Audrey Gruss has no problem talking about her mother’s depression — even to a large audience in a ballroom at an elegant hotel in Palm Beach, where everything and everyone looks so refined and polished. She speaks candidly – not as a victim but as a daughter. It is her way of taking at swipe at the stigma that still stifles families who need help.

“Hope is a very important word. It is also my mother’s name,”  Audrey told a crowd at a fund-raising luncheon at The Breaker’s Hotel last Friday. Thirty five years ago Audrey’s’ mother had a “nervous breakdown.” She went away to a hospital. The doctors told the family very little about their mother’s condition.

“That was an era when cancer was thought to be contagious,” she said. “Patients weren’t told very much.”

Over the years her mother tried medications. “At certain time she was balanced but not totally.” Five years ago, Audrey’s mother died. About the same time Audrey became interested in the work of Dr. Jaak Panksepp, an Estonian born psychologist and neuroscientist who coined the term “affective neuroscience” – the study of the neural mechanisms of emotion.

To anyone who has depression, affective neuroscience is common sense. Of course emotions are related to activity in our brains. We might not be able to tell you how emotions affect our hypothalamus,  cingulate cortex and hippocampi but we know there is something going on up there and it is not good.

I went back and read article in the Journal of the American Medical Association that started the debacle called “The Newsweek Article.” I am even more convinced that circulation trumped sound journalism in the Newsweek article.

Authors of the study published  in JAMA base their findings on the results of six, randomized placebo-controlled trials of TWO ANTIDEPRESSANTS. Let me say that again: TWO ANTIDEPRESSANTS.

“Expensive Tic Tacs”

That phrase keeps rolling around in my head…

“Expensive Tic Tacs”

That’s what saved my life?

“Expensive Tic Tacs”

I just finished reading the controversial cover story – ANTIDEPRESSANTS DON’T WORK – in Newsweek‘s Feb. 10 edition. I don’t know where to start. How about

IS THERE AN EDITOR IN THE HOUSE????!!!!

I went to the Ryan Litch Sang Bipolar Foundation’s annual dinner dance in Palm Beach on Sunday night. I did not know a soul besides Joyce and Dusty Sang, Ryan’s parents, whom I met a couple of years ago when I wrote a story about the Sangs’ efforts to raise money for research into early onset bipolar disorder and to help find an empirical test for bipolar.

At age five, Ryan began exhibiting symptoms of Bipolar Disorder, a serious mental illness which manifests itself with recurring episodes of mania and depression. Unbeknownst to everyone, Ryan had decided to stop all prescription mood stabilization medications because he did not like their powerful side effects.

He believed he could control his illness, a decision all too common with Bipolar Disorder. When Ryan suddenly entered a manic episode, he had nothing to help stabilize his brain chemistry. He had not slept in days, and in order to sleep, he self-medicated. Tragically, Ryan passed away in his sleep. Ryan was 24-years-old.

It was a swank affair – black tie, champagne and lots of beautiful people  with eye popping bling. Ruh-roh. My idea of jewelry is the permanent henna tattoo that wraps around my left wrist. I felt a teeny bit intimidated with my fake diamond earings, my one and only snazzy dress and my rental car. Thank God for Crest Whitestrips. At least I could stand there and smile if I nothing else.

But, no, as soon as I was introduced by my gracious host, I felt fine. “Christine has just written about book about her depression, bipolar and alcoholism…” Wow. That kind of intro usually provokes stammering and raised eyebrows. But not here. Everyone at this party had been touched by bipolar – whether a child, sibling, parent or other loved one. We all shared this one, very private secret about which we rarely speak. We all “get it” – as I like to say.

The walls fell down and, man, did we talk. It was so amazing to hear others tell their stories – what worked for them and what didn’t, …

On Thursday former First Lady Rosalynn Carter, 82, will do what she has done for over 30 years – bring together doctors, policy makers and consumers to draft policies that will decrease stigma and discrimination against people with mental illnesses and promote positive policy change on mental health issues.

Mrs. Carter’s annual Symposium on Mental Health Policy is one of the best kept secrets in the ranks of mental health advocacy. Although the symposia are not open to the public, they can be viewed in realtime on the Carter Center’s website. The idea is to bring stakeholders together – not only to listen to each others’ problems but to create solutions that address the needs and goals of all.

I like to think that things happen when they happen for a reason. There are no coincidences in life, just synchronicity. How else can you explain Congress debating health care reform in Washington on the same day that Rosalynn Carter opens this year’s symposium, entitled Fixing the Nation’s Broken Behavioral Health Care System? It’s destiny – good karma.

So when you get to work on Wednesday check your calendar for Thursday and Friday. Make some time to listen in to the symposium – even for a few minutes, for a little inspiration. Sometimes, just listening to others care so deeply about what you care for and hearing how badly they want to help you is enough to get you through the day.

Someone wants to help you. Her name is Rosalynn.

As someone who has depression, bipolar and alcoholism, I love to read about research. My problem is that I often cannot understand a word of what I am reading. I cannot even pronounce half of the words, which is why I have to thank The New York Times columnist David Brooks and NARSAD for their recent efforts to make neuroscience intelligible and palatable.

Last Sunday Brooks had a simple column on a recent academic conference of the Social and Affective Neuroscience Society.  Normally I would not read a snooze-o-rama like this – especially on a Sunday morning. But the headline sucked me in - The Young and the neuro - and Brooks’ first paragraph held my attention:

“When you go to an academic conference you expect to see some geeks, gravitas and graying professors giving lectures. But the people who showed up at the Social and Affective Neuroscience Society’s conference in Lower Manhattan last weekend were so damned young, hip and attractive.”

Thank you David Brooks and the editor who wrote the headline. You got me. Because of your clever writing I now know that dominant behavior activates the reward center of the brain in Americans,  but in the Japanese that center of the brain was more likely to be activated by subordinate behavior.

A region of the brain in American and Chinese subjects activates when they see members of their own group endure pain, but at lower levels when watching others endure pain. “These effects may form the basis of prejudice.”

Brain scans of Yankee and Red Sox fans showed their “ventral striatum and nucleus accumbens were activated” when they watched highlights of their own team’s games but neither reacted much when watching an Orioles-Blue Jays game. I am not sure what this means. It could be simply be a statement about the quality of play by the Orioles and Blue Jays. Or it could mean “that we are awash in social signals, and any social science that treats individuals as discrete decision-making creatures is nonsense.”

Why is any of this important? There are two reasons:

1. We know how other parts of the body work but the brain …

Being a geek at heart, I was delighted yesterday when the NIH released data on $5 billion in grants it has awarded with stimulus funds. I sliced and diced the data, extracted the mental health grants and sorted them descending by the amount of the grant. Click here to find out who got how much and what for.

There are 388 mental health grants worth about $207 million. The two biggest grants – about $10 million each  - were awarded to investigators at Yale and the University of Southern California to create a “Transcriptional Atlas of Human Brain Development”  and to the Henry M. Jackson Foundation for Military Medicine to develop “Modifiable Risk and Protective Factors for Suicidal Behaviors in the Army.”

About $2.6 million funds mental health research affecting African Americans. Nine grants, totaling $1.1 million, will fund research on mental health among Hispanics.

What is up with Dr. Thomas Szasz?

I know Szasz is the name to drop when I want to rile up a debate about the state of psychiatry in America. As a proponent of the Anti-Psychiatry movement in the 60′s, Szasz ticked off – and continues to tick off – mainstream psychiatry with his belief that mental illness is a metaphor for bad and bizarre behavior and that the pharmaceutical industry and mainstream medical community have perverted treatment for these problems.

But Szasz went way over the top with an article in the Wall Street Journal on July 15. I have a problem Szasz’ comparison of car repairs to health “repairs.” Bizarre.  Big difference between a humane society’s responsibility to pay for my car repairs versus my body “repairs.”

“The concept of reimbursable health-care service rests on the premise that the medical problem in need of servicing is the result of involuntary, unwanted happening, not the result of voluntary, goal-directed behavior. Leukemia, lupus, prostate cancer, and many infectious diseased are unwanted happenings. Are we going to county obesity, smoking, depression and schizophrenia as the same kinds of diseases?”

I don’t know where he gets that idea. I have never categorized medical problems “in need of servicing” under reimbursable health care as either voluntary or involuntary maladies. Carry Szasz’ logic a few steps further and you have to ask – who gets to decide whether a medical problem is voluntary or involuntary? I hope it is not Szasz.

Why wouldn’t we lump depression and schizophrenia in with “involuntary, unwanted happenings” such as leukemia and lupus? It has been nearly 50 years since Szasz began making his argument that mental illness should not be classified as a disease. Maybe back then, before the invention of CAT, PET and other technologies used in neuroimaging, Szasz’ theory kinda made sense.  But come on. In 1961, the year Szasz published his controversial book, The Myth of Mental Illness, IBM introduced the Selectric typewriter. That is how advanced technology was.

How much science do we need before we stop classifying mental illnesses as character defects or bad behavior? And let’s not use the argument that if …

We have yet another study finding that the number of adults taking anti-depressants, anti-psychotics and Alzheimer’s drugs is rising. Pardon my sarcasm, but DUH!

This one was recently reported in the journal Health Affairs. This study found a 73 percent increase in the use of these drugs between 1996 and 2006. Experts said it shows that more doctors have become familiar with the drugs and are more comfortable prescribing them. Well, I don’t know about that. But I do know this: Critics argue that the numbers prove that Americans are overmedicated.

Undoubtedly, some are. What we don’t hear is that this decade saw the introduction of some of the most successful drugs for treating mental illness and Alzheimer’s: Lexapro 2002; Wellbutrin XL 2002; Lamictal for bipolar 2003; Celexa goes generic 2003; Cymbalta 2004; Aricept and Exelon for Alzheimer’s 2006.

No one mentions the hit-or-miss factor: Because no one knows how these drugs work, it can take months of trying different drug combinations before a doctor finds the right one or the right dose. How many of us have half empty prescription bill bottles for drugs that did not work?

And what about the Medicare Modernization Act of 2003 which greatly expanded prescription drug coverage for the elderly? Could that account for some of the increase?

Obviously I am biased. I have been on antidepressants and a mood stabilizer since 2006. They not only saved my life, they made it much, much better. We often hear horror stories about overmedicated kids and zombie grandmothers. But we rarely hear the success stories because there is so much stigma about using these drugs.

I am not going to use these numbers to say we are overmedicated. I am not going to use these numbers to prove anything. Numbers always look impressive. But they can be twisted like a strand of DNA. They are just numbers. Period.

Wait! News flash! I see another story in the paper this morning about a study that says that antidepressant use among young people has fallen – since the drugs began carrying a “black box” warning. The study also found a DECREASE in the number of depression diagnosis! Holy cow! …

I am in awe of Dr. Helen Mayberg. Actually, I am in awe of anyone who can drill holes in someone’s head, insert some wires and bring that person out of the most hopeless depression.

It is called Deep Brain Stimulation and, yes, the “stimulation” part involves electricity. But DO NOT think of this as the old-fashioned kind of shock therapy. It is far from that. Mayberg, a professor of psychiatry and neurology at Emory University, along with her colleagues found a small region, deep in the brain, called Area 25. This region of the brain sits inside the anterior cingulate cortex (I have no idea where that is but for I am mentioning it for those really smart readers). 

The neural circuits in this area are very, very busy in people with depression. This is the area heavily involved in cortisol production, sleep, and serotonin and emotion regulation in the brain. It’s the place where get our motivation and drive. DBS has worked wonders for people with Parkinson’s. Mayberg figured why not try it for people who have tried everything but nothing has given them relief – not even what is commonly referred to as “shock therapy.” As Mayberg describes is, electroconvulsive therapy re-boots the brain, DBS just tinkers with it.

The procedure is as freaky as the effect. You drill two holes in a person’s head WHILE THEY ARE AWAKE!. With the help of an MRI, Mayberg guides two wires into Area 25. She must find the exact position or the treatment will not work. A little battery pack, which lasts up to four years, is implanted under the skin near the patient’s chest.

During her first attempt at this procedure in 2002, she slowly turned up the current to four volts. Within seconds the patient said, “Did you do something? I feel a sudden sense of calmness.” Not all her patients responded this way, but many did. Can you imagine being in an operating room and a patient who has been told there is nothing more they can do, that their case is hopeless, suddenly says they feel better? 

The amazing thing about Mayberg, besides the procedure, …