Most of us know someone — a friend, colleague, or relative — who has experienced a fight with cancer. We share their names and stories, do what we can to help, and take part in fundraisers for cancer treatment and research. And thanks to all that research, doctors today are able to construct individualized treatment programs for cancer patients with great accuracy. It’s a far cry from the “one-size-fits-all” approach of the past.
So, what if we could apply such targeted treatments to depressions and bipolar illnesses?
As a society, we pay for our ignorance of the costs of depression. An article in the July 2013 issue of the New York Times Magazine, entitled “The Half-Trillion-Dollar Depression,” noted that about one in five American adults lives with this debilitating mental illness. Depression frequently starts when people are young, and too often becomes chronic. When direct medical costs (therapy, drugs, hospitalizations, etc.) are combined with indirect medical costs (missed work due to illness, lack of focus, or the use of Social Security Disability Insurance), the damage jumps to half a trillion dollars. Such costs create an environment where everyone suffers.
To combat serious diseases, you have to spend money to save money down the road. But how can these dollars best be spent? A major allocation for research that would fine-tune the use of anti-depressant or mood stabilizer medications based on people’s genetic makeup. By collecting and coordinating nationwide data, we could find what medications work best for each person’s illness. This effort could be a “tipping point” that could fundamentally change the way we treat depression or manic-depression. Not only would this new knowledge save money, it could save lives and families.
So what’s The Next Idea?
Imagine yourself walking into a doctor’s office seeking treatment for depression. You hand your clinician a strand of your hair and a cotton swab from inside your cheek. Analyzing that material could lead to development of personalized, precise treatments. In the cancer world, there are more than 100 different types of cancer and most require different, individualized treatment programs.
Depressive and bipolar illnesses are similar. Like cancers, they have many different causes. Consider just a few: genetic alterations that can produce changes in brain serotonin and other neurotransmitters; elevated stress hormones; thyroid illnesses; inflammatory changes in the brain; head trauma with concussions; and sleep apnea. These and many other factors can lead to depressive symptoms. Each patient’s depression will need its own treatment.
In the future, your biological samples could inform your doctor about what kind of medication metabolizes well in your body, what medication will not, or whether you might metabolize some medicines so rapidly that you may need two or three times the recommended dosage to get better. Down the line, these samples may even indicate which type of treatment should be selected first. Potentially, we are looking at the end of a trial-and-error approach.
The trial-and-error factor is, unfortunately, one of the obstacles to funding depression research. With stiff competition for research dollars, less quantifiable treatments like counseling and therapy are harder to get money for, even though they have proven helpful. Focusing on the concrete, “hard science” aspect of matching medicines to patients will likely be considered a more practical use of funds — and is more likely to draw those funds.
In the past, cancer was a disease that was, in many ways, as misunderstood and stigmatized as depression is today. Between 1960 and the mid-1970s, however, cancer treatment and prevention research drew national attention with the formation of the National Cancer Institute and the passage of the National Cancer Act. The result was significantly greater funding for research into the diagnosis, treatment, and prevention of cancers. Today, mortality rates for some of the most prevalent cancers have declined by double digits, and cancer is no longer perceived as a “disease of the weak.”
But for mental health research initiatives to similarly flourish, money needs to be invested. A November 2014 article published in Nature noted that depression research receives much less funding than cancer research does: $415 million versus $5.3 billion. This distribution occurs despite World Health Organization data showing that clinical depression produces more disability than all cancers combined.
Michigan is also spending less on depression. In 2013, the state spent $281 million on mental health care. That allocation is now $97.5 million as of 2015, even as costs to businesses, communities, and individuals continue to rise. And Michigan is not unique.
The University of Michigan Depression Center is working to reverse this trend. Since its inception in 2001, the UMDC has worked to bring depression into the mainstream of medical discussion and research; to deliver advances to doctor’s offices in months instead of decades; to educate the public; and to light a fire for research funding. We aim to make personalized treatments — what works best for each person — a reality and an expectation. We have made progress in furthering many parts of this agenda. UMDC leaders have been invited to testify on multiple occasions to U.S. congressional committees on policy, advocacy, and public health issues. But considering the severity of the problem, progress remains too slow. Additional voices are needed. The word needs to be spread.
And more data are needed. Leaders at the UMDC knew from the beginning that a single center would never be enough. So in 2001 they also proposed starting a national network of centers to work collaboratively on a large scale. The National Network of Depression Centers (NNDC) brought together the UMDC with 15 other eminent academic institutions from around the country. The network has grown to 24 leading universities in the United States. And there are six more centers affiliating with the NNDC in Canada.
The time for advocating for more research and for better diagnoses and treatments is now. We are jumping the hurdles. We need many more voices and many more dollars to do it better and faster, and to permanently conquer these illnesses.
John Greden is the executive director of the University of Michigan Comprehensive Depression Center, the Rachel Upjohn Professor of Psychiatry and Clinical Neurosciences in the Department of Psychiatry, and research professor in the Molecular and Behavioral Neuroscience Institute.