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People with major depression often find themselves crying for no apparent reason; they report feelings of seemingly insurmountable sorrow, like plummeting down a well of worsening despair. Suicide attempts are common.
Incidences of the debilitating mental illness major depression are spiking worldwide. From 1992 to 2017, the number of people with depression at all levels of intensity rose from 168 million to 254 million – an increase of 51 percent.
For years, researchers focused on the neurochemical explanation for depression: Patients had a deficiency of one or more of the three neurotransmitters that affect mood.
A June 2019 article from the Harvard Medical School states that numerous non-neurologic causes for depression are now understood. Depression can be triggered by stressful life events, medications the patient is already taking, other medical problems, genetic vulnerability.
Experts are still focusing on neurochemistry -- but on many more than three chemicals. ``There are millions, even billions, of chemical reactions that make up the dynamic system that is responsible for your mood, perceptions, and how you experience life,’’ the Harvard Medical School article states.
Indeed, when we consider the different extents that depression affects different people of different ages, ethnicities and genders, we can see that depression is not merely a matter of the presence or absence of neurotransmitters.
In the United States, the epidemic has proven to be especially rough going for women, younger people, native Alaskans and American Indians and whites. According to the National Institute for Mental Health, in the United States in 2017, 5.3 percent of males and 8.7 percent of females were diagnosed with major depression in the last year. Thirteen percent of people aged 18 to 25 had the diagnosis. The percentage for those aged 26 to 49 is 7.7 percent. For everyone aged 50 and over, the figure is 4.7 percent.
The highest incidence was the 8 percent suffered by American Indians and native Alaskans. A close second were white people, of whom 7.9 percent were diagnosed. The figure for African Americans and Hispanics is 5.4 percent. (This is interesting because it works against the tide of the conventional wisdom that the lives of African Americans and Hispanics are usually much more stressful than those of white people.)
Also, there are noteworthy global disparities. For instance, in Greenland in 2017, 6.2 percent suffered some degree of depression. The percentages, respectively, were 4.8 in the United States and 3.5 in India.
The demographic data raise the question of whether researchers could find a course of treatment that would help a significant of people with depression. Would the same therapeutic regimen provide a comparable level of benefit to a 39-year-old white man and a 15-year-old Hispanic girl? How about a middle-aged woman in southern Asia and a teenage boy in the United States?
As with all mental-health problems, experts recommend a combination of medication and talk therapy to tackle depression. They also recommend that patients pay attention to their daily routines. But these days researchers are looking into new treatments that are based on neurology.
In March, the U.S. Food and Drug Administration gave the go-ahead to esketamine, the first new anti-depressant to be approved in decades. The drug is a result of research into ketamine, an aesthetic that acts on NMDA receptors, to which researchers had hitherto given relatively little attention. ``Homing in on this channel appears to provide relief from depression that is better, arrives faster, and works in far more people than current drugs,’’ Business Insider reported in December.
Researchers are also looking into the use of psilocybin. ``Brain scan studies suggest that depression ramps up the activity in brain circuits linked with negative emotions and weakens the activity in circuits linked with positive ones. Psilocybin appears to restore balance to that system,’’ Business Insider reported.
The work on esketamine, marketed as the nasal spray SPRAVATO, and psilocybin stem from a ``resurgence of interest’’ in therapies that affect parts of the brain that are not targeted by anti-depressant medications now.
In March 2018, researchers at the Scripps Research Center’s Florida campus announced that they had started to investigate another unexplored area, the brain receptor GPR158. They found that people with a high GPR158 level were susceptible to major depression.
"The next step in this process is to come up with a drug that can target this receptor," Science Daily quoted top research investigator Kirill Martemyanov as saying.
The GPR158 research won’t result in a new drug therapy anytime soon, according to the report. "This is really new biology and we still need to learn a lot," Martemyanov said.
A psilocybin-derived treatment may not arrive for at least another 10 years.
Sources
· A fresh crop of promising drugs is poised to change the way depression is treated for the first time in decades. Here are the ones to watch in 2019. https://www.businessinsider.com/most-promising-new-depression-drugs-treatments-predictions-2019-2018-12 accessed July 8, 2019
· Depression: Overview
https://www.nimh.nih.gov/health/topics/depression/index.shtml
accessed July 7, 2019
· Depression: What Are Signs and Symptoms http://mentalhealth.fitness/learnabout-your-diagnosis/depression/ accessed July 7, 2019
· Major Depression https://www.nimh.nih.gov/health/statistics/major-depression.shtml accessed July 7, 2019
· New research points to better way to treat depression https://www.sciencedaily.com/releases/2018/03/180301125040.htm accessed July 9, 2019
· Our World in Data https://ourworldindata.org/mental-health#depression accessed July 6, 2019
· What Causes Depression? https://www.health.harvard.edu/mind-and-mood/what-causes-depression accessed July 6, 2019
(c) 2019 Daniel S. Miller
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