Mental illness is one of the most common and debilitating human conditions – and one that doesn’t always get the attention it deserves due to the effects of shame and stigma. For example, the patient in the study discussed below talks about her belief that her depression was a personal moral failure because she could not “get better” just by having a positive attitude. She kept herself anonymous (as reported in new reports) because the stigma of mental illness was too severe for her. I’ve seen this kind of close-up thinking in a lot of those around me. Depression is the leading cause of disability in the world, and studies have found that women suffer from depression twice as often as men.
But there is hope.
Younger generations of individuals express their concerns about mental illness and advocate a change in these narratives. (There is a generation gap in the diagnosis of major depression. One study suggests depression is underreported in less than 70% in adults over 65.) In 2019, Dr. Arthur Evans, CEO of the American Psychological Association, said the increased prevalence of depression diagnoses in Generation Z could be linked to increased awareness of mental health issues and openness to ongoing conversations about depression and mental health stigma.
And last month, the University of California, San Francisco (UCSF) published a study and one patient trial that offers an exciting approach to treating major depressive disorder (MDD) — although there is very limited evidence of effectiveness to date.
MDD is a common disorder. One model estimates that 30 percent of women (compared to 17 percent of men) experience major depressive episodes (MDE). Many patients with this condition also have resistance to typical depression treatments such as the use of antidepressants, which can contribute to relief for 40 to 60 percent of individuals with moderate or severe depression. However, with MDD, individuals may experience treatment resistance, which means that – although many individuals suffer from MDD, there are still long-term, sustainable, and effective treatment options available.
Women are more prone to depression for several reasonsLike gender-based violence, more social and economic deprivation, more responsibility to care for others. There are a variety of co-occurring stressors that can build up in a woman’s life and make her more susceptible to depression. Major depressive disorder can also develop in adolescents, and one major depressive episode can be the trigger for subsequent episodes. Additionally, a 40-year longitudinal study conducted in New Haven revealed that children of depressed mothers are three times more likely to develop depression themselves (in addition to anxiety and substance use disorders). Although the research points to the need to focus on women’s mental health, MDE treatment and prevention at an early age are critical to lifelong health and wellness.
In the UCSF study, individuals with major depressive disorder underwent brain scans to map brain circuits with their neural activity recorded for 10 days. While treatments for conditions including epilepsy and Parkinson’s disease have focused on the same brain regions for all patients, there has been evidence that neural circuits underlie depressive symptoms on an individual basis.
After this initial individual appointment, one patient was continued in the UCSF clinical trial. Electrodes were implanted in her brain to send electrical impulses to specific areas of her brain where abnormal signals and biomarkers were detected. The electrical impulses from the implant can block these erratic signals in the brain, helping to ease the imbalance for several months until its battery needs to be replaced. The patient in the UCSF study felt immediate relief from depressive symptoms as well as long-term relief as she was monitored over the course of the trial.
Although this experimental treatment has only been successfully tested on one woman, researchers believe it has broader potential. Treatment plans and electrode implants can be highly tailored to each individual’s brain and the specific locations of any abnormal signals detected. However, there are several caveats as this research continues to move forward. First of all, this is a very expensive treatment that requires brain surgery, the basic technology of which costs about 30 thousand dollars. In addition, some individuals with major depressive disorder may have different neural circuits that underlie their symptoms that need to be targeted differently than the first – and so far – only patient. However, if the patient studied by UCSF continues to respond well, if other patients have similar success to expand the trial, and if further development can reduce the cost of the intervention, this study could revolutionize care for those with Effects of treatment-resistant MDD.
I find this incredibly exciting and hopeful. With new, effective, and long-term treatment options, we can gain a better understanding of not only depression but also the brain. With time and effort, the stigma around mental health can continue to fade, and instead of seeing the overwhelming presence of anonymity in the mentally ill and affected, we’ll see advocacy, hope, and community.
Jillian is a junior at Timothy Dwight College studying molecular, cellular and developmental biology, and anthropology. Read more from Gillian on the WHRY blog: “Why didn’t I know this?