Depression’s changing face

A discussion with Anthony J. Rothschild, MD,
director of the nationally recognized
UMass Medical School Depression Center

By Dennis Nealon

Depression in the United States hasn’t been the same since the late 1980s, when the availability and marketing of safer drugs like Prozac simplified treatment for patients, made it much less worrisome for physicians to prescribe medications for those who needed them, and helped to usher in a new era of de-stigmatization – an easing of the burden of shame associated with seeking help.

“I have lived through that change,” said Anthony Rothschild, MD, director of the UMass Depression Center and a nationally renowned authority in the depression field. Rothschild characterizes the easing of stigma as “a good thing,” because it has empowered more people who need treatment to step up and find it. Likewise, he counts the arrival of new medications for depression as a positive, because it has freed doctors and patients from having to work with far more complex depression medicines and their side effects.Rothschild Tony

Today it is estimated that 13 percent of the 308 million people living in the United States, or more than 40 million people, suffer from some form of depression. By comparison, about 1 percent of the population suffers with bipolar disorder and an additional 1 percent is afflicted with schizophrenia, says Dr. Rothschild.

“Depression is a brain-based, total-body illness that touches every race, religion and socio-economic class, and it reaches around the world,” he says. “It is not a product of western civilization.”

No one really knows how old depression is. Ancient peoples may have suffered with it. Experts do suspect, however, that rates of depression are rising. And major challenges remain in the fight against the affliction – challenges that also drive the mission of the UMass Depression Center.

The Center is part of the National Network of Depression Centers (NNDC), a select group of the country’s leading depression and academic medical organizations for mood disorders that also includes Harvard University (Brigham & Women’s Hospital and Massachusetts General Hospital), the Johns Hopkins University, Stanford University, the University of Michigan and the University of Pennsylvania, among others.

As a leader in the field, the UMass Depression Center takes a progressive, recovery-driven approach to depression based on reducing stigma, and promoting and encouraging treatment; recognizing that recovery needs direct participation by the patient and their family members; and accepting that prescription drugs when appropriate are best viewed as one ingredient of a comprehensive, successful treatment program.

Rothschild says the country desperately needs more therapists. But it is not an easy field to work in. Failure can sometimes be measured in lives lost to depression. But the feeling of having helped someone with their depression, having guided them to turn their life around, can be enormously rewarding.

“There are still a lot of people out there who are suffering,” Rothschild says. “Most people can be helped and you can actually assist someone to become completely better.”

In his career spanning over 30 years of treating depression, Rothschild said he and his UMass colleagues have worked with thousands of patients who have turned their lives around almost miraculously, including one of Rothschild’s who went from nearly dying after a very serious suicide attempt to landing a job, becoming a parent, and living a satisfying life.

Apart from better medications, there are other reasons that Rothschild cites for being optimistic about treatment today. Practitioners have enhanced group therapy methodologies and techniques, making that approach to treatment more effective than ever. Cognitive behavioral therapy, which works through an array of goal-oriented, explicit systematic procedures, has proven to be a successful treatment for a variety of conditions, including mood, anxiety, personality, eating, substance abuse, and psychotic disorders. Clinical trials at UMass and other institutions are holding out hope for future breakthroughs in our understanding of mental illness.

Still, it is the therapists themselves that hold the key, says Rothschild. “It is very important to instill hope in the patients,” he says. “It’s about saving and improving patient’s lives.”

Dennis Nealon is associate director for communications, continuing medical education and global initiatives, UMass Department of Psychiatry