The Encumbrance of Depression

Depression is the single largest disability which has afflicted nearly two-thirds of the humanity. More than 350 million have been affected depression so far making it a most common disorder. Nearly two –thirds of people suffering from depression attempt suicide. But it has been least researched though the instances of depression are increasing at a quicker pace, the remission methods are still not clearly chalked out. Almost three quarters of people suffering from depression go undiagnosed, had it been the case with cancer care, it would have been reckoned as calamitous. But unfortunately, the patients suffering from depression are often ignored and are not extended proper care. There is still a social stigma attached to the disorder.

The three most common mental disorders are anxiety, depression and substance use. Surprisingly, honest and meaning full conversations on these mental disorders are shunned. The tragic death of comedian and actor Robin Williams brought the discussions on the mental disorders into forefront. Issues related to mental health or more specifically mental disorders have been associated with social stigma. Of late the stigma of living with depression and other mental disorders has reduced considerably as people suffering from depression have started openly sharing their experiences in their life. Depression is a scourge on mankind. Of the top ten causes of disabilities depression accounts for maximum healthy years lost as they live with both physical and mental disability. Nearly 76.4 million years are lost to disability (YLD) due to depression world-wide. But unfortunately depression is undiagnosed and untreated due to social stigma. It is startling that nearly half of the world population has 2 psychiatrists per 100,000 people.

Paltry funding for research on mental health:

Depression research as such receives paltry funding and is unable to garner much attention and scientific resources over a period of time. While new diagnostic techniques, disease-associated mutations, genetically targeted therapies and sophisticated animal models have been developed for other disorders depression research has floundered. It is important to understand often research agendas are dictated by political, social and economic concerns. Thus, while there has been a great deal of public uproar to fight cancer, there is no strong political or public will to wage a war against depression. Mental health research receives just one-fifth of funding as compared to cancer research. Many people still believe that depression is a legitimate condition and is associated with lot of social stigma.

 

Cancer Vs Depression:

Some scientists opined that cancer too once carried a stigma around 70’s. But the awareness created by advocacy groups changed people’s perception towards cancer who were sensitised that cancerous tumours can be monitored and removed. Depression, on the other hand affects deeply entrenched tissues of brain which can neither be seen nor removed. Moreover people failed to acknowledge that mental illness is a real illness. Depression is associated with anxiety and difficulty in communication and other psychiatric disorders. Though depression is perceived as human blight, its well-defined traits are not identified so far. Hence the ground for diagnosis is still clumsy. Further, the researchers working on depression are laid back by the existing belief that it is intractable. Unlike cancer studies which progressed remarkably due to the animal models depression studies are hampered by the inability to develop a suitable animal model which can truly mimic human conditions. Depression studies involve unravelling of intricate human circuitry which is extremely complex. They require studying single cells, mapping neural connections and activating specific brain centres. By and large research on depression so far was hampered by the unavailability of tools and the basic information.

Equipped with the required ensemble to unlock the mysteries of neural circuitry, researchers are now confident of waging a war against depression. As thought earlier, treating depression is not about replenishing brain with tonnes of neurotransmitters, it is about fixing woefully functioning neural networks. With the availability of new techniques in imaging to guide surgery and deep brain stimulation scientists are hopeful of relieving the disorder of depression.

 

Existing Treatments:

Anti-Depressants Medication Vs Cognitive Behaviour Therapy:

The first line of treatment for depression has been anti-depressants which relives nearly 20-44% of patients from depression. Another important treatment is Cognitive Behaviour Therapy (CBT), which helps to identify and change the negative and self destructive thought patterns. CBT has been useful in treating some subjects. Depression is a complex disorder and manifests in people in different ways. Depression stems from deep seated negative thought patterns.  CBT, a kind of psychotherapy is aimed at inculcating a positive thought process wherein depression symptoms are relieved in some patients. The consequence has been improved mental health.

Neuroimaging techniques indicated there are detectable differences in the two primary systems of brain: prefrontal complex and amygdala. Prefrontal complex is responsible for complex mental tasks like planning and self-control while the limbic system including amygdala is involved in emotional processing. In healthy people prefrontal complex inhibits the activity of amygdala keeping the emotions under check. The prefrontal cortex is relatively weak in people with depression. fMRI, functional magnetic resonance imaging also suggests that amygdala has increased levels of activity in depressed people. CBT is speculated to increase the activity of the underutilised prefrontal complex and helps in quietening the hyperactive limbic system. While CBT worked effectively for some individuals, antidepressant medication offered great relief for others. To sum up, the complex networking of brain goes haywire during depression and these broken systems of different individuals respond differently to different treatments. In general it was found that relapse of depression symptoms are minimal after CBT than people who stopped antidepressant medication. Married people are more benefitted from CBT than medication.

 

Way Forward

Discovery of new drugs & Genetic Studies:

Though scientists have employed molecular and neurological clues to develop new drugs, but most antidepressants or psychotropic drugs are arrived at through serendipity. The calming effects of benzodiazepines and lithium have been accidentally discovered in animal experiments. These kinds of drugs were effective on few people other failed to respond. Depression lacks a distinctive pathology and hence designing new drugs is highly challenging. Another promising clue with effective solution for depression is through genetic studies. Risk of depression is highly polygenic involving hundreds of genes. Since the disease mechanism is not known, more than 100,000 with Major Depressive Disorder (MDD) are needed to trace the genetic loci that help in designing therapeutics and in understanding the biological phenomenon. Latest technological developments galvanised genetic analysis which yielded powerful clues in autism, schizophrenia and bipolar disorder.