TEDxUCLA 2018: Waves
Depression is all of us
Michelle G. Craske, Ph.D., is Professor of Psychology, Psychiatry and Biobehavioral Sciences and the Director of the Anxiety and Depression Research Center, and Associate Director of the Staglin Family Music Center for Behavioral and Brain Health, at the University of California, Los Angeles. She is also a member of the Executive Committee of the UCLA Depression Grand Challenge (Co-Chair, Human Studies section). She has published extensively in the area of fear, anxiety and depression. In addition to over 392 research articles, she has written academic books on the topics of the etiology and treatment of anxiety disorders, gender differences in anxiety, translation from the basic science of fear learning to the understanding and treating of phobias, and principles and practice of cognitive behavioral therapy, as well as several self-help books and therapist guides.
When I was nine years old I came home from school to find my mother bent over the kitchen counter, sobbing. She dried her tears and explained to me that my older brother Ian was on his way to the mental hospital, as it was called back then, where he would now be living. He was 15 years old.
I felt helpless. I was afraid for my brother living in a strange place alone, and I was really worried about my mother because I knew how much she had dedicated her life to caring for Ian, hoping that this day would never happen.
I will always remember the first time we visited Ian. The hospital was fenced in by tall barbed-wire fences. We knocked on two large metal doors. I heard footsteps on concrete and the sounds of keys clinging as two internal sets of doors were unlocked before the outside door was opened and Ian walked out.
He looked so gaunt with such a sadness in his eyes I’d never seen before. I couldn’t imagine what his life was like behind those hospital walls. He would beg Mum and Dad, Don’t send me back. Let me come home.” But they had no option. They just couldn’t manage. They had to make sure he was safe, and there was nowhere else to go.
And it hurt my parents beyond belief to know that there was nothing more that could be done. Years later, I learned that my father had even contemplated ending his own life along with Ian’s to end the pain for all of us.
This life, this set of experiences, drove me to become a clinical scientist and a professor of clinical psychology. And I have dedicated my life’s research to advancing scientific understanding of mental health problems so that we can develop better treatments to help families like mine. Because as much as I wish no other family ever had to go through what we did, it happens time and time again, from all walks of life, all over the world, in one form or another.
My brother Ian had very little joy or happiness in his life. He had many problems. One of them was depression. Depression’s more than being sad and down. At its core, it’s a paralysis of hopelessness, a sense of there’s no reason to going on or no point to living. No way out.
This depression is one of the most common health problems, affecting more than 320 million people globally today. In the United States, around one in four women and one in six men will suffer a major depression at some time in their lives, and the rates are increasing, especially among adolescent girls, where the estimates are as high as one in three. One in three. And suicide is second only to accidents as the leading cause of death among adolescents in the United States. So depression touches all of us, and it affects our entire social fabric, from infant development to economic gain.
I have directed a clinical research center for almost 30 years where we provide treatment for individuals, so I’ve seen how depression affects people’s lives. We had a new parent come to us for help because she was worried that she was harming her baby’s development by not being there, by not connecting with her infant. She was right to be concerned, because our own research has shown that children of depressed mothers are at greater risk for problems at school and of becoming depressed themselves. We worked with her to help her overcome her depression. And you can imagine the joy that she experienced when she was able to hold her baby in her arms and smile along with her baby’s laughter.
I have seen a 13-year-old girl so consumed with depressive thoughts that she could barely get out of bed in the mornings. She missed a lot of school. And this happens far more often than we think. But with the right treatment, school for her became the place she looked forward to rather than dreaded. Just imagine the millions of kids who could thrive in school if we could lift their depression.
And depression exerts a huge economic toll, causing people to not be able to work and diminish their productivity when they do work. And depression and poverty live in a vicious cycle because how does anyone go on in the face of poverty when they feel as if there is no hope?
The economic impact of mental disorders is projected to soon be $16.3 trillion dollars worldwide and increasing. And these estimates are higher than the estimates for medical diseases like cancer, chronic respiratory problems, and diabetes. And of all the medical and mental health problems, depression is the leading cause of disability and poor health around the world.
But the right treatments have the power to reverse that situation. Even existing subpar treatments could yield huge economic gain and help lift people out of poverty if they were implemented globally.
So the possibility of improving lives is real, and we’ve certainly come a long, long way since my brother’s hospitalization. And we do now have some treatments for depression that work, but they only reach a half of the people in need. And when they’re available, they only work about half of the time. And the reason is because we still don’t really understand the causes of depression.
The pace of finding solutions is far too slow. We cannot pretend that this problem is just going to go away. The costs of ignoring it are far too great. It is simply astounding that in this day and age, when we’ve made such remarkable scientific advances for the treatment of medical diseases like cancer, that we’ve achieved so little in the field of mental health for problems like depression.
What is the barrier?
My parents’ struggle to find help for Ian was met by another struggle, which was we had to keep it quiet for fear of being judged. We kept it in the family. Depression and other mental health problems simply were not talked about back then.
Shame and stigma around depression still pervade our society. I have worked with countless individuals who have delayed seeking treatment for fear of being fired. Many who don’t tell their family or friends for fear of being judged, some who won’t even accept their own depression for fear of seeing themselves as weak or inadequate.
And these fears are not baseless or irrational. Surveys show that from one-third to one-half of people will actively socially distance and withdraw themselves from those who are depressed. Who among us have had those moments when we could sense someone was struggling and we didn’t know what to say? Or we thought we might make matters worse and we just let the moment pass?
Shame and stigma around depression are strangling us from moving forward. What if we could lift the shame and stigma? What if we could talk about depression like cancer, a disease to be addressed, not a condition to hide?
We know from social science that if we talk openly and objectively about depression in schools, in the media, in social groups, those stigmatizing beliefs will decline. And they will decline even further once we get to know the person and see life through their eyes.
And by bringing depression to the forefront, we as a society can publicly recognize the enormity of this shared burden and demand better treatments for this condition.
I remember thinking all those years ago that the doctors had just given up on finding help for my brother Ian. I now realize they just didn’t have the skills or knowledge to help.
We now have the science and technology to make leaps and bounds, to make the same remarkable advances that have happened for the treatment for cancer. We just need to dedicate our scientific resources to the topic of depression.
A new ambitious project we launched at UCLA, the UCLA Depression Grand Challenge, is doing exactly that. We aim to study depression from all angles, from cells to brain to behavior in 100,000 individuals, most of whom are at risk for or suffer from depression. It’s the largest data collection effort ever to focus on a single problem in the field of mental health.
And we have over 100 scientists involved from all disciplines, from basic animal science to human clinical science to engineering to the arts, all working on the problem of depression. By working together at this unprecedented pace, we believe we can uncover the biological and environmental causes of depression.
And with that information in hand, we can then develop a laser-targeted and personalized treatments for depression that will be much more effective, just like what happened for the treatment for cancer. Non-invasive transcranial magnetic stimulation for the brain, or virtual reality to train people to attend to positive experiences, are just glimpses, glimpses into the new treatments we can achieve.
But we can’t wait for all of the solutions before we take any action, because remember, In the United States, one-half of the people who are depressed are not receiving any kind of treatment at all. And new technologies provide an answer. Using the smartphone and the internet, we can actually diagnose depression and now treat depression. And the smartphone will detect things like social interaction and sleep that are affected by depression. And by using that tracking information, we can identify the moments of most critical need so that we can reach out and offer help just in time and prevent weeks and months of paralyzing depression and even save lives.
As part of the Depression Grand Challenge, the 45,000 students at UCLA are now being offered screening, tracking, and treatment for depression using their smartphones. And we believe this model will become a template for many other places around the world. New technologies fundamentally change our ability to treat depression, possibly sending lifelines to hundreds of millions of lives.
Depression is enormous in scale and impact. It is happening right in front of us, and it is growing. We need to do something big and we need to do it now.
UCLA chose to take on this challenge with an unprecedented amount of science power. But to succeed, we need help from the public to make depression a priority. We can’t sit by and let millions of people continue to suffer alone with this disease.
So let’s talk more openly about depression in schools, in the media, in the halls where public policy is made. Let’s call on our politicians to fund more research for depression at the same scale that happened for cancer treatments. And let’s invest in the science so we can understand this disease and develop new and better treatments.
You can all make a difference by publicly recognizing the enormity of our shared burden. Each of you in your own way can work to break the stigma and support the science that is so desperately needed to provide hope for our families and friends.
Just imagine what we could achieve if our greatest shared burden was lifted and how our world could be transformed.