A PATIENT'S PERSPECTIVE — DICK CAVETT, a report on an interview 1 of Dick Cavett, Smooth Sailing, Spring 1992

For our symposium, celebrity Dick Cavett found himself on the less familiar side of the talk-show situation, with Dr. DePaulo as the host asking him about his experience with depressive illness. In serious as well as many lively, quick-witted comments, Mr. Cavett told his story.

His first depressive episode was during his freshman year at Yale. It lasted four to five weeks, during which he was oversleeping and feeling very exhausted. Fortunately, although his depression was misdiagnosed and thus never treated, it lifted spontaneously.

Several years later, when Mr. Cavett was starting out in the media business in New York, he experienced a paralyzing depression. He slept until 3:00 P.M. and stayed in bed all day, getting up only to watch the Jack Paar Show. When he dragged himself to a doctor, the doctor prescribed Geritol!

About nine years ago, Mr. Cavett experienced his worst depression. He felt flattened, destroyed, impoverished by it. A total numbness of feeling descended on him. He lost his confidence, had no interest in sex, felt like he couldn't talk and had no talent, and wasn't interested in anything (except books and articles on depression). He said he "couldn't pass a couch without falling in love with it." Mr. Cavett did do a series of talk shows for public television during this time, but he said they were torture because of his lack of concentration. He generally wasn't sure that he was asking his guests relevant, interesting questions. He felt 100 times worse than he looked to others, so the shows came out satisfactorily.

After the television series ended, Mr. Cavett went to a famous New York psychiatrist and expert on depression who put him on Parnate, one of the monoamine oxidase inhibitor (MAOI) antidepressants. Some medication adjustments were necessary before stability was achieved, but for the last eight years, Mr. Cavett has had no depressive episodes. He did mention, however, that there is a six-to eight-week period every year when he feels "off," not at his best. The candor with which Mr. Cavett speaks about his illness in public has great potential to reduce the stigma associated with depressive illness.

1 An interview at a DRADA/Johns Hopkins symposium, Baltimore, Maryland, April, 1992

Click here to order a video tape of Dick Cavett's entire appearance at the symposium.

CREATIVITY AND DEPRESSION AND MANIC-DEPRESSION

ROBERT LOUIS STEVENSON, a report on a presentation 1 by Kay Redfield Jamison, Ph.D., 2 Smooth Sailing, SUMMER 1996

Man is not truly one, but truly two. — Robert Louis Stevenson

Dr. Kay Jamison's colorful presentations are highlights of the annual mood disorders symposium. Her particular interest is well expressed by the subtitle of her recent book (Touched With Fire; available through DRADA): Manic-Depressive Illness and the Artistic Temperament. Each year she discusses the family and medical history of an artist, writer, poet, or musician, pointing to evidence of manic-depressive illness.

This year the spotlight fell on Scots writer and poet Robert Louis Stevenson (1850-1894), best known for works such as Treasure Island, Kidnapped, and The Strange Case of Dr. Jekyll and Mr. Hyde. Using family trees, photos, sketches, and quotations, Dr. Jamison documented not only that Stevenson had manic-depressive illness himself, but also that his father died during a deep depression and that he was a close relative of several others with the illness. Stevenson wrote that his father had a most "profound underlying pessimism and tragic view of life; his innermost thoughts were ever tinged with the Celtic Melancholy."

Stevenson called that same pessimistic outlook in himself a "malignant hypocrisy." He described himself as "given to explaining the universe" - because he was "Scotch, sir, Scotch." By turns charming, then nervous and excitable, he was subject to sudden fits of rage-followed, just as suddenly, by heartfelt remorse. He developed fiery loyalties to family, friends, and political causes. After Stevenson's death, his friend J.M. Barrie (Peter Pan) said that although Stevenson may not have been the greatest of literary figures, he was "the one we would like best to come back."

Stevenson showed symptoms of manic-depressive illness early in life; once, reminiscing how as a child he would lie for hours in bed in a "miserable exaltation," he flawlessly described symptoms of dysphoric (uncomfortable) mania, an atypical manic-depressive irritability, for example, and inability to finish projects once begun. He moved about the world, partly in search of relief for his tubercular condition: first to England, then France, then the United States, and, finally, Samoa.

His manic-depressive illness also bore some characteristics of seasonal affective disorder; the nature and intensity of his symptoms varied with the season of the year and the latitude at which he was living. On a winter day, he wrote "Let me get down on the hearthrug, full of laudanum grog, or as easy as may be, into the nice wormy grave." He had an unmistakable breakdown in October of the same year that, according to a friend, he had "sped summer nights and days along" urgently.

Stevenson's major commercial success followed publication of his novelette, The Strange Case of Dr. Jekyll and Mr. Hyde. The book, unlike film versions, places Hyde already within Jekyll, awaiting the catalyst for his emergence. The seemingly cool and rational Dr. Jekyll finds his inner self in the sensual and immoral Hyde. When Hyde materializes unannounced, he assumes an attractive disguise: perhaps charming eloquence or irrefutable logic, or perhaps utter clarity. From personal experience, Stevenson understood Hyde's seductiveness to Jekyll; Hyde may be a metaphor for Stevenson's hypomanic self. Stevenson knew that hypomania can be addictive and fun.

Stevenson died in his beloved Samoa at age 44-primarily because of his tubercular condition, but his life was probably shortened somewhat by his manic-depressive illness. Through it all, he persevered courageously and was writing up to the time of his death, struggling to complete his work.

His tomb sits upon a Samoan hillside, bearing an epitaph he selected from his poem "Requiem": "Glad did I live and gladly die," reads the epitaph; "I laid me down with a will"; and "Here he lies where he longed to be." Is this enigmatic epitaph the poet's final metaphor for his life and his manic-depressive "death-in-life" - together, united, blended at last?

Dr. Jamison concluded her presentation on Stevenson by playing to the still-dimmed house, a recording of one of his ballads, sung appropriately by noted folk singer Jean Redpath, who is Scots, sir, Scots.

1 Presented at the DRADA/Johns Hopkins symposium, Baltimore, Maryland, April 199

Order Touched by Fire, by Kay Jamison

NEUROBIOLOGY OF CYCLIC AFFECTIVE ILLNESS: IMPLICATIONS FOR TREATMENT, excerpts from a presentation1 by Robert M. Post, M.D.,2 Smooth Sailing, Summer 1996, pp. 2,3.

Dr. Robert Post [discussed] the vital roles that neurobiology can play in helping to explain affective disorders and in targeting treatment.

We have known for about 75 years that an episode of affective disorder may be triggered by a major experience in a person's life, such as the death of a loved one. Only recently, however, have advances in neurobiology begun to show us how this can happen. Research indicates that the impact of a traumatic experience actually changes gene expression (that is, what genes are currently acting) and, therefore, brain biochemistry. Each episode of depression is thought to increase vulnerability to further episodes. At present, it seems probable that a traumatic experience sets off a chain reaction of changes in neuronal (nerve cell) firing, messenger RNA, gene expression, and hormones that influence the central nervous system, eventually producing symptoms. We need to understand more about the mechanisms involved in this process. The structure of the hippocampus has been shown to change, and very recent research by Dr. Post and coworkers suggests that most depressed patients have decreased glucose metabolism in the frontal cortex of the brain.

In other words, life events affect the central nervous system and actually tune both long-term regulation of impulse transmission between neurons and functioning within neurons. This sensitization model suggests that as depressive illness continues, increasingly fewer stressors are needed to trigger an episode. This model is not unique. The kindling model, as it applies to seizures, suggests that each seizure occurrence increases the chance for another seizure. Eventually, Dr. Post said, a trigger stressor is no longer needed, and the system goes on automatic. At this point, neuronal pathways are sufficiently sensitized that depression can occur spontaneously.

Dr. Post strongly emphasized the importance of "ganging up" on the depressive illness—that is, treating it aggressively, early, and preventively to keep the nervous system from becoming set in the patterns of the disorder. According to the sensitization model, each depressive episode can increase the chance of a future episode. Family members can be instrumental in helping the patient get proper treatment. Depression is a serious illness and should be treated as one.

_______________

1Presented at a DRADA/Johns Hopkins symposium, April 23, 1996.

2Chief, Biological Psychiatry Branch, National Institute of Mental Health.

by Ann M. Bain, Ed.D.
Smooth Sailing: Summer 1996

An Unquiet Mind, Jamison, Kay Redfield. New York: Alfred A. Knopf, 1995. (Hardback, 224 pages, $22.00)

Dr. Kay Redfield Jamison, professor of psychiatry at Johns Hopkins University School of Medicine, author of Touched with Fire: Manic-Depressive Illness and the Artistic Temperament, coauthor of the definitive medical text Manic-Depressive Illness, and writer and producer of public television specials on creativity and manic-depressive illness, has revolutionized the public's perception of the illness. And now, in An Unquiet Mind, Dr. Jamison has written probably the best book yet about manic depression and the mind—because the "unquiet mind" was her own.

In this memoir, Dr. Jamison reveals that she has had manic depression, a "horrible disease," for over 30 years. With honesty and wit, she traces the flight of her "loopy but intense life: marvelous, ghastly, indescribably difficult, gloriously and unexpectedly easy, complicated . . . and a no-exit nightmare."

She experienced mood disruptions as a child; as a teenager she became very depressed. In her twenties, the illness worsened—she found herself "unpredictably and uncontrollably irrational and destructive." Once she was diagnosed as manic depressive, she (like many other patients) began her "war" against medication. Against professional advice, she went off her medication and eventually attempted suicide. At that moment, she "could not stand the pain any longer," and believed she "could no longer be responsible for the turmoil [she] was inflicting on friends and family."

An Unquiet Mind is the story of Kay Redfield Jamison's journey to and from this "almost arterial level of agony." It is also the story of the importance of family and professional support; the theme is love "as sustainer, as renewer, and as protector." Dr. Jamison acknowledges that the only thing that protected her from "each terrible storm that came her way" was her mother's "love and strong sense of values," providing "powerful and sustaining, countervailing winds." Her brother, too, was devoted: despite Dr. Jamison's "mood or problem," he was always glad to see her. "He made it unequivocally clear that if I needed him, no matter where he was, he would be on the next plane home." She also maintains that the "debt" she owes her psychiatrist is "beyond description." He sustained her "with a granite belief" that hers was "a life worth living" and that "with steely effort, the grace of God, and an inevitable break in the weather," she could make it.

Woven through Dr. Jamison's story are informative discussions about the course of the illness. She uses her own thoughts and behaviors to illustrate the classic symptoms of manic depression. She also advocates a partnership between medication and psychotherapy. As both a patient and a mental health professional, she explains that "lithium [or other medication] moderates the illness, but therapy teaches you to live with it."

The beauty of the book lies as much in Dr. Jamison's style as it does in the story. Her language is powerful and her images are riveting—for example, depression was "flat, hollow, unendurable," and even now, her old "summer manias . . . coalesce, each July, into brief, occasionally dangerous cracklings of black moods and high passions." Yet because of her illness, she has found "new corners" in her "mind and heart . . . limitless corners, with their limitless views."

We—patients, family members, friends, and other readers—owe a debt of gratitude to Dr. Kay Redfield Jamison for letting us peek into these "corners" and share their "views." Like all visionaries, she was lonely with her secret; for sharing the truth, she has earned our admiration and respect.

by Connie Pryor
Smooth Sailing: Fall 1995

Click here to order the book, An Unquiet Mind, by Jamison, Kay Redfield

Let's Talk About Depression

Sure, everybody feels sad or blue now and then. But if you're sad most of the time, and it's giving you problems with your grades or attendance at school

your relationships with your family and friends

alcohol, drugs, or sex

controlling your behavior in other ways

the problem may be DEPRESSION.

The good news is that you can get treatment and feel better soon. Approximately 4% of adolescents get seriously depressed each year. Clinical Depression is a serious illness that can affect anybody, including teenagers. It can affect your thoughts, feelings, behavior, and overall health.

Most people with depression can be helped with treatment. But a majority of depressed people never get the help they need. And, when depression isn't treated, it can get worse, last longer, and prevent you from getting the most out of this important time in your life.

So....Listen Up:

Here's how to tell if you or a friend might be depressed.

First, there are two kinds of depressive illness: the sad kind, called major depression, and manic depression or bipolar illness, when feeling down and depressed alternates with being speeded-up and sometimes reckless.

You should get evaluated by a professional if you've had five or more of the following symptoms for more than two weeks or if any of these symptoms cause such a big change that you can't keep up your usual routine.....

When You're Depressed...

You feel sad or cry a lot and it doesn't go away.

You feel guilty for no reason; you feel like you're no good; you've lost your confidence.

Life seems meaningless or like nothing good is ever going to happen again. You have a negative attitude a lot of the time, or it seems like you have no feelings.

You don't feel like doing a lot of the things you used to like - like music, sports, being with friends, going out - and you want to be left alone most of the time.

It's hard to make up your mind. You forget lots of things, and it's hard to concentrate.

You get irritated often. Little things make you lose your temper; you over-react.

Your sleep pattern changes; you start sleeping a lot more or you have trouble falling asleep at night. Or you wake up really early most mornings and can't get back to sleep.

Your eating pattern changes; you've lost your appetite or you eat a lot more.

You feel restless and tired most of the time.

You think about death, or feel like you're dying, or have thoughts about committing suicide.

When You're Manic...

You feel high as a kite...like you're "on top of the world."

You get unreal ideas about the great things you can do...things that you really can't do.

Thoughts go racing through your head, you jump from one subject to another, and you talk a lot.

You're a non-stop party, constantly running around.

You do too many wild or risky things: with driving, with spending money, with sex, etc.

You're so "up" that you don't need much sleep.

You're rebellious or irritable and can't get along at home or school, or with your friends.

Talk to Someone

If you are concerned about depression in yourself or a friend, TALK TO SOMEONE about it. There are people who can help you get treatment:

a professional at a mental health center or Mental Health Association

a trusted family member

your family doctor

your clergy

a school counselor or nurse

a social worker

a responsible adult

Or, if you don't know where to turn, the telephone directory or information operator should have phone numbers for a local hotline or mental health services or referrals.

Depression can affect people of any age, race, ethnic or economic group.

Let's Get Serious Here

Having depression doesn't mean that a person is weak, or a failure, or isn't really trying...it means they need treatment.

Most people with depression can be helped with psychotherapy, medicine, or both together.

Short-term psychotherapy, means talking about feelings with a trained professional who can help you change the relationships, thoughts, or behaviors that contribute to depression.

Medication has been developed that effectively treats depression that is severe or disabling. Antidepressant medications are not "uppers" and are not addictive. Sometimes, several types may have to be tried before you and your doctor find the one that works best.

Treatment can help most depressed people start to feel better in just a few weeks.

So remember, when your problems seem too big and you're feeling low for too long, YOU ARE NOT ALONE. There's help out there and you can ask for help. And if you know someone who you think is depressed, you can help: Listen and encourage your friend to ask a parent or responsible adult about treatment. If your friend doesn't ask for help soon, talk to an adult you trust and respect — especially if your friend mentions suicide.

What You Need to Know About Suicide...

Most people who are depressed do not commit suicide. But depression increases the risk for suicide or suicide attempts. It is not true that people who talk about suicide do not attempt it. Suicidal thoughts, remarks, or attempts are ALWAYS SERIOUS...if any of these happen to you or a friend, you must tell a responsible adult IMMEDIATELY...it's better to be safe than sorry....

Why Do People Get Depressed?

Sometimes people get seriously depressed after something like a divorce in the family, major financial problems, someone you love dying, a messed up home life, or breaking up with a boyfriend or girlfriend.

Other times - like with other illnesses - depression just happens. Often teenagers react to the pain of depression by getting into trouble: trouble with alcohol, drugs, or sex; trouble with school or bad grades; problems with family or friends. This is another reason why it's important to get treatment for depression before it leads to other trouble.

Depression and Alcohol and Other Drugs

A lot of depressed people, especially teenagers, also have problems with alcohol or other drugs. (Alcohol is a drug, too.) Sometimes the depression comes first and people try drugs as a way to escape it. (In the long run, drugs or alcohol just make things worse!) Other times, the alcohol or other drug use comes first, and depression is caused by:

the drug itself, or

withdrawal from it, or

the problems that substance use causes.

And sometimes you can't tell which came first...the important point is that when you have both of these problems, the sooner you get treatment, the better. Either problem can make the other worse and lead to bigger trouble, like addiction or flunking school. You need to be honest about both problems — first with yourself and then with someone who can help you get into treatment...it's the only way to really get better and stay better.

Depression is a real medical illness and it's treatable.

Be Able to Tell Fact From Fiction

Myths about depression often prevent people from doing the right thing. Some common myths are:

Myth: It's normal for teenagers to be moody; teens don't suffer from real depression.
FACT: Depression is more than just being moody, and it can affect people at any age, including teenagers.

Myth: Telling an adult that a friend might be depressed is betraying a trust. If someone wants help, he or she will get it.
FACT: Depression, which saps energy and self-esteem, interferes with a person's ability or wish to get help. It is an act of true friendship to share your concerns with an adult who can help.

Myth: Talking about depression only makes it worse.
FACT: Talking through feelings with a good friend is often a helpful first step. Friendship, concern, and support can provide the encouragement to talk to a parent or other trusted adult about getting evaluated for depression.

For Additional Information About Depression Write To:

6001 Executive Boulevard, Room 8184, MSC 9663
Bethesda, MD 20892-9663

For free brochures on depression and its treatment, call: 1-800-421-4211.

For More Information About NIMH

The Office of Communications and Public Liaison carries out educational activities and publishes and distributes research reports, press releases, fact sheets, and publications intended for researchers, health care providers, and the general public. A publications list may be obtained by contacting:

Office of Communications and Public Liaison, NIMH
Information Resources and Inquiries Branch
6001 Executive Blvd., Room 8184, MSC 9663
Bethesda, MD 20892-9663
Phone: 301-443-4513
TTY: 301-443-8431
FAX: 301-443-4279
Mental Health FAX 4U: 301-443-5158
E-mail: nimhinfo@nih.gov

NIMH home page address: http://www.nimh.nih.gov

NIH Publication No. 97-4162
Last updated: 11/01/1999

For more detailed information on depression or bipolar disorder (manic-depressive illness), be sure to visit our Reference Shelf. Supplemental information can be found in our First Person Experiences, Books, and Videos sections.

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