To explore the latest research and treatments for depression, Georgetown physicians and scientists convened at the March 11 session of Doctors Speak Out. More than 100 people attended the program, hosted by Georgetown University Medical Center (GUMC).
Panelists brought a variety of research and clinical experience to the discussion. Mayada Akil, MD is professor of psychiatry at GUMC, vice chair for education in the department of psychiatry and medical director of the outpatient program at MedStar Georgetown University Hospital. She was joined by Kenneth J. Kellar, PhD, professor and vice chair of the department of pharmacology and physiology at GUMC, and Edilma L. Yearwood, PhD, RN, PMHCNS-BC, FAAN, associate professor and interim chair of the department of nursing in the School of Nursing & Health Studies.
Akil noted the unfortunate use of the term “depression” to describe a wide spectrum of mental states. In addition to a normal, transient state of discouragement we all feel and most recover from, she said, the same term is used to describe the extreme end of the spectrum, where people are deeply affected in many ways.
“They are in psychological pain, unable to think clearly and unable to connect with other people. They feel overwhelmed, burdened, anxious, guilty, hopeless, helpless and sometimes suicidal,” said Akil.
She added that the suffering is not just a matter of duration and severity, but that patients with clinical depression experience a certain kind of pain that is difficult for others to understand. The different forms and causes of depression further complicate diagnosis and treatment, Akil explained.
“Depression can be low grade, long standing—almost unremitting, with some periods of relief—which is called dysthymic disorder. Major depressive disorder tends to be more episodic,” said Akil, who noted that the average time for a patient suffering from depression to finally obtain treatment is eight years.
“Way too long,” she added.
EXPLORING NEW AND OLD TREATMENTS
Kellar’s research focuses on understanding factors that regulate the brain’s neurotransmitters and their receptors that are critical in treating mental disorders. Depression comes in many forms, he explained, but once scientists learn to distinguish one kind of depression from another and tailor the treatments, great progress can be made.
He noted that research is a challenge because there is no clear test for depression, and at this time, no good animal model to allow for detailed study of the disease. “Depression is a communication disorder,” he said. “It’s how you feel, and rats can’t tell us how they feel.”
New therapies are being explored including the use of ketamine, an anesthetic around since the 1960s that has been found to work as an anti-depressant for people with drug-resistant depression. The research on ketamine is exciting because it works quickly, said Akil, versus other commonly used therapies that may take weeks or even months before benefits can be seen. However, she noted, the effects of the intravenously administered drug tend to wear off after a week, complicating administration of the treatment.
Kellar’s lab is revisiting electroconvulsive therapy, hoping to better understand why this controversial but effective therapy works. It is an underappreciated and underused treatment, he said, and research into how it affects the brain may offer solutions for drug development to mimic the mechanisms of the therapy.
FACTORS AFFECTING VULNERABILITY
Yearwood spoke to the variety of social determinants on mental health. Where children live, grow and become educated impacts their vulnerability to depression, she said. Group support and a sense of connectedness in a community are critical factors in providing children, adolescents and adults with a feeling of hope.
She noted a growing trend in self-harming behaviors in adolescents. She added that today’s youth are comfortable using the internet to get information, and tele-consultations and app technology may offer some solutions for basic diagnosing of mental illness, particularly in areas where remote care is the only option. Better health literacy in all populations can help prevent depression, she said.
Akil added that Georgetown is currently developing an app to screen for depression.
Panelists also addressed the gender issue in depression, with women presenting twice as often as men with the illness. Men often try to hide their vulnerability, said Akil, so their depression may express itself in ways that make it harder to diagnose, such as irratibility, anger and substance abuse. “I tell my medical students to look for depression harder in men,” she said, “because they’re not going to tell you about it.”
SHATTERING THE STIGMA
Moderator Rear Admiral, USPHS (Ret.) Susan J. Blumenthal, MD, MPA, spoke about the societal sensitivities around mental illness. “Unfortunately, the symptoms of depression are considered by many to be personal weaknesses or character flaws, rather than an illness with effective treatments,” she said.
Advancing research on how the brain functions, in addition to breakthroughs in treatment for depression, offer new hope.
“Forums like this one are helping shatter the past stigma of mental illness by opening up windows of understanding about the causes, treatments and prevention of these illnesses,” she added.
By Jane Malhotra, GUMC Advancement
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