Return to Transcripts main page
CNN Live Today
'Paging Dr. Gupta': Interview With Dr. Philip Ninan
Aired October 10, 2002 - 11:47 ET
THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.
THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.
DARYN KAGAN, CNN ANCHOR: At some time or another, many of us get depressed. But how do you know if you're just having a bad day or a more serious problem?
Today, we're "Paging Dr. Sanjay Gupta" on breaking the stigma of mental illness. And last hour, we learned some of the facts. Now we're going to hear from you and your questions.
Dr. Gupta joining us again from New York, he did not go far, as instructed. And then, here with me in Atlanta across our newsroom, Dr. Philip Ninan. He is a professor and director of the mood and anxiety disorders program at Emory University School of Medicine.
Doctors, plural, good morning and thanks for being with us.
SANJAY GUPTA, CNN MEDICAL CORRESPONDENT: Good morning.
KAGAN: Sanjay, you wanted to start with a question for Dr. Ninan.
GUPTA: Yes, and one of the things that sort of strikes, Dr. Ninan, is that it seems like we see more depression than we ever have before. And I was curious as to whether you think this is more a reflection of increased awareness and increased diagnosis, or are we just actually seeing more depression than ever before?
DR. PHILIP NINAN, EMORY UNIVERSITY SCHOOL OF MEDICINE: There is an increase in awareness about depression, but there is also evidence that the prevalence and the incidents of depression seems to be increasing every decade. In fact, it seems to be happening at a younger and younger age group.
GUPTA: So, really sort of a combination of both things there.
We've got lots of e-mail questions, as Daryn mentioned. Let's just go ahead and get to our first one right away.
This first question comes to us from Alison Hann, who asks: "Can someone who has suffered a 'nervous breakdown' -- quote/unquote -- return to normal health, or do they generally have mental problems to some degree?"
Dr. Ninan, can people recover fully and get back to their normal way of life?
NINAN: Well, a nervous breakdown is a very broad term, and there are a number of different illnesses that can occur. So, you can have an illness that you have a break from reality, like schizophrenia, or you have changes in the way you feel, so you can have an anxiety disorder or depression.
Some disorders are continuous, and others are more episodic in nature. And you can have full recovery in some, and others you can have residual symptoms that you continue to struggle with.
KAGAN: Our next question coming from Milwaukee, Wisconsin, a good one, because it comes down to having the money to pay for treatment. This one from Emily Schultz. She asks: "How can one be expected to apply for health insurance with mental illness? If you tell the truth about your illness, you will most likely be rejected. Are we supposed to lie to compensate for the insurance industry's prejudice?"
Dr. Ninan, you must deal with this all of the time.
NINAN: Yes, and it's really a very challenging situation. And what I would say is that we all should be advocating for parity for mental illness coverage, because it is sad when you have an illness. It is tragic when you have an illness, where a treatment is available, but you can't deliver the treatment because of some issue like lack of insurance or financial capacity to pay for the medication that might bring about a dramatic result.
KAGAN: So, what do you do? What would be your recommendation to our viewer out there?
NINAN: I would never tell somebody to openly lie about an issue like that, but I think you should be able to talk to people that might have the capacity to make differences in those policies.
KAGAN: Sanjay, you have the next one?
GUPTA: Yes, let's keep going. We've got another question from Chris, I think this is in Fort Smith, Arkansas. The question: "I have a 39-year-old friend that has BDM" -- it stands for Body Dysmorphic Disorder. "He is totally obsessed with aging, his hair, his face, but his hair and face are fine. He talks about his hair or face several times a day." It sounds like Bill Hemmer, doesn't it, Daryn? "No amount of reassurance helps."
KAGAN: Bill is not here to defend himself -- not fair.
GUPTA: I know. Don't tell him I said that. His hair and face are fine as well
"What is the treatment for this sort of disorder?"
Dr. Ninan, have you heard of this sort of thing, and is there a treatment for this?
NINAN: Yes, Body Dysmorphic Disorder is a condition of imagined ugliness. And what's happening in this disorder, we think, is that the representation of the body in our brain, there is an area of what we call the somatosensory cortex, where our body is represented. And that particular area for some reason in this individual might be overrepresented. And so, the person can't seem to let it go, and they are stuck on that.
Reassurance does not seem to be very effective in this condition. A medication group called the selective serotonin reuptake individuals has been demonstrated in controlled studies to be very effective. And so, medication would be one strategy.
Cognitive behavior therapy, a form of psychotherapy, might also be effective in this condition.
KAGAN: John...
GUPTA: Do they actually...
KAGAN: Oh, go ahead, Sanjay. I didn't mean to interrupt you.
GUPTA: Do they actually have something that you would see wrong with their brain if you did an MRI scan or actually looked at it? Or is this totally something that you just see in terms of behavior?
NINAN: It wouldn't necessarily be a structural abnormality. It would be a functional abnormality. So that the amount of activity that might be going on in this particular area might be exaggerated to the detriment of other areas that might potentially balance it out.
GUPTA: Well, that's fascinating -- Daryn.
KAGAN: All right, we have time for one more question, and it's almost a philosophical one, which I think is interesting for history buffs out there.
It's from John in Pennsylvania. He writes, he thinks: It is incredibly difficult to differentiate between personality flaws, as defined by society, and 'mental illness.' Who defines the behavior patterns which would result in being labeled as 'mentally ill'?"
Dr. Ninan, you look back towards history, and some the greatest figures we have had in this time might be considered mentally ill.
NINAN: Well, just like in other medical illnesses, there are illnesses where there is a very clear boundary between the ill person and somebody who doesn't have the illness. So, like schizophrenia for example, the boundary is very clear.
There are other illnesses, like say blood pressure, where it's on a spectrum, and you decide that at a certain point the person has moved from the normal spectrum to a mild version of the illness, a moderate or a severe version of the illness. And so, similarly in those situations, I mean, we consider a diastolic of 90 to be the threshold where you move into mild hypertension. But if you have a diastolic of 89 or 91, you would argue that that's a very fuzzy boundary.
So, similarly, there are mental illnesses which are on a spectrum of normal function. And so, the boundary is, in some ways, arbitrary. But clearly, when you get to the more severe ends of the spectrum, it is substantially different from the rest of the general, typical population.
KAGAN: Just real quickly, Dr. Ninan, best place for someone to go for help if they think they have a problem?
NINAN: Well, we have several systems. We have mental health central systems. We have academic systems. We have hospitals. So, it's really a question of where your insurance would send you, would cover your care. And that if you're not satisfied with the care that you're getting over the outcome, then you would want to explore other options.
KAGAN: But help is out there.
Dr. Philip Ninan from Emory University, Dr. Sanjay Gupta also with Emory, and ours right here, thank you so much.
NINAN: Thank you.
GUPTA: Good seeing you.
TO ORDER A VIDEO OF THIS TRANSCRIPT, PLEASE CALL 800-CNN-NEWS OR USE OUR SECURE ONLINE ORDER FORM LOCATED AT www.fdch.com.
Aired October 10, 2002 - 11:47 ET
THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.
DARYN KAGAN, CNN ANCHOR: At some time or another, many of us get depressed. But how do you know if you're just having a bad day or a more serious problem?
Today, we're "Paging Dr. Sanjay Gupta" on breaking the stigma of mental illness. And last hour, we learned some of the facts. Now we're going to hear from you and your questions.
Dr. Gupta joining us again from New York, he did not go far, as instructed. And then, here with me in Atlanta across our newsroom, Dr. Philip Ninan. He is a professor and director of the mood and anxiety disorders program at Emory University School of Medicine.
Doctors, plural, good morning and thanks for being with us.
SANJAY GUPTA, CNN MEDICAL CORRESPONDENT: Good morning.
KAGAN: Sanjay, you wanted to start with a question for Dr. Ninan.
GUPTA: Yes, and one of the things that sort of strikes, Dr. Ninan, is that it seems like we see more depression than we ever have before. And I was curious as to whether you think this is more a reflection of increased awareness and increased diagnosis, or are we just actually seeing more depression than ever before?
DR. PHILIP NINAN, EMORY UNIVERSITY SCHOOL OF MEDICINE: There is an increase in awareness about depression, but there is also evidence that the prevalence and the incidents of depression seems to be increasing every decade. In fact, it seems to be happening at a younger and younger age group.
GUPTA: So, really sort of a combination of both things there.
We've got lots of e-mail questions, as Daryn mentioned. Let's just go ahead and get to our first one right away.
This first question comes to us from Alison Hann, who asks: "Can someone who has suffered a 'nervous breakdown' -- quote/unquote -- return to normal health, or do they generally have mental problems to some degree?"
Dr. Ninan, can people recover fully and get back to their normal way of life?
NINAN: Well, a nervous breakdown is a very broad term, and there are a number of different illnesses that can occur. So, you can have an illness that you have a break from reality, like schizophrenia, or you have changes in the way you feel, so you can have an anxiety disorder or depression.
Some disorders are continuous, and others are more episodic in nature. And you can have full recovery in some, and others you can have residual symptoms that you continue to struggle with.
KAGAN: Our next question coming from Milwaukee, Wisconsin, a good one, because it comes down to having the money to pay for treatment. This one from Emily Schultz. She asks: "How can one be expected to apply for health insurance with mental illness? If you tell the truth about your illness, you will most likely be rejected. Are we supposed to lie to compensate for the insurance industry's prejudice?"
Dr. Ninan, you must deal with this all of the time.
NINAN: Yes, and it's really a very challenging situation. And what I would say is that we all should be advocating for parity for mental illness coverage, because it is sad when you have an illness. It is tragic when you have an illness, where a treatment is available, but you can't deliver the treatment because of some issue like lack of insurance or financial capacity to pay for the medication that might bring about a dramatic result.
KAGAN: So, what do you do? What would be your recommendation to our viewer out there?
NINAN: I would never tell somebody to openly lie about an issue like that, but I think you should be able to talk to people that might have the capacity to make differences in those policies.
KAGAN: Sanjay, you have the next one?
GUPTA: Yes, let's keep going. We've got another question from Chris, I think this is in Fort Smith, Arkansas. The question: "I have a 39-year-old friend that has BDM" -- it stands for Body Dysmorphic Disorder. "He is totally obsessed with aging, his hair, his face, but his hair and face are fine. He talks about his hair or face several times a day." It sounds like Bill Hemmer, doesn't it, Daryn? "No amount of reassurance helps."
KAGAN: Bill is not here to defend himself -- not fair.
GUPTA: I know. Don't tell him I said that. His hair and face are fine as well
"What is the treatment for this sort of disorder?"
Dr. Ninan, have you heard of this sort of thing, and is there a treatment for this?
NINAN: Yes, Body Dysmorphic Disorder is a condition of imagined ugliness. And what's happening in this disorder, we think, is that the representation of the body in our brain, there is an area of what we call the somatosensory cortex, where our body is represented. And that particular area for some reason in this individual might be overrepresented. And so, the person can't seem to let it go, and they are stuck on that.
Reassurance does not seem to be very effective in this condition. A medication group called the selective serotonin reuptake individuals has been demonstrated in controlled studies to be very effective. And so, medication would be one strategy.
Cognitive behavior therapy, a form of psychotherapy, might also be effective in this condition.
KAGAN: John...
GUPTA: Do they actually...
KAGAN: Oh, go ahead, Sanjay. I didn't mean to interrupt you.
GUPTA: Do they actually have something that you would see wrong with their brain if you did an MRI scan or actually looked at it? Or is this totally something that you just see in terms of behavior?
NINAN: It wouldn't necessarily be a structural abnormality. It would be a functional abnormality. So that the amount of activity that might be going on in this particular area might be exaggerated to the detriment of other areas that might potentially balance it out.
GUPTA: Well, that's fascinating -- Daryn.
KAGAN: All right, we have time for one more question, and it's almost a philosophical one, which I think is interesting for history buffs out there.
It's from John in Pennsylvania. He writes, he thinks: It is incredibly difficult to differentiate between personality flaws, as defined by society, and 'mental illness.' Who defines the behavior patterns which would result in being labeled as 'mentally ill'?"
Dr. Ninan, you look back towards history, and some the greatest figures we have had in this time might be considered mentally ill.
NINAN: Well, just like in other medical illnesses, there are illnesses where there is a very clear boundary between the ill person and somebody who doesn't have the illness. So, like schizophrenia for example, the boundary is very clear.
There are other illnesses, like say blood pressure, where it's on a spectrum, and you decide that at a certain point the person has moved from the normal spectrum to a mild version of the illness, a moderate or a severe version of the illness. And so, similarly in those situations, I mean, we consider a diastolic of 90 to be the threshold where you move into mild hypertension. But if you have a diastolic of 89 or 91, you would argue that that's a very fuzzy boundary.
So, similarly, there are mental illnesses which are on a spectrum of normal function. And so, the boundary is, in some ways, arbitrary. But clearly, when you get to the more severe ends of the spectrum, it is substantially different from the rest of the general, typical population.
KAGAN: Just real quickly, Dr. Ninan, best place for someone to go for help if they think they have a problem?
NINAN: Well, we have several systems. We have mental health central systems. We have academic systems. We have hospitals. So, it's really a question of where your insurance would send you, would cover your care. And that if you're not satisfied with the care that you're getting over the outcome, then you would want to explore other options.
KAGAN: But help is out there.
Dr. Philip Ninan from Emory University, Dr. Sanjay Gupta also with Emory, and ours right here, thank you so much.
NINAN: Thank you.
GUPTA: Good seeing you.
TO ORDER A VIDEO OF THIS TRANSCRIPT, PLEASE CALL 800-CNN-NEWS OR USE OUR SECURE ONLINE ORDER FORM LOCATED AT www.fdch.com.
