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FARAI CHIDEYA, host:

This is NEWS & NOTES. I'm Farai Chideya.

Is it all just in your head? Psychiatrists are still arguing over how much your brain's chemistry affects the way you feel and act. Serotonin and dopamine are just two of the chemicals that your body generates to regulate your moods. Drugs and therapy can be used to keep things in balance. But a lot of African-Americans still steer clear of antidepressants and other medications. Many of us won't step foot in a psychiatrist's office.

In a few minutes I'll talk with best-selling author Rebecca Walker about her experience on antidepressants, which she took even while she was pregnant. But first, we'll dive into a discussion on how brain chemistry works and how everything from sunlight to the strength of your local community can affect your mental health. Dr. Carl Bell is president and CEO of the Community Mental Health Council in Chicago. He's also a clinical professor of psychiatry and public health at University of Illinois, Chicago. Dr. Bell, welcome to NEWS & NOTES.

Dr. CARL BELL (Professor, University of Illinois, Chicago): Thank you. Thank you.

CHIDEYA: So let's talk basics. In simple terms, how does our brain chemistry affect our moods?

Dr. BELL: Well you know, the best example of that would be alcohol in the brain, because that's certainly an issue of brain chemistry. Alcohol gets in the brain and it creates all kinds of problems. And because of that, psychiatrists, physicians, have often tried to figure out what's going on that creates mental disorders.

Currently we've got a limited amount of absolute specific evidence that brain chemistry causes mental disorders. But we sort of get this idea because we're prescribing people medications that clearly change brain chemistry, and as a result, we see them get better and we see their mental disorders improve. So that's really where this whole notion that psychiatric disorders stem from brain chemistry.

CHIDEYA: We live in an age of medication. Antidepressants like Prozac, Zoloft and Paxil are household names. And there was a time not so long ago when psychiatric medication was used only in severe cases. We didn't see these ads running constantly on TV, if you're feeling down, if you're feeling mood disorder, social disorder, some other disorder. So why did things change so that these medications were widely prescribed, easy to get if you have insurance. What are the up sides and down sides of living in a time when antidepressants are actually the most commonly prescribed drugs in the United States?

Dr. BELL: Well if you look at any well-done epidemiologic studies, that is studies which count the number of people who have depression for example, Ron Kessler's work out at Harvard, what we learn is that 20 out of 100,000 people have a clinically, needed to be treated, major depression. And so the reality is you know, there's a lot of denial in this country that people get ill, mentally, and as a result, what we've actually done, if you look historically, is that we have under-treated these conditions.

If you look at the numbers of people who are on medication for high blood pressure, diabetes, it's high. And the same is true for psychiatric disorders, except people don't want to believe that they are mentally ill.

CHIDEYA: I understand that you are someone who, among other things, does martial arts in order to keep yourself, I'm sure, not just in physical shape, but mental shape.

Dr. BELL: Absolutely.

CHIDEYA: How do things like how much we exercise, what we do, you know, for mental stimulation, how do all of those factors affect our brain chemistry, our ability to stay healthy?

Dr. BELL: Well what we're learning now, because part of the reason that these medications are being prescribed like they are, we got into the brain during the decade of the brain and we are now producing medications that we actually know what they are doing and where they go as opposed to just sort of guessing. We are also learning that for example, if you have an alligator brain problem and I'm breaking this down rather than being technical.

CHIDEYA: What does that mean, an alligator brain?

Dr. BELL: Alligator brain are motor neuron centers below the supertentorium of the brain. And so I call it alligator brain just to keep the conversation understandable.

CHIDEYA: I still want, you know, I have to ask about this because that's, alligator brain is super simple but I still don't get it. Do you mean like the basic functions of life? Is that what you...

Dr. BELL: Ganglion reflexes, breathing...

CHIDEYA: Right.

Dr. BELL: Motor functions...

CHIDEYA: So just the very, very basics.

Dr. BELL: - Functions, you know, the flight or fight, fight, flight or freeze systems of the brain.

CHIDEYA: Got it.

Dr. BELL: That animal nature that we talk about.

CHIDEYA: Right.

Dr. BELL: And then you have the computer brain or the frontal, cingulate gyrus of the frontal lobes which I call the computer brain just to keep it simple. And what we find is that people who have Tourrette Syndrome, which is a disorder of the lower motor neuron and basal ganglian, and the like, parts of the brain and they curse and they have tics and they have these jerky movements. Well, we find that if people develop their frontal lobes and their cortex and they do concentration and attentional things like meditation and martial arts, they can control their symptoms.

We know, for example, that if people are producing, if - we're getting into genetics so we know that if people have short chromosomes in certain of their chromosomes, they are more likely to be vulnerable to post traumatic stress disorder. But if they are in an environment which is loving and nurturing, that genetic predisposition does not manifest. The same is true for antisocial personality disorder, borderline personality disorder - where people are traumatized and so they grow up with a supercharged alligator brain. They are in a fight or flight state constantly.

But if they can get their frontal lobes trained and as their frontal lobes develop, that computer brain develops, they are able to be discriminatory about whether to fight or flight, or there's no threat. So we're actually learning a great, great deal.

Psychiatry, if you look historically, we used to have problems of mental retardation called phenylketonuria, a genetic disorder that absolutely causes brain chemistry problems because the brain, the body cannot metabolize phenylalanine which is an amino acid that's commonly occurring in food.

So if you pick up a diet cola, it says warning, phenylketonurics don't use this product, it's got phenylalanine in it and your body can't digest it. And if you use this product, you'll become retarded. We don't see cretinism anymore. I just left the Institute of Medicine's Committee on the Prevention of Mental Disorders, Substance Abuse and Problem Behaviors in Children, Adolescence and Young Adults and we are now having serious conversations about the prevention of schizophrenia, the prevention of depression, the prevention of postpartum depression. You know, there's a bill in Congress to start screening women who deliver for this. Because if you put those women in social contexts and in supportive, emotional, warm, loving contexts where there is an environment that stimulates and nurtures, they don't see the manifestation of this postpartum depression.

CHIDEYA: Well Dr. Bell, this is a perfect chance for me to bring in our other guest, Rebecca Walker. Rebecca Walker's latest book is "Baby Love" and that memoir tracks her emotional and spiritual growth during her pregnancy and after the birth of her son. One of many questions she had to ask herself was, will I keep taking antidepressants while I'm pregnant? Rebecca is with us now. Rebecca, thanks for coming on.

Ms. REBECCA WALKER (Author, "Baby Love"): Oh, it's my pleasure, Farai. It's so great to be here.

CHIDEYA: So let's back up a little bit. You have been an activist for years. You wrote another memoir about your life called "Black, White and Jewish" and like a lot of strong, smart people - I'm sure you were always on the go, under a lot of stress - tell me briefly about when and why you started taking antidepressants.

Ms. WALKER: Well first I want to just say, it's so wonderful to be doing this program because we really do need to raise awareness about how important mental health is, especially in the African-American community...

Dr. BELL: Yes.

Ms. WALTER: And thank you so much, Dr. Bell, for all of your work and for being so clear and articulate and historically present. I mean this is a critical discussion. I grew up like many people in my generation, as a child of divorce, moving back and forth between different communities. And I think that created in me a kind of fragmented sense of self. And as a result I had serious social anxieties about how to behave in different cultural environments, how to negotiate who I was in relation to other people.

I also had a hereditary predisposition to depression. It's, you know, run in my family for generations, untreated. And at a certain point, I realized that I needed support and that I had been in therapy you know, to work through some of my familial issues. But after years of therapy, there was a sense that I was, I kept going back to the same issues and going over them and over them and I was kind of reifying the wound rather than finding a solution.

And I decided, after much consternation, because depression is still so stigmatized and we are supposed to be able to just work it out on some level -but because as an African-American woman, a mixed race woman, I was raised to believe that you know, we've overcome so much, you know, why, you know, we shouldn't need to get any help. You know, on my father's side we lived through the Holocaust. On my mother's side, we lived through slavery, you know. If they could get through all of that, growing up the way I did, you know, please, you know, I had an easy life.

CHIDEYA: You don't have any problems compared to - that mentality.

Ms. WALKER: Right, exactly. Yes. So I finally decided to go to a psychiatrist, and he was really wonderful, very good. He was a very diagnostician - however you say that. I think the diagnosis aspect of psychiatry is so important, and it's such an important skill, and we started to work together, and through medication, I began to feel, you know, like a normal, stable human being, and that, you know, was a very important aspect of my development.

CHIDEYA: And you got into a relationship with a man who has become your life partner, became pregnant, and then you had to face this question: Do I continue medication while I'm pregnant? How stressful was that conversation you had to have with yourself and your doctor, and how did you finally make the decision?

Ms. WALKER: Oh, it was brutal. I mean...

Dr. CARL BELL (President and CEO, Community Mental Health Council): It's a big question.

Ms. WALKER: It was terrible, and I agonized over it. I, you know, talked very intensely with my doctor and my partner about all the different antidepressants and which I could take that would be the least potentially damaging to my infant, you know, my newborn, the baby that was growing inside of me and which would be best for me at the same time. Because I finally had to admit to myself that there was the chance that if I just stopped taking my antidepressants that I would fall into a depression that would make me not want the baby at all and not be able to have a healthy relationship with him.

And so I had to really decide that my mental health was as important as his biological health, and so I made certain trade-offs. You know, I stayed on my medication throughout the pregnancy, but then when it was time to nurse, I decided that I could only expose him to my milk, which had very small traces, but still I felt I could only expose him for a few months, in terms of my conscience, and then I would have to switch over to formula because I wanted to find some kind of balance.

But it was a very, very difficult decision and one I still grapple with, you know, because the drug I was on has a slight chance of creating seizures in children who were exposed to it in the womb. And whenever I see my son getting a little bit hyper, you know, I always think oh, you know. You know? I'm always scanning...

(Soundbite of laughter)

CHIDEYA: But so far so good.

Ms. WALKER: Well he's a beautiful, wonderful child. He does get a little hyper, and who knows if that's traces of the medicine or it's just he's a normal three-year-old.

CHIDEYA: Yeah, it's probably toddlerhood and you know.

Ms. WALKER: But yeah, I do have to say that I wonder.

CHIDEYA: Well, Dr. Bell, have you ever had to lead people through these kinds of discussions?

Dr. BELL: Oh yeah, are you kidding? Yeah, it's hard. It's a hell of a decision to make. You talk to the person about it because, you know, you've got to - you can't be the boss of somebody. You've got to do informed consent. So, you know, all this paranoia that black folk have about Tuskegee, and - doctors are scared of two things: hurting somebody, which is number one, and being sued. And as a result - plus, we didn't go to medical school to hurt people, you know.

So you talk to people, and you just heard a beautiful explanation of thinking about it and trying to figure it out. The patients that I have had to do that with, I've seen - as a matter of fact, one of their children came in here who is now in the Ph.D. psychology problem, that had grown up and walked in my office talking about I remember seeing you when I was five years old.

It scared me to death, you know, but she was doing fine. So I've never seen -and I've looked, mind you - in the children who I've been treating with antidepressant medications and other medications. The biggest worry, of course, are the mood stabilizers, the anti-convulsive mood stabilizers, in terms of pregnancy.

CHIDEYA: Give me a quick example of a couple of drugs that would fall in that category.

Dr. BELL: Well, any drugs that people use to treat manic-depressive illness or bipolar disorder.

CHIDEYA: Those have a higher risk. Well, let me go back to Rebecca. We don't have much time left for - between the both of you, but Rebecca, I want you to give me a sense of what else you think can be done to keep yourself mentally healthy. I know that you're someone who has spent a lot of time with spirituality. What else do you think keeps you centered?

Ms. WALKER: Very good question. I've always been - well, for the last 15 years, I've been a student of Buddhism, and that has helped a great deal. The tradition that I have studied, Vajrayana Buddhism, is really about being able to move into the parts of your mind that are wild, that fluctuate, that are unstable, and to exercise the muscle that stabilizes them, that can kind of remind you that underneath all of that static, there is, indeed, a calm that you can access at any time.

Dr. BELL: Outstanding.

Ms. WALKER: And that's - yeah, I think that's what Dr. Bell is talking about, how to begin to retrain or to train that front part of your mind to interact with the reptilian, you know, so that you can actually forge new synapses -this idea that we actually can work inside of our mind to change the way that it reacts.

CHIDEYA: Change it from the inside. Dr. Bell, I have to ask Dr. Bell just quickly, almost out of time, what advice would you give someone who is seeking help?

Dr. BELL: I would tell black people, especially, that we rarely, if ever, get the benefit of modern medical technology. There are new medications, there are evidence-based psychotherapies and, I think even more importantly, we are on the verge of developing prevention strategies so that this stuff can be prevented the same way that we used to prevent polio and still prevent polio.

CHIDEYA: Well, Rebecca and Dr. Bell, thank you both so much.

Dr. BELL: Thank you.

Ms. WALKER: Thank you, Farai. Thank you, Dr. Bell.

Dr. BELL: You're welcome. Good to hear you talk about your voyage.

CHIDEYA: Dr. Carl Bell is president and CEO of the Community Mental Health Council. He's also a clinical professor of psychiatry and public health at the University of Illinois, Chicago; and Rebecca Walker is a writer living in Hawaii. Her latest book is a memoir titled "Baby Love," and she joined me from the studios at KUOW in Seattle.

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