IS it just me or is this ridiculous? They separated people who were having different symptoms and they showed it in MRIs. All this does is prove that you can derive these brain "biotypes" without the MRI. Why is this new or special or needed? We need treatment, not more tests to tell us what we already know.
Depression presents with many symptoms, some of the are mutually exclusive. Take for example psychomotor changes. It could be retarded or agitated. Some people have anxiety, some don't. Some are irritable, some sleep very much and some sleep very little. There have been the classifications of melancholic and atypical depression, but they aren't used very often as many patients have features of both.
Now consider the poor response to available medication (IIRC 30% remit and 60% respond, which leaves roughly 40% with a potential deadly disease without medication). Some symptoms of depression occur in other mental illnesses, like the similarity between bipolar and unipolar depression. Maybe the disease we currently call depression is acutally a cluster of diseases. That's the reason to look for biomarkers that separate those different diseases and the develop treatments specifically for one disease. Similar to the development of brexanolone for postpartum depression.
Right. What if this were to be conformed and we could find out that A is best treated by Prozac but C responds really badly to it?
Right now we just try lots of drugs, one after another, on each patient until something works or the patient gives up. What if we could confidently predict the drugs that were the most likely to succeed for each group? It may cut treatment times and help people find relief faster.
Even if we don’t find new treatments or gain a better understanding of cause/effect it could still be useful.
You are talking like there are medical treatments that work for those of us with mental illness. There are not. They only have medication to treat the symptoms.
I am one of the people with this deadly disease and frankly I want to die right now because I am homeless living with schizoaffective disorder and it its the 15 year anniversary of my nephews suicide and all anyone here does is downvote me because they cannot take the time to listen.
DO you know how many years I have heard of sht like this and then I go to the doctor and I am getting the same medications my mother got when she was sick 60 years ago?
Do me a favor, read my blog, look at what I know and what I have and am living with, then come back here and tell me I should be happy about this study that will do nothing for me and nothing for anyone in the next 20 years. Then tell me how not giving me that money to help me other people living with mental illness who are homeless to find housing is not better.
I don't think defunding studies on mental illness to fund those who suffer with it is the way to get progress on helping. You're entirely right to be unimpressed with this study and to feel some despair that essentially no study that comes out today will materially affect your life.
But nevertheless, if these studies don't happen, there will forever be people who have to suffer like you do.
Instead, there are many other places where money is being wasted on things that not only have 0 chance of helping, but are actively hurting people. The war budget is many times over all of the psychiatric research money ever spent - maybe we should target taking money from there to help people people struggling with mental illness or homelessness or both, before taking that money from research.
So, I agree that an awful lot of what passes for research and treatment is chosen based on the comfort zone of the practitioners, more than what is most likely to be found to help the patient. But I think in this case you are attacking one of the ones that is more likely to be useful.
> All this does is prove that you can derive these brain "biotypes" without the MRI.
From the article:
> There is an urgent need to derive quantitative measures
> We need treatment, not more tests to tell us what we already know.
Testing for objective markers can/should lead to choosing the most adequate treatment faster than relying on self reported symptoms or subjective opinion from therapists (even if experienced or informed).
My point is that this was a waste of effort and money. They just need to listen to us patients and stop thinking we cannot be objective. Whenever it comes to mental health people think there is a total loss of objectivity. All you have to do is look at the patient. Is there a need to get a brain scan to see if I am anxious if I am acting objectively anxious?
This need to measure everything is almost pathological.
Patients generally can't be relied upon to be objective. There may be exceptions but patients will often say they don't have symptoms that they do and that they do have symptoms that they don't.
Speaking as a patient myself.
I wish there was a way I could get an objective test that spits out exactly what's wrong with me and which treatments are most effective. I've been through several psychiatrists and treatments and am yet to find something effective.
> Patients generally can't be relied upon to be objective.
Neither can doctors, or researchers. They obviously see something wrong with you, as they did with me, so do we worry about their objectivity? No. Because bias and stigma.
And if you are looking for answers, like I have been for 20 year, you might want to look at the role the purine pathway plays in mood disorders. Here is an article I wrote about it.
It's always been interesting to me that psychiatrists and psychologists just have to sort of trust the story they're being told. Recently CVS and other pharmacies have started denying prescriptions from some telehealth based psychiatrists because they believe they're over-prescribing amphetamines. How do they know?
This article also makes me think of the neurologist that unknowingly analyzed his own brain scan only to discover he was a psychopath.
Am I "telling a story" when I am walking down the street taking pictures of people because I think they are working for the government and spying on me?
The doctors "objectively" thought I was on drugs.
And those tele-health centers are being shutdown because they do no legitimate screening and are pill farms.
> This need to measure everything is almost pathological.
What's pathological is the tendency to see everything in black or white, right or wrong. There are many different causes for fatigue and tiredness: the flu, atypical depression, chronic fatigue, etc. But those conditions can overlap with depression. Putting the symptoms through a sieve by eliminating some causes helps pinpoint the origin (I over-simplify of course).
> Putting the symptoms through a sieve by eliminating some causes helps pinpoint the origin (I over-simplify of course).
That is nothing close to what they are doing. Do you think they are going to be giving these scans to everyone that walk in with fatigue and/or depression? I cannot even get to see a rheumatologist and I am disabled with schizoaffective disorder.
It's true that doctors should listen to patients, and that diagnosing medical problems, especially psychological problems, can be very difficult.
However, your post has a very "we don't need x-rays, we can just tell the bone is broken" vibe. It reads like you think better and more objective, quantitative diagnosis is not worth pursuing.
I do not care about your vibe. I care about finding the truth and telling it like it is from my lived experience.
They diagnosed the patients to get them in the study and they they said "see, it matched out "objective" diagnosis based on the patients "subjective" complaints.
There is nothing quantitative about what they are doing. Take a look at figure 5. How quantitative is that?
Honestly a lot of these diagnosis issues are incredibly difficult.
depression with anxiety is dramatically more difficult to treat than either or.
Bipolar can come across as ADHD in certain parts of the cycle or just usually depression. In fact, you can even have uni-polar depression that does not respond to traditional anti-depressants and you don't necessarily exhibit hypomanic episodes.
Relying on patients to know and understand what they are experiencing other than "this is just normal I assume everyone else experiences this" is not reliable.
Having something that can reliably diagnose and find markers for these conditions would be _huge_.
I wade through whitepapers and books on this stuff because of my own issues. I don't expect the average person to even remotely know about all of this; it's a lot and very subtle.
To add on to all of this, people tend to not seek treatment until there IS a problem. Sometimes this can be really life alteringly bad, sometimes it's benign. But it would be helpful if people could just "take a test" and know or at least have an idea.
The issue with being "objective" is also that your doctor has to be "objective" and I've had a lot of friends that are clearly ADHD and end up with DRs that think they are just trying to get medication and don't have ADHD.
Worse yet; they do get medications and they have to cycle a few different ones because of the way they tolerate it. It would be really nice if we had an idea to correlate your ADHD, your body chemistry, and which drugs would be most effective for you rather than the 3-12 month ordeal of figuring that out.
"To enable more precise diagnosis and selection of the best treatment for each individual, we need to dissect the heterogeneity of depression and anxiety. The dominant ‘one-size-fits-all’ diagnostic approach in psychiatry leads to cycling through treatment options by trial and error, which is lengthy, expensive and frustrating, with 30–40% of patients not achieving remission after trying one treatment"
