The feeling that there is no progress, and therefore no hope, can be among the worst aspects of depression. However, developments are occurring in the identification and treatment of depression. Examples presented at a major conference include factors most associated with suicide, and insight into a particularly poorly understood treatment that uses magnetic fields.
Conditions known as “depressive mixed states” are known to be associated with suicide risk. “A depressive mixed state is where a patient is depressed, but also has symptoms of "excitation," or mania,” said Dr. Dina Popovic of the University of Barcelona. However, depressive mixed states are often not diagnosed, hindering attempts to measure just how large a risk they are. Popovic is one of the authors of the BRIDGE-II-MIX study on depression and suicide, which has produced a series of findings on mixed states, depression and other mental conditions.
Popovic studied 2,811 patients diagnosed with depression, 628 of whom had previously attempted suicide. Speaking at the European College of Neuropsychopharmacology conference in Amsterdam, Popovic said, “40% of all the depressed patients who attempted suicide had a ‘mixed episode’ rather than just depression. All the patients who suffer from mixed depression are at much higher risk of suicide.”
Moreover, Popovic concluded that mixed depressive states are greatly underdiagnosed, putting many patients at unnecessary risk. Popovic argued that depressed patients who present risky behavior, psychomotor agitation (pacing or wringing hands) or impulsivity have a suicide risk at least 50% higher than patients who are depressed without any of these additional symptoms.
"In our opinion, assessing these symptoms in every depressed patient we see is extremely important, and has immense therapeutical implications,” Popovic said. “Most of these symptoms will not be spontaneously referred by the patient, the clinician needs to inquire directly, and many clinicians may not be aware of the importance of looking at these symptoms before deciding to treat depressed patients.”
At the same conference, attendees heard an explanation of how transcranial magnetic stimulation (TMS) affects the brain, a necessary stepping point to better target regions of the brain using the mysterious treatment.
TMS involves generation of strong magnetic fields around the skull. It has been used to treat a variety of conditions including severe depression, schizophrenia and neuropathic pain. It also has far less severe side effects than most alternatives.
However, its success is highly inconsistent. Little is known about how TMS achieves its effects, and it is hoped that some insight will help improve targeting.
Thus, in a first-of-a-kind study, researchers compared MRI-guided TMS pulses with MRIs for a control group who received a fake version of TMS, and observed its effects on brain chemistry and individual networks within the brain.
"We found that one session of TMS modifies the connectivity of large-scale brain networks, particularly the right anterior insula, which is a key area in depression,” said lead researcher Dr. Sarina Iwabuchi of the University of Nottingham. “We also found that TMS alters concentrations of neurotransmitters, such as GABA, which are considered important for the development of depression.”
Suicide prevention resources in the countries that make up most of IFLScience's readership.
National Suicide Prevention Lifeline: 1-800-273-TALK (8255). 24-hour hotline for crisis intervention, suicide prevention, and mental health services. Every call is free, anonymous, and confidential.
Suicide.org: This website contains links to suicide prevention resources in every state.
The Trevor Project: A suicide prevention and crisis intervention resource for LGBTQ teens.
National Suicide Prevention Lifeline: 1-800-273-TALK (8255). A 24-hour hotline for crisis intervention, suicide prevention, and mental health services. Every call is free, anonymous, and confidential.
Suicide.org: This website contains links to suicide prevention resources across Canada.
Kids Help Phone: Free, anonymous, confidential hotline for Canadians under the age of 20.
PAPYRUS Prevention of Young Suicide: Charity dedicated to raising awareness and reducing the stigma of depression. There are counselors available via phone, email, or text who can provide crisis intervention.
Samaritans: Though the name sounds religious, this is a secular organization that provides crisis intervention for those in need.
Campaign Against Living Miserably (CALM): England-based charity aimed to reduce depression and crisis among males.
Lifeline: This organization provides mental health support and crisis intervention through free, anonymous, and confidential phone calls across Australia.
Kids Help Line: Hotline provides crisis intervention and mental health support for young Australians ages 5-25.
If your location is not listed here, please search for resources local to your area, or contact your doctor, family, or friends for help.
Please remember that you are not alone and that you can get through this.