New research may soon change the way doctors treat depression. As this ScienCentral News video reports, scientists are unraveling the mystery of how mental illness begins while brain experts reveal how the mind responds to treatment.
Brains on Blues
Thirty-five million Americans, more than 16% of the population, suffer from depression severe enough to warrant treatment at some time in their lives. Poet Eve Stern has battled depression for years, taking different medications for her condition.
"The usual direction the doctors will point you in is in the direction of medication," says Stern. "I got pushed there to the point where I had tried over 50 meds and one became poisonous to my brain and I nearly died."
To prevent situations like this, scientists are trying to learn how the brain reacts to depression remedies. "We have no idea about the neurobiology of what starts depression," says Helen Mayberg, a neurologist at the Emory University School of Medicine. "We've got clues from these studies of different kinds of depressed people. We have clues knowing that not everybody gets better on whatever you treat them with first. But we've not got these clues that the brain may be actually giving us very important info so that we can treat optimally."
Mayberg wanted to see what happens in patient's brains during different forms of treatment for depression. She compared brain scan images from 13 people taking antidepressants and 14 people undergoing cognitive behavioral therapy, expecting both treatments to affect the same brain regions. But she found that some parts of the brain responded to medication, while other regions reacted to therapy, such as the frontal cortex, cingulate, and hippocampus.
"For the first time we have good evidence that the brain recovers through a variety of different paths," says Mayberg, "and that the important news is something that we've always known: If we have depression, it's important to get treatment and that different treatments are available. And they're quite efficacious. But what we're learning now is that how those different treatments work on the brain is affecting the same brain network, but in alternative and complimentary ways, and we need to build on that."
|The brain on the left is responding to therapy; the one on the right, to medication.|
image: Helen Mayberg
Mayberg points out that treating depression isn't about singling out individual brain regions. "We can actually look at how these important brain regions interact with one another," she says. "We have to actually start to realize that when a person is depressed their brain just doesn't lie there doing nothing. The brain is attempting to adapt to the insult. And the problem is that we don't know what the insult is."
Samuel Barondes, psychiatry professor at the University of California at San Francisco, wrote the book Better than Prozac, about the need for better depression drugs. "We call depression 'depression,' but there are probably a lot of different kinds of depression, and probably certain types of depression work better than others as far as these drugs are concerned," he says, adding that finding the genetic root of depression will also help match patients with the right treatment. "To make really big changes, in my view, will depend on a discovery about the genetic underpinnings, which lead people to be vulnerable to various mental disorders. As we learn which variations of our genetic makeup make people more vulnerable to depression or anxiety or schizophrenia or whatever, as we find those gene variations that are responsible, we will be in a position to design better drugs based on the knowledge of what the genetic variations are."
But for now, Stern is still on medication. "I will always have to be on something to stabilize my mood because of the kind of depression I have," she says. "Itâ€™s very lethal. And there's a lot of suicidality to it. I'm now on just trace trace doses of three medications, and this is after 15 years of being really pretty heavily medicated."
This research was published in the January 2004 issue of the Archive of General Psychiatry, and was funded by the Rotman Research Institute (Toronto), the Canadian Institutes of Health Research, and a University of Toronto Institute of Medical Science Open Fellowship Award.