Interview Dr Bill Glasson, AMA President, with John Laws, Radio 2UE - Mental illness

LAWS:           I want to talk to a doctor - Dr Bill Glasson, President of the Australian Medical Association.  He's on the line now.  Good morning, doctor.

GLASSON:      Good morning, John, how are you this morning?

LAWS:           How, doctor - given what you've just said to me, and what we both understand - how can people be depressed in an environment like this?

GLASSON:      Yes, it's interesting, John.  I mean, I suppose the reality is that mental illness has always been out in the community.  As you quietly suggested in your introduction, we failed to recognise that it is valid and we tended to hide it under the carpet.

LAWS:            We did.

GLASSON:      But the good thing now is that I think people, as you say, are treating mental illness like a physical illness.  Now, during my lifetime there's no doubt that I will feel depressed, for whatever reason, and you could label me as having a psychiatric disorder.  Now, that doesn't mean I'm somehow abnormal or different - I just have an ailment that needs to be identified, needs to be recognised and needs to be treated.

Now, that treatment may consist just of some counselling and the fact that I know that I've got the problem and I know the fact that I'm not particularly isolated in having that diagnosis, makes me feel comfortable.  So I think in reality we have come a long way with mental disease in the sense that we are openly recognising the problem and we're recognising it both within our community and with our friends around us.

And so I think that each of us have a responsibility to look at the people around us to see those people that might need help and make sure we support them, I suppose, during those periods when each and every one of us may feel depressed for whatever reason.

LAWS:           How do you detect depression?

GLASSON:      Well, there are a number of key questions that doctors will ask you, essentially to outline or to indicate that you might be feeling depressed.  But I think in reality if you're talking to people, if you know people well, and you often see mood changes occur where they are really not themselves.

You know, you say to them, "Listen, you're not yourself today" - or this week, or whatever - "What's going on?  Talk about it."  I think it's important that we are open and we discuss this issue in a frank manner.  And I think by doing that, John, we feel more comfortable about it and we can then don't feel bad about going and seeking treatment.

LAWS:         Yes, do you think that - I just worry that, given that it's now become more acceptable, which is a very good thing because I thought the stigma attached to mental illness was a very, very cruel thing - but this could also be, the pendulum may swing too far - do you think people are too ready now to ask for anti-depressants?

GLASSON:      Well, I think that's a good question.  Are we swallowing more pills rather than necessarily actually talking about the problem?  I think it's very easy to just say, "Listen, I'll swallow a pill and I'll feel better about it."  I think in reality we have to talk about, we have to talk it through.

And that's why, I think, that time with your GP, time with your friends, time with your family discussing the issue is often probably as important as swallowing a pill.  And I think that studies have shown that if you can identify it early, treat it early - either with counselling and/or a pill in the short term - then the outcome is usually very good.  The important thing is not to let it drag on, go undiagnosed and untreated because it's much harder to reverse the problem at that stage.

LAWS:            Yes, the problem, doctor, is that it's very difficult to talk about it if you don't know what's causing it.

GLASSON:      Yes, that's true, John.  Obviously, there was a group of patients out there where there was no specific cause.  You can say, "Listen, I'm feeling depressed because my wife's died" - or whatever's happened.  But in reality there are people that have true endogenous depression where there is no real cause for the depression as far as something in their environment, but it's the clinical disturbance in their body that's gone wrong.

And that's where these newer agents, which actually are well tolerated, have less side effects and allow the patient to function relatively normally, are seeing I suppose an increased use amongst the community.

LAWS:           Is it dangerous to take these drugs?

GLASSON:      No, it's not dangerous.  The newer drugs actually are very well tolerated and the side effects are fairly minimal, and so long as, as I said, it's done in a close consultation relationship with their doctor, usually the outcome is very good.  And these patients function extremely well in their normal day-to-day activities.

LAWS:           There are, it seems to me, a number of anti-depressants that are almost designer drugs, like Prozac, I suppose, would be one of them, Zoloft would be another - and I imagine that there are many others.  Are they all safe?

GLASSON:      Yes, on the whole, they have a very low side-effect profile.  Obviously, they need to be taken according to the way they're prescribed, so you don't sort of overdose on them, etcetera.  But in reality if you've got a true endogenous depression then those drugs actually work very well.

And so I think it has changed the lifestyle of many people out there in the community who've found it traditionally hard to function by being on these drugs, actually find themselves functioning extremely well, and as I said, not having a whole range of side effects that the old anti-depressants had.

LAWS:           Given that most of these things are subsidised, it must have a hell of an impact on health funding?

GLASSON:      Well, it does, it's costing us over a hundred million, I think, for this particular class of drugs, John.  So the reality is that we are spending a lot of money.  But I suppose at the end of the day, is the investment in the drugs outweighed by the fact of the benefits that the patients are receiving?  And, I think, when you talk to the patients who are on these drugs and they describe the benefits they are getting, then in reality I think you can argue, well that's justifiable expense.

But it's often hard to measure and it's often a measure of lifestyle, it's a measure of how the patient actually functions in his or her job and around their family.  And so, yes, these drugs are expensive.  But I think in the longer term that the drug prices will come down.  Often when these first come on the market, they are more expensive, but hopefully in time they'll become cheaper and more available, John.

LAWS:           Do people become addicted to them?

GLASSON:      No, these newer medications you don't really become addicted to them.  They're not like some of the traditional older medications.  They really just adjust the physiology within your body so that whatever chemical is out of balance, the cause of the depression, allow that to be put back into tune, so to speak.

LAWS:           So is it always a chemical imbalance that causes the depression?

GLASSON:      Well, no, there's various forms of depression, John.  There's sort of reactive depression which you and I might get when we lose a loved one.  That's somewhat different to a true endogenous depression where you may have very happy surrounds and a happy job and a good job, yet you're just getting depressed.  And that is truly a chemical depression that there is imbalance in your body that needs to be realigned I suppose, put it simplistically.

LAWS:           So that's for the people who are depressed and have no idea why they're depressed?

GLASSON:      That's exactly right- -

LAWS:           Because you're talking to one of them, now.

GLASSON:      John, it's interesting, I know more of my friends who have - and I say this because I suppose going through medicine, there were high-achieving people there - and a significant number of those ended up with this endogenous depression - and a number of them ended up taking their lives.

And I keep saying I know more of my friends that have died from taking their lives from suicide, than from actually dying from car accidents.  And I think that's a reflection on how common this disease is, and how it's important we must identify it and treat it because these are good people who had wonderful potential, were high achievers, as I said, but they felt that they just couldn't continue.

LAWS:           Do you think it's got something to do with high achievers?

GLASSON:      Well, I don't know.  I'm from the bush, so I see a lot of my bushie friends out there in a similar situation.  It's amongst the indigenous community.  Young males, in particular, are very prone to suicide successfully.  So I think it's multifactorial, unfortunately.  But I think as a community we must identify these people.  We must ensure that they do not resort to suicide.  And if people are feeling depressed out there, please put up your hand, we've got a special program called the Yellow Ribbon Campaign, which just means you put your hand up and say, "Help.  I need help" - and society, and those around you should be there to give you that help.

LAWS:           Is there some kind of hot line number that people who feel they have a problem can ring?

GLASSON:      John, there is - there is the Yellow Ribbon hot line, which I can't give you from the top of my head, but there is a number that they can ring if they're feeling suicidal or feeling just that they need help, and that they can ring and get that counselling.

But, as I say, the important thing is to develop a good relationship with your general practitioner.  He or she is the person that basically will help you through this situation, and try and make sure that the outcome is for the best for everybody around you.

LAWS:           Are general practitioners cautious about prescribing these sorts of drugs, or are they a bit hasty?

GLASSON:      I don't actually think so.  There's been a targeted campaign in education for our GPs to identify these patients and to make sure that the drug is being appropriately prescribed.  And so I think that, as I said, it's because of the education that probably GPs are diagnosing more of these patients anyway, which is good.  And I don't think there's necessarily over-prescribing at all.

LAWS:           Okay, I appreciate your time, doctor, thank you very much.  We'll get hold of that hot line number for the Yellow Ribbon.  That's what it's called - the Yellow Ribbon?

GLASSON:      The Yellow Ribbon Campaign - they're a wonderful group of people who really try and identify, or help people identify, when they're feeling depressed, and the important thing is for people who raise their hand and say, "Listen, I need help" - and we have the systems in place to help them.  And please don't hesitate to scream out, as I say.

LAWS:           Okay, well, we've got the number - 1800 359 770 - [run by Here for Life.  So we'll pass that on to our people during the morning again.  And Dr Bill Glasson, thank you very much for your time.

GLASSON: John, my pleasure.

LAWS:           And I hope we talk about.

GLASSON:      Look forward to it.

LAWS:           Bye.  President of the Australian Medical Association, a very, very nice forthright kind of fellow - that's the kind of doctor we want - Dr Bill Glasson.  And if you want to call that Yellow Ribbon hot line number - if you feel that you have got problems with depression, if you get depressed and you have no idea in the world why you're depressed.

I mean, why should I get depressed?  I'm the luckiest man on the face of the earth, but I still get depressed.  But if you want to talk to somebody about it, you could ring that number, the Yellow Ribbon number, which is 1800 359 770.  If there's any other information available, we'll pass that on to you.

Ends