The Future Of Depression Treatment


Thanks for CuriosityStream for supporting
this episode! Go to CuriosityStream.com/Psych to learn more. { ♪INTRO } Dealing with depression is not easy. And it doesn’t help that it is really difficult
to find effective treatments for it. Your genetics, your environment, and various factors in your brain all seem to play a role in whether you develop depression and how you experience it. So the most common treatments don’t work for everyone. Some researchers think that the solution to
this is personalized medicine: using information about a patient’s symptoms or even their genome to match them to drugs that actually help. “Personalized medicine” sometimes sounds like a futuristic buzzword, but there are already big projects looking
into it — and they’re making some progress. So for depression, these kind of treatments might actually not be that far off. One of these projects is spearheaded by a
group called CAN-BIND, short for Canadian Biomarker Integration Network in Depression. This team has already published a handful
of studies and is working on many more, and they’re mainly searching for biomarkers for depression. Biomarkers are defined pretty broadly by the larger scientific community, but they’re basically something a doctor
or lab can reliably measure that tells them about your illness. Anything from your pulse to a specific hormone in your blood is fair game. Doctors can use biomarkers to learn how well a patient is responding to a specific treatment, or they can use them to predict how likely
a patient is to respond to treatments in general. But when it comes to depression, the most
sought-after biomarkers by far are those that tie a specific drug
to a patient’s response. Basically, markers that take out the guesswork and say, “If you take this, here’s what you can
probably expect.” If we could find a marker like this for depression, doctors could do something like a blood test, look for a certain result, and then match someone to an effective antidepressant based on that. Of course, we’re nowhere near that yet. But the CAN-BIND group is working on it, and even though there’s a long way to go, they’re learning a lot. For example, they’ve investigated whether
or not people have gene expression markers that can predict how they’ll respond to medication. These markers would be things like messenger RNAs that tell scientists how much protein is being made by a cell. Which could, in turn, affect how the body
processes or responds to a drug. Scientists have studied a ton of potential
markers, but unfortunately, the CAN-BIND team concluded in a 2017 review that none of them are ready for primetime
just yet. The results are too inconclusive — maybe because we don’t know enough about our genetic material. But that doesn’t mean we should give up
on this method yet. It likely just means there’s more to learn. In the meantime, though, the CAN-BIND team has also been looking at other kinds
of biomarkers. In 2018, they published a review that looked at brain imaging rather than molecular markers. This time, they looked at how all kinds of
treatments — including psychotherapy — could affect the brain, not just drugs. And this time, they found some promising results. In this review, the team found studies that
suggested that things like size and shape changes in several brain regions could be tied to specific treatments. For example, they cited previous research
where both increased activity in the prefrontal cortex, and decreased activity in a handful of other regions, were associated with better symptom improvement in patients who underwent cognitive behavioral therapy. In other words, there were specific brain
features that predicted how well someone would respond to treatment. These results do need to be validated, but if they’re true, this essentially means
a doctor could look at someone’s brain for things
like increased prefrontal cortex activity. And if they found it, they could use that
knowledge to recommend someone for therapy. At the end of the day, CAN-BIND still has
a lot to do, but they’re paving the way for some major
advances in medicine. Looking for biomarkers isn’t the only way
to approach personalized medicine, though. Another approach is to look for actual differences in the gene sequences among people. We’re talking differences in those famous
four DNA bases that make up someone’s genetic code. This approach has become more feasible in recent years as personal gene sequencing has become widely available, and as we’ve begun to understand how these gene variants function. For example, there’s a liver enzyme that
processes certain medications, including some used to treat depression, before they ever reach the brain. It’s called CYP2D6, I’m sure you’ll
remember that and the gene that codes for it has over a hundred different variants, which might make chemical changes to medications that render them more or less effective. If we could track down all of these genetic
changes, we could start to figure out how to tailor
medications to someone’s personal genetic code. And another major research effort, called the GUIDED study, was a big step forward in that. The study was published online in January
2019, and it split over a thousand patients with
depression into two groups. In one group, doctors were allowed to use
the results of a genetic test to look for potential drug interactions — ones that could make those drugs either more or less effective. In the other group, doctors couldn’t use
that knowledge, and made their drug choices the old-fashioned way. In the genetic testing group, both patients’
response to treatment and the number of people who experienced remission of their depression symptoms were significantly higher than in
the business-as-usual group. And partway through the study, if patients
were allowed to switch to a drug supported by their genetic tests, they also showed better rates of symptom improvement, treatment response, and remission. Which is potentially awesome news — especially since this was a large, carefully-controlled study. Scientists will always call for more research, but the GUIDED trial shows that knowledge
of a patient’s genes can potentially help them get better — especially if their depression has been otherwise tough to treat. So there is a lot of reason to be hopeful
about the future of depression treatments, even if a lot more research is
still needed. Whether it’s through biomarkers or our actual genes, we’re working on ways to know whether specific treatments will help specific people. So maybe in the future, no one will ever need to go through three, four, or a dozen treatments to find
something that works. We might figure out how to do it on the first
try — and that’s worth celebrating. If you want to learn more about psychology
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100 comments

  1. Go to https://curiositystream.com/psych to start streaming Birth Of The Internet. Use the promo code ‘psych’ during the sign-up process to get your first 30 days free!

  2. With how some medications can worsen symptoms if they're wrong for you, it will be nice to not feel like I'm playing Russian Roulette when I go to try a new prescription.

  3. Hey. Everyone I'm looking for some data on a test I have developed. I would really appreciate your participation. Just answer the question and what kind of mental problem you have.

    Test:
    Hold your dominant hand out in front of you. Try to imagine a ball in you hand. Try really hard. Do you see the ball like you do other objects around you? If not try again with eyes closed.

    Did you see a picture? Again important I'm talking about seeing like you do objects around you in the real world.

    Thanks for your participation.

  4. I wonder if I was involved in that study mentioned around 5:00. A few years ago I started seeing a new psychiatrist for my major depression, and he told me about genetic testing they could do to aid in selecting a more appropriate medication, though he never mentioned a study. I opted for the testing, and the new medication worked (and has continued to work) far better than any other medication I had been on. So, for me at least, personalized medication is already here! And I'm very grateful for it 🙂

  5. The future is bright. One day Remember how much trial and error/ineffective treatments doctors used to rely on? Sure glad were past that.

  6. As someone who's currently trying a 4th antidepressant, this would be amazing for doctors and patients and would spare so much wasted time and awful side effects.

  7. Can't help but wonder if we're looking at this in the wrong way. Maybe lots of people are depressed because the society we've built goes against our nature as a species. Maybe depression is a healthy response to what's going on and we should change the societies we've made instead of chemically or genetically forcing people to fit this new mold.

  8. This is already available, the central wyoming community health center on blackmore rd, in casper wy offers this as an option to try to help find a medication (for bipolar, and likely depression) that might be more likely (NOT GUARANTEED) work. It was expensive and not covered by insurance at the time.

  9. If you live in the UK, are 16 years or older, and have ever suffered with anxiety or depression, then please consider signing up for the GLAD (Genetic Links to Anxiety and Depression) study -> https://gladstudy.org.uk/

  10. Wouldn’t it be great if depression was eliminated in the world? I imagine humanity going much further, much faster.

  11. I'm not wearing my glasses and I read the thumbnail as "Boomwackers and depression" and I was pumped to see how the plastic tubes you hit against things to make different musical notes were going to help me. Cuz that's way more fun than anything I've tried yet.

  12. Until we address the fact that not everyone grows up in a stable environment with reliable support, depression is always going to be a thing, not matter how fancy the drugs get. This treatment may help a lot of people, but it ignores a lot of others who have depression as a result of trauma.

    Seems like treating the symptom without understanding the cause. Why does nobody in the industry ever acknowledge that, sometimes, mental illness is a logical and rational response to a difficult situation? Why are we always demonizing the individual for their mind's attempt to cope with things out of their control? I know improving society is less profitable and more labor intensive than prescribing a bunch of drugs, but that doesn't mean we shouldn't try to do it.

  13. real solutions to depression and addiction: giving people a universal basic income, promoting economic self-sufficiency, helping people grow their own food (like urban gardening), opening local tool-libraries, lowering the prices of solar panels.. these are all good solution steps to reduce economic stress /scarcity /competition, and thus also favor social health, the quality of social relations. it's about socioeconomic stability, it's about human needs. now, if these genetic /biomarker treatments proposed in the video actually offer some relief and no side effects, they will sell, but keep in mind that there's a lot of money involved (from the research to the selling of the treatments or drugs) and most psych drugs so far are mostly useless and harmful.

  14. Seeing the title of this video after deciding to write a lit review about metabolomics and their role in biomarker discovery in depression and other psychiatric disorders… I think it's a sign

  15. Allowing doctors to use a particular type of treatment (or not) isn't double-blind so all kinds of other effects could be in play.

  16. You know what makes me upset? One day we will have the definite cure for depression, even the treatment resistant kind. Thing is, I probably won't be alive by the time they figure it out. My whole life will have been a waste. Before you say "but you just need to be positive!" why are you even watching this video? Anyway, treatment resistant depression is just that. You can't treat it. The only hope right now seems to be psychedelics, particularly microdosing, but of course that's illegal. I may end up breaking the law because I don't know how much more I can stand living like this.

  17. Brain Spect Imaging… The Amen Clinics have been looking at brains for years and helping people for 30 yrs with over 150,000 brain scans. They are psychiatrists and they use it as a tool to treat people more specifically. They like not looking at a brain like a mechanic not looking under the hood of your car to figure out what's wrong.

  18. SSRIs are a step in the wrong direction. Hopefully in the future we’ll look back at modern day psychiatry in the way we look back at lobotomies now. I took Prozac for a couple years and now I’m chemically castrated. I got genital anesthesia while on the drug and I’ve been of Prozac for a year now and I still can’t feel my penis. My emotions are still blunted as well. I feel like I’ve lost a fundamental part of myself. Sure, side effects don’t happen to everyone, but that doesn’t mean that you shouldn’t be aware of them. I wish my doctor had told me about them. I never knew damage like this was possible from ssris.

  19. I wonder what are the odds of Tom Hanks becoming as famous as he is, compared with the survival of his character in "Cast Away"? – am I just as likely to see a troma-ville remake of "The Fly" starring Tom Hanks? That is all. Thanks.

  20. Over the course of five years, I've tried about a dozen medications for my depression, have done genetic testing to help figure out what has the best chance of being effective, and am still severely depressed. I hope one day my doctors and I will find a solution.

  21. Depression is a tricky thing — I look forward to the days of personalized medicine, so at least that pillar of problems is stabilized and I can focus on correcting all the other dysfunctions, like lack of sleep and other stressors. Thanks for continuing the updates on depression treatments, Hank.

  22. we all have demons inside ourselves, if we dont find inner peace, we can not grow as human beings. we need to stop giving our demons power over our emotions, we need to control them before they control us. we need to learn to detach from them, learn to let things go, stop taking things so personal and become aware of the topics we get defensive over, reflect on why they make us defensive in the first place. we need to surrender our egos, and rise above petty insecurities to gain a bigger view of the world and universe. we need to humble ourselves. we need to give up the need to be right, to see unbiased truths. this takes practice, because the truth often hurts the image our egos have built up in our minds.

    our culture is toxic, it tells us we arent good enough, that we need x, y , and z to be happy. this creates debt, stress, depression, sadness, anger, and hatefulness. in order for us to grow, to create, learn and become better people, we need to get real, with facts, evidence, unbiased truths. otherwise, what are we. just do the best you can do, its all any of us can.

  23. Depression (and anxiety, for that matter) are heterogeneous – meaning they have more than one cause. Science is willing to admit that much, mostly. But as more study is put into all this, I am certain we will discover that what we call depression (or anxiety, as well) isn’t one thing. It’s a whole passel of different conditions thrown into a single basket.That’s why all those treatments have remarkably different failure rates. Think of the sniffles. That’s a cold, right? Oh, wait, Mebbe it’s the flu? Or could it be allergies? Or a sinus infection? Or…etc. etc. Treating every single case of sniffles as a cold instead of as an allergy or the flu will have some pretty scary results. And what if those sniffles are a result of an allergy? Sure, some antihistamine could be helpful, but what is the actual thing you’re allergic to? Would you treat every allergy as if it were caused by grass pollen? Instead of a reaction to a sulpha drug you’ve been given for something else? Etc. etc. but all that is exactly how depression and anxiety are treated by the medical system. No wonder people kill themselves. SMH…

  24. I actually had the genetic test Hank was talking about at 4:02, back in 2016. They not only matched up psychiatric medications with the genetic results, but they threw in ADHD medication, analgesics, and folate processing too.

    It was incredibly detailed. It told exactly what mutations I have on my liver enzyme genes, as well as a chart for how these specific mutations affected each drug. They provided a summary as well, with categories for "Hey, she can break this down fine!", "Mmmm, this one you may need to adjust the dose on" and "Just don't bother", lol.

    For example, with the CYP2D6 enzyme that Hank was talking about, I'm an intermediate metabolizer. That means one parent gave me a working, normal copy, and the other gave me a dud, lol – it doesn't work at all. So, I have reduced enzyme activity from CYP2D6. And that, along with all the other drug-metabolizing genes they test, gives a rounded picture of what meds to try first and which to avoid.

    This test has been incredibly helpful for me and my doctors. It also explained a lot, in reactions to medications I've tried. I really recommend any patient with the disorders they test for have it, especially if you're new to getting medication. This can save years on trying different things.

  25. Now if only I could've had a one-and-done solution for my asthma; I would live with the depression for that.

    Although, I can't deny I would love to know how much of my depression is my DNA, how much of it is socioeconomic, and how much is related to past emotional trauma.

  26. I took a blood test called Gene-Sense to find what anti-depression meds would do for me. They were all wrong. All the pills I tried gave me such horrible side effects I had to stop them.

  27. If this was better researched I might be willing to get treatment. But until then I am scared of all of the side-effects of meds that might not work.

  28. I am worried that our dna will be used for other purposes.
    Especially since one of those ancestory websites have given DNA information to the FBI.

    Why dont we just find the roots of what causing depression like, bad work environment, single parenthood, the loss of a family member.
    Instead of giving them riskful dtugs that can cause even more damage.

  29. Congrats to future generations!! Meanwhile I’ll just keep taking various pills and pray that it’ll help me, not screw me up.

  30. Our knowledge of medicine and its affects on the human body is pretty limited, much more so than what is commonly thought. It's getting better, slowly.

  31. Gotta sell them drugs. Gotta put happy pills in the water. Gotta shock your brain, because we can't fix society.

  32. Wow, this is awesome research

    With something as nuanced and symptpmatically diverse as depression, it's cool that we're slowly but surely finding tangible ways of measuring and diagnosing treatment – less guesswork the better

  33. I wonder if they could also determine the effects of other kinds of medicine on someone before they have to take it. Like, people can find out if they'd have a reaction to things like botox or anesthesia before it's administered and the patient suffers

  34. Bio markers… measure depression… low serotonin levels… Isn't this supposed to be what's a cause of depression? I questioned my GP doctor when he prescribed me antidepressants and I asked him if he could check and see if I indeed have low levels of serotonin… He said he couldn't. Depression is a very very wide playing field but I hope some day scientists and doctors get close to being able to quantify and measure it in our bodies/heads/minds. Come on science, you're our only hope!

  35. I feel so conflicted whenever something like this comes out, because it has so much potential to help people, but any type of gene testing is going to open up doors for eugenics. we have to be careful

  36. I really hope this field of study yields results that can help. Ideally in my lifetime, but honestly just happening at all would be amazing

  37. As some one who has had MDD since I was a young child, this really gives me hope that one day I wont have to feel this way. Thank you Scishow for sharing info on things that aren't pretty like mental illness and the science behind them.

  38. What happens to someone (in terms of brain development perhaps) when they "grow up too fast"? – for example, by the time they are old enough to have a YouTube account (12 years of age) most of the content supposedly aimed at them just seems too immature. A cliche is that kids who have to be street wise grow up fast. But I think its more than that just being street wise. Climate Change is a good example – realising that you have no power and your future is essentially f*cked.

    I don't know whether this is true. But imagine we have two kids: one (kid a) who has had a rosey childhood while the other (kid b) was basically punched in the face with life. They both hear about the discovery of "cold nuclear fusion".

    'Kid a' is fascinated by it and tries to understand all the science to see whether it is true or not (maybe they get the idea that scientists can be flawed?). Maybe they want to speak to scientists about it.

    While 'kid b' just thinks the scientists involved in claiming they have produced nuclear fusion were just acting out a joke on humanity (maybe they get the idea that the prank scientists were trying to expose a flaw in the world we live in). Maybe they will speak to scientists to see if they will tell them why someone would release such a controversial study – perhaps listening expecting to be fobbed off with a simple answer rather than a complex realistic one.

    And on that point. Why don't we hear about fusion-fission hybrid reactors? Why is it always we either hear about conventional fission reactors that produce radioactive waste that have been run well past their intended use (threatening public safety), or fantastical experimental fusion reactors that always remain a pipe dream?

    When maybe nuclear fusion could be developed in fusion fission hybrid reactors that would have less risk of a meltdown, produce more power, and less toxic waste and would not even require weaponizable isotopes of nuclear materials to run them?

    I mean afterall. How many technologies have been developed off the back of existing technologies? – the thermonuclear bomb, rocket motors from water pumps used in fire engines, and the jet engine from turbo chargers used on car engines, and the fuel-electric hybrid cars used to advance technologies for electric vehicles, to name but a small few of the many examples…

    …what happens when you try to run before you can walk (a-ha! – how clever am I?…)

  39. That looks like the very near future of them – the use of data science. But are antidepressants really as effective as we are led to believe? Is depression totally understood? What do we not know yet? What about other illnesses? Can you make a video answering these questions? That would be very informative and would fit your style like how it is. Badass.

  40. I just had genetic testing done to see how my body will react to psych drugs. It’s called genesight. The info my doctor gave me doesn’t say CYP2D6 specifically, but after watching this video, that’s my best guess. The results are in on Thursday!

  41. I found science works great for depression. Just understand thats it just chemistry that dictates how you feel… once you think of it that way… it really helps, if that dont work… a shot of whiskey helps 😛

  42. A couple months ago my doctor offered a test done via cheek swab that can point to medications that are more likely to work. I can't remember what it was called (the thing is, being depressed for decades, you don't really have much hope that anything will work, so it's hard to even take the initiative to get the test.)

  43. It is so cool that this has come up! Mentioning CYP2D6 reminded me that there is a company called Genomind that your psych doc can send a sample to that will run genetic tests to find these genetic markers, and send back a report that shows you what genes express in which way, and how that changes how medications effect you. When I had mine done, I learned that I have a duplication in CYP2D6 (and CYP2C19) which makes me an ultra-rapid metabolizer. Knowing that, they could list which medications are metabolized by those enzymes and I can steer clear of them since I would have to take super-high doses to get the same effect as someone without the dupe. Funnily enough, the med I was on at the time (Celexa) was on that list.

  44. I signed up to donate a saliva swab to a research group looking into this.
    Since getting the kit my own paranoia/anxiety over how this data could be used has stopped me from returning the sample.
    I'm just a bit concerned that the information could be used to predict who is likely to suffer with mental health problems and used to hike health insurance or more sinister goals.
    It's not that long since the mentally ill were institutionalised in some pretty dire conditions.

  45. There's another ongoing research study called bsnip (bipolar+schizophrenic network for intermediate phenotypes). I've been participating in this one for about a year now. I have high hopes for this area of research.

  46. I got very confused when you said that this wasn't known or ready, because I literally just did a cheek swab for this exact purpose a couple months ago. I've been struggling to find effective medicine, and when my doctor told me about this he totally made it sound like it was already a thing. Now I've got some questions.

  47. You're telling me if you figure out what the depression is a symptom of you can treat it!?!? Biohackers already did that and me and my new GF is proof of this. depression treated successfully.

  48. Idk if i have depression or not. Ive been called fat n obese from my friends and family. Having harsh times with my family members and having suicidal thoughts.whenever i cry i beat my chest cause my heart hurts so much n i always wanna say sry to myself n to another if i hav done wrong

  49. If you had to be strapped to a chair everyday and be electrocuted and go to sleep in a Dog cage fed Dog food for 3 months to get rid of your depression would you do it ?

  50. Depression is likely caused by a lifelong dis engagement from one's personal and basal requirements resulting in subjective perceived helplessness in the face of life. A probable treatment is likely to be helping an individual re-connect with their basal and personal needs. All this babble is likely to be irrelevant distracting crap. Drugs are a dangerous and complicating factor. You're welcome….I have suffered depression all my life, so I have made the effort to resolve all this over complicated gibberish. Unfortunately humans seem unable to see the obvious and replace it with meandering circuitous rubbish, like this video.

  51. Almost in tears thinking about how different my life could be if I didn't have to treat my mental illness with years of temporary fixes through ineffective and sometimes dangerous trial and error

  52. I have a deficient CYP2D6 enzyme. Biggest effect for me is the opiates my doctor can legally give me don't work.

  53. Maybe there is hope I can get better treatment. I think what I'm on right now is working good enough, but I'm still mildly depressed.

  54. That's VERY good news!!! I'm 66, and I've been depressed my whole life (my mom said I was a depressed kindergartener). It's been difficult, to say the least.

  55. This is a truly fascinating topic and I sincerely hope that one day, treating depression, as well as other conditions that require medications/therapy, will be as easy as a blood test. As someone who has suffered with crippling depression and anxiety for as long as I can remember, I am hopeful that one day I won't be living with these overwhelming elephants on my back. I wish that for everyone…

  56. No mentions of psilocybin mushrooms? disappointing
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5367557/
    https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(16)30065-7/fulltext

  57. I got the generic testing for my antidepressants and ADHD meds and I just wish they had it in the early stages of my prescribing because it took 7 antidepressants for me to get to the one I'm on and one of those landed me in the ER. And the genetic tests said I probably wouldn't react the best with pretty much every single one I've been given. Nice thing was the genetic test was covered by my insurance. I'm also not supposed to take folic acid.

  58. We need more cures for mental health problems. Some have experienced improvement with exposure to electromagnetic fields, or direct electrical stimulation. There have to be more permanent non chemical treatments for depression and anxiety.

  59. I had semi-treatment resistant depression as a teenager, this means that the standard treatment option SSRIs weren't working fully. My med manager had me get tested for one gene, MTHFR, which effects processing of folate and eventually serotonin. one of my is the made one, so I got switched to SNRIs and taking a supplement. This has made my drugs so much more effective. Finding other genes like this that can easily predict what medications will and will not work is amazing.

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