[Congressional Record Volume 147, Number 52 (Tuesday, April 24, 2001)]
[Extensions of Remarks]
[Pages E596-E598]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




          NATIONAL DEPRESSIVE AND MANIC-DEPRESSIVE ASSOCIATION

                                 ______
                                 

                        HON. PATRICK J. KENNEDY

                            of rhode island

                    in the house of representatives

                        Tuesday, April 24, 2001

  Mr. KENNEDY of Rhode Island. Mr. Speaker, I submit the attached 
testimony that was given by Lydia Lewis of the National Depressive and 
Manic Depressive Association to the House Appropriations Subcommittee 
on Labor, Health, and Human Services and Education for the Record.

     National Depressive and Manic-Depressive Association, Chicago

 (Statement on Fiscal Year 2002 Budget, National Institutes of Health 
    and National Institute of Mental Health--Submitted to the House 
 Appropriations Subcommittee on Labor, Health and Human Services, and 
                       Education, March 21, 2001)

       Good afternoon. Chairman Regula, Ranking Member Obey, and 
     distinguished members of the Subcommittee, thank you for the 
     opportunity to testify today. My name is Lydia Lewis, and I 
     am the Executive Director of the National Depressive and 
     Manic-Depressive Association (National DMDA). We are pleased 
     to have this opportunity to testify on fiscal year 2002 
     funding for mental health research supported by the National 
     Institutes of Health (NIH) and the National Institute of 
     Mental Health (NIMH).
       National DMDA has been gratified to see the overall NIH 
     budget increase over the past three years, including last 
     year's nearly $2.5 billion increase, and we urge the 
     continued full funding of these research priorities in order 
     to maintain an active, progressive research agenda. We fully 
     support President Bush's 2002 budget request of a $2.8 
     billion increase above the 2001 funding level for NIH,

[[Page E597]]

     to a total of $23.1 billion, and we applaud the President's 
     stated initiative to double NIH's 1998 $13.6 billion funding 
     level by 2003.
       With nearly 400 patient-run support groups in every major 
     metropolitan area, National DMDA is the nation's largest 
     patient-directed, illness-specific organization. We are 
     committed to advocating for research toward the elimination 
     of mood disorders; educating patients, professionals and the 
     public about the nature of depression and manic-depression as 
     treatable medical diseases; fostering self-help; eliminating 
     discrimination and stigma; and improving access to care. We 
     have a distinguished Scientific Advisory Board of nearly 65 
     leading researchers and clinicians in the field of mood 
     disorders which reviews all of our materials for medical and 
     scientific accuracy and provides critical and timely advice 
     on important research opportunities and treatment 
     breakthroughs. While I am here today to testify on behalf of 
     National DMDA, I know personally what it is like to battle 
     depression every day, to fight the urge to end my life. I 
     myself suffer from the disease. It's a dreadful way to live.


                 COMBATING THE STIGMA OF MENTAL ILLNESS

       The facts are staggering. More than 20 million American 
     adults--10% of the U.S. population--suffer from unipolar or 
     major depression every year. An additional 2.3 million people 
     suffer from bipolar disorder, also known as manic-depression. 
     According to a study done in 2000 by the World Health 
     Organization, the World Bank, and the Harvard School of 
     Public Health, unipolar major depression is the leading cause 
     of disability in the world today. It also found that mental 
     health has long been misunderstood. In fact, mental illness 
     accounts for more than 15% of the burden of disease in 
     established market economies such as the United States. This 
     is more than the disease burden caused by all cancers 
     combined.
       Women are more than twice as likely as men to experience 
     depression, and one out of every four American women will 
     experience a major depressive episode in her lifetime. Ten to 
     fifteen percent of women develop postpartum depression the 
     first year after birth--the most underdiagnosed obstetrical 
     complication in America. Among the many consequences of this 
     illness is the depressed new mother's inability to bond with 
     and nurture her child. Experts say these babies are at 
     increased risk of depression throughout life.
       Coping with these devastating illnesses is a tragic, 
     exhausting and difficult way to live. Despite these facts, 
     stigmatizing mental illness is a common occurrence in the 
     United States. Labeling people with mental illness has been a 
     part of the national consciousness for far too long, and 
     continues to send the message that devaluing mental illness 
     is acceptable. An estimated 50 million Americans experience a 
     mental disorder in any given year, and only one-fourth of 
     them actually receive mental health and other services. Two 
     out of three people with mood disorders do not get proper 
     treatment because their symptoms are not recognized, and 
     misdiagnosed or, due to the stigma associated with mental 
     illness, are blamed on personal weakness. Far too often, the 
     fear of being judged or abandoned wins out over the need to 
     seek medical attention, and the person remains untreated.
       Equally devastating is the stigma associated with the 
     research of mood disorders and other mental illnesses. 
     Research in behavioral science is as critical as that 
     undertaken for any other illness. Our understanding of the 
     brain is extremely limited and will remain so for decades 
     unless much greater financial support is provided. 
     Neuroscience research is also critically important to 
     understand the mechanisms in the brain that lead to these 
     illnesses. When we begin to understand these, we will be able 
     to develop more effective and rational ways to treat, and 
     hopefully cure, mental illness.
       Increased public awareness and understanding of mood 
     disorders will contribute significantly to improved diagnosis 
     and treatment rates for these illnesses. Progress is slowly 
     being made, and we encourage the Subcommittee to continue to 
     fully fund programs that address the stigma and isolation 
     associated with mental illness. We must, as NIMH Director Dr. 
     Steven Hyman has said, sound the alarm that we are in the 
     midst of a public health crisis--that our glaring 
     misperceptions about and undertreatment of mental illness, 
     especially for children and minority populations, represents 
     nothing less than a national health emergency.


                   PROGRESS IN RESEARCH AND DIAGNOSIS

       Mood disorders and other mental illnesses kill people every 
     day. Depression is the leading cause of suicide in the United 
     States. One in every five bipolar sufferers takes his or her 
     own life, and the Centers for Disease Control report that 
     suicide is the third-leading cause of death among 15 to 24 
     year old Americans. For every two homicides committed in the 
     United States, there are three suicides.
       We know that science destigmatizes, and as more people come 
     to understand that mood disorders are treatable medical 
     illnesses, we can make significant reductions in both their 
     human and economic costs. The Surgeon General released a 
     groundbreaking report on mental illness, an important first 
     step in this process. The study concluded that these diseases 
     are real, treatable, and affect the most vital organ in the 
     body--the brain. Research supported by NIMH has lead to new 
     and more effective medications for both depression and manic 
     depression. We have a much better understanding of these 
     illnesses, and are learning more about their impact on 
     cardiovascular disease and stroke.
       The Surgeon General's 1999 report was the first ever, from 
     that office, on mental illness. While this is a shameful 
     statistic--by comparison, there have been 23 Surgeon 
     General's reports on tobacco since 1964--National DMDA is 
     nevertheless encouraged by this development, and we hope to 
     take advantage of this turning tide. Finally, there is hope 
     that these disorders will start to be seen by Americans for 
     what they are--real diseases. But we urgently need to 
     increase funding for NIMH and other research institutions to 
     ensure that any forward momentum is not lost.


                           CLINICAL RESEARCH

       National DMDA plays an important role in several large 
     NIMH-sponsored clinical trials. Our consumer representatives 
     are members of oversight committees for trials studying the 
     effectiveness of treatments for bipolar disorder, the study 
     of treatment of adolescents with depression, and the study of 
     treatment of individuals with depression who do not benefit 
     from standard initial treatments. National DMDA participates 
     in the oversight of these trials to ensure that the first 
     priority of all clinical trials is the safety of the patient. 
     One of our primary objectives is to limit the number of 
     people exposed to placebo and limit the duration of their 
     exposure without compromising scientific validity.


               MOOD DISORDERS IN CHILDREN AND ADOLESCENTS

       The issue of mood disorders in children and adolescents is 
     of particular concern to National DMDA, and we support the 
     aggressive research being done by NIMH in this area. Nearly 
     2.5 percent of children and 8.3 percent of adolescents suffer 
     from clinical depression. There has, however, been virtually 
     no research to date on bipolar disorders in children, despite 
     evidence that families wait an average of 10 years before 
     receiving the proper diagnosis after seeking help. We know 
     that up to 90 percent of bipolar disorders start before age 
     20, meaning more high school dropouts, more illegal drug and 
     alcohol use, higher teen pregnancy rates, more teen violence 
     and more adolescent suicides. The costs of waiting for proper 
     treatment do not just affect the individual sufferer, but 
     society as a whole.
       We fully support NIMH plans to further expand clinical 
     trials of treatments for mental illnesses, including the 
     exploration of depression in young children. We urge a 
     significant increase in funding for research of mood 
     disorders in children and adolescents with special emphasis 
     on the efficacy and safety of current treatments, the 
     epidemiology of these illnesses and improved diagnostic 
     tools.
       We are pleased that NIMH played a lead role in the Surgeon 
     General's report on youth violence. With further research 
     into the relationship between mental disorders and violence, 
     we are hopeful that tragedies like the recent school 
     shootings in California and across the country can be 
     prevented in the future. Many of the perpetrators of these 
     shootings exhibited symptoms of mental illness, and further 
     research into the connection between behavior problems and 
     anxiety disorders, depression, and suicidal ideation is 
     critical. National DMDA is also pleased with the coordination 
     between NIMH and other federal agencies, such as the Centers 
     for Disease Control and the departments of education and 
     justice, and continued information sharing about the 
     relationship between mental illnesses and violence.


                  BIPOLAR (MANIC-DEPRESSION) DISORDER

       The World Health Organization has identified bipolar 
     disorder as the seventh-ranked cause of disability in the 
     world today. Nearly one in 100 Americans suffers from manic-
     depression, yet research in this area has been continually 
     under funded.
       That is slowly changing. NIMH's current Systemic Treatment 
     Enhancement Program for Bipolar Disorder (STEP-BD) is a 
     landmark study of 5,000 people with bipolar disorder, the 
     largest psychiatric trial ever held. While this is a 
     critically important study, it also underscores the 
     unfortunate circumstance that mental illnesses remain 
     woefully under funded. The STEP-BD trial has a budget of just 
     $20 million. A brief check of, for example, the National 
     Cancer Institute programs will reveal that this is an 
     unjustly small allocation for researching this pervasive and 
     fatal disease. In fact, in FY 1999, NIMH spent only $46 
     million on bipolar research. Congress must continue to 
     increase its investment in this important area of mental 
     health research.


              THE IMPACT OF DEPRESSION ON OTHER ILLNESSES

       National DMDA is pleased to be participating next week in 
     an important NIMH forum on improving health outcomes for 
     major diseases such as cancer, diabetes, heart disease, 
     stroke, AIDS, and Parkinson's through the effective treatment 
     of co-occurring depression. The forum will highlight 
     scientific advances linking depression and other illnesses, 
     and the role that treating depression plays in improving the 
     course of the co-occurring disease. Participants will also 
     focus on ideas for shaping the Institute's research agenda, 
     and further educational and communication plans for improving 
     health care. National DMDA applauds NIMH for its efforts to 
     include the public in its agenda setting.

[[Page E598]]

       Important new research has shown that treatment of co-
     occurring depression often improves health outcomes for 
     patients with a wide variety of diseases. Researchers are 
     tracing various aspects of depression, that may affect 
     illnesses as varied as neurological diseases such as 
     Parkinson's disease, diseases of the cardiovascular system, 
     and diseases involving suppression of the immune system, such 
     as cancer and AIDS. It appears that depression is an 
     important risk factor for heart disease. In a recent study, 
     it was found that heart patients who had depression were four 
     times as likely to die in the next six months as those who 
     were not depressed. There are also studies linking depression 
     and obesity and diabetes, as well as findings showing common 
     genetic patterns in diabetes and depression.


                          OTHER RESEARCH NEEDS

       More research is needed on the medications for mental 
     illness. There has not been a drug developed specifically for 
     bipolar disorder since the discovery of lithium more than 50 
     years ago. In addition, it is not fully understood how 
     psychiatric drugs work in the brain. A person often must 
     choose between lessening suicidal thoughts or getting life 
     threatening rashes, seizures, or lithium poisoning. So many 
     of us have to choose a life without libido or a life of 
     fatigue, exacerbated by insomnia. Although these medications
       National DMDA is therefore particularly pleased to see the 
     NIMH's renewed commitment to research of more viable 
     treatment options for depression and bipolar disorder and we 
     hope that the Congress will continue to fund important 
     studies in this area. Great strides are being made, but it is 
     critical that even more research is done on how different 
     medicines affect both the body and the mind.


                               CONCLUSION

       We urge the National Institutes of Health and the National 
     Institute of Mental Health to continue to expand and enhance 
     behavioral science, neuroscience and genetics research of 
     mental illnesses. We commend the Subcommittee's past support 
     of NIH and NIMH, and look forward to continuing to work with 
     you in the next year to ensure renewed commitment to full 
     funding of mental health research. We are confident that 
     together, our efforts will mean real treatment options, an 
     end to the stigma associated with mental illness, lives saved 
     and a far more productive America. Thank you again for the 
     opportunity to testify on issues critical to the health and 
     well being of all Americans.

     

                          ____________________