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| Photo by Zachary Veach. |
Two common types of depression are major depression and persistent depressive disorder. Major depression is usually understood as short term and high intensity, and the individual diagnosed with this ailment may undergo several “episodes” throughout a lifetime. If an individual were in a constant state of depression for at least two years, then this individual would be classified as having persistent depressive disorder. One key difference between persistent depressive disorder and major depression other than timeframe is intensity level. Those who suffer from persistent depressive disorder tend to experience depression at a smaller magnitude than one with major depression. An individual dealing with persistent depressive disorder, however, may also experience moments of major depression.
When it comes to dealing with therapy, two common routes taken are medication (antidepressants) and psychotherapy, otherwise known as psychological treatment. In psychotherapy, psychotherapists will try to 1) understand the patient’s thought process, and 2) help the patient develop new ways of thinking. One of the most common types of psychotherapy used to treat depression is cognitive behavioral therapy, or CBT. CBT focuses on figuring out any negative thoughts created by the patient. Once these negative thoughts have been indicated, the therapist then attempts to help the patient completely get rid of these thoughts or change them into positive ones. During CBT, the therapist will also teach the patient how to focus more on the positive things pertaining to their life rather than negative ones.
CBT is the most common method of treatment used among those diagnosed with depression (Holmes, Craske, Graybiel). Although we understand the process of CBT, scientists are yet to gain a solid grasp on how CBT actually works. This lack of understanding is a problem because out of those who chose to undergo CBT, only 60% of these individuals see promising initial results. Although 60% may sound like a good number, it means almost nothing because only 30% of those who started CBT will actually finish the treatment process, and 10% of those who saw promising initial results experience relapse(s) later on (Holmes, Craske, Graybiel). Emily A. Holmes, Michelle G. Craske, and Ann M. Graybiel believe that in order to gain a greater understanding of CBT, we must 1) invest more time in the study of current psychological treatments, 2) categorize certain types of psychological treatments to certain situations based off of research findings, and from there, 3) determine if new methods of psychological therapy must be developed or if current methods should be improved. In order for this process to occur, we must first gain fundamental knowledge on how psychotherapy cures depression.
Increased knowledge about neuroscience can help us make advancements in the field of depression. Through neuroscience research over the years, scientists have been able to discover that depression is associated with the frontal part of our brain. The frontal part of the brain hosts contrasting emotions - the front left being associated with positive behavior and the front right being associated with negative behavior. Individuals experience depression or anxiety due to an imbalance between the front left and front right parts of the brain (“Depression Treatment”). The imbalance in this case shows that the front right part of the brain is overpowering the front left part of the brain, which leads to thoughts of fear and wanting to be alone. These neuroscience findings are a huge step in the right direction because now, medication and psychological treatment can be engineered toward restoring imbalances in the human brain – but the only problem is that we aren’t quite sure about how exactly to restore these balances yet.
The amygdala and prefrontal cortex are two parts of the brain that are crucial when examining the relationship between the brain and depression. The amygdala is located in the previously mentioned front right part of the brain, while the prefrontal cortex is located in the front left. The amygdala is a part of the limbic system, which controls our motivation and emotions. The prefrontal cortex is not a part of the limbic system. Its job is to assist in self-organization and control. Scientifically speaking, we undergo emotional changes or outbursts (such as anger) when the amygdala is stimulated. The role that the prefrontal cortex plays here is sending messages to the amygdala, which “flattens” it – therefore reducing the intensity (or sometimes completely eliminating the intensity) of these emotional outbursts. Depression creeps in when communication between the amygdala (front right) and prefrontal cortex (front left) is skewed. Both medication (antidepressants) and psychological therapy attempt to restore equilibrium between the amygdala and prefrontal cortex, but they each attack the brain in different ways. Medication will usually reduce activity in the amygdala, while psychotherapy will increase the productivity of the prefrontal cortex.
Advances in depression treatments have been halted for years, and a big reason for this is a lack of neurological and clinical research. Although we know how medication and psychotherapy attack the brain, 60% of current treatment methods fail initially (“No Dishonour in Depression”). One reason for this is because we have yet to find new and/or improved methods that would maximize results based off our current neurological knowledge. This in itself is a sign that although we have made some significant findings, there is still more to be done. Some people are against investing time, money, and other resources into depression research, arguing that depression can be caused by cultural, environmental, and other factors. However, research in the field of depression has been decreasing ever since President Nixon signed the National Cancer Act of 1971. In 2013, cancer research outweighed depression research by $4.885 billion (Ledford). Clinical depression research has always struggled due to the fact that people with depression are either ashamed to admit it, or too embarrassed to share personal experiences. Clinical research will continue to struggle unless scientists break the norm and attempt to learn more about what a day in the life with depression is like.
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| Photo by DES Daughter. |
In terms of laboratory research, the only real option from here is to go forward. In the past decade, new systems have been developed and produced that image physical and molecular features of illnesses. Because of these recent technological breakthroughs, the US National Institute of Mental Health is attempting to promote more imaging of mental illnesses in these systems (“The Burden of Depression”). This is another step in the right direction, but some people still undermine the importance of mental health research, stating that these newly released machines should be used for other purposes. What these people do not realize is that we will have to wait even longer to see advancements in the field unless we change the way we research mental illness now.
Since we have not made much progress in terms of research, current treatment methods for depression are outdated and need improvement. As of now, a depressed individual’s best bet when it comes to treatment would be medication or CBT. The only issue here is that every person reacts differently to each method, and we do not have a current way to determine which treatment should be given to an individual initially (this is a problem that branches off of the lack of research and knowledge). Some patients may prefer CBT, while some may prefer antidepressant medication. Some patients may need both! Since there is no way (other than trial and error) to find out which treatment best suits the individual, actually getting results may take up to two or three months longer than planned. This is a significant time period when you consider the fact that the patient is hoping for results while battling through a mental illness that has been caused by an imbalance in their brain. Some patients may lose hope within this time period and gain a perception that their problem cannot be cured.
Not all hope is lost with those who do not see immediate results. Recent research has led to the belief that treatment response level depends on the level of insula present in the person’s brain. If research can be continued and confirmed, this two to three month “waiting period” can be removed for most individuals (“No Dishonour in Depression”). The one thing that looms along with the research barrier is the question of how to actually measure an individual’s insula level before receiving treatment, which is why greater knowledge about depression is crucial. Even when we find new possibilities and/or information, the knowledge needed to execute these new ideas is lacking. In the article “Depression, the best way forward” from Nature magazine, Robert C. Malenka & Karl Deisseroth propose a possible way to improve future treatments using neuroscience. They believe that if we can find the brain circuits that relate to mental illness, we could attempt to develop new drugs that would manipulate the brain cells in these circuits, leading to brain balance restoration.
Another way to improve treatment methods outside of neuroscience and the discovery of insula level is by changing the ingredients of current antidepressant medication. In the previously mentioned Nature article “Depression, the Best Way Forward,” Lisa Monteggia says that the main problem with antidepressant medication other than the “waiting period” is that this medication typically does not work on those who suffer depression at a high magnitude (she categorizes these individuals as “treatment resistant”). Her solution to this is a drug called ketamine. Monteggia shows that when ketamine was used in testing, it led to quicker results AND results for those who previously categorized as “treatment resistant”.
Since we have not made much progress in terms of research, current treatment methods for depression are outdated and need improvement. As of now, a depressed individual’s best bet when it comes to treatment would be medication or CBT. The only issue here is that every person reacts differently to each method, and we do not have a current way to determine which treatment should be given to an individual initially (this is a problem that branches off of the lack of research and knowledge). Some patients may prefer CBT, while some may prefer antidepressant medication. Some patients may need both! Since there is no way (other than trial and error) to find out which treatment best suits the individual, actually getting results may take up to two or three months longer than planned. This is a significant time period when you consider the fact that the patient is hoping for results while battling through a mental illness that has been caused by an imbalance in their brain. Some patients may lose hope within this time period and gain a perception that their problem cannot be cured.
Not all hope is lost with those who do not see immediate results. Recent research has led to the belief that treatment response level depends on the level of insula present in the person’s brain. If research can be continued and confirmed, this two to three month “waiting period” can be removed for most individuals (“No Dishonour in Depression”). The one thing that looms along with the research barrier is the question of how to actually measure an individual’s insula level before receiving treatment, which is why greater knowledge about depression is crucial. Even when we find new possibilities and/or information, the knowledge needed to execute these new ideas is lacking. In the article “Depression, the best way forward” from Nature magazine, Robert C. Malenka & Karl Deisseroth propose a possible way to improve future treatments using neuroscience. They believe that if we can find the brain circuits that relate to mental illness, we could attempt to develop new drugs that would manipulate the brain cells in these circuits, leading to brain balance restoration.
Another way to improve treatment methods outside of neuroscience and the discovery of insula level is by changing the ingredients of current antidepressant medication. In the previously mentioned Nature article “Depression, the Best Way Forward,” Lisa Monteggia says that the main problem with antidepressant medication other than the “waiting period” is that this medication typically does not work on those who suffer depression at a high magnitude (she categorizes these individuals as “treatment resistant”). Her solution to this is a drug called ketamine. Monteggia shows that when ketamine was used in testing, it led to quicker results AND results for those who previously categorized as “treatment resistant”.
Although depression and mental illness as a whole have struggled over time, the future looks promising. More and more resources are becoming available to us each day, and scientists are finally starting to see where the field of mental illness needs improvement. If we take full advantage of technological advancements being made, we can overcome the mysteries of neuroscience. Research is not the only thing holding back advancements in depression. Those who currently suffer from it or those who have suffered from it need to let their voice be heard. Depression is a mental illness, and every person’s interaction with it is unique. Once scientists can overcome neurological barriers and understand more of the human perspectives, depression can become a topic that we are no longer scared to face.
Works Cited
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