If you live in the United States, Canada, or Western Europe, you are witnessing an explosion in the numbers of people diagnosed with mental health disorders. According to National Institute of Mental Health (NIMH), 26.2 percent of Americans 18 years old and older are suffering with diagnosable mental health conditions. Almost 70 percent of these cases are people with major depression disorder (MDD) and general anxiety disorder (GAD). It looks like entire population of the western world is about to have a nervous breakdown. The problem with these numbers is the shortage of professionals, who can deliver mental health services. Typical answer of existing healthcare system, such as blanket prescription of anti-depressants, just doesn’t work anymore.
It is well known that around half of all patients who suffer from depression do not respond well to drug treatment. This fact was always an unsolved piece of puzzle for psychiatrists and neuropsychologists. Only now (based on research findings published in 2013) we are beginning to understand the reason why.
Let’s go back in time. Drug treatment for depression began in 1950s when MAO inhibitor was first used as an antidepressant. It wasn’t because the drug was specifically designed to treat depression, rather mood enhancement was a unexpected but useful side effect. As time passed, new and safer drugs came onto the market. These drugs would usually target a specific neurotransmitter called 5-hydroxytryptamine or Serotonin. Nevertheless, as treatments, these drugs were more band-aids than cures.
Now, as neurochemistry of the brain is becoming a bit more understood, there is hope of developing new and more effective drugs with fewer dangerous side effects. These antidepressants may actually cure depression assisting the brain to build natural defenses.
Still, we must get around the hard problem of “Mechanics”.
Here, we consider Mechanics as a philosophical outlook, that is deeply imbedded in the way we approach the human mind. Mechanics began in the 18th Century, prospered in the 19th Century, dominated the 20th Century and its influence can still be felt today. It began with Newton’s approach to the universe. Mechanics treats the universe as just a gigantic machine that can be predicted and even, to some extent, controlled. While the mechanical approach has enabled us to build more and more advanced machines, it doesn’t work so well with living organisms that have developed through variation over a long period of time. The very capacity for variation and individualized responses to the environment mitigates against “one size fits all” solutions.
The big reason why the purely mechanical approach fails in the realm of biology is because life transcends the mechanical. Take a sledge hammer to an automobile engine and it will remain broken, smash an asteroid into a planet, and as long as some life survives, it will change and adapt over time to fill in all the niches that have been vacated. This is because even the simplest organisms are more dynamic and adaptable than machines.
Another problem, when it comes to anti-depressants, is that those responses tend to occur in clusters. A certain number of people will respond a certain way, while a particular number will respond a different way. And it usually isn’t just an either/or proposition. Responses vary based on chemistry, genetics, and biological adaptation to the drugs involved, to name but a few of the variables.
Adding a drug is adding a change to the system. With a simple mechanism like a steam engine, if you adjust valve A then result B will happen every time. But, adjust “valve A” in the human brain and you don’t get “B” every time. While the mechanical approach relies on constants and consistent results, the response of the human organism tends to be variable and inconsistent. This is a common trait of life in general and the more complex the organism, the more variation there is. And so, in battling depression, we are battling the very complexity that makes life adaptable in the first place. Treating depression is not as simple as it first appeared.
Depression is not a binary disorder with an on and off switch. It can have many different causes and, in many cases, be as unique to the individual as his or her fingerprint. And so treatment tends to be the most successful when it is personalized to the individual.
Fortunately, it seems that the very complexity which makes the mechanistic approach invalid can also provide us with the information we need to develop new and more efficient protocols.
Feeling upset about the state of affairs? Don’t be. There are a number of encouraging signs. New research is opening up the possibility of personalized treatment while still maintaining a rigorous approach. These include new drugs that inhibit the production of ceramide and encourage the development of new nerve cells. If this is the case, then it is possible that a new window of treatment opportunity will open up. While this research is only in the beginning stages, it is promising.
Quoting Canadian psychologist Dr. Tali Shenfield: “The more we learn about the brain, the more we realize that each human being is a complex, interrelated system. We are, in a sense, microcosms of Nature itself.”
New research may give us the opportunity to take into account this complexity and uniqueness and to treat depression with predictability by working with the human brain, rather than trying to impose our will upon it.
Modern healthcare needs increasing number of professionals that can deliver diagnostic and therapy services to patients. We already feel shortage of psychiatrists, psychologists, psychotherapists, social workers, and special education teachers. The demand for these occupations is only expected to raise in the next 10-20 years. If you decide to pursue a career related to mental health you have many opportunities and will be rewarded with high salaries and job satisfaction.