If the medical discipline of brain health or psychiatric disorders is misunderstood, depression is the stepchild borne of stigma. Depression, also known as Major Depressive Disorder (MDD), is a disease of the brain that that carries a physical burden on the patient worse than a heart attack. There are two schools of thought regarding the origins of depression. The first is the old (and I mean old) psychoanalytic model that defines depression as “anger toward others turned inward”. The second approach uses the approach that MDD is a medical illness caused by a chemical imbalance in the brain.
As a physician, I personally and clinically throw out the psychoanalytic model. The chemical imbalance model is based on targeted, modern, medical science, including data from neuroimaging trials. The NIH, universities, and even pharmaceutical companies have been collecting DNA samples from patient volunteers with various psychiatric diseases for the past 15+ years. Experts across the board believe that the focus of future research and obtaining a deeper understanding of depression includes identifying the specific genetic predisposition to this illness. Some even think it may be a constellation of genes.
A recent study published in Nature showed that adding a diabetes medication to an antidepressant protected the telomeres (the caps on the end of chromosomes, our DNA). By protecting the structural integrity of the telomeres this treatment combination provided a better quality of life than outcomes for patients given an antidepressant plus a placebo. While cognitive behavior therapy has value in a comprehensive treatment protocol, first line treatment must include addressing depression as a root cause of functional impairment. For that reason, the genetic-chemical-behavioral paradigm is the most effective way to address brain illnesses such as depression.
Genetics! What a profound concept and segue to start the discussion on de-stigmatization of brain health. Psychiatric illnesses such as anxiety and depression clearly run in families. Some families are open and talk about the disease, encouraging their loved ones to get help while other families pretend it does not exist. If hypertension or high cholesterol runs in the family, everyone is off to find a specialist after discussions at the family reunion. People are happy to discuss their current LDL numbers or dosage of Lipitor but no one is willing to discuss their Prozac prescription.
How do we get the world to see psychiatric illnesses for what they are--medical conditions? How do we talk openly about anxiety, depression, ADHD, bipolar, and schizophrenia? Hopefully medical science has started the change in perceptions. The research on genetics, new approaches to treatment, new medications and new technologies have all helped us to better understand the etiology of psychiatric disease. My team is currently testing not only new medications but also innovative approaches such as Botox well as low frequency magnetic stimulation as potential antidepressants, and intravenous infusions of medications similar to ketamine. It is an exciting time to be a research physician but an even more exciting (and heartening) time for individuals whose daily life is negatively affected by illnesses like depression. The light at the end of the tunnel is getting closer and brighter every day.