Mental illness is one of the most common and debilitating set of human conditions — and it is one that does not always receive the attention it deserves due to the effects of shame and stigma. For example, the patient in the study I discuss below talks about how she believed her depression was a personal moral failing because she could not just “get better” by having a positive attitude. She has kept herself anonymous (as she has said in new reports) because the stigma of mental illness has been so hard on her. I have seen this type of thinking up close in so many 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 are voicing concerns about mental illness and advocating to change these narratives. (There is a generational divide in major depression diagnoses. One study cites the under-reporting of depression to be around 70 percent in adults over the age of 65.) In 2019, Dr. Arthur Evans, the CEO of the American Psychological Association, said that an increased prevalence of depression diagnoses in Generation Z could be associated with a greater awareness of mental health issues and an openness to continued conversations about depression and mental health stigma.
And last month, the University of California at San Francisco (UCSF) published a single patient study and trial that offers an exciting approach to treating major depressive disorder (MDD) — albeit one that with, so far, extremely limited evidence of efficacy.
MDD is a common disorder. One model estimates that 30 percent of women (compared to 17 percent of men) suffer from major depressive episodes (MDE). Many patients with the condition also suffer from resistance to typical depression treatments such as the use of antidepressants, which can contribute to relief in 40 to 60 percent of individuals experiencing moderate or severe depression. However, with MDD, individuals may experience treatment resistance, meaning that — although many individuals suffer with MDD, there are yet to be long-term, sustainable, and effective treatment options available.
Women are more likely to suffer depression for a variety of reasons such as gender-based violence, greater socioeconomic disadvantage, and more responsibility to care for others. There are a variety of co-occurring stressors that may compound in a woman’s life and make her more prone to developing depression. MDD can also develop in adolescents, and one major depressive episode can be the impetus for later incidents. Additionally, a longitudinal 40 year study conducted in New Haven revealed that children of mothers with depression are three times as likely to develop depression themselves (in addition to anxiety and substance abuse disorders). Although, the research indicates a need to focus on the mental health of women and that treating and preventing MDE at a young age are crucial to life-long health and wellness.
In the UCSF study, individuals suffering from major depressive disorder underwent brain scans to map their brain circuitry with their neural activity recorded for 10 days. Whereas treatments for conditions including epilepsy and Parkinson’s disease have focused on the same brain regions for all patients, in MDD, there has been evidence that neural circuits underlie depressive symptoms on an individual basis.
After this initial individual mapping, one female patient continued in the UCSF clinical trial. Electrodes were implanted into her brain to send electrical impulses to specific regions of her brain where abnormal signals and biomarkers were detected. The electrical impulses from the implant could then inhibit these irregular signals in the brain, thereby helping to alleviate the misfiring for months until its battery needs to be replaced. The patient in the UCSF study experienced immediate relief of depression symptoms in addition to 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, the researchers believe that it has broader potential. The treatment plans and electrode implants can be highly tailored to each individual’s own brain and to the specific locations of any abnormal signals that are detected. However, there are several caveats as this research continues to move forward. First and foremost, this is a very expensive treatment requiring brain surgery in which the basic technology costs around $30,000. Additionally, some individuals with MDD may have different neural circuits underlying their symptoms that need to be targeted differently than the first — and so far — only patient. And yet, if the patient studied by UCSF continues to respond well, if other patients have similar success as the trial is expanded, and if additional development can bring down the cost of the intervention, this study could revolutionize care for those enduring the effects of treatment-resistant MDD.
I find this incredibly exciting and hopeful. With new, effective, and long-lasting treatment options, we can gain better understanding of not only depression but also of the brain. With time and effort, mental health stigma can continue to fade, and instead of seeing the overwhelming presence of anonymity in the mentally ill and affected, we will see advocacy, hope, and community.
Gillian is a junior at Timothy Dwight College studying Molecular, Cellular, and Developmental Biology and Anthropology. Read more from Gillian on WHRY's blog: "Why Didn't I Know This?