Headed in the Right Direction

What progress have we made in mental illness research and treatment?

A Q&A with Claudia Reardon, Assistant professor and associate residency training director at the UW School of Medicine and Public Health

Q: Do you think mental illnesses have lost much of the stigma surrounding it? Are people becoming better educated on mental health issues than in the past?
A:
Certainly some of the stigma has subsided, but we are not done fighting the stigma by any stretch. There was a study that came out in 2010 by the National Institute of Mental Health that looked at American attitudes toward mental illness and how those have changed between 1996 and 2006. What the results showed is that Americans are more fully accepting that mental illnesses have a neurobiologic basis, and it’s not a “soft diagnosis.” But despite that, Americans still show just as much discrimination toward people with mental illness compared to ten years ago. We have a lot of work to do [to teach the general public that] these are normal, hardworking, respectable people who aren’t to be feared and are integrated into society.

Q: What are the most common mental health issues you’re seeing in your patients?
A:
The things we see [most] in our clinic are anxiety and depression. These include generalized anxiety, obsessive-compulsive disorder, panic attacks and post-traumatic stress disorders. If you study the U.S. population over the course of people’s lifetimes, about thirty percent of people’s symptoms would meet a diagnosis of anxiety.

Along with primary psychiatry, we see a lot of substance abuse, which is probably due to a number of reasons. It can be secondary to the illness—people are trying to self-treat the [illness]. On the flip side if people end up depending on substances like alcohol or drugs, that can cause depression and anxiety.

We also see a fair bit of diseases like bipolar disorder and schizophrenia.

Q: How have treatments progressed? What’s next on the horizon for treating mental illness?
A:
New medicines and new types of talk therapy are being developed all of the time. There are some high-tech developments that are recent, like repetitive transcranial magnetic stimulation. It’s extreme in the sense that you have to do it daily for two to three weeks, it’s very expensive and it’s generally not covered by insurance. This would be used for depression and people who’ve tried many medications and are at risk of losing their life to depression.

There’s been a lot of work on the use of genetic testing to determine what kind of medications [will work] for a patient. Will someone respond to one antidepressant over the other? If we have these blood tests that we can do [right away], that’s helpful. The longer someone goes with an untreated mental illness, the more potentially treatment-resistant it’ll be.

At the other end of the spectrum is preventive psychiatry in which we want to prevent mental illnesses before they happen. [For example we might see someone] who is at a high risk for schizophrenia—how can we detect it and intervene at as early a point as possible? You want to be sure that the treatment you’re using isn’t risky or doesn’t have side effects. Or we’ll want to make sure someone we know who’s at risk for schizophrenia absolutely does not use marijuana, which can be what tips someone over the edge in developing that illness.

Q: How is the brain affected by mental illness?
A:
Mental illnesses are brain diseases. One of the disorders that’s increasingly being studied is depression. What we’ve found is that if
depression goes untreated it can result in brain shrinkage—in particular in the hippo-campus—which is associated with memory or cognition. There are certain stress hormones, like cortisol, that our brain is not designed to tolerate over the long haul, and untreated that can result in shrinkage.

This [shrinkage] is also true with bipolar disorder and certain personality disorders. If we effectively treat depression with an antidepressant, exercise or talk therapy you can regenerate those parts of the brain. So, it’s not an irrevocable change.

We can get someone’s symptoms into remission and we can help them overcome their episode of major depression or anxiety. However, [when we do that] we won’t say they’re “cured.”

Shayna Miller is associate and style editor of Madison Magazine.

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