If the extent of human suffering were used to decide which diseases deserve the most medical attention, then depression would be near the top of the list. More than 350 million people are affected by depression, making it one of the most common disorders in the world. It is the biggest cause of disability, and as many as two-thirds of those who commit suicide have the condition.
“But although depression is common, it is often ignored.
First published in 1869, Nature is one of the most cited scientific publications. It is also one of the most read (Nature claims an online readership of 3 million unique readers a month).
This special issue of Nature is dedicated to Depression.
There are several worthwhile articles.
One, by Kerri Smith, seeks to put Depression in a global context. The article contains several info graphics. The following illustrates the global burden of disease, with Depression accounting for the most years lost to disability — more, in fact, than diabetes, chronic lung disease, and migraines put together.
Another, penned by Emily Anthes, considers the success of CBT with Depression – but how little we really understand about the neuro-biological underpinnings for this treatment, beyond involvement of the prefrontal cortex. Much to like in that piece, including the graph showing that CBT outlasting meds in terms of long-term effects.
Though I encourage you to read all the Depression-related articles, the features piece by Dr. Heidi Ledford is particularly good and thought-provoking, “Medical research: If depression were cancer.”
Dr. Ledford makes several observations:
· “[A]lthough depression is common, it is often ignored. Three-quarters of people with depression in the United Kingdom go undiagnosed or untreated… The comparison between depression and cancer is a common one. Cancer, too, is a terrible blight: it affects more than 32 million people and kills some 8 million a year, many more than depression. But at least in developed countries, the vast majority of people with recognized cancers do receive treatment.”
· “Cancer research today is a thriving field, unearthing vast catalogues of disease-associated mutations, cranking out genetically targeted therapies and developing sophisticated animal models. Research into depression, meanwhile, seems to have floundered: once-hopeful therapies have failed in clinical trials, genetic studies have come up empty-handed.”
· “The US National Institutes of Health pumped about US$5.3 billion into cancer research in 2013 — a stark contrast to the $415 million it spent on depression research and the $2.2 billion on mental-health research as a whole.”
· Dr. Ledford explores why this is: noting problems around advocacy (people with depression often lack the energy to advocate, and stigma makes it that much more challenging), but other problems, too…
· The genetics dead-end issue. “The largest study so far — a search through the genomes of just over 16,000 patients with major depressive disorder and another 60,000 controls — has turned up just one, as yet unconfirmed, genetic association.”
· The animal model (or lack thereof) issue. In cancer, animals (like mice) have been engineered to express cancer-associated genes found in humans; “Depression researchers, however, have faced huge challenges in creating mice or other animals that behave in a way that mirrors how people are affected by the disorder.”
· The neural circuit complexity issue. Notes Dr. Noah Philip of Brown University: “Treating depression isn’t as simple as filling up a tank of neurotransmitters. It’s correcting a disorder of different neural networks that are not behaving properly.”
I’m particularly struck by the comment that Depression research is needed, but that we aren’t ready for a War on Depression (like the War on Cancer).
Still, as frustrating as this piece is, my unbridled optimism remains undiminished. In 2014, it’s possible to pick up one of the most important scientific journals and read about psychiatric illness. Progress.
Further reading? The rest of the issue (515:7526) can be found here:
Reading of the Week. Every week I pick a reading — often an article or a paper — from the world of Psychiatry.