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Scientists have developed the first blood test to diagnose major depression. The landmark test could give psychiatrists a more objective way to identify different types of depression in their patients, and would be especially helpful in designing treatments for depression in highly-vulnerable teenagers. The blood test is not designed to determine whether a teen is at risk for the condition or already suffers from major depression. That's something psychiatrists can do, using traditional subjective analysis, during their patients' office visits.
Rather, says Eva Redei, a professor of psychiatry at Northwestern University's Feinberg School of Medicine in Illinois, the new blood test is the first to identify the many different types of major depression, from bipolar disorder to depression driven by severe anxiety. She says this additional information can help doctors tailor therapies for each patient. "The test probably can identify subgroups of depressed patients, which is the aim in define[ing] the best treatment," Redei says. Statistics show that depressed teenagers are at particularly high risk of suicide, so there is an urgent need for a test that can zero in on the precise nature of their depression and suggest the most appropriate treatments.
Redei had previously discovered 26 genetic markers, or substances in the blood, that appear to be elevated in depression. She says everyone has the markers, which she likens to those that indicate levels of blood sugar and cholesterol, and the depression markers can be in the normal range or elevated. That's what Redei and her colleagues discovered in their study of blood markers in a group of 14 male and female adolescents, aged 15 to 19. They had been diagnosed with, but not yet treated for, major depression. The study also included 14 healthy volunteers. In the blinded study - where researchers did not know which of the subjects had a mood disorder - investigators found they were able to differentiate between the two groups on the basis of 11 genetic markers in their blood.
Among depressed teens, researchers found 18 of the 26 blood markers could tell which participants had major depression and which also suffered from depression plus an anxiety disorder. Patients with depression are treated with a variety of medications but, according to Redei, treatment is not always effective because one-size does not fit all. "We can't choose a treatment at the moment because...we can't objectively diagnose how many kinds of depressions there are, what are the characteristics, and so on," Redei says. The new test will enable that objective diagnosis. But Redei believes the markers she's discovered could be just "the tip of the iceberg," because depression is such a complex disorder. And she says further study should help scientists more precisely identify which markers are positively associated with each subtype of depression.
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Researchers at the University of Auckland tested an interactive 3-D fantasy game called SPARX on a 94 youngsters diagnosed with depression whose average age was 15 and a half. SPARX invites a user to take on a series of seven challenges over four to seven weeks in which an avatar has to learn to deal with anger and hurt feelings and swap negative thoughts for helpful ones. Used for three months, SPARX was at least as effective as face-to-face conventional counselling, according to several depression rating scales.
In addition, 44 percent of the SPARX group who carried out at least four of the seven challenges recovered completely. In the conventional treatment group, only 26 percent recovered fully. "Use of the programme resulted in a clinically significant reduction in depression, anxiety and hopelessness, and an improvement in quality of life," according to the study led by Sally Merry, an associate professor at the Department of Psychological Medicine.
The adolescents also gave a high rating to SPARX, saying they liked being able to use it at home and to learn at their own pace. Eighty percent said they would recommend the computer therapy to others, although the treatment-as-usual group had similarly high approval ratings.
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The research, which covered almost 50,000 people in 21 countries, found that even in wealthy nations with relatively good health services, barely 20 percent of depression patients get adequate treatment. In poor countries the situation is far worse, the study found, with only one in 27 people with depression receiving adequate treatment.
Leading cause of disability
“Much treatment currently offered to people with depression falls far short,” said Graham Thornicroft, a professor at King’s College London who led the study. He called on national and international organizations to increase resources and scale up the provision of mental health services “so that no one with depression is left behind.” The WHO estimates that 350 million people of all ages suffer from depression, and the condition is the leading cause of disability worldwide.
National Depression Screening Day is in October every year and provides members of the general public an opportunity to determine if they may be experiencing symptoms associated with depression.
They found that while there is increasing awareness that depression can be diagnosed and often successfully treated using psychological therapies or medication, the treatments are not being widely delivered. “Providing treatment at the scale required to treat all people with depression is crucial, not only for decreasing disability and death by suicide, but also from a moral and human rights perspective, and to help people to be fully productive members of society,” Thornicroft said.
What is adequate care?
The study, published in the British Journal of Psychiatry Thursday, analyzed data from WHO mental health surveys in 21 countries including Brazil, Bulgaria, Colombia, Iraq, Mexico, Nigeria, China, Argentina, France, Germany, Israel, Japan, Portugal, Spain and the United States. The researchers defined minimally adequate treatment as either pharmacotherapy, consisting of at least a month of medication plus four or more visits to a doctor, or psychotherapy, consisting of at least eight visits with any professional including a religious or spiritual adviser, social worker or counselor.
WHO: Most People With Depression Get Poor Care or None at All
