Welcome to "Tell Me More."

I'm Kelly Corrigan.

I'm a writer, a podcaster, and a mom.

This season, number seven, is unlike anything you've seen from us before, because everyone who works on this show is reading the same headlines.

There is so much unsettling news about how people are actually feeling.

So, we have recruited the best scientists and researchers to separate fact from fiction and surface a set of practices we can all live by.

Join us for a 10-part conversation on wellness-- how do you get it, and how do you keep it.

Once every 40 seconds-- so, that's multiple times while we talking-- someone will die by suicide.

Kelly: This is Dr. Leanne Williams, an Australian, who is studying precision medicine and how it might change outcomes for people suffering from mental health disorders everywhere.

She has contributed 375 scientific papers to the field and is the associate chair of translational neuroscience at Stanford's medical school.

When I'm talking with folks who are dealing with depression or in my own life, those folks don't seem to have access to joy.

Kelly: This is Dr. B.J.

Miller.

He wrote a book called "A Beginner's Guide To The End."

He is a hospice and palliative care doc who advocates for the roles of our senses, community, and presence in designing better endings.

I'm very aware that, like, I don't really know what any of us are going through, other than what we present.

Kelly: This is W. Kamau Bell, my friend and longtime Bay-area neighbor.

He's a standup comedian.

He's also an Emmy-winning force behind CNN's docuseries the "United Shades of America."

He spends his time running after his three daughters and making very powerful documentaries.

Both of you have lost someone to suicide.

Can you talk about your partner?

Yes.

This was just over eight years ago.

It was in April.

This is my life partner.

We were living together.

He was an E.R.

doctor.

We talked about the fact that he was experiencing depression.

He was open about that, but he felt that, because he was an E.R.

doctor, then "I should cope."

Also, the stigma really impacted in that he thought, if it was recorded on his record, he would not be able to work, and therefore, seeking treatment was not an option at the time.

Is that... Was he accurate?

I think it is accurate all too many times, that it's very hard for people in the health profession-- maybe you see this-- to actually share that they experience mental health issues themselves.

There was a number of life events that happened, but him actually choosing to kill himself was unexpected to his colleagues, his mom, and myself.

I was the one to find him and to share the awful news with his family.

And now that's given me extra motivation that we really need solutions.

So, I understand when families go through this awful experience and just the feeling of not having answers and hearing someone who's, you know, close to doing the research, we should have answers.

For my situation, it was my sister, my elder sister Lisa.

She was 32, you know, and posthumously diagnosed with bipolar depression, by way of my parents going through her journals with a psychiatrist.

And in retrospect... wildly obviously so.

I don't know how we all missed it.

I think she just had a lot of us...fooled.

Without a diagnosis to help make sense of it, you know, I think she had the illusion that she was getting help because she was in therapy.

I think it's such a reflex for a lot of folks when they hear of a young person ending their own life to look at the parents just immediately with some suspicion, you know.

Whether it's explicit or not, you kind of see it in their eye, and I know my parents felt that, and that was very hard.

I think about... whatever you probably went through after your partner died and how that could easily look like depression and whatever you went through after your sister died or after your accident and how that could look like depression or it could look like a perfectly reasonable response to something really tragic, right?

And how do you know the difference?

Like, how do you know that it's not just... Grief?

Just grief?

Did you ever feel like there was something about your grief that was depression?

Yes, and I would struggle to tell you the difference.

When I'm talking with folks who are dealing with depression or in my own life, those folks don't seem to have access to joy, like you can't feel certain things, whereas folks who are grieving seem to have access to the spectrum of emotions but hang out in one part of it or something like that.

I think there's a lot of people, when you hear suicide, what was wrong with that person, instead of, like, what was that person going through?

I think that's the thing.

So, I've had multiple people in my life, some closer than others, and I'm always very clear that it's like, what was that person going through in that moment to take off the pressure of, like, what was wrong with that person?

We're all so connected to various things being lost all the time, we're probably all in some amount of grief all of the time.

So, these distinctions start getting a little soft and fuzzy.

But then it's so hard to know how to treat it, because if someone were to give medication to someone who is grieving, it may or may not work.

They may not need it, yeah.

Sometimes also when you're grieving, like, it can feel loving.

To move through it.

And appropriate and realistic, et cetera, but also loving to actually...

Totally.

The depths of my pain having some relationship to the peaks of my love for that person.

Totally, totally, totally.

I so relate to that.

Going through extreme negative emotional experiences makes you aware that that's how you can actually access how you connect in a really positive way.

So, yeah.

I find with me, like, especially since the pandemic, what I'm trying to do-- I stayed with a friend of mine today.

He's like, "How are you doing?"

I was like, "Awful," like, just trying to be more clear about where I am in my life.

Even people in our lives that we're not actually answering the question the way we feel it at the time, because we're sort of supposed to be, like-- I think there's this-- I can only speak to this culture, the one I grew up in.

But so much of American culture is about "put your head down.

If it's hard, you've got to get through it."

And so, like, I've tried to, like, in my...with my kids, sort of model, like, "No, just be clear about where you're at, especially with the people in your life."

Again, not with everybody, not the stranger on the bus.

I mean, I sometimes feel like it's that idea in media of "civic uplift."

Like, I feel like when I'm not doing well, I sometimes feel like I owe it to the other person to be like, "I'm good.

I'm good.

How are you?"

Because it's like, "God, if I tell you I'm not well," then you're gonna be like, "Nobody's doing well."

It's a social contract.

"I'm good!"

Yes, right.

It's the meme of the dog in the fire.

That's how you know they're not, is that however high it goes up at the end-- "I'm GOOD!

I'm GOOD!"

"Everything's great.

Everything's great."

I'm very aware that, like, I don't really know what any of us are going through other than what we present.

And so I'm not gonna be even judgmental, but also I feel like I should reach out.

You know what I mean?

You have that tingle.

Like, I started to pay attention to that more.

Being sad in this life makes a hell of a lot of sense.

How do you figure out how to treat depression right now?

Like, what are the... What's the menu?

It's essentially a heuristic approach.

What happens is you're asking a series of questions about how someone feels or what they're thinking, what's going on in their life relevant to a set of criteria.

So, for depression, you have nine criteria used to diagnose depression.

If you have five or more, you'll meet criteria as long as you have at least one of either being very sad or having this complete loss of pleasure.

So, that relies on someone being able to report to you, "This is what's going on in my life" and tell you what they're feeling.

Are they experiencing normal sadness or everyday sadness?

Where do you kind of draw the line?

Or accurate sadness.

I mean, it's sort of like, during the pandemic, I remember I went to my medical doctor at one point, and it was like, "Are you feeling depressed?"

And I was like, "Yeah."

Like... "Aren't you?"

So, yeah, I'm like, we're both wearing masks, I've got two kids on Zoom school, I've got a two-year-old who's feral.

I'm, like, trying to direct a movie from Zoom.

Like, "Yeah, I feel depressed."

But he sort of like...

I saw him stand up and sort of go through this checklist now, like, "I don't know how to answer this because do I want him to think I'm depressed?"

Kelly: Right, right, right.

W. Kamau: Or do I want him to think-- Or do I want to be okay?

Do I actually want to be depressed, because then there's help?

The checklist, of course, is then used to make the diagnosis, and from there, the treatment process is this heuristic...

So, typically some medication or psychotherapy or CBT, cognitive behavior therapy.

More often than not, if it's through primary care, it will be medication.

But there's no way to say, "This is a right treatment for you" or "You don't need this treatment."

It's more a one-size-fits-all trial-and-error process.

You wait 8 to 12 weeks, and then if that treatment hasn't worked, as in made you feel better, we try another one.

But there's good news.

Ooh!

You ready for it?

I'm ready for it, yeah.

I mean, this is what gives me hope about the research.

What we have now available is ways to image the brain and see it in action, like actually look at what's going on as the source of those experiences, and that's through techniques I use, for example, functional magnetic resonance imaging, and it means you can image the brain and look at what I call circuits that are regions of brain that talk to each other.

They communicate with each other.

They govern our very human functions of feeling emotion, regulate emotion, how we think, how we self-reflect, how we worry, all of those things.

But in depression, we can see when they're outside the healthy range.

So, you can actually see the activity or the connection of these circuits in the brain.

So, it's more like if you were measuring, as a rough analogy, blood pressure or an EKG in your heart.

So, this is this huge difference from self-reporting to something that you could observe or measure.

Yes, and it also, in my view and what I've seen with many people in our studies, is it helps with stigma because we can actually show someone their brain.

We can show them how it's functioning.

You can see, "Well, here's "six different circuits in the brain "that are involved in depression.

"Five of these, you can see "how they're all functioning well, "and this one here is functioning outside the healthy range."

That must be so validating.

Dr. Williams: There's innocence there, too.

If you see structurally something's wrong physiologically, you have a banner of a diagnosis, then it's not your fault.

Right, exactly.

So, so far in my research, I've characterized eight different types, and I call them biotypes, because they have this anchor in brain circuits, but they link to what we're experiencing as the individuals.

We are now mapping out how that brain circuit will respond.

So, once you have biotypes, then does it just point directly to a set of treatments that will be way more effective way sooner than this trial-and-error thing that you described?

The short answer is yes.

What we've found in our studies and others have found, you can actually double the chances that someone's going to get better at least, and you have the opportunity to find the right treatment sooner.

The other opportunity with biotypes is you can link them to different types of treatments.

So, in some cases, it may be standard antidepressant medications, but that's maybe one-third, and then you would have some newer kind of medications and more selective that are being developed.

We found some biotypes do really well in cognitive-type therapies or behavior therapy.

You may want some lifestyle interventions and diet, exercise.

Some biotypes that can do well on some of the very exploratory approaches.

So, those are... like, the psylocibin that's talked about so much.

There is some evidence that they do match to some biotypes, and then there are new techniques that we call neuromodulation.

They noninvasively stimulate the brain.

What do people say who listen to your whole spiel about precision mental health and say, "It'll never work because...blank"?

I do definitely have that experience of, "It'll never work because..." Usually it will be because the brain's too complex, or it'll be it's too expensive.

What do you say?

The one about the brain being complex, yes, of course, it's very complex.

So was the heart when we first tried to understand it, and now we can measure it, and it's the gold standard to measure it for cardiology.

The brain is more complex, but what I say is, because we have now mapped the connections of the brain-- There's a project called the Human Brain Project and the Human Connectome Project.

Like we mapped the human genome, we now have the GPS.

We can see which are the superhighways, and what I mean by "superhighways" is they have a lot of connections that feed into them, and they communicate about our core emotions, and those superhighways happen to include about 13 to 17 circuits, of which at least 6 are very much involved in depression, and those superhighway circuits are trackable to measure.

So, that's the answer to the first part.

Yeah, and what about the second part?

There's multiple kind of angles on this question about the cost.

I think it's really important to situate what would be the cost of getting a test introduced into mental health compared to what we're currently bearing as the cost of not getting a right treatment or not getting treated at all.

The other thing I think about this, whenever I think about even my going to therapy once a week, that's a tremendous privilege that I have, to be able to afford it, to have insurance that sometimes wants to cover it, all those things, and that, like, most people don't in this country because of economic reasons, because of literal, like, "I don't know "where to go in my neighborhood to find that person."

The future I would envision is that we would have access to these kind of tests available in community settings.

We'd be part of health and health prevention.

Right now, because we don't have precision medicine in mental health, do you think we're overprescribing?

The key issue is that we're not prescribing the right treatment for the need.

Secondly, if we're not able to look at the root cause, we don't have a means of knowing if we've actually shifted whatever that-- let's say it's the circuit function-- if that is shifted as a consequence of the medication.

How prevalent is depression in the U.S.?

We're talking about 21 million people.

So, in our lifetime and our children's lifetime, that's one in every five, and it's on the increase since the pandemic.

And is that, like, diagnosed by a psychiatrist depression or people who are raising their hand and saying, "I'm depressed," or how do we count the numbers?

Those data come from very wide-scale epidemiological studies.

Is depression, like, the number-one mental health disorder in the U.S.?

Yes, if you take into account that it's highly coassociated with anxiety.

How often is it coassociated?

It will be about... between 70% and 80% of the time, you would have a combination of some form of depression and anxiety, and together, they explain way more than 21 million.

Is the fact that they are coassociated related to how we define them or how they present?

The overlap between anxiety and depression in part reflects the fact that they have some common features.

So, they both have, for example, difficulty sleeping.

They both have difficulty in concentrating and making decisions.

And then they have some distinct features.

So, aspects in anxiety are feeling agitated or worried, and in depression, sadness.

In some cases, one can actually lead to the other.

And what's the cost to society and to individuals?

The sustainability of the future is at stake.

I feel it's an incredibly important issue because we're talking about illnesses that affect our young people and can often be lifelong.

So, if we put it into dollar values, we are talking worldwide that depression contributes one trillion in lost dollar to the global economy, and that's because we are disrupting people's capacity to work and be performing at their peak in their prime years of their life.

There are other really important costs.

The World Health Organization numbers tell us that once every 40 seconds-- so, that's multiple times while we're talking-- someone will die by suicide.

And that is currently estimated about 700,000 people per year.

And if we think of young people, dying by suicide is now the main cause of death after accidents.

Maybe that's such a hard thing for people to think about that it's to the disadvantage of possible solutions and therapies because it's just the most painful idea.

There's a generation of kids who are marked pretty profoundly.

What I saw some of the young people in my life, like, not just my kids, but friends of my kids go through in the pandemic, like, and we're just sort of in this rush to go back to normal is what starts to make people go, like, "Normal?

Am I normal?

Is this normal?"

So, I really think that that is... that when we bring up mental health, to me feels like what is society doing wrong that we have this epidemic of mental health and we only address it when somebody explodes basically?

Sometimes I wonder how people kill themselves, because I think somehow that might indicate whether it was a moment versus... An impulse, yeah.

Yes.

I mean, I think that people say that often about guns, is that, if you want to reduce suicide, get guns out of houses, because if you don't have a way to do it in that lowest moment, you might find that the next moment, you have some resilience surfacing.

Do you think that?

Certainly there's evidence for that, particularly, actually, in rural areas.

Because we can now understand, using these kind of very advanced brain-imaging techniques what type of depression you may have, like, what is the root cause, there's one type we can characterize that is about a disruption in the circuits of the brain that help you regulate your thoughts, and they help you regulate your impulsivity and your decision-making.

When those circuits are disrupted, it's more likely that you can act on a feeling of "I need to end my life.

I can't see hope.

I can't see a future."

So, that group of depression, that subtype, is at an elevated risk.

Is it 100% true that if someone takes their life, they are mentally ill?

Well, my personal view, I don't think it's 100% true.

At the same time, we know from--this is even from genetic data-- that if you have had depression, genetically it is the strongest risk factor for your likelihood to take your life.

I'm aware there are efforts to introduce these topics in school, particularly around what are called those clusters, the clusters of suicide in schools in the local area.

But I feel like, you know, if we could talk more to kids about mental health, mental resilience, and what do you do if you're starting to have these thoughts, and make them something we can talk about-- and I think kids are more open-- then it's a way for them to either have a way to speak up or know that whatever is going on at the time isn't necessarily what's always going to be going on, in the same way that we talk about how do we manage other areas of our health or navigating our world.

I've actually been in and out of therapy-- My mom, she was, like, in therapy and reading all the books, and so, as a kid, she basically encouraged me to go to therapy when I had some rough times.

So, as a teenager, I would be in therapy, and it was very interesting to see there's a type of therapist that they will put you in front of as a black kid that's like, "Are you on drugs?

Is there violence in the home?"

Which is like, "No, it's none of that."

They go, "Well, then, I think you're fine."

And so, we really had to work to find somebody who would, like, talk to me as an individual kid.

Yeah, yeah.

Have you done therapy?

Yeah, many times.

Have you used medication?

I have, maybe two or three times, traditional sort of SSRI's and stuff.

How did you know to do it?

When I would seek help was early-morning wakening and ruminations.

That was the tell for me to get help.

Did you ever think about suicide?

Yeah.

Yeah, for sure.

Earlier in life, a fair amount.

Less so as I've gotten older.

The shame overlay was much thicker when I was younger, the feeling weak.

As I've gotten older, I don't equate it with weakness.

I think that's given me more breadth for myself.

I have a world view into which I and my sorrows can fit now.

I know, for me, as, like, a young person or whatever, when I was in those bad stretches, it just feels like it's forever.

And the older I get, the more I go, "This sucks right now, but, you know..." Ha ha!

It'll just... Something will happen.

Like, there's a sense of, like, knowing that it's not going to be-- This is not a forever feeling.

I certainly feel like I'm allowed to wallow for a little bit.

Like, I don't think I want to take wallowing away.

I think wallowing is self-care, you know, not perpetual wallowing, but, like, a little bit of, like-- Scrape the barrel.

Yeah, just like, "Okay.

Just give me a moment."

Kelly: Yeah.

All right.

I mean, no feeling is final.

It's, like, one of my favorite lines ever, and I think it all the time.

Brain circuits also change over the lifespan.

They actually shift towards relatively more positive as you get older, and the argument is that, when you're younger, you're kind of learning all the negative things that could happen, so you're very responsive to them.

And as then you learn, like you were saying, things do actually change, you literally see that kind of a mellowing-out in the brain literally physically happen.

Thank you so much.

It's so wonderful to be with you.

I really appreciate everything, yeah.

Thanks.

Love being with you.

Thank you, Kamau!

Here are my takeaways from talking to Kamau, B.J., and Leanne.

Number one, depression is costing the global economy one trillion dollars.

Number two, treatment for depression is about to get much more precise and therefore effective.

Number three, maybe the difference between grief and depression is our ability to feel a range of emotions.

Number four, depression is as physical as a heart condition or diabetes.

Number five, patients have suffered through too much trial and error when it comes to treating depression medically.

And finally, number six, not all depression is best treated with medication.

If you'd like us to send this list to you, just e-mail us-- PBS@kellycorrigan.com.

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