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It was a sunny day in Pittsburgh, Pennsylvania, when the National Institute of Mental Health (NIMH), the Federal agency responsible for the Nation's mental health research, held the fourth of a series of trail-blazing mental health forums on March 26, 2001. But for the 400-plus people, including a small group of whom journeyed from Minnesota, the opportunity to discuss the impact of depression and its co-occurrence with other illnesses, and to help NIMH formulate its research agenda on depression meant that the weather was no impediment to a day of lively, informative discussions. The NIMH organized The Unwanted Cotraveler: Depression's Toll on Other Illnesses to brief the public about improving health outcomes for major diseases such as cancer, diabetes, heart disease, stroke, HIV/AIDS, and Parkinson's disease through the effective treatment of co-occurring depression. In addition, the public was invited to participate in breakout sessions that would allow for more intensive discussions of research and educational efforts needed to improve care and health outcomes. Discussion topics were to include: - What steps can be taken to improve recognition and treatment of depression in general health care settings?
- What is the role of medication and other therapies for people with co-existing illnesses? How do the effectiveness and appropriateness of these treatments vary depending upon the co-existing illness?
- How does treating depression improve health outcome and quality of life for patients? What are the biological and psychosocial mechanisms underlying these changes?
- When symptoms of depression emerge in the context of another illness, how does early preventive intervention benefit the patient?
- How can the provider/patient interaction be improved to foster better care for people with depression and a co-existing illness?
- What are the additional costs of treating depression and not treating depression for health care agencies and businesses?
On the morning of the meeting day, during the forum's plenary sessions, the capacity audience heard presentations from scientists, physicians, patients, and the Honorable Arlen Specter, U.S. Senator representing Pennsylvania, about various real-life aspects of depression and its impact on other diseases. Each speaker then had time to entertain questions from the audience. After a rousing lunchtime speech by the Honorable Patrick J. Kennedy, U.S. Representative from Rhode Island, the forum attendees sat in on various breakout groups charged to develop action plans for developing necessary NIMH research, creating helpful educational/communication materials, and designing the next steps for working together. The Pittsburgh forum, The Unwanted Cotraveler: Depression's Toll on Other Illnesses, was the first NIMH forum designed to seek input from members of the public on shaping the Institute's future research activities in the area of affective disorders. The Institute chose Pittsburgh because it is home to a major core of mental health research and treatment centers, and to consumer and mental health advocacy organizations. NIMH worked closely with consumer and professional organizations, universities, and State and local agencies, including the Jewish Healthcare Foundation and the University of Pittsburgh, to plan The Unwanted Cotraveler: Depression's Toll on Other Illnesses, and to promote an open sharing of ideas and expertise. Dr. David Kupfer, Thomas Detre Professor and Chairman, Department of Psychiatry, University of Pittsburgh Medical Center, served as chairperson for the event. Individuals with affective disorders, as well as with other medical diseases that are often accompanied by depression, family members, care providers, policymakers, and researchers were invited to help set NIMH's research priorities. The forum generated key ideas and questions that will inform NIMH's research priorities and enhance that research's relevance to America's mental health needs. A. Improving Health By Treating Depression "What NIMH is doing in terms of identifying depression as a co-factor [in other diseases] could be so helpful in helping us educate the public on the true role that depression plays in health care." - Charles Curie, Deputy Secretary, Office of Mental Health and Substance Abuse Services, Pennsylvania Department of Public Welfare Given the title of the Pittsburgh forum, one of its goals was to address the increasingly recognized role that affective disorders, particularly depression, can play in the cause, progression, and rehabilitation of many physical ailments. People living with cancer, diabetes, heart disease, stroke, HIV/AIDS, Parkinson's disease, and other major illnesses may be fighting depression as well. Research has shown that treatment of co-occurring depression can often improve health outcomes for many people with a wide variety of diseases. Not only may relief from depression help a person adhere to complex treatment plans and improve their quality of life, but researchers are tracing the biological aspects of depression at the physiological and cellular levels that could affect these other illnesses. For example, depression alters various neurotransmitters that are critical to the progression of Parkinson's and other neurological diseases. In addition, depression induces stress hormones that can affect the cardiovascular system and that are associated with changes in platelet function that may be important in people who have heart disease. Depression's physiological effects may also include the suppression of the immune system, which may adversely alter the course of cancer and HIV/AIDS. The interconnections go on, with studies linking depression and obesity and diabetes, as well as intriguing findings showing common genetic patterns in diabetes and depression. Depression, alone or co-occurring with another illness, is a treatable disorder. With proper treatment, nearly 80% of those with depressive illness can feel better, and most within a matter of weeks. Current treatments provide relief from depression's symptoms, which include sadness, loss of interest or pleasure in activities that were once enjoyed, change in appetite or weight, difficulty sleeping or oversleeping, physical slowing or agitation, energy loss, feelings of worthlessness or inappropriate guilt, difficulty thinking or concentrating, and recurrent thoughts of death or suicide. B. The Depression Epidemic and Its Toll "Our work to bring more effective treatment to more people is, in the finest American tradition, an effort to promote opportunity. It is extending the American dream to those who have had difficulty seeing its promise." - Hon. Patrick J. Kennedy, U.S. Representative from Rhode Island's First District Each of the forum's first three speakers—meeting chair Dr. David J. Kupfer of the University of Pittsburgh, Pennsylvania Deputy Secretary of Public Welfare Charles Curie, and NIMH Director Dr. Steven E. Hyman—spoke to the enormous burden that mental illness in general, and mood disorders in particular, places on individuals, their families, and society at large. Dr. Kupfer began the forum by presenting some facts from the World Health Organization report on the global burden of disease: unipolar or major depression is the fourth leading cause of disability (measured in Disability-Adjusted Life Years) in the world, and by the year 2020, it will be second only to ischemic heart disease. If nothing is done, unipolar depression will be the leading cause of disability among women worldwide by 2020. Worse yet, these figures do not take into account that between 40-65 percent of patients who have had a heart attack also suffer from major depression, as do approximately 25 percent of cancer patients, and between 10-27 percent of patients who have had a stroke. What's the economic cost of this epidemic? Dr. Kupfer presented data generated by University of Pittsburgh colleague Dr. Judith Lave showing that the impact of these co-existing conditions is a great economic cost to our health system. Mr. Curie then spoke to an issue that came up many times throughout the forum—the penalty paid for society's continuing to treat mental illness as something different than all other "physical" illnesses. Citing the stigma that is often associated with depression, Mr. Curie said the only way to change that attitude, both among the public and policymakers, is with solid scientific data. He told the forum attendees that strong data, generated from research programs funded or directed by NIMH, were the key factor in Pennsylvania's decision to aggressively fund mental health care as part of the State's Medicaid program. But now, he added, it is time for everyone connected with the Nation's health care system—patients, relatives, physicians and policymakers—to develop new strategies to translate available data to educate the public and eliminate the stigma that arises solely from ignorance about depression and other mental disorders. In Pennsylvania, this means redoubling efforts to realize the state's vision concerning mental health: that every citizen of the state with serious mental illness and/or addictive disease and every child and adolescent who abuses substances and/or has a serious emotional disturbance will have the opportunity for growth, recovery, inclusion in the community, access to services and supports of their choice, and enjoy a quality of life that includes family and friends.
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