Tipper Gore successfully treated her depression. Photo Credit: Thomas Neerken

By John Morgan, Spotlight Health
With medical adviser Stephen A. Shoop, M.D.

At last Friday's "Erasing the Stigma Awards" in Beverly Hills, master of ceremonies Larry King introduced award presenter Tipper Gore as having rebounded from her depression -- over her husband's election loss in Florida.

But King's kidding aside, Gore actually did achieve a major victory over a 1989 bout with depression, triggered in part when her son was struck by a car and seriously injured.

"I suffered from depression and I underwent a very successful treatment," says Gore, whose mother also suffered bouts of clinical depression. "Mental illness is a biochemical disorder. It happens in the brain, a physical part of the body.  The person can not help it when they have a mental illness or biochemical disorder. They need help, support and treatment from professionals in most cases."

And Gore is not alone.

According to the National Institute of Mental Health, over 22% of adult Americans - or approximately 44 million people -- suffer from a diagnosable mental disorder in a given year. Mental illness accounts for 4 of the 10 leading causes of disability in the U.S. and other developed countries.

And depressive disorders cause a substantial percentage of mental illness.

Depressive disorders include major depressive disorder, dysthymic disorder, and bipolar disorder. Major depressive disorder is the leading cause of disability in the United States.

Nearly 19 million Americans in any given year experience a depressive disorder -- with women suffering almost twice the rate of men.

The most effective treatment for depression is generally recognized as a combination of medications like selective serotonin-reuptake inhibitors (SSRIs) and counseling.

"When we talk about a standard course of treatment, in general psychiatrists will treat someone with a first episode of depression for between 9-12 months of feeling normal," says Duane E. McWaine, medical director, Didi Hirsch Community Mental Health Center and a psychiatrist in private practice.  "Once someone has had two episodes of depression there is a 75% chance they will have another.  By three episodes, the risk of another occurrence is over 90%. So we begin to think of depression in those patients as a chronic, but manageable, illness."

But as daunting as the statistics indicate, there is a much greater problem facing the mental health community.

Stigma

"We know that of all the people who have the illness depression, less than half present for treatment," McWaine reports. "Of those that get treatment, less than half get adequate treatment. We also know that even when people begin with adequate treatment very shortly thereafter nearly 40% are no longer participating in treatment. In essence, a very low number of the millions who have depression are adequately diagnosed and treated."

McWaine acknowledges that a large reason for this is the stigma associated with mental illness.

After her own experience with depression, Gore braved public scrutiny and has become a passionate advocate for mental health. Among her biggest concerns is the damaging effect of stigma.

"We need to make sure people can get help for their mental illness without fear of losing their job, recrimination, without being discriminated against," Gore urges. "Most important of all they need the support of their family, friends and colleagues and this can only be achieved if people understand what these biochemical illnesses really are."

"The people that are going to notice changes are the people that are closest to us," Gore says. "They are often the early warning system for getting people help. But stigma can cause people to deny what they are seeing in a loved one.  And ignorance about mental illness can prevent a loved one from identifying symptoms that indicate a first time episode. It can be very frightening for people if they don't truly understand mental illnesses."

"I speak about my experiences with depression because it is important people understand how stigma affects us all," adds Gore, who earned two degrees in psychology. "I suffered from depression and got help but I was quiet.  I didn't want people other than my family and friends to know about it, but I realized that my silence about my experience was passing on the stigma.  I was passing on the stigma to yet another generation. I wanted to stop that from happening so I went public with my experience."

The Didi Hirsch Community Mental Health Center that sponsors the Erasing the Stigma Awards has been public in its commitment to help people struggling with mental illness for 60 years. The organization provides care at 13 mental health centers and outreach programs in California, regardless of a person's ability to pay.

Erasing inequity

Resources like the Didi Hirsch Center have become an increasingly important in the Golden State where an estimated 7 million people are uninsured. But even those who do have insurance often discover they are only covered for 50% or less of mental illness costs.

"Can you imagine if you had epilepsy and went to your doctor and he said, 'Sorry that's not covered under your plan,' asks Kita Curry, president and CEO of Didi Hirsch. "Well that can happen if you have a brain disorder that is considered 'mental.' The parity laws in this nation are so weak insurance companies get around them by simply excluding mental health altogether."

"I saw a poll recently that indicated the majority of Americans had more of an understanding of mental health issues than they ever had in the past and that they did want to see equal coverage by insurance companies for these illnesses," Gore notes.

Without proper coverage, many people cannot afford to get treatment from mental health professionals.  By default, more and more primary care doctors are becoming the front line defense against mental illness.

"If people do go to a doctor, it's usually a primary care doctor," Gore explains. "Many of them are not trained to diagnose mental illness.  It's often difficult to diagnose and they're doing their best. And many do often help."

But often not.

The US Preventive Services Task Force has recommended helping primary care physicians better recognize mental illness to provide first line treatment. The task force recently estimated that over 50% of patients with depression are missed or under treated by primary care physicians.

For this reason, many mental health experts believe that insurance parity would actually save money in the long run. That's because in many cases untreated biochemical disorders lead to other medical complaints that require additional healthcare dollars to diagnose and treat. 

But the cost is not just financial.

"Many people with untreated mental illness face a loss of work, as well as marriage and family break-ups," Gore says. "If we had early diagnosis and treatment, these very real and devastating human costs might be avoided."

"Mental illnesses are physical illnesses and they can be managed," Gore concludes. "And stigma remains the biggest barrier to people getting adequate treatment. The good news is there is diagnosis and treatment available. We just need to make it even more available."

• Didi Hirsch Community Mental Health Center

• California Community Mental Health Agencies

• National Institute of Mental Health

Click here for more information about depression or other mental health issues.

Spotlight Health is the leading creator of celebrity-featured health-issue awareness campaigns, connecting consumers with impassioned celebrities whose personal health battles can open eyes, dispel myths and change lives. Spotlight Health helps sufferers and caregivers meet the challenges of difficult health circumstances with understandable, in-depth medical information, compassionate support and the inspiration needed to make informed healthcare choices.

Created: 6/2/2003  -  John Morgan & Stephen A. Shoop, M.D.
Reviewed: 6/2/2003  -  Donnica Moore, M.D.