University Times

Based on the way depression currently is being diagnosed and treated, it will rank second only to heart disease as a global health burden by the year 2020, researchers warned the World Bank several years ago.

More than 20 percent of depressed people will attempt suicide at least once during their lifetimes and about 6 percent will kill themselves, according to studies also indicating that three-fourths of people who commit suicide have major depression (characterized by mood disturbances and depressive symptoms persisting for at least two weeks) or bipolar disease (depression interspersed with episodes of mania, a state of abnormal elation and excitement).

Depression exacerbates the effects of diabetes, stroke, heart disease and other common illnesses, and costs the U.S. economy tens of billions of dollars in lost productivity, researchers say.

Fortunately, scientists have come a long way in understanding the biochemistry of depressive disorders and how to treat them, depression researcher David J. Kupfer told Pitt’s Board of Trustees Feb. 20 in an informational report.

“We’re beginning to understand depression using the same methods that we use to understand cancer, diabetes, hypertension and other medical diseases,” said Kupfer, who is the Thomas Detre Professor and chair of Pitt’s Department of Psychiatry and Detre’s successor as head of that unit.

Changes in electrical patterns of depressed people’s brain waves during sleep have been linked to depression for nearly 40 years. Recently, brain imaging studies at Pitt and other sites have observed decreased blood flow in the prefrontal cortexes of depressed patients’ brains. “When we successfully treat such individuals, these decreased [blood flow] levels go back to normal,” Kupfer said.

At the molecular level, researchers have connected depression with low levels of the neurotransmitter serotonin. Antidepressant drugs called selective serotonin reuptake inhibitors (SSRIs) increase the amount of serotonin available to the brain.

“Depression is treatable,” he emphasized. Counseling or psychotherapy, often in combination with antidepressant medications, usually is prescribed for depression sufferers with no history of mania and no psychotic symptoms. Treatment of bipolar depression usually includes use of the mood stabilizing drug lithium, sometimes in combination with psychotherapy.

“Most depressions are not treated by psychiatrists,” Kupfer pointed out. “They’re actually treated by primary care practitioners.”

Depression is chronic (“If you’ve had a couple of depressive episodes, your chances of getting depression again are 70 to 80 percent,” Kupfer said) and often linked with other medical conditions.

“Almost two years ago, the National Institutes of Mental Health and the University of Pittsburgh held a major symposium in Pittsburgh dealing with the fact that depression doesn’t travel by itself,” Kupfer said. The symposium examined relationships between depression and cancer, cardiovascular disease, diabetes and a number of neurological conditions including Parkinson’s disease.

“Just to give you a sense of the numbers, it appears that 40-65 percent of depressed people who have had a myocardial infarction [a failure of the blood supply to the heart] may have a shorter life expectancy than those who have had an infarction but have never been depressed,” said Kupfer.

“Research is beginning to identify a set of connections between heart disease and depression which basically means that if we don’t treat depression as well as we can, we may be impacting on the morbidity and mortality related to heart disease. This seems also to be the case with a number of cancers. It’s also true in relation to outcomes of individuals who have had strokes.”

“At the risk of sounding chauvinistic, I believe that the University of Pittsburgh has become the Mecca for depression research,” Kupfer told trustees, noting that:

• Western Psychiatric Clinic and Institute houses centers for research and treatment of depression in children and adolescents, young and mid-life adults, and the elderly. “These three centers work with six or seven departments in the medical school and the Faculty of Arts and Sciences to explore the frontiers of depression research,” Kupfer said.

• Some 29 faculty members in Pitt’s psychiatry department and at least another 20 elsewhere on campus are conducting research on depression. Pitt currently receives $24.3 million from the National Institutes of Health for depression studies, supporting 30 grants and 12 career development awards. “It’s important to realize that this represents only one-third of the research funding that comes into the University of Pittsburgh for mental health and psychiatric research,” said Kupfer.

• The state recently designated Pitt as a Commonwealth Center for Excellence for Bipolar Disorder. Kupfer said: “This center will deal with health disparities in the treatment of bipolar disorder among young people, the elderly and, in particular, African Americans” — three groups among whom depressive disorders frequently are misdiagnosed or untreated.

Summing up the current state of depression research and treatment, Kupfer said: “We’re on the playing field, but we’re not even in position to kick a field goal yet. I would like us to score a couple of touchdowns, to be honest with you.”

— Bruce Steele