Sopranos Psychiatrist Gets Tough on Depression
By E.J. Mundell, HealthDay Reporter
THURSDAY, March 17 (HealthDay News) -- "The irony isn't lost on me," actress Lorraine Bracco said with a smile over her morning coffee.
Even though she plays smart, savvy psychiatrist Dr. Jennifer Melfi in the HBO hit series The Sopranos, Bracco admits she suffered through a full year of what she calls "joylessness" before seeing her own doctor for help against depression.
"It was the late 1990s, I was already with The Sopranos," the Brooklyn-born actress recalled. After a divorce and custody battle, "my whole life seemed to be finally pulling itself together."
"But it was as if I was living my life without any joy," said Bracco, 50, an Emmy- and Golden Globe-nominated actress who was also nominated for an Academy Award for her work in Goodfellas.
"I was doing what I was supposed to be doing, but I wasn't experiencing it. Whatever I had to do -- whether it was being interviewed, or a movie premiere, or making oatmeal for the kids in the morning -- I did it, but without any sense of fun."
Finally, a friend noticed the mood change, and suggested Bracco seek professional help.
"Even then I thought, 'What? My life is on the upswing!' I thought I'd exercise and yoga my way out of this -- I was going to beat it," she said. "But of course, we know now that that's impossible. Depression gets a hold on you, and the longer you wait, the harder it is to get out."
That type of denial and procrastination is typical of many depressed individuals, said psychiatrist Dr. Patrice Harris, who is working with Bracco and drugmaker Pfizer Inc. on a campaign and Web site (DepressionHelp.com) that urges people to spot depressive symptoms early and seek out care.
"There are lots of people out there that are saying, like Lorraine did, 'I'll just exercise this away, or think it away, or it'll just go away,'" Harris said. "There's also this misperception that depression is a moral weakness, a failing. People don't understand that it's a serious medical illness with a biological basis."
As far as researchers can tell, much of the biology of depression relies on an imbalance in amounts of a specific brain chemical called serotonin. While psychotherapy can help fight depression, medications called selective serotonin reuptake inhibitors (SSRIs) try to re-balance serotonin levels, and thus correct the problem. SSRIs include drugs such as Celexa, Paxil, Prozac and Zoloft. (Beginning this spring, antidepressants are to begin carrying a "black box" label warning of the potential suicide risk among children and teens.)
A year into her depression, Bracco made the decision to see her doctor and underwent a combination of talk therapy and Zoloft.
"The talk therapy I wasn't worried about, but I had some serious misconceptions about the medication," she recalled. "I thought, 'Oh, I'm never going to feel anything anymore' -- not just as an actress, but in my everyday life."
She also worried that she'd become hooked on Zoloft for life.
Neither fear was realized.
Like other SSRIs, Zoloft "doesn't void or dull you," she said. And about 18 months into therapy, Bracco said, she felt she could slowly wean herself off the drug. She hasn't felt the need to use it since, she said, although she said she's thankful effective medications exist.
"For me, it was one of the most important decisions I made, I just regret not going for help earlier," she said. "I suffered for a year -- why?"
According to Harris, specific events, such as a death in the family, divorce or trauma, can help trigger depression.
"But we also don't want to lose sight of the fact that there doesn't have to be a stressor," said Harris, a practicing psychiatrist who also teaches at Emory University in Atlanta. "In fact, that's even more problematic, because I have people come into my office and say, 'I'm sad, but I don't know why.'"
She said depression is distinct from just intermittent bouts of the blues. "Symptoms have to occur all day, every day, for at least two weeks," she said. Typical symptoms include an inability to sleep or sleeping too much, a loss of appetite or compulsive eating, poor concentration, frequent crying and suicidal thoughts.
According to Harris, more than 34 million Americans will be diagnosed with depression at some point in their lives, "but only half of them will go get treatment."
"Depression is scary to people, they're afraid and I really want to help lift that taboo," Bracco said, stressing that Zoloft is just one of many SSRIs with proven effectiveness. "If one doesn't work for you, there are others."
While women often find it tough to seek help, studies show that men are even more reluctant to see a doctor about their feelings, and often turn to 'self-medicating' with alcohol or drugs, creating what Bracco called a "vicious cycle."
That's why she's especially proud of her role in The Sopranos, which hinges, in part, on Dr. Melfi's psychotherapy sessions with tough-guy mob boss Tony Soprano.
"He originally came in because he was having fainting spells," Bracco said. "Then we kind of broke down the walls, and I put him on medication. But we know that story has absolutely helped take away some of the stigma [about depression] for men."
"A lot of psychiatrists from all over the country have told me, 'I now have a lot more men coming to see me,' " she said.
In the meantime, Sopranos fans across the country may be feeling a little blue missing their weekly dose of Tony, Carmella, Paulie, Silvio and the gang.
Unlike her alter ego on the show, Bracco wasn't able to give immediate relief for those symptoms, however.
"We go back to work shooting the end of April," she said, "and the new episodes won't be out till the winter of '06."
More information
To learn more about the causes, symptoms and treatment of depression, visit the National Institute of Mental Health (www.nimh.nih.gov ). 
SOURCES: Lorraine Bracco, actress; Patrice Harris; M.D., M.A, psychiatrist, private practice, and clinical associate professor, psychiatry and behavioral sciences, Emory University, Atlanta
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