Depression: A Killing Disease (with Dr. Nemeroff, part 1 of 2)

Depression is a killing disease: the effects of depression on the body beyond suicide
In the first part of this interview, Dr. Charles Nemeroff, Director of the University of Miami Center on Aging and Chairman of the Department of Psychiatry and Behavioral Sciences at University of Miami, discusses depression, including its symptoms, epidemiology, and the link to other physical illnesses like cardiovascular disease and diabetes. In particular, he discusses the role of depression in clot formation and inflammation. He then looks ahead to future studies and treatments that might target inflammatory factors, including stem cells, and argues for psychiatrists to consider obtaining inflammatory marker labs on every patient that they see.
TRANSCRIPT
Welcome to Psyched, a podcast about psychiatry that covers everything from the foundational to the cutting edge, from the popular to the weird. Thanks for tuning in.
Welcome to Psyched, a podcast about psychiatry that covers everything from the foundational to the cutting edge, from the popular to the weird. Thanks for tuning in.
David Carreon: Hey, everybody. This is David Carreon.
Jessi Gold: This is Jessi Gold.
David Carreon: And this is Psyched, a psychiatry podcast. Today, we have Dr. Charles Nemeroff, the Leonard M. Miller Professor and Chairman of the Department of Psychiatry and Behavioral Sciences at the University of Miami. He was born in New York City and graduated from City College of New York in 1970. He earned his PhD in neurobiology and his MD from the University of North Carolina at Chapel Hill. Dr. Nemeroff has received numerous honors during his career, including the distinguished Menninger Prize from the American College of Physicians and the Research Award from the American Foundation for Suicide Prevention. He's published more than 1100 research reports and reviews. Dr. Nemeroff, thank you for joining us on the show.
Charles Nemeroff: It's a really pleasure to be here with both of you.
Jessi Gold: Thank you.
David Carreon: You've got an incredible body of work here. We'd like to start the conversation off about depression. For our audience that does have a pretty broad range, what is depression? What is its essence? What does it look like?
Charles Nemeroff: Depression is a syndrome, a collection of symptoms like any disease. It happens to be a very common disorder, so that about 11% of men and about 21% of women in their lifetime will suffer with what we call major depression. The constellation of symptoms, of which you have to have five of nine in the DSM-5 criteria, include such symptoms as sleep disturbance, difficulty falling asleep, having trouble staying asleep, waking up too early, although a small percentage of patients oversleep. A very clear decrease in appetite. Most people, a decrease with body weight loss. Some small number, an increase. Difficulty concentrating, thinking, making decisions.
Obviously, the symptom we worry about the most . . . is suicide. Suicide is the 10th leading cause of death in the United States. It's the only one of the top 10 causes of death that are increasing in number. All the others, including stroke, cancer, heart disease, are decreasing in number. And we can talk about that, if you'd like.
But depression is this terrible syndrome. Its cornerstone is the inability to experience pleasure. If you think about the worst day of your life, loss of a loved one, lost your job, breakup of a relationship, think about feeling that way every day and not knowing why. There's a feeling of hopelessness and helplessness associated with depression that, of course, then leads to suicidal thinking.
David Carreon: It's a pretty devastating condition and something that both Jessi and I have seen plenty of patients with. I guess, from your perspective as somebody who's done a lot of research in biological psychiatry, what does depression look like in the brain, from your perspective?
Charles Nemeroff: Well, before I answer that, let me just interject a couple of other things about depression for the audience. First, one of the really important facts to know is that depression is a systemic illness. It affects the whole body. Part of having depression is being very vulnerable for other medical disorders, including diabetes, heart disease, certain forms of cancer, stroke. Depression is a killing disease. Not only does it kill you by suicide, it kills you because your life expectancy is shorter because of the biology of the illness. What I mean by that is the biology of depression is not just in the brain. It's in the whole body.
David Carreon: I think that's an important thing to emphasize. Certainly, on some popular levels, it's all in your head, just snap out of it. But you're saying that it's something much more than that. It's not even just in ...