Why is treating depression such a guessing game?

"We know depression varies widely across people, and we think that has something to do with why treatment is not always effective," says Andrea K. Wittenborn. (Credit: Rob Baird/Flickr)

Depression is likely caused by multiple biological, psychological, social, and environmental drivers—and these factors often overlap.

Yet most previous research has focused on only one or two factors, and disregarded how the many factors can intersect and unfold over time.

Now scientists are developing a new model that incorporates the myriad drivers of depression. They think it could lead to more precise and more personalized treatments for an illness that affects 350 million worldwide.

“Clinicians who treat depression tend to work on a trial-and-error basis, whereas this model could give them a more systematic and effective method for making decisions about treatment,” says Andrea K. Wittenborn, associate professor in the human development and family studies department at Michigan State University. “Most importantly, this model provides a method for personalizing treatment to each unique patient.”

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For the new study, published in the journal Psychological Medicine, researchers analyzed nearly 600 scientific articles and incorporated the major drivers of depression discussed in the research into a complex model that essentially diagrams how one driver affects another. Examples of drivers include sleep problems, social isolation, and inflammation of the brain.

Study coauthor Hazhir Rahmandad, a Massachusetts Institute of Technology scholar, is an expert in a process called system dynamics, an approach that’s more common to engineering and business. The team used this approach to create a comprehensive model of depression. While future research is needed to further validate the model, it’s a vital first step in better understanding depression and potentially improving care for the illness.

The goal is for therapists or even patients to one day plug triggers into a smartphone app and receive a recommendation for the most appropriate treatment.

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Despite decades of intervention, research, and public awareness efforts, depression remains a remarkably destructive public health problem that costs the United States more than $210 billion a year, Wittenborn says. While psychotherapy and antidepressants help some people, response varies widely and only leads to meaningful improvement for about half of patients.

“This model opens the gate to understanding depression as it relates to the whole person and all of his or her experiences. It helps us understand how depression varies by person—because we know depression varies widely across people, and we think that has something to do with why treatment is not always effective.”

Source: Michigan State University