Medical research: If depression were cancer (2014)
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Re: Medical research: If depression were cancer (2014)
#2> The problem stems — yet again — from the disorder's fuzzy definition: grouping everyone with a diagnosis of major depressive disorder into one genetic study is like looking for the genetic risk factors for fever, explains Flint. “You would have lumped together autoimmune disease, infection, cancer and a whole set of different conditions.”
This is quite the problem, yes.
But ultimately the perceived intractability and the root cause of the difficulty of investigating this phenomenon is the subjective nature of the reports of the symptoms. Clearly _something_ is up, we can see that from macro-behavioural patterns and cases of attempted suicide -- but these diagnostics are crude.
What is needed are robust bullet-proof objective diagnostics[1][2]. It's great that we've progressed beyond "humours" and "hysterics" and "demons" but compared to other areas of modern medical research we are practically in the stone ages as the article points out.
For instance: we could have genetic, bio-chemical, neuro-chemical, and/or neuro-wiring diagnostics. Any others? Until there is a comprehensive set of biological markers scientists are of course going to be reluctant to research this. It's unfortunate but I can't say I blame them.
And what if the majority of major depressive disorders turn out to be down to wiring? And what about the perfectly natural reactive depression one gets when someone close to you dies or when a relationship breaks up and you lose your partner and/or your kids. Are we now saying that we oughtn't feel this way? And what if the way we've structured society plays a large role in our individual well-being and wellness, what then? What if it turns out to be part of the human condition, as is perhaps the case with existential depression[3]?
Absolutely the best book I've read on depression and suicide is Night Falls Fast[4] by Kay Redfield Jamision, a Johns Hopkins psychiatry professor. It's a few years old now but I don't think that the topics and themes in it will ever date even though the science in it might. It is filled with compassion, it strives for precision. I cannot recommend this book highly enough.
Welcome your thoughts on the matter.
[1] https://www.ncbi.nlm.nih.gov/pubmed/19396703
[2] http://www.newsweek.com/first-blood-test-depression-holds-pr...
[3] http://www.davidsongifted.org/db/Articles_id_10554.aspx
[4] https://www.nytimes.com/books/first/j/jamison-night.html
Re: Medical research: If depression were cancer (2014)
#3> genetic studies have come up empty-handed
Perhaps we should focus more on data with a hereditary component (?) This would eliminate depressions that are really sadness caused by life events.
Also, I wonder if clustering techniques have been tried to the fullest in separating genetic data.
Re: Medical research: If depression were cancer (2014)
#4The big shift that's taking place is the gradual removal of nosology (disease classification) from its pedestal in psychiatry - naming symptoms as the foundation of all practice and services, which no other area of medicine does anymore - and replacing it with a scientific framework for discovering dysfunctional mechanisms at every level from genetic to neural to behavioural. This was started by Thomas Insell / NIMH (named in the article) and has been followed in the EU.
The framework is called RDoC and you should familiarise yourself with it if you've been influenced by psychiatric literature or practice as to your own mental health.
TLDR General argument: https://www.youtube.com/watch?v=PeZ-U0pj9LI
More in-depth presentation: https://www.youtube.com/watch?v=hU_5i2clSKI
Slightly more technical introduction: https://www.youtube.com/watch?v=OyGt8-ddacA
Google Scholar search: https://scholar.google.co.uk/scholar?hl=en&q=rdoc
RDoC @ NIMH: https://www.nimh.nih.gov/research-priorities/rdoc/index.shtm...
RDoC inspired EU project: http://www.roamer-mh.org/
Interested if anyone here has an inside take on RDoC.
Re: Medical research: If depression were cancer (2014)
#5It's becoming increasingly taboo to suggest that depression and other mental disorders are not diseases per se but may arise purely from the use of the mind. This in turns depends to some extent on a person's ideas and not solely (or even at all) on the presence of pathogens, tissue injuries, faulty genes, etc (though there may be medical consequences).
There could be important social reasons for this taboo. Perhaps it helps people suffering from disorders to get more practical help and sympathy (instead of righteous indignation, unemployment and ostracism).
However, without intellectual honesty there's less hope in the long term of finding solutions to these problems.
Re: Medical research: If depression were cancer (2014)
#6It's becoming increasingly taboo to suggest that depression and other mental disorders are not diseases per se but may arise purely from the use of the mind. This in turns depends to some extent on a person's ideas and not solely (or even at all) on the presence of pathogens, tissue injuries, faulty genes, etc (though there may be medical consequences). There could be important social reasons for this taboo. Perhaps…
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Re: Medical research: If depression were cancer (2014)
#7The big shift that's taking place is the gradual removal of nosology (disease classification) from its pedestal in psychiatry - naming symptoms as the foundation of all practice and services, which no other area of medicine does anymore - and replacing it with a scientific framework for discovering dysfunctional mechanisms at every level from genetic to neural to behavioural. This was started by Thomas Insell / NIMH…
Thank you for more or less responding to my comment elsewhere in this post. I've watched the first two vids, looking forward to the rest of your links.
Diagnostically RDoC (Research Domain Criteria) looks like a welcome overhaul of the increasingly derided DSM.
Them's a lot of circuits: https://www.nimh.nih.gov/research-priorities/rdoc/units/circ...
Re: Medical research: If depression were cancer (2014)
#8The big shift that's taking place is the gradual removal of nosology (disease classification) from its pedestal in psychiatry - naming symptoms as the foundation of all practice and services, which no other area of medicine does anymore - and replacing it with a scientific framework for discovering dysfunctional mechanisms at every level from genetic to neural to behavioural. This was started by Thomas Insell / NIMH…
Thank you for more or less responding to my comment elsewhere in this post. I've watched the first two vids, looking forward to the rest of your links. Diagnostically RDoC (Research Domain Criteria) looks like a welcome overhaul of the increasingly derided DSM. Them's a lot of circuits: https://www.nimh.nih.gov/research-priorities/rdoc/units/circ...
You're welcome. RDoC was tactically proposed just before DSM5 was published [1]
For comparing RDoC and DSM there are some good books published recently:
The DSM-5 in Perspective: Philosophical Reflections on the Psychiatric Babel https://www.amazon.com/dp/B00U4JLKM4
Alternative Perspectives on Psychiatric Validation: DSM, IDC, RDOC, and Beyond http://www.amazon.com/dp/B00Y355QZC/
Re: Medical research: If depression were cancer (2014)
#9It's becoming increasingly taboo to suggest that depression and other mental disorders are not diseases per se but may arise purely from the use of the mind. This in turns depends to some extent on a person's ideas and not solely (or even at all) on the presence of pathogens, tissue injuries, faulty genes, etc (though there may be medical consequences). There could be important social reasons for this taboo. Perhaps…
> sympathy
Dunno. Claiming to have X, Y or Z mental issue do not nearly get the kind of response you get from walking in the door with a bandage around your hand.
Re: Medical research: If depression were cancer (2014)
#10Just like cancer is caused by environmental pollutants, depression is caused by toxic social environments. You learn to be helpless. Shine light there and research funding goes bye bye.