Transcript: Environment Or Brain Chemistry, Looking At Anxiety And Depre | Oct 01, 2003

(music plays)

Against a blurry background of blue and pink pills, a video reel displays pictures of medical gear such as a needle, a scan of a human body and heart rate monitors.

The title of the show slides in: “Mini-Med School.”

Then, Thomas Unger stands on a stage in a university auditorium giving a lecture. He’s in his forties, clean-shaven with short black hair. He’s wearing a black suit, a white shirt and a black tie.

Behind him, a computer screen is projected on a tall white wall.

Thomas says OKAY, IN
MEDICAL SCHOOL WE'RE BEING
TESTED ALL THE TIME.
SO, YOU MIGHT AS WELL GET USED
TO IT.
SO, LET'S START TONIGHT.
TRUE OR FALSE?
EVERYONE GETS DEPRESSED FROM
TIME TO TIME.

Thomas runs a PowerPoint presentation.

He continues TRUE, HANDS UP.
FALSE, HANDS UP.
TRUE.
DEPRESSION THE WORD IS ACTUALLY
A NORMAL MOOD.
IT'S A FEELING THAT WE ALL GET
FROM TIME TO TIME, UM, AND IT'S
A FEELING, IT'S AN EMOTION.
SO, DEPRESSION IN AND OF ITSELF
IS NOT AN ILLNESS.
WE ALL GET SAD.
WE ALL GET UPSET ABOUT THINGS.
GET BLUE FROM TIME TO TIME.
TRUE OR FALSE?
STRESS IS BAD FOR US.
HANDS UP, TRUE.
HANDS UP, FALSE.
OKAY, YOU'RE A PRETTY SPLIT
CROWD THERE.
FALSE IS THE ANSWER.
STRESS IN AND OF ITSELF IS NOT
AN ILLNESS.
IT IS NOT A PROBLEM.

A caption appears on screen. It reads “Thomas Ungar. University of Toronto. Environment or Brain Chemistry: Looking at Anxiety and Depression.”

He continues
STRESS IS ACTUALLY SOMETHING
THAT DRIVES US.
IT'S AN ALERT RESPONSE THAT THE
BODY HAS.
BECAUSE I KNEW HAD TO GIVE THIS
TALK TONIGHT, I GOT A LITTLE
BIT MORE STRESSED.
IT GOT ME GOING.
IT GOT ME MOVING.
MADE SURE I GOT MY STUFF
TOGETHER.
SO, IT'S NOT NECESSARILY
ILLNESS IN AND OF ITSELF.
OKAY, WE'LL TALK ABOUT HOWEVER
WHEN IT ACCUMULATES AND DOESN'T
REMIT, HOW IT MIGHT CAUSE OTHER
TYPES OF HEALTH PROBLEMS.
ANXIETY IS BAD FOR US.
TRUE OR FALSE?
HANDS UP FOR TRUE.
HANDS UP FOR FALSE.
OKAY, ANOTHER FUNNY WORD.
THAT'S ACTUALLY FALSE, BECAUSE
ANXIETY IN AND OF ITSELF IS A
FEELING OF WORRY.
ANOTHER EMOTION THAT WE GET.
AS I'M WATCHING A HORROR MOVIE,
I FEEL A LITTLE BIT ANXIOUS OR
SCARED.
OKAY?
I'M WALKING TO MY CAR AT NIGHT
AND THERE'S A SHADY LOOKING
CHARACTER OVER THERE BY THE
SIDE, I GET A LITTLE ANXIOUS.
THAT'S NOT AN ILLNESS OR A
PROBLEM.
IT'S ACTUALLY A GOOD, HEALTHY,
ADAPTIVE RESPONSE THAT WE ALL
GET.
OKAY, HANS SELYE, I'M SURE I'M
NOT PRONOUNCING THAT CORRECTLY,
FIRST DESCRIBED WHAT HE CALLED
THE NATURAL STRESS RESPONSE.
OKAY?

Slides show the affirmations he makes.

He continues THIS IS A NORMAL THING THAT WE
ALL GET, IN THAT OUR STRESS
HORMONES, THAT ARE STRESS
REACTION IS THERE TO ALERT US.
DA-DA, DANGER COMING.
IT STARTS IN THE BRAIN AND
WORKS ITS WAY THROUGH THE BODY.
OKAY?
SO, IT'S AN ALARM RESPONSE, THE
STRESS RESPONSE.
IT'S HEALTHY.
WE NEED IT TO SURVIVE.
OKAY?
BUT WHAT HAPPENS SOMETIMES WHEN
THAT STRESS CONTINUES?
ONE GUY BY THE CAR, HERE.
ANOTHER GUY THERE, ANOTHER GUY
ABOUT TO MUG ME WHEN I COME TO
MY HOUSE, AND IT DOESN'T REMIT,
AND IT CONTINUES.
YOU GET A SUSTAINED ACTIVATION
OF THAT SYSTEM.
IT JUST KEEPS GOING AND GOING,
AND WEARING YOU DOWN FURTHER
AND FURTHER AND FURTHER, UNTIL
YOU MAY GET TO THE FINAL STAGE,
NUMBER THREE, THAT HE
DESCRIBED, EXHAUSTION.
OKAY?
AND THAT'S WHEN PROBLEMS AND
HEALTH CUMULATIVE EFFECTS MAY
START TO HAPPEN.
OKAY, LET'S LOOK AT THE
PHYSIOLOGY OF STRESS FOR A
MOMENT.
AS DOCTOR POOLE SO ELOQUENTLY
SHOWED US, THE BODY HAS VARIOUS
NERVES IN DIFFERENT SYSTEMS.
WE'VE GOT AN ALERT SYSTEM TO
WAKE UP, GET GOING, GET READY
TO FIGHT.
GET READY TO RUN, AND A
PARASYMPATHETIC OR A QUIETER
SYSTEM TO CALM YOU DOWN AND
RELAX YOU.
SO, THE PHYSIOLOGY OF STRESS IS
VERY CHEMICAL AND NEUROLOGICAL
AND BIOLOGICAL IN OUR BODIES.
SO, YOU HAVE YOUR ALERT SYSTEM.
YOUR SYMPATHETIC NERVOUS SYSTEM
THAT GETS YOU GOING.
IF YOU HAVE A COFFEE, THAT'S
THE ONE THAT GETS BOOSTED UP.
YOU HAVE YOUR PARASYMPATHETIC
NERVOUS SYSTEM.

He points to the slide with a laser pointer and continues
THAT'S THE ONE THAT CALMS YOU
DOWN.
THERE'S NERVES LIKE THE VAGUS
NERVE.
NOT, NOT THE PLACE YOU GO TO
SEE WAYNE NEWTON SING SONGS.
BUT THE VAGUS NERVE.
THE HYPOTHALAMUS IN THE BRAIN.
THE PITUITARY GLAND AT THE BASE
OF THE BRAIN.
THE ADRENAL GLANDS THAT SIT
JUST ABOVE YOUR KIDNEYS IN THE
BACK OF YOUR BELLY AND RELEASE
ADRENALIN.
AND STRESS WHEN IT CONTINUES,
CAN ALSO EFFECT YOUR IMMUNE
SYSTEM FUNCTION.
YOUR ABILITY TO FIGHT CERTAIN
TYPES OF INFECTIONS AND OTHER
DISEASES.
AND ONE OF THE NATURAL
RESPONSES WE HAVE IS CALLED,
FIGHT, FLIGHT, OR FRIGHT
RESPONSE.
HANDS UP THOSE WHO HAVE HEARD
OF THAT?
YEAH.
OKAY, MOST PEOPLE KNOW THAT.
THAT IS IF THERE'S A LION IN
THE JUNGLE COMING TO GET YOU,
OR SOMEBODY ABOUT TO MUG YOU,
OR THERE'S A BIG, SUDDEN,
SUSPENSE MOVIE, AND SOMEBODY
JUMPS OUT FROM BEHIND THE
WINDOW AND YOU WEREN'T
EXPECTING IT, YOU CAN GET THE
FIGHT, FLIGHT OR FRIGHT
RESPONSE.
AND THAT IS WHERE THE BRAIN
SENSES ANXIETY OR DANGER OR
WORRY, SENDS A, A, A SIGNAL TO
THE HYPOTHALAMUS IN THE BRAIN.
SO, THERE'S A WHOLE CIRCUIT
GOING ON HERE, TO THE PITUITARY
GLAND THAT RELEASES A PRE-
HORMONE.
OKAY?
SO, IT ACTUALLY RELEASES
SOMETHING.
IT GOES ALL THE WAY IN YOUR
BLOOD SYSTEM DOWN TO YOUR
ADRENAL GLANDS, AND THAT'S
WHERE ADRENALINE'S RELEASED.
AND THAT GOES INTO THE BLOOD
AND CIRCULATES ALL THROUGHOUT
THE BODY TO GET THE BODY READY
FOR ACTION.
OKAY?
AND GET GOING.
AND THAT HAS EFFECTS ON YOUR
BODY SYSTEMS.
ONE OF THE THINGS YOU HAVE TO
DO IF YOU'RE GONNA FIGHT OR
YOU'RE GONNA RUN, OR YOU'RE
SCARED, IS THAT THE HEART HAS
TO GET GOING.
YOU HAVE TO START BEATING.
ITS GOTTA START PUMPING.
WE GOTTA GET READY FOR ACTION.
WE'RE READY TO GO HERE.
OKAY?
FIRST PERIOD'S ABOUT TO BEGIN,
AND I'D RATHER BE TALKING ABOUT
HOCKEY TONIGHT.
BUT UM, THE MUSCLES MAY GOT HOT
AND SWEATY, BECAUSE THE BLOOD
IS FLOWING INTO DIFFERENT AREAS
AND OUT OF AREAS WHERE YOU
DON'T NEED IT.
YOUR STOMACH MIGHT START TO
CHURN, CAUSE THE BLOOD'S
SHIFTING AROUND AND YOU GET
BUTTERFLIES AND SOMETIMES A
NAUSEOUS OR QUEASY FEELING.
AND YOUR LUNGS START BREATHING.

Thomas pants and continues CAUSE YOU NEED
THE OXYGEN TO GET READY TO GET
GOING.
AND IF YOU KEEP BREATHING AND
YOU'RE NOT BURNING OFF THAT
OXYGEN YOU ACTUALLY START TO
HYPERVENTILATE, AND THEN YOU
MIGHT EVEN GET, WHOO, A LITTLE
LIGHT HEADED OR SOMETHING LIKE
THAT.
OKAY?
SO, THERE'S A PHYSIOLOGICAL
RESPONSE TO THAT.
WHAT ARE PANIC ATTACKS, OR
ANXIETY ATTACKS?

A slide reads “Panic Attacks-false alarms.”

He continues AS THEY'RE ALSO KNOWN.
PANIC ATTACKS OR ANXIETY
ATTACKS IS WHEN THAT WHOLE
FIGHT, FLIGHT OR FRIGHT
RESPONSE GOES ON IN YOUR BODY,
HORMONES ARE RELEASED, THE
BRAIN SAYS THERE'S A DANGER AND
WHOOSH, WE'RE READY FOR ACTION,
WHEN YOU'RE SITTING ON THE SOFA
WATCHING TV.
I MEAN WHAT'S GOING ON HERE?
YOU'RE LOOKING AROUND AND WHAT,
BOOM-BOOM-BOOM-BOOM-BOOM, AND -

[Panting]

Thomas continues AND YOU DON'T
QUITE UNDERSTAND.
AND THEY REPEAT OUT OF THE BLUE
FOR NO APPARENT REASON.
OKAY?
AND THOSE ARE PANIC ATTACKS,
AND SOMETIMES PEOPLE SAY, OH,
THEY'RE ALL IN YOUR HEAD.
DON'T WORRY, THERE'S NOTHING
WRONG WITH YOU.
NOTHING --

[Panting]

Thomas says WRONG WITH ME.
YEAH, TELL ME ABOUT IT.
RIGHT?
OKAY, SO THE EXPERIENCE IS VERY
REAL AND IT'S VERY PHYSIOLOGIC.
THAT'S PANIC ATTACKS.
THE PROBLEM IS YOU'RE GETTING
FALSE ALARMS.
THERE IS NO IMMEDIATE, IMMINENT
DANGER IN FRONT OF YOU, BUT THE
BRAIN IS SENSING DANGER FOR A
VARIETY OF DIFFERENT REASONS.
OKAY?
SO, THOSE ARE THE PANIC ATTACKS
OR THE FALSE ALARMS.
THERE'S ANOTHER ANXIETY
DISORDER, KNOWN AS GENERALIZED
ANXIETY DISORDER.

The slide changes to “Generalized Anxiety Disorder: excess worry about ordinary events.”

He continues AND WE'VE ALL SEEN WOODY ALLEN
MOVIES, WHERE HE'S WORRIED AND
HE'S NERVOUS.
OH, MY GOODNESS, I CAN'T
BELIEVE WHAT'S GONNA HAPPEN.
I THINK I'VE GOT A BRAIN
TUMOUR.
HE'S ALWAYS WORRYING.
AND IT'S QUITE COMICAL.
AND A LITTLE BIT OF WORRY CAN
BE QUITE FUNNY, NEUROTIC, THEY
USED TO CALL IT.
RIGHT?
BUT THERE ARE PATIENTS WHO
WORRY SO MUCH THAT ITS
UNREMITTING.
THEY'RE ALWAYS WORRYING ABOUT
SOMETHING, AND THEIR WORRIES
ARE NOT STRANGE WORRIES.
THERE THE WORRIES ABOUT THINGS
WE ALL WORRY ABOUT.
MONEY, FAMILY, HEALTH, AH, YOUR
MORTGAGE, THINGS LIKE THAT.
OKAY?
BUT IN THESE PATIENTS ITS
UNREMITTING.
IT WEARS THEM DOWN AND IT
IMPAIRS THEM FUNCTIONALLY.
SO, THEY SUDDENLY AREN'T
FUNCTIONING AS WELL AT WORK,
AREN'T FUNCTIONING AS WELL WITH
THEIR FAMILY, WITH THEIR
CHILDREN, IN THEIR
RELATIONSHIPS.
SO, WE MAKE A, YOU KNOW, IT'S
GOOD FUN IN THE MOVIES, BUT
THERE ARE PATIENTS WITH
GENERALIZED ANXIETY DISORDER
WHERE THEY NEVER RELAX AND GO
DOWN TO NORMAL.
WHERE THEY'RE ALWAYS AT A
HEIGHTENED STATE OF ALERT.
OKAY?
DEFCON, WHATEVER, OR STATE
ORANGE, OR WHATEVER SYSTEM IS
GOING.
IT'S VERY HIGH ALL THE TIME.
OKAY?
OKAY, TRUE OR FALSE?
I'M WINNING THIS BY THE WAY, IN
CASE YOU WERE WONDERING.
WINNING THE LOTTO 6-49 SOLVES
ALL OF YOUR STRESS?
TRUE, HANDS UP.

[Audience laughing]

Thomas laughs and says FALSE, HANDS
UP.
OKAY.
THE CORRECT ANSWER IS FALSE.
OKAY.
LIFE EVENTS CAN CONTRIBUTE TO,
BUT THEY DON'T ACCOUNT FOR OR
CAUSE EVERYTHING THAT GOES ON
WITH US, AND A GOOD EVENT
DOESN'T NECESSARILY SOLVE ALL
YOUR PROBLEMS.
AND HOLMES AND RAHEY WERE A
COUPLE OF RESEARCHERS, AND THEY
FIRST DESCRIBED WHAT WE CALL,
THE SOCIAL READJUSTMENT RATING
SCALE.

A new slide shows a table.

He continues AND THEY RANK IN TERMS OF
STRESS NUMBERS, FROM 100, THE
MOST STRESSFUL EVENT, DEATH OF
A SPOUSE, DOWN TO LESS
STRESSFUL THINGS.
AND YOU'LL NOTICE CERTAIN ITEMS
LIKE NUMBER SEVEN, HOPEFULLY A
HAPPY EVENT IN YOUR LIFE,
MARRIAGE, UM, IS QUITE A
STRESSFUL EVENT, AND THEY
ACTUALLY ASSIGNED THAT 53
POINTS.
OTHER EVENTS ON THERE INCLUDE
NUMBER TEN, RETIREMENT.
AGAIN, SOMETHING MOST PEOPLE
LOOK FORWARD TO.
YOU KNOW, FREEDOM, WHATEVER,
NUMBER THEY PRETEND TO TELL US
ABOUT.
AND NUMBER 16, CHANGE IN
FINANCIAL STATE.
SO, WINNING THE LOTTERY,
SUDDENLY GETTING ALL THIS MONEY
SOUNDS LIKE A GREAT IDEA, BUT
IT'S ACTUALLY VERY STRESSFUL.
AND OFTEN CHANGES IN OUR LIVES
ARE VERY STRESSFUL.
EVEN GOOD CHANGES.
GOOD OR BAD CHANGES.
OKAY?
OKAY.
DEPRESSED PEOPLE ARE JUST
OVERSTRESSED?
HANDS UP, TRUE.
FALSE.
OKAY.
RIGHT.
THE ANSWER IS FALSE.
EARLIER I ASKED IF EVERYONE
GETS DEPRESSED FROM TIME TO
TIME.
EVERYBODY GETS THE FEELING OF
DEPRESSION FROM TIME TO TIME.
FEELING SAD OR BLUE FROM TIME
TO TIME.
BUT WHOEVER NAMED THIS ILLNESS
DIDN'T GIVE IT A VERY SMART
NAME IN MY OPINION.
THEY SHOULD HAVE NAMED IT SMITH
DISEASE, OR JONES' DISEASE, OR
PARKINSON'S DISEASE, OR
ALZHEIMER'S, OR AFTER SOMEBODY.
BECAUSE WHEN YOU SUGGEST
DEPRESSION IS AN ILLNESS, YOU
START SAYING, WELL, EVERYONE'S
DEPRESSED.
HOW CAN THAT BE AN ILLNESS?
WHAT PHYSICIANS ARE TALKING
ABOUT, OR MENTAL HEALTH
PROFESSIONALS ARE TALKING
ABOUT, IS CLINICAL, MAJOR
DEPRESSION.
OKAY?
AN ENTIRELY DIFFERENT ENTITY
THAN NORMAL, SAD OR DEPRESSED
MOOD.
BUT THE WORD DEPRESSION MAY
CONFUSE US.
SO, IT'S CALLED CLINICAL
DEPRESSION.
IT'S SOMETIMES REFERRED TO
TECHNICALLY AS A MAJOR
DEPRESSIVE DISORDER, OR A MAJOR
DEPRESSIVE EPISODE.
OKAY?
AND THOSE ARE MEDICAL ILLNESSES
WE'RE TALKING ABOUT.
TRUE OR FALSE?
MAJOR DEPRESSION IS A MEDICAL
ILLNESS AFFECTING THE BODY AND
THE MIND?
HANDS UP FOR TRUE.
HANDS UP FOR FALSE.
THE CORRECT ANSWER IS TRUE.

A scan of a brain appears on a large screen.

He continues THIS IS A NORMAL BRAIN.
NICELY LIT UP, LOTS OF BLOOD
FLOWING, BRAIN ELECTROCHEMICAL
ACTIVITY.
THINKING, FEELING, ENJOYING.
THIS IS A DEPRESSED BRAIN ON A
PET SCAN.
IT IS BLUE, COOLER.
NOT AS MUCH ELECTROCHEMICAL
ACTIVITY.
NOT AS MUCH FLOW.
THE BRAIN IS ACTUALLY NOT
FUNCTIONING AS WELL WHEN
THEY'RE DEPRESSED.
SO, SURPRISE, SURPRISE.
YOUR MOOD SYSTEM, ONE OF THE
TWO THINGS THE BRAIN DOES,
AMONGST OTHER THINGS IS YOUR
MOOD AND YOUR THOUGHTS, YOUR
MOODS GO DOWN.
WHAT ARE THE SYMPTOMS OF
DEPRESSION?
WELL, MOST PEOPLE GET A
DEPRESSED, SAD, DOWN, OR BLUE
MOOD.
HOWEVER, OTHER PEOPLE, IT
DOESN'T MANIFEST IT SO MUCH AS
SADNESS AS MUCH AS
IRRITABILITY.
ANXIOUS, UPSET, CRANKY, NEVER
HAPPY.
OKAY?
MEN ARE PARTICULARLY MORE PRONE
TO THE IRRITABLE MANIFESTATIONS
FOR SOME REASON.
SLEEP CAN BE DISTURBED.
95 percent OF PATIENTS OR SO, SLEEP
LESS, THEIR SLEEP IS
INTERRUPTED.
BUT THERE'S A SMALL GROUP OF
ABOUT FIVE PERCENT WHO SLEEP
MORE.
THEY GET HYPERSOMNIA.
TOO MUCH SLEEP.
INTEREST IS CHANGED, AND THEIR
MOTIVATION FOR THINGS OFTEN
DECREASES.
OKAY?
GUILT IS PROMINENT.
THEY HAVE GUILTY FEELINGS MORE
THAN THEY NORMALLY DO.
I AM RESPONSIBLE FOR THINGS.
IT'S ALL MY FAULT, AND THEY GET
THESE COGNITIVE THOUGHTS ABOUT
THAT.
ENERGY USUALLY GOES DOWN.
CONCENTRATION IS DISTURBED.
THEY CAN'T THINK AS CLEARLY.
THEY CAN'T FOCUS ON THEIR WORK,
AND SOMETIMES THEY COME IN
THINKING THEY HAVE DEMENTIA OR
ALZHEIMER'S DISEASE.
AND THAT'S A COMMON COMPLAINT
PRESENTING FOR DEPRESSION.
APPETITE CAN BE DISTURBED.
USUALLY REDUCED AND THEY MIGHT
LOSE WEIGHT.
BUT AGAIN FIVE PERCENT OF
PEOPLE SOMETIMES EAT MORE AND
GAIN WEIGHT.
AND IT'S THAT SAME FIVE PERCENT
WHO USUALLY SLEEP MORE AND EAT
MORE.
IT'S CALLED ATYPICAL
DEPRESSION.
PSYCHOMOTOR SYMPTOMS, SO, THEY
CAN GET HEAVY, LEADEN, SLOW,
BODY FEELINGS WHERE THEY DON'T
WANT TO MOVE.
IT'S AN EFFORT TO MOVE.
OR THEY CAN BE FIDGETY AND
EDGY, AND THEY JUST CAN'T SIT
STILL, AND ANTS IN THEIR PANTS,
AND JUST RESTLESS, WRINGING
THEIR HANDS A LOT.
IT'S CALLED PSYCHOMOTOR
AGITATION.
AND FINALLY ONE OF THE MOST
SERIOUS, SYMPTOMS, SUICIDAL
THOUGHTS.
THEY CAN HAVE THE THOUGHTS.
THEY CAN HAVE ACTUAL PLANS,
INTENT AND ACTUALLY GO ON TO
ATTEMPT AND AT TIMES
UNFORTUNATELY, COMPLETE
SUICIDE.
HOW MIGHT YOU RECOGNIZE THAT
YOU HAVE A MAJOR DEPRESSION?
WELL, YOU CAN ASK YOURSELF
THESE QUESTIONS.
DO YOU FEEL SAD OR HOPELESS OR
IRRITABLE?
DO YOU, AND YOU WANT FIVE OUT
OF NINE OF THESE TO DIAGNOSE
CLINICAL DEPRESSION FOR TWO
WEEKS, STRAIGHT.
DO YOU FEEL SAD OR HOPELESS OR
IRRITABLE?
DO YOU, YOU CAN DO THIS FOR
YOURSELVES.
YOU DON'T HAVE TO SHOW YOUR
NEIGHBOUR.
IT'S UP TO YOU.
DO YOU SLEEP LESS OR MORE THAN
USUAL?
DO YOU LACK INTEREST OR
PLEASURE IN MOST DAILY
ACTIVITIES?
DO YOU FEEL GUILTY FOR MANY
THINGS?
ARE YOU TIRED AND LACK ENERGY
MOST OF THE TIME?
IS IT DIFFICULT TO CONCENTRATE
ON THINGS, MAKE DECISIONS?
HAS YOUR APPETITE CHANGED?
ANY CHANGE IN YOUR WEIGHT?
THAT'S A GOOD SIGNI, SIGNIFIER.
DO YOU FEEL PHYSICALLY SLOWED
DOWN OR FIDGETY?
DO YOU THINK SOMETIMES LIFE
ISN'T WORTH LIVING, OR YOU'RE
BETTER OFF DEAD OR COMMITTING
SUICIDE?
AND YOU'RE NOT GONNA GIVE
ANYBODY THE IDEA TO DO IT,
BECAUSE YOU ASK THEM THE
QUESTION.
THAT'S A COMMON FEAR, AND A LOT
OF, AND DOCTORS OFTEN HAVE THE
FEAR.
I'M NOT GONNA ASK THEM, BECAUSE
I DON'T WANT TO GIVE THEM THE
IDEA, AND THAT'S GONNA BE MY
FAULT THEY DID IT.
IN FACT IT'S QUITE THE
OPPOSITE.
PEOPLE ACTUALLY FIND IT THAT
THERE'S A REDUCED LIKLIHOOD,
BECAUSE FINALLY THEY CAN SHARE
THEIR THOUGHTS WITH SOMEBODY,
TALK ABOUT IT, AND THEY CAN
INTERVENE.
AND ACTUALLY TALKING ABOUT IT
IS ACTUALLY HELPFUL.
IT MAKES IT LESS LIKELY.
OKAY?
AND MOST PATIENTS WHO THINK
ABOUT IT OR MAKE AN ATTEMPT OR
DO IT, HAVE ACTUALLY VISITED A
DOCTOR WITHIN THE MONTH OR SO
BEFORE ATTEMPTING SUICIDE.
OKAY?
OR COMMUNICATED IT TO A LOVED
ONE.
SO, IT'S IMPORTANT TO ASK AND
TALK ABOUT IT.
MAKE IT SAFE.
PUT IT ON THE TABLE.
OKAY?
SO, FOR MAJOR DEPRESSION YOU
NEED TWO WEEKS OF CONSISTENT
DOWN MOODS.
SO, IF YOU HAVE A BAD DAY OR
TWO, THE WEATHER WAS REALLY
LOUSY HERE FOR QUITE A WHILE,
BUT PARTICULARLY A FEW DAYS
AGO, YOU HAVE TWO OR THREE DAYS
YOU JUST FEEL HORRIBLE.
YOU COULD PROBABLY COUNT FIVE
OF THOSE NINE SYMPTOMS.
BUT NOW IT'S OKAY, THE SUN WAS
SHINING TODAY.
THAT'S NOT A CLINICAL
DEPRESSION.
YOU NEED TWO WEEKS STRAIGHT,
FIVE OF THOSE NINE SYMPTOMS,
AND YOU'VE GOT HAVE A DEPRESSED
MOOD OR LOSS OF INTEREST AS ONE
OF THEM.
TRUE OR FALSE?
WHEN MEN ARE BEING HONEST,
DEPRESSION RATES ARE EQUAL FOR
MEN AND WOMEN?

Slides continue to run.

He continues OKAY, THE CORRECT ANSWER IS
FALSE.
IT TURNS OUT THAT IN ANY MOMENT
IN CANADA, IT'S ABOUT A TWO TO
ONE LIKLIHOOD, WOMEN MORE
LIKELY THAN MEN.
AND THIS IS CONTROLLED IN THE
RESEARCH.
THEY'VE TRIED TO TAKE OUT SEX
BIAS FACTORS AND THINGS LIKE
THAT.
SO, AT ANY MOMENT IN TIME, MEN,
TWO TO THREE PERCENT, WOMEN
FIVE TO NINE PERCENT.
YOUR LIFETIME RISK AS A WOMAN,
DEPENDING ON THE STUDIES IS 10
TO 25 percent, AND FOR MEN IS FIVE TO
TWELVE PERCENT.
MOST PEOPLE SAY IT'S ABOUT 11
OR 12 PERCENT.
OKAY?
SO, A VERY HIGH LIKLIHOOD IN
YOUR LIFETIME OF PEOPLE HAVING
THAT.
OKAY, TRUE OR FALSE?
DIRECT AND INDIRECT COSTS OF
DEPRESSION IN ONTARIO ARE
ESTIMATED AT 50 MILLION DOLLARS
PER YEAR?
HANDS UP, FOR TRUE.
A LOT OF MONEY.
HANDS UP, FOR FALSE.
THAT IS FALSE.
500 MILLION IS THE ACTUAL
AMOUNT.

[whistling, murmuring ]

Thomas says OKAY?
AND AS ONE OF MY COLLEAGUES,
DOCTOR SOTO, A FRIEND OF MINE FROM
MEDICAL SCHOOL WHO WORKS AS AN
EMPLOYEE, HEALTH PHYSICIAN,
TELLS ME THE NUMBER ONE CAUSE
NOW OF WORKPLACE DISABILITY IS
BECOMING MENTAL HEALTH
DISORDERS.
OKAY?
SO, IT'S BIG TIME STUFF.
OKAY, THE WORLD HEALTH
ORGANIZATION STUDY IN 1990,
LOOKED AT DISABILITY ADJUSTED
LIFE YEARS.
THEY TOOK A MEASURE WHERE THEY
ADDED UP ALL THE ILLNESS AND
DEATHS, AND MORBIDITY AND
MORTALITY FROM ALL ILLNESSES IN
THE WORLD.
OKAY?
AND IN THIS AGE GROUP, THE 15
TO 44 YEAR OLDS, THE TIME WHERE
PEOPLE ARE FORMING
RELATIONSHIPS, STARTING
CAREERS, STARTING FAMILIES OFF,
UNIPOLAR DEPRESSION THAT WE'RE
TALKING ABOUT, WAS THE NUMBER
ONE CAUSE OF DISABILITY
WORLDWIDE.
THIS BLEW ME AWAY.
AHEAD OF THINGS LIKE TRAFFIC
ACCIDENTS, EVEN AHEAD OF WAR
AND VIOLENCE.
YOU'LL SEE THAT BIPOLAR
DISORDER, ANOTHER MOOD
DISORDER, WHERE THEY NOT ONLY
GO DOWN AND SAD, BUT THE BRAIN
NOW FUNCTIONS.
PEOPLE GET TOO MUCH ENERGY.
THEY GO THE OTHER WAY.
THEY USED TO IT MANIC
DEPRESSION.
WE NOW CALL IT BIPOLAR, BECAUSE
WE GO BOTH WAYS.
IT IS ACTUALLY QUITE HIGH UP
THERE.
IT'S NUMBER SIX.
SO, MOOD DISORDERS CAUSE A LOT
OF DISABILITY.
OKAY, THAT'S THE DEPRESSION
SIDE OF THINGS.
LET'S GO TO THE ANXIETY SIDE OF
THINGS.
HOW MIGHT YOU RECOGNIZE YOU'RE
HAVING A PANIC ATTACK, OR THAT
YOU HAVE PANIC DISORDER?
AND ONE ATTACK OF PANIC DOESN'T
MAKE YOU HAVE PANIC DISORDERS.
THEY'VE GOT TO BE RECURRENT.
OUT OF THE BLUE, YOUR HEART
STARTS POUNDING.
YOU FEEL DIZZY.
YOU CAN'T BREATH.
YOU FEEL LIKE YOU'RE ABOUT TO
DIE.
YOU'VE HAD THESE SYMPTOMS OVER
AND OVER AGAIN.
OKAY?
SO, THOSE MIGHT BE INDICATIONS
THAT YOU'RE HAVING PANIC
DISORDER.
AND SOMETIMES BECAUSE YOU DON'T
WANT TO GO ONTO A BUS, OR ONTO
THE TTC, OUR SUBWAY SYSTEM, OR
TO A PARTY, OR ANY CROWDED
PLACE AT THE MALL, BECAUSE IF
YOU START HAVING ONE OF THESE,
YOU'RE GONNA NEED AIR, CAUSE
YOU NEED TO BREATH.
AND YOU WON'T BE ABLE TO GET
OUT.
YOU'LL BE STUCK.
YOU STOP GOING TO THOSE PLACES,
AND THAN THAT BECOMES SOMETHING
CALLED AGOROPHOBIA.
FEAR OF GOING OUT TO CROWDED
PLACES.
HOW DO YOU RECOGNIZE YOU MIGHT
HAVE ONE OF THE OTHER ANXIETY
DISORDERS?
GENERALIZED ANXIETY DISORDER,
THE ONE THAT DOESN'T GO AWAY.
WELL, YOU'RE ALWAYS WORRIED
ABOUT THINGS, EVEN WHEN THERE
ARE NO SIGNS OF TROUBLE.
YOU HAVE FREQUENT ACHES AND
PAINS THAT CAN'T BE TRACED TO
PHYSICAL ILLNESS OR INJURY.
THAT'S GONNA BE THE NUMBER ONE
THING BRINGING PEOPLE INTO YOUR
OFFICES, IF YOU BECOME
PHYSICIANS.
OKAY?
THEY CALL THAT SOMATIZING.
BODILY EXPERIENCING THOSE
EMOTIONAL SYMPTOMS.
OKAY?
AND IT'S HARD TO CONVINCE
PEOPLE, EVEN WHEN ALL THE TESTS
ARE DONE.
AND JUST THINK OF THE AMOUNT OF
MONEY WE SPEND ON TESTS, OVER
AND OVER CONVINCING PEOPLE THAT
WE KNOW THERE ISN'T THAT TYPE
OF AN ILLNESS THERE.
WE THINK IT'S AN ANXIETY TYPE
OF ILLNESS OR A DEPRESSION TYPE
OF ILLNESS.
YOU GET TIRED EASILY AND YOU
HAVE TROUBLE SLEEPING.
YOUR BODY IS CONSTANTLY TENSE,
AND THAT MIGHT BE GENERALIZED
ANXIETY DISORDER.
WHY DO SOME PEOPLE GET ILL AND
NOT OTHERS?
WELL, THERE'S A VARIETY OF
REASONS.
GENETIC VULNERABILITY.
WE NOW KNOW THAT MOOD DISORDERS
AND DEPRESSION DO TEND TO HAVE
A GENETIC COMPONENT AND IF YOU
HAVE FIRST DEGREE RELATIVES
WITH IT, YOU'RE MORE LIKELY
THAN MAYBE HAVE A RISK OF
DEVELOPING IT.
IT DOESN'T MEAN THAT FOR SURE
YOU'RE GONNA GET IT.
BUT YOU'RE MORE LIKELY THAN IF
SOMEBODY WHO WASN'T RELATED TO
YOU HAD IT.
OKAY?
SO, THERE IS A COMPONENT OF
GENETIC THINGS.
SO, IF YOU WANT TO BLAME IT ON
YOUR PARENTS, GO RIGHT AHEAD.
THAT CAN BE DONE.
NEGATIVE LIFE EVENTS.
WE KNOW THAT PEOPLE THAT HAVE
EXPERIENCED NEGATIVE LIFE
EVENTS ARE MORE LIKELY TO
DEVELOP DEPRESSION.
ESPECIALLY EARLY IN LIFE,
ABUSE, PHYSICAL ABUSE,
EMOTIONAL ABUSE, SEXUAL ABUSE
ARE NEGATIVE THINGS IN A
PERSON'S LIFE THAT MAY GO ON TO
INFLUENCE THEIR FUTURE, AND
EARLY LOSS.
AH, LOSS OF PEOPLE CLOSE TO
THEM, PARTICULARLY PARENTS.
SO, THOSE ARE LIFE EVENTS THAT
MAY CONTRIBUTE.
WHAT ACTUALLY HAPPENS IN THE
BRAIN WHEN WE DEVELOP A
DEPRESSIVE ILLNESS?
NOW, I SHOWED YOU A, A SCAN
BEFORE OF A BRAIN.
THIS IS JUST TO SHOW YOU, NOT
TO GET DETAILED YET, THAT
DIFFERENT AREAS OF THE BRAIN
LIGHT UP DIFFERENTLY, CAUSE
WHEN SOMEONE'S DEPRESSED, WE'RE
STARTING TO FIND THAT CERTAIN
AREAS IN THE BRAIN AREN'T
WORKING THE WAY THEY SHOULD AND
LOCALIZING IT.
WE DON'T KNOW ENOUGH ABOUT THIS
TO KNOW EXACTLY WHAT AREAS IN
WHICH CASES.

He uses the laser pointer on another scan of the human brain and continues
BUT THEY ARE AREAS LIKE THE
FRONTAL CORTEX WE TALKED ABOUT.
THE IMIGDILO, WHICH IS PART OF
YOUR MOOD AND LYMPIC SYSTEM,
SOME OF THAT OLDER, EMOTIONAL
RESPONSE THAT AREN'T WORKING
THEY SHOULD BE.
SO, WE'RE DOING TONS OF VERY
INTERESTING RESEARCH AND
IMAGING RESEARCH TO FIND OUT
WHAT'S GOING ON.
NOW IT'S NOT IN THE BIG LEVEL
AS TO WHAT'S GOING ON.
AT THE CELLULAR OR MICROSCOPIC
LEVEL, WE ALSO KNOW THERE ARE
CHANGES RIGHT AT THE CELLULAR
LEVEL.
BECAUSE THE WAY MESSAGES GO ON
THE BRAIN FROM ONE NERVE TO THE
NEXT, IS THEY JUMP OVER THESE
LITTLE, ELECTROCHEMICAL,
NEUROTRANSMITTERS.
AND THEY COME DOWN, A MESSAGE
COMES DOWN THE NERVE.
A LITTLE PACKAGE CALLED THE
SYNAPSET, AS THE SYNAPSET IS
RELEASED FROM THE VESSEL IT
GOES TO THE OTHER SIDE, THE
MESSAGE CONTINUES DOWN.
SO, THERE'S A FLOW, AND WHEN
PEOPLE ARE DEPRESSED, THAT FLOW
IS DISRUPTED.
SOME OF THE THINGS FLOWING
AREN'T FLOWING QUITE THE RIGHT,
QUITE THE RIGHT WAY.
SOME OF THE CHEMICALS YOU WILL
HEAR ABOUT AND SOME OF THE
MEDICATIONS WE USE TARGET THESE
CHEMICALS, INCLUDE THINGS LIKE
SEROTONIN.
NOREPHINEPHRINE, BRAIN
CHEMICALS, NEUROTRANSMITTERS.
AND TO A LESSER DEGREE WE'RE
LEARNING ABOUT OTHERS CALLED
DOPAMINE, AND NEWER CLASSES
THAT YOU MAY NOT HAVE HEARD
ABOUT NOW.
THINGS CALLED THE NEUROKININS,
SOMETHING CALLED BRAIN DERIVED
NEUROTROPIC FACTOR, WHICH
ACTUALLY AFFECTS THE GROWTH.
IT'S KIND OF LIKE THE
FERTILIZER MAYBE IN YOUR
GARDEN, IN THE BRAIN, WITH THE
BRAIN CELLS.
AND CORTISOL, WHICH IS A STRESS
HORMONE, AND THAT ONE'S GETTING
VERY INTERESTING RESEARCH THESE
DAYS.
OKAY.
DOES ANYBODY KNOW WHO THIS IS?
HE LOOKS LIKE A PSYCHIATRIST,
RIGHT?

An old painting of a man with long hair and a moustache appears.

[Audience murmurs]

Thomas says HOW MANY
PEOPLE THINK PSYCHIATRISTS ARE
STRANGE?
PUT YOUR HANDS UP.
JUST ONE HAND.

[Audience laughing ]

Thomas says OKAY.
I'M JUST CHECKING.
THANK YOU.
ANBODY RECOGNIZE THIS GENTLEMAN
BY ANY CHANCE?

A male member of the audience says RENE DESCARTES.

Thomas continues RENE
DESCARTES, OUI.
HE IS A VERY FAMOUS, FRENCH
PHILOSOPHER, WHO LIVED IN THE
LATE 1500S AND TO THE MID
1600S.
HE IS LARGELY RESPONSIBLE FOR
OUR CURRENT THINKING OF
SPLITTING THE MIND AND THE BODY
SEPARATE FROM EACH OTHER.
AND HE DID THIS SO THAT HE
COULD STUDY CERTAIN THINGS IN
THE BRAIN AND NOT UPSET THE
CHURCH, AND IT WAS A
PHILOSOPHICAL SHIFT, WHICH WAS
WONDERFUL, EXCEPT THAT HE
CAUSES ME A LOT OF PROBLEMS
TODAY.
BECAUSE OF THIS SHIFT IN MIND
AND BODY, WE HAVE A SPLIT
BETWEEN BODY AND MIND,
SOMETHING ORGANIC, WHICH IS THE
BODY.
WELL, THAT'S REAL YOU KNOW, AND
FUNCTIONAL.
WELL, IT'S JUST NOT WORKING
RIGHT.
IT'S NOT REAL.
IT MUST BE ALL IN YOUR HEAD.
YOU'VE ALL HEARD THAT.
OKAY.
WHEN I FIRST GOT INTO MEDICAL
SCHOOL I TOLD MY MOTHER.
THEY'RE, THEY CAME FROM
HUNGARY, VERY EXCITED.
I, MOM, DAD, I'M IN MEDICAL
SCHOOL.
OH, MY SON'S IN MEDICAL SCHOOL.
IT'S SO WONDERFUL.
AND I FINISHED MEDICAL SCHOOL,
AND I WAS DECIDING TO BE A
FAMILY PHYSICIAN FIRST THING.
SO, MOM AND DAD, I'VE DECIDED
I'M GONNA GO INTO FAMILY
PRACTICE.
OH, HE'S GONNA BE A FAMILY
DOCTOR.
SO LOVELY, WITH ALL THE BABIES
COMING THROUGH, NICE.
UM, AND THEN I WORKED FOR A
COUPLE OF YEARS AS A FAMILY
PHYSICIAN.
MOM AND DAD, I'VE DECIDED TO
SPECIALIZE.
OH, MY GOD, HE'S GONNA BE A
SPECIALIST.
OKAY.
OKAY, MOM AND
DAD I DECIDED ON PSYCHIATRY.
OH, MY GOD, HE'S GOING INTO
PSYCHIATRY.

[Audience laughs ]

Thomas says OKAY?
SO, YOU FEEL THE KIND OF SHIFT
THAT HAPPENS AND IT'S ALL BASED
ON THIS GUY.
OKAY, SO I CAN BLAME HIM FOR
IT.
BUT THAT PLAYS OUT
UNFORTUNATELY, IN YOUR CLINICAL
PRACTICE.
BECAUSE DO YOU THINK THIS IS A
REAL ILLNESS?
WILL YOU GIVE IT THE SAME KIND
OF CREDENCE OF REAL, OTHER
ILLNESSES?
PEOPLE COME INTO THE EMERGENCY
ROOM, AND SOMETIMES THEY'RE
THRASHING ABOUT, ODD BEHAVIOUR,
SOMETIMES THEY'RE EVEN
VIOLENCE.
THEY HIT A NURSE OR SOMETHING,
A TERRIBLE THING.
TERRIBLE THING.
BUT IF WE KNOW THAT THEY HAVE
BRAIN CANCER AND THEY'RE NOT
THINKING STRAIGHT, OH, THE
POOR, PATIENT.
IF WE KNOW THEY'VE JUST BEEN IN
A MOTOR VEHICLE ACCIDENT AND
HIT THEIR HEAD, THEY'VE GOT A
CONCUSSION AND THERE'S BLEEDING
IN THE BRAIN, LET'S HELP THIS
POOR PERSON OUT.
IF WE THINK THEY HAVE A MENTAL
HEALTH PROBLEM WE SAY, ALL
KINDS OF FEELINGS.
WE PUT HIM IN THE BACK ROOM,
AND WE MAY NOT GIVE IT THE SAME
CREDENCE.
SO, THAT'S ALL BASED ON THIS
GUY AND THIS SPLIT WE HAVE.
SO, WE HAVE TO WATCH OUT FOR
THAT.
THE TREATMENT, WELL, GEORGE
ENGEL, A FAMOUS PHYSICIAN,
DESCRIBED THE BIO-PSYCHO SOCIAL
MODEL, CAUSE YOU'RE GONNA COME
AT IT FROM THREE DIRECTIONS.
BIOLOGICAL, MEDICATIONS AND
OTHER BIOLOGICAL INTERVENTIONS.
PSYCHOLOGICAL, PSYCHOTHERAPIES,
AND SOCIAL INTERVENTIONS.
OKAY?
AND LET'S LOOK AT A FEW OF
THOSE, JUST TO GIVE YOU NICE
HOPE.
THIS IS ANOTHER PET SCAN.
THIS WAS A DEPRESSED BRAIN.
WITH TREATMENT, YOU SEE THE
AREAS LIGHTING UP, RECOVERED.
YOU ACTUALLY SEE THE CHANGES,
AND YOU SEE IT AT ABOUT THE
SAME TIME YOUR SYMPTOMS GET
BETTER.
SO, THAT'S A VERY HOPEFUL
STORY.
MY PATIENTS GET BETTER.
BIOLOGICAL TREATMENTS INCLUDE,
ANTIDEPRESSANT MEDICATIONS.
THIS IS AMAZING.
I, I GOT PAGED EARLY ONE
MORNING.
MY DAUGHTER WOKE UP.
I HAD TO RUN INTO THE HOSPITAL,
SEE A PATIENT IN THE EMERGENCY
ROOM.
AND SHE ASKED, DADDY, WHERE ARE
YOU GOING?
WHAT ARE YOU DOING?
AND I SAID, WELL, I'M GOING TO
SEE SOMEBODY.
THEY'RE NOT FEELING WELL IN THE
EMERGENCY ROOM.
SHE GOES, WHAT'S WRONG WITH
THEM?
SO, YOU'RE TRYING TO EXPLAIN TO
AN EIGHT YEAR OLD WHAT'S GOING
ON.
THEY'RE VERY SAD AND THEY'RE
VERY WORRIED, SO MUCH IT'S
MAKING THEM SICK.
SHE GOES, WHAT ARE YOU GONNA
DO?
I GO, I'M GONNA GO AND TALK TO
THEM FOR A LITTLE WHILE.
THAT'LL HELP, AND I MIGHT GIVE
HIM SOME MEDICATIONS.
SHE GOES, MEDICATIONS THAT CAN
MAKE HIM FEEL BETTER?
I GO, YEAH.
YOU CAN DO THAT?
SHE SAYS.
YEAH, WE CAN DO THAT.
SO, IT TOOK A CHILD TO ASK ME
TO, TO REFLECT UPON WHAT I'VE
BEEN DOING FOR YEARS.
HOW AMAZING THAT IS.
SO, WE HAVE ANTIDEPRESSANT
MEDICATIONS.
THEY RESET THE LEVEL OF
NEUROTRANSMITTERS IN THE BRAIN
BACK TO A NORMAL LEVEL.
THEY DON'T MAKE IT ABNORMAL.
THEY GO BACK TO A NORMAL LEVEL.
THERE ARE MANY CHOICES, AND YOU
CAN TALK TO YOUR DOCTOR ABOUT
WHICH ONE.
THEY DIFFER IN SIDE EFFECT
PROFILES.
BUT UNFORTUNATELY, THEY TAKE A
FEW WEEKS TO KICK IN.
USUALLY, THREE, FOUR, UP TO SIX
WEEKS TO KICK IN.
THEY DON'T CHANGE YOUR
PERSONALITY, AND THEY'RE NOT
ADDICTIVE.
AND DESPITE MY SAYING THAT,
MISTRESS SMITH DOWN THE STREET IS
GONNA TELL YOU A STORY ABOUT
HER COUSIN'S, AUNT'S, WIFE WHO
HEARD A STORY, AND THEY'RE
GONNA COME AND NOT DO WHAT
YOU'RE TELLING THEM TO DO.
OKAY?
BECAUSE IT'S VERY POWERFUL, THE
FEELINGS AROUND THIS STUFF.
SO, THAT'S BIOLOGICAL
TREATMENTS.
OTHER BIOLOGICAL TREATMENTS
YOU'RE GONNA LEARN ABOUT AND
YOU MAY CHOOSE TO DO, INCLUDE
LIGHT THERAPY.
PARTICULARLY NOW BEING USED FOR
SEASONAL DEPRESSION.
OKAY?
A SUBSET OF PATIENT.
YOU CAN'T USE ANY OLD LIGHT OR
YOU'RE GONNA BURN YOUR EYES,
YOU'RE GONNA HURT YOUR EYES.
YOU HAVE TO BUY A SPECIAL,
MEDICAL LIGHT THAT'S SAFE FOR
YOUR EYES.
SIT A CERTAIN DISTANCE FOR A
CERTAIN PERIOD OF TIME, SO YOU
CAN TALK TO THE DOCTOR ABOUT
THAT.
ECT, ELECTROCONVULSIVE THERAPY.
SHOCK TREATMENT.
OH, MY GOD.
OKAY?
HORRIBLY PORTRAYED IN THE MEDIA
AND IN THE MOVIES, BUT BEING
USED ALL THE TIME.
THE MOST EFFECTIVE TREATMENT
FOR DEPRESSION, AND EXTREMELY,
WELL STUDIED.
OKAY?
AND THEY'RE STILL, WE'RE DOING
LOTS OF IT, AND PATIENTS ARE
ANESTHETIZED.
IT'S NOT LIKE, NO ONE'S
BOUNCING AROUND.
OKAY?
EXPERIMENTAL TREATMENTS INCLUDE
MAGNETS, BELIEVE IT OR NOT.
THE DAYS, OLD DAYS OF ANTON
MESMER AND PEOPLE ARE BACK.
TRANSCRANIAL MAGNETIC
STIMULATION, AND THERE'S
RESEARCH GOING ON AT MCMASTER
UNIVERSITY AND OTHER PLACES,
AND VAGUS NERVE STIMULATION
HERE IN TORONTO, WHERE THEY
ACTUALLY MIGHT STIMULATE THAT
VAGUS NERVE WITH AN ELECTRODE
AT THE BASE OF THE BRAIN.
OKAY, PSYCHOTHERAPY.
WELL, I DO HAVE THIS RECURRING
DREAM THAT ONE DAY I MIGHT SEE
SOME RESULTS.

[Audience laughing ]
A slide displays a drawing a psychotherapist listening to a patient lying on a couch.

Thomas says OKAY.
THERE ARE DIFFERENT TYPES OF
PSYCHOTHERAPIES.
THIS IS THE KIND OF PSYCHO,
DYNAMIC, ANATLYTIC TYPE OF
THERAPY, WHICH UNFORTUNATELY,
THE RESEARCH, IT'S NOT SO EASY
TO RESEARCH.
IT HASN'T SHOWN AS IMMEDIATE OR
EASILY MEASURABLE EFFECTS FOR
DEPRESSION AND ANXIETY, BUT IT
CAN BE VERY USEFUL.
YOU NEED TO KNOW THAT THERE ARE
MANY THEORETICAL APPROACHES,
AND THAT THERE ARE GOOD AND BAD
THERAPISTS OUT THERE.
IN ONTARIO AND IN MOST OF
CANADA RIGHT NOW THERE ARE NO
STANDARDS FOR PSYCHOTHERAPISTS.
EVERY ONE OF YOU IS A
PSYCHOTHERAPIST, COULD BE A
PSYCHOTHERAPIST, BECAUSE WE
DON'T HAVE ANY LAWS OR RULES
GOVERNING THE CREDITS FOR
PSYCHOTHERAPY, SO YOU HAVE TO
BE VERY CAUTIOUS.
LOOK FOR ACCREDITED THERAPY
TRAINING.
MOST TREATMENTS, 10 TO 20 ONE
HOUR SESSIONS IS PRETTY
AVERAGE.
AND SPECIFIC TYPES THAT HAVE
SHOWN EFFECT FOR DEPRESSION AND
ANXIETY, INCLUDE COGNITIVE
BEHAVIOURAL THERAPY.
LOOKING AT THE THOUGHTS YOU'RE
HAVING AND INTERPERSONAL
THERAPY, FOCUSING ON THEIR
RELATIONSHIPS.
BUT EVERY TIME A PATIENT IS
BEING TREATED, WHETHER ITS
MEDICATION OR OTHERWISE,
SUPPORTIVE COUNSELLING AND
EDUCATIONAL COUNSELLING ABOUT
DEPRESSION AND ITS TREATMENTS
SHOULD BE PROVIDED ANYHOW.
LESSONS FROM COGNITIVE THERAPY,
YOUR THINKING STYLE.
WE FOCUS ON HOW PEOPLE THINK.
OKAY?
AND THESE ARE SOME OF THE
MISTAKES, SOME, THAT SOME
PEOPLE MAKE.
FOR INSTANCE, I WAS ON MY WAY
HERE, DRIVING DOWN HERE
TONIGHT, THERE WAS AN ACCIDENT
IN FRONT OF ME.
SO, IMMEDIATELY I COULD HAVE
THOUGHT, OH, MY GOD, THERE'S AN
ACCIDENT.
I'M GONNA BE LATE.
WHAT'S GONNA HAPPEN?
I'M NOT GONNA MAKE IT IN TIME.
THEY'RE GONNA THINK TERRIBLY OF
ME.
THEY'RE GONNA THROW ME OUT OF
THE UNIVERSITY.
I'M NOT GONNA HAVE A JOB AND
I'M GONNA GO DESTITUTE.
ALL IN A SPAN
OF ABOUT 20 SECONDS.
OKAY?
THE LIGHT
CHANGED, I WENT, IT WAS FINE.

[Audience laughing ]

Thomas continues SO, THAT COULD
BE BLACK AND WHITE THINKING OR
AWFULIZING OR CATASTROPHIZING.
THIS IS MARK BERBER'S WORK.
HE WORKS AT MARKHAM STOUFFVILLE
HOSPITAL AT THE MOMENT.
AH, DISCOUNTING POSITIVES,
MAXIMIZING THE NEGATIVES.
THAT'S THE CUP HALF FULL OR
HALF EMPTY.
OVERGENERALIZING,
OVERESTIMATING NEGATIVE
OUTCOMES, DEMANDING, AND SELF-
BLAMING YOURSELF.
SO, THOSE ARE COMMON ERRORS.
SO, YOU CAN ACTUALLY DO
PSYCHOTHERAPY TO TRY TO
DISCOVER THE WAY YOU THINK.
AND ARE YOU COMMITTING ANY
ERRORS OR NOT?
SOCIAL INTERVENTIONS.
OF COURSE THESE ARE OBVIOUS
WORK-RELATED ISSUES.
IF THERE'S A PROBLEM AT WORK,
YOU HAVE TO INTERVENE IN THAT
AND HOPEFULLY HELP THAT OUT.
FAMILY AND CHILD CARE CAN BE
BIG STRESSES ON PEOPLE, AS CAN
HOUSING AND FINANCES.
LIFESTYLE CAN BE ADDRESSED AND
YOUR SUPPORT SYSTEM.
THEY ACTUALLY FIND PEOPLE WITH
A GOOD SUPPORT SYSTEM, IT'S ONE
OF THE BEST PREVENTIVE MEASURES
WE HAVE.
AND THAT COULD BE FAMILY.
THAT COULD BE A SCHOOL GROUP.
A RELIGIOUS AFFILATION,
WHATEVER.
A HEALTHY, BALANCED, LIFESTYLE
MAY HELP YOU PREVENT IT, BUT
NOT A GUARANTEE.
THINGS THAT ARE GOOD FOR YOU
FOR ELIMINATING ANXIETY INCLUDE
REGULAR EXERCISE.
CUTTING DOWN THE CAFFEINE, AND
IN YOUR FOOD PARTICULARLY IF
YOU'RE ANXIOUS.
ADEQUATE, GOOD, QUALITY, SLEEP.
AVOIDING TOO MUCH ALCOHOL OR
OTHER SUBSTANCES, BECAUSE THAT
CAN THEN FUEL DEPRESSION AND
ANXIETY PROBLEMS.
ALTHOUGH THEY MAY BE SEDUCTIVE
AND YOU MAY WANT TO SELF
MEDICATE WITH THOSE, THEY
ACTUALLY CREATE ANOTHER
PROBLEM.
AND INCREASING A SOCIAL SUPPORT
NETWORK.
TRUE OR FALSE?
PSYCHOTHERAPY IS EQUALLY
EFFECTIVE AS PHARMACOTHERAPY,
MEDICATIONS FOR MAJOR
DEPRESSION?
TRUE?
FALSE?
OKAY, THIS IS A BIT OF AN
UNFAIR QUESTION.
THE ANSWER IS, IT DEPENDS.

[Audience laughing ]

Thomas says IF YOU HAVE A
MILD, SORT OF MILD, OR MILD TO
MODERATE DEPRESSIVE ANXIETY
ILLNESS, THE EVIDENCE SHOWS
THAT THEY'RE PRETTY MUCH EQUAL.
OKAY?
SO, IF YOU DON'T WANT TO TAKE
MEDICATION AND YOU WANT TO DO,
DO THE WORK OF DOING GOOD,
PSYCHOTHERAPY COUNSELLING WORK
WITH AN ACCREDITED PERSON WHO
KNOWS WHAT THEY'RE DOING, UM,
YOU CAN GET GOOD OUTCOMES IF
YOU WANT TO DO THAT.
BUT ONCE THE DEPRESSION OR
ANXIETY IS QUITE SEVERE,
MODERATE TO SEVERE, YOU NEED
GENERALLY MEDICATIONS BECAUSE
IT CAN BECOME A LIFE
THREATENING ILLNESS.
AND WE USUALLY COMPLIMENT EACH
OTHER WITH BOTH SIDES OF THE
TREATMENT.
OKAY?
DON'T FORGET ABOUT OTHER CAUSES
OF A DEPRESSED MOOD, OR ANXIOUS
MOOD.
GENERAL MEDICAL CONDITIONS,
THYROID, MEDICATION AND
SUBSTANCE ABUSE.
I WORK WITH A WONDERFUL MULTI-
DISCIPLINARY TEAM AT NORTH YORK
GENERAL HOSPITAL, AS I HAVE AT
OTHER HOSPITALS.
IT'S, AH, WE INCLUDE SOCIAL
WORKERS, OUR FAMILY PHYSICIANS,
PSYCHIATRISTS, PSYCHOLOGISTS,
OCCUPATIONAL THERAPISTS,
NURSES, NUTRITIONISTS, AND
THERE'S OTHERS WHO I HAVEN'T
INCLUDED.
SO, THEY CAN ALL BE HELPFUL IN
PART OF THE TREATMENT TEAM.
I'VE GIVEN YOU A LIST OF SOME
RESOURCES INCLUDING YOUR FAMILY
DOCTOR.
IF YOU'RE IN TROUBLE, GO TO A
WALKIN CLINIC.
GO TO ANY HOSPITAL EMERGENCY
ROOM, PARTICULARLY IF YOU'RE,
IF PEOPLE ARE SUICIDAL, YOU CAN
REFER THEM AND THERE ARE SOME
PHONE NUMBERS AND WEBSITES UP
THERE.
BE CAREFUL ABOUT THE
CREDIBILITY OF THE WEBSITES
YOU'RE SEEING.
SO, I'VE GIVEN YOU THOSE
NUMBERS.

A slate appears on screen. It reads “Canadian Mental Health Association (CMHA): www.cmha.ca. Canadian Network for Mood and Anxiety Treatments: www.canmat.org. Centre for Addiction and Mental Health: www.camh.net.”

He continues AND JUST TO REMIND YOU THAT IT
CAN BE A VERY SERIOUS ILLNESS,
AND DEATH RATES FROM MAJOR
DEPRESSIVE ILLNESS CAN BE TEN
TO FIFTEEN, CONTEMPLATING IT
AND COMPLETING IT.
SO, THAT WRAPS UP THE FORMAL
PART OF OUR PRESENTATION.
THANK YOU VERY MUCH.

[Audience applauding]

The slate changes t “For more information about Mini-Med School at the University of Toronto visit us on the web at: www.tvo.org.”

The end credits roll.

Mini-Med School Producer, Wodek Szemberg.

Logos: CEP Local 72 M and Canadian Media Gold.

A Production of TVO Ontario.

Copyright The Ontario Educational Communications Authority 2003.

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