a stressful life, then the vulnerability gets even greater. So it's a combination of your genetics and the environment in which you are brought up, in which you live.

JANE PAULEY: And the documentary indicated that it was one-third genetics, and the rest are environmental. But that could include your experiences, include trauma, include exposure to drugs, uh, in uh my case it was exposure to medically precscribed drugs...

DR. DENNIS CHARNEY: Well, the one-third number that you mentioned, that it's one-third genetic, is really on average. When you get down to the level of the individual person, it's gonna vary. Because, for example, if you have a family history in which your father and/or your mother have depression, and there's depression in your grandparents, the genetic contribution to your risk of getting depressed is much more than one-third. However, if you have a family history in which there is no depression or anxiety or substance abuse, but you have a very stressful life, you're brought up in poverty, you've been traumatized in different ways, then the environmental factor is gonna be much greater than the genetic factor. So you really have to look at the individual, and not look at things in general.

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