The World Health Organization recently predicted that depression will become the second leading cause of disability worldwide in just five years. The ongoing discussion about mental health in the United States has largely centered on gaps in access to care, but — particularly for the nearly 20 percent of Americans who experts say will endure major depression in their lifetime — the effectiveness of current treatments perhaps needs to be a bigger part of the conversation.
The most prevalent treatment option for various types of depression combines psychotherapy — also known as psychological counseling — and the ingestion of antidepressants that quells symptoms like a lack of energy, low appetite, feelings of worthlessness, and slowed cognition and body movements. While experts tout the counseling portion as crucial in helping patients sort out their problems, some critics have concerns about the medication, citing antidepressants’ side effects — weird dreams, dry mouth, diarrhea, and decreased libido — and potential for abuse.
Those drawbacks of taking antidepressants, and the reluctance of some patients to continue their regimen, prompted neuropsychologist Dr. Greg Siegle to explore options that treat depression more like a physical ailment than a mental problem. Since 2005, Siegle’s research has reflected that mindset by focusing on the dorsolateral prefrontal cortex — the part of the brain that controls executive function, working memory, and cognitive flexibility.
“We thought that when it comes to depression, the brain might be like a muscle that needs to be toned up. People who go over negative things in their head a lot tend to respond most poorly to cognitive behavior therapy,” Siegle, a professor at University of Pittsburgh School of Medicine, told ThinkProgress. “Some of them don’t want to take medication or talk to another about their emotions. Early on we thought about what would happen if we treated a mental disorder more like a stroke. How would the treatments look?”
Previous studies have shown that depressed people can’t use their dorsolateral prefrontal cortex as easily as their counterparts, leaving Siegle and his colleagues to speculate that a key to helping people overcome their depression lies in strengthening this part of their brain. Subsequent clinical trials have tried to test this theory, calling on test subjects to shift their attention from negative images to positive images on a sheet of paper. During another test, subjects added numbers according to a set of rules outlined beforehand. They would also take on activities that they would find pleasurable.
Ten years after the start of his journey, Siegel said that the treatment, called “cognitive control therapy,” shows some promise of helping depressed people dwell less on the negative. He said these findings have been upheld with studies in Brazil and Australia, during which researchers directed a gentle electric current into subjects’ brains. A trial was also recently launched at Yale University in which subjects will undergo cognitive control therapy before they start counseling sessions.
There is some anecdotal evidence that these alternative therapies can help patients who haven’t responded to more traditional approaches. For instance, Sean Elliott, a 37-year-old educator from Melbourne, Australia told the Wall Street Journal that neither antidepressant medication nor therapy quelled his symptoms of depression. Making matters worse, when he tried to stop taking his medication, he only felt dizzy. But after participating in a clinical trial for cognitive bias modification-interpretation — a treatment similar to the cognitive control that calls on the depressed to positively interpret ambiguous situations — Elliott said that his condition improved, pointing out that he could bounce back from arguments more easily and experienced “wipe out days,” or long periods in recluse, less often.
Siegle said his approach doesn’t intend to target depression as a whole, but rather tackle some of the most persistent symptoms.
“Many depressed people think about things they don’t want to think about over and over again,” said Siegle. “Medications don’t help decrease rumination much. This suggests that even if you’re taking them, it might be helpful to get the rumination under control. In our research we set out to use these exercises to improve executive control and working memory.”
This area of study could have significant implications for a population that’s diving deeper into depression. Last year, researchers at San Diego State University found that symptoms of the mental ailment have increased significantly among Americans since the 1980s, including a 38 percent jump in memory trouble. Teens also experience sleeplessness nearly 75 percent more often now compared to 30 years ago. This epidemic has particularly affected college students, many of whom feel overwhelmed by the demands of balancing an academic, professional, and personal life. Traumatic life events and the stress of adolescent change can distort one’s feelings, actions, and perceptions, ultimately triggering a mental disorder.
If left untreated, depression can lead to suicide, as seen in the cases of nearly 4,600 young people between the ages of 10 and 24 who take their lives annually. In her summary, Jean Twenge, the psychology professor who led the aforementioned San Diego State study, stressed the need to address the mental health problem while acknowledging that antidepressants alone won’t heal patients.
In recent years, more people in the mental health space have taken on that school of thought. During a gathering of thousands of mental health advocates in Washington, D.C., former U.S. Rep. Patrick Kennedy (D-RI) implored lawmakers to push through legislation that would comprehensively reform mental health care in this manner. The collaborative care model has also grown in popularity for those who want their family members to work closely with their depression care managers in deciding the ideal treatment.
Siegle wants to go in a similar direction to treat disorders as multifaceted as depression. He said that enabling patients to control their thoughts before they undergo therapy should prove more effective in reducing depressive symptoms. Moving forward, Siegle said he would like to team up with a developer to make a smartphone app. He also wants to implement a similar type of therapy in the Army, where service members have historically been plagued by mental health issues.
However, he stressed that cognitive control therapy shouldn’t replace professional health care. “Even if we do make it available, I am not recommending that people stop seeing their therapist or stop taking their medication to take this program,” Siegle said. “This program is under active research and we’re hopeful about it but I don’t want to see people replacing their professional health care by using it yet.”