Expert Perspectives on Advances in the Management of Major Depressive Disorder - Episode 18
Andrew J Cutler, MD; Gregory Mattingly, MD; and Sagar V. Parikh, MD, FRCPC, comment on the need to improve awareness around depressive disorders and break the stigma of mental health treatment.
Andrew J. Cutler, MD: While we’re waiting for these new treatments to come about, let’s talk a bit about, how can we improve adherence to our treatments, and awareness and communication and education of our patients and our colleagues? Greg, you’re certainly a master educator and communicator. What advice would you have?
Gregory Mattingly, MD: I think one of the keys is breaking down stigma. There are stigmas with all of our health conditions, including depression. I was part of a study recently, Andy, where we asked patients, “Where do you face stigma when you’re battling depression?” And a significant chunk, about 1 in 5, said they had internal stigma. “I beat up on myself about having this condition.” Those feelings of, “I’m lazy, dumb, stupid…get up off the couch. Also, there’s stigma in my society. People around me may not understand why I have depression. How come you’re not doing those things?” The biggest place of stigma was occupational stigma. For patients struggling with depression, 83% said, “I face stigma or perceive stigma in the workplace.” It’s OK to tell my employer I need to take a day off because I’m having asthma attacks. It’s OK to tell them I’ve had a flare-up of my arthritis, I’ve got to get some steroids. Most people are reluctant to tell their employer, “I have to take a day off because I’m struggling with depression and I need to go see my mental health provider.”
Breaking down that mental health stigma is part of a couple of initiatives right now with One Mind. The One Mind at Work initiative is working with employers across the country to break down mental health stigma within the workplace. Putting in engagement paradigms, where it’s OK to come and ask for help. We want you to be at a healthy workplace. We know it’s one of the biggest causes of disability within our workplace, and if you’re struggling with this, please come in and get help. I think those are some of the really important initiatives right now.
Andrew J. Cutler, MD: Sagar, what do you think are some misconceptions out there among our colleagues in various disciplines of medicine? What are some of the needs that they might have in better understanding depression?
Sagar V. Parikh, MD, FRCPC: I’m a little more optimistic. I think there have been a lot of antistigma efforts over the years. There’s been a lot of attention on depression at health care providers. While there is stigma across a lot of mental disorders, I think for the most part, most clinicians are understanding depression as a real thing, and as something worthy of treatment, and not a particularly shameful thing. I will go down on the side of optimism and positivity and say we’ve made progress in stigma. Where we saw, and where Greg started us off was commenting on the tsunami of depression because of the pandemic and everything like that. And as we already knew, the particularly vulnerable people are adolescents.
I think our strategy should be let’s go where the action is. I’m really happy to say that at the University of Michigan, we’ve had 2 major programs that are delivered in high schools. One program teaches principles of CBT [cognitive behavioral therapy] to teachers and other educational providers right in the schools. The second program is directly aimed at the students themselves, and it mobilizes students to create depression awareness programs for their own school. These work in complementary ways. One works on teachers and principals and things like that. In the old way of thinking when we were in high school, we went to gym class to learn the basics of physical fitness. So, why don’t we do that with mental health? Why don’t we start not only shooting a basketball, but also shooting down negative thoughts or learning some other mental health skills? Learning some CBT skills informally, before we’re clinical, in high school as a prophylactic against future depression. Simultaneously, address the issues of any potential stigma through other kinds of awareness, so that adolescents early in the course of illness, maybe we prevent some, maybe we delay some illness. And when the illness occurs, they are motivated to get treatment quicker.
Andrew J. Cutler, MD: That’s really exciting, Sagar. I love the idea of reaching out and being proactive, and like you said, getting to the source and meeting people where they already are. I suppose that kind of program could also be done in workplace environments and other areas. Greg, as we wrap up here, what would you say are some of the remaining unmet needs in recognition and/or treatment of depression?
Gregory Mattingly, MD: Once again, depression is nobody’s fault, and depression doesn’t discriminate. We’ve all had friends, family members, loved ones, people we know who have been touched by depression. I think prescribing with hope, Sagar’s comment about being optimistic with our patients, relating to them as people, not just as illnesses. “Who are you, what’s important to you? What are your values? What’s this journey together as we go through it?” I think that’s the exciting thing. Then for those of us who are clinicians, let me just say, it’s never been a more exciting time as far as all the things right now that are in development: digital interventions, therapeutic tools that have totally different mechanisms of action, treatments that can be taken as needed instead of on a chronic treatment basis. It’s an exciting time to be in neuroscience.
Andrew J. Cutler, MD: I want to thank you gentlemen for this rich and informative discussion. Before we conclude, I’d like to get final thoughts from each one of you. Greg, what would you like to leave our audience with when we’re thinking about depression?
Gregory Mattingly, MD: I’m going to go back to a common theme in our talk today, and that’s hope. There is hope for our patients who have been struggling. There’s hope with medicines that have novel mechanisms of action. There’s hope to move the needle in ways we haven’t been able to, with our use of digital tools, and digital therapeutics. Hope would be what I’d leave the audience with.
Andrew J. Cutler, MD: Sounds great. Sagar, how about you?
Sagar V. Parikh, MD, FRCPC: I’d say to our clinicians, be proud of the work that you do, no matter what the environment was when you were a kid and maybe your parents said, “What? You’re going into psychiatry?” You know what? Our turn has come. Society has accepted that mental illness is real, and there are a variety of strategies that can be helpful. And the work that we do, the work that you do, is critical to the individual and society, so be damn proud.
Andrew J. Cutler, MD: Sounds great, and I’d add one final thing. I think it is very exciting that we’re developing these new tools, and ideally, we’ll be able to do a better job of individualizing and personalizing our treatments, just like people do in other fields of medicine.
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Transcript edited for clarity