Our understanding of depression It has changed, but still psychiatrists and neurologists are unable to understand what treatment is more effective, stay with us to understand why human weakness.
May Diagnostic criteria for depression seem contradictory; That is, people can report completely opposite clinical symptoms—for example, one person may be anxious and complain of insomnia, while another may be lethargic and sleep most of the day—but the interesting thing is that both treatments are likely to be similar. have and in the first line of treatment, the same treatment is offered to them, which almost always means: antidepressants or psychotherapy.
On average, such treatments are successful in only one-third of cases. In this regard, Conor Liston, a psychiatrist and neurologist, said:
“It’s great that our treatments work so well for such diverse people. But these treatments don’t work for everyone!”
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At the heart of this problem lies the reality that, despite knowing that depression is a syndrome with various underlying causes, our clinical guidelines do not distinguish patients apart from the severity of their illness, and in addition to that, current treatment approaches only have varying degrees of clinical success. have.
According to Liston, in recent years, with the help of advances in brain imaging technologies, researchers have reached a more accurate point of view that is able to detect various changes in the brain and identify its symptoms. Liston continued, that the human brain can be seen as a set of circuits connected by neurons, and in the middle, these neurons are controlled by Neurotransmitters which originate from electrical signals communicate.
Functional magnetic resonance imaging (fMRI) can identify the different functioning of these circuits in people with depression and the symptoms they manifest. We hope that such techniques will identify the biological causes or “biotypes” (biotypes) of depression and help doctors in categorizing patients and identifying which people respond best to which treatment methods so that they can target and develop treatments accordingly.
Liston says:
“These new tools and technologies are changing how we do science in this field, allowing us to ask questions that would have seemed like the stuff of science fiction just a few years ago.”
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The reality of depression
Researchers estimate that something approx Five percent of the world’s adult population They suffer from some kind of depression. That is, for example, around 2020, more than 21 million adults in the United States will have experienced at least one episode of major depression.
Liston says:
“If you do some simple math, all this means is that there are 256 unique ways a person can explain their illness and still get treatment for it.”
Liston explains that treatment is partly trial and error. First, the patient is likely to be prescribed medication that affects the levels of mood-related neurotransmitters, such as serotonin, or some type of Speech therapy such as cognitive behavioral therapy (CBT) affects. If these fail, other drugs may be substituted to find an effective combination.
People who do not respond to medication alone may need other forms of treatment such as Electroshock therapy (ECT) or Less invasive transcranial magnetic stimulation (TMS) to be treated. Therefore, selecting each option can waste months of searching for an effective treatment. And for someone who is suicidal, it could be the difference between life and death.
Getting to the right answer faster – that’s what we all want to do. Liston.
He explains that fMRI could potentially help simplify this process. If this technology can show connections between underlying brain regions and clusters of depressive symptoms, we will be able to identify specific subtypes of the disease, and with such a more precise diagnosis, doctors may be able to tailor treatments to specific neural circuits.
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Search for circuits
Liston likens the circuits of the brain to airports in the United States of America, where large cities act as hubs connecting small towns, and congestion in one part of the network can have adverse effects on other nodes.
“You can be stuck on the LaGuardia runway for an hour or three on a beautiful sunny day because of bad weather at your destination[Chicago],” he explains. We suspect that the same thing can happen in depression to some extent.”
In terms of biology, the hypothesis is that a problem in one “hub” of the brain can penetrate the rest of the network and cause a set of symptoms related to various downstream areas of the brain.
fMRI could potentially give neuroscientists the ability to observe which brain regions are being activated together to identify cases where activation is uncoordinated and causing connectivity disruptions.
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In 2017, Liston and colleagues tested this hypothesis. They use fMRI technology for Brain network mapping More than a thousand people, both people with depression and healthy people, used it to see if certain activity patterns were associated with certain symptoms.
They are four types species Latent depression was identified that was related to different patterns. For example, some of the subjects in this study had abnormal connectivity in important upper regions of the brain.
Liston says:
“This may be a promising way to understand the mechanisms that lead to their symptoms.”
However, the limitations of human studies make it difficult to determine what kind of brain circuit problems are causing specific symptoms. Here, laboratory experiments on rodents have been invaluable. In particular, neuroscientists were able to manipulate mouse brain cells with light using “opto-genetic” tools.
“Opto-genetics allows us to turn brain circuits on and off and see experimentally and causally what that potential effect is on behavior,” Liston says. Also such developments in cognition, Finally, it can lead to new treatments by showing the connection between symptoms and related biological processes.
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The perspective that optogenetics and brain imaging will provide us
Most importantly, we may be able to pair group syndromes with appropriate treatments. First-line treatment is usually a choice between CBT and antidepressants, which neuroimaging has shown to be effective in identifying patients most likely to experience positive outcomes with CBT10 and provides a good predictor of the effectiveness of TMS.
Repeated TMS treatments They usually target an area along the midline of the scalp, the dorsomedial prefrontal cortex. According to Liston, patients with abnormal connectivity in this area show a stronger response to TMS, which has been proven in practice.
Even in a similar way, certain drugs are known to affect certain areas of the brain, so it seems to Liston that this trick can show up in different people; Because the activity of the connecting circuits of those areas may or may not be receptive to these drugs. “Neuroscientists hope to identify more biologically specific subtypes of depression in order to develop treatments tailored to their biological basis,” Liston says.
The last word
The outlook is expanding, however, to make real progress, scientists need more large-scale neuroimaging data. The goal is to understand causality and then identify existing treatments that best match the underlying mechanisms of new biological forms of depression—or develop new treatments that work better. In other words, so that we can develop the morphology of symptoms for use in the clinical treatment of depression with more characteristics.
Liston explains that he is optimistic about the studies being conducted around the world: “I hope they open doors to fundamental ways to treat depression.”
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Source:Scientific American