The feeling that there is no progress, and therefore no hope, can be among the worst aspects of depression. However, developments are occurring in the identification and treatment of depression. Examples presented at a major conference include factors most associated with suicide, and insight into a particularly poorly understood treatment that uses magnetic fields.
A major multi-national study of suicides has identified the behavior patterns which precede many suicide attempts. This may lead to changes in clinical practice in the care of patients affected with depression, as it shows the clinical factors which confer major risk of suicide attempts.
The statistics for suicide are frightening. According to the World Health Organization (WHO), more than 800,000 people commit suicide every year, with perhaps 20 times that number attempting suicide. Suicide is one of the leading causes of death in the young (in the UK for example, it is the leading cause of death in men under 35).
Conditions known as “Depressive mixed state (DSM)” are known to be associated with suicide risk. “A depressive mixed state is where a patient is depressed, but also has symptoms of “excitation,” or mania,” said Dr. Dina Popovic of the University of Barcelona. However, depressive mixed states are often not diagnosed, hindering attempts to measure just how large a risk they are. Popovic is one of the authors of the BRIDGE-II-MIX Study on depression and suicide, which has produced a series of findings on mixed states, depression and other mental conditions.
Popovic studied 2,811 patients diagnosed with depression, 628 of whom had previously attempted suicide. Speaking at the European College of Neuropsychopharmacology conference in Amsterdam, Popovic said, “40% of all the depressed patients who attempted suicide had a ‘mixed episode’ rather than just depression. All the patients who suffer from mixed depression are at much higher risk of suicide.”
The study looked especially at the characteristics and behaviors of those who had attempted suicide, and compared these to depressed patients who had not attempted suicide. They found that certain patterns recur before suicide attempts.
In a second analysis of the figures, they found that if a depressed patient presents any of the following symptoms:
• risky behavior (e.g. reckless driving, promiscuous behavior)
• psychomotor agitation (pacing around a room, wringing one’s hands, pulling off clothing and putting it back on and other similar actions)
• impulsivity (acting on a whim, displaying behavior characterized by little or no forethought, reflection, or consideration of the consequences),
then their risk of attempting suicide is at least 50% higher.
At the same conference, attendees heard an explanation of how transcranial magnetic stimulation (TMS) affects the brain, a necessary stepping point to better target regions of the brain using the mysterious treatment.
Transcranial Magnetic Stimulation
Transcranial Magnetic Stimulation is a safe and effective FDA approved treatment for depression. The treatment is non-invasive (does not involve surgery, anesthesia or sedation) and non-systemic. It does not have the significant side effects associated with antidepressants. TMS uses pulsing magnetic fields to activate brain centers associated with mood. TMS has been used as a research tool since the 1980’s and has been shown in controlled studies to produce good results in the treatment of depression.
– Transcranial Magnetic Stimulation is the use of an electromagnetic coil to deliver small, powerful bursts of energy to targeted areas known to be involved in mood regulation. It is a painless, non-invasive treatment than involves no drugs, no IVs, or any other kind of sedation, and whose chief possible side effect is a headache.
TMS involves generation of strong magnetic fields around the skull. It has been used to treat a variety of conditions including severe depression, schizophrenia and neuropathic pain. It also has far less severe side effects than most alternatives.
In a first-of-a-kind study, researchers compared MRI-guided TMS pulses with MRIs for a control group who received a fake version of TMS, and observed its effects on brain chemistry and individual networks within the brain.
“We found that one session of TMS modifies the connectivity of large-scale brain networks, particularly the right anterior insula (anterior insular cortex (AIC)), which is a key area in depression,” said lead researcher Dr. Sarina Iwabuchi of the University of Nottingham. “We also found that TMS alters concentrations of neurotransmitters, such as GABA (gamma-aminobutyric acid), which are considered important for the development of depression.”
The anterior insular cortex (AIC) is implicated in a wide range of conditions and behaviors, from bowel distension and orgasm, to depression, cigarette craving and maternal love, to decision making and sudden insight. Its function in the re-representation of interoception offers one possible basis for its involvement in all subjective feelings. New findings suggest a fundamental role for the AIC (and the von Economo neurons it contains) in awareness, and thus it needs to be considered as a potential neural correlate of consciousness.
“In our opinion, assessing these symptoms in every depressed patient we see is extremely important, and has immense therapeutical implications,” Popovic said. “Most of these symptoms will not be spontaneously referred by the patient, the clinician needs to inquire directly, and many clinicians may not be aware of the importance of looking at these symptoms before deciding to treat depressed patients.”
“This is an important message for all clinicians, from the GPs who see depressed patients and may not pay enough attention to these symptoms, which are not always reported spontaneously by the patients, through to secondary and tertiary level clinicians. In highly specialized tertiary centers, clinicians working with bipolar patients are usually more aware of this, but that practice needs to extent to all levels.
The strength of this study is that it’s not a clinical trial, with ideal patients – it’s a big study, from the real world.”
Suicide prevention resources:
National Suicide Prevention Lifeline: 1-800-273-TALK (8255). 24-hour hotline for crisis intervention, suicide prevention, and mental health services. Every call is free, anonymous, and confidential.
Suicide.org: This website contains links to suicide prevention resources in every state.
The Trevor Project: A suicide prevention and crisis intervention resource for LGBTQ teens.
National Suicide Prevention Lifeline: 1-800-273-TALK (8255). A 24-hour hotline for crisis intervention, suicide prevention, and mental health services. Every call is free, anonymous, and confidential.
Suicide.org: This website contains links to suicide prevention resources across Canada.
Kids Help Phone: Free, anonymous, confidential hotline for Canadians under the age of 20.
PAPYRUS Prevention of Young Suicide: Charity dedicated to raising awareness and reducing the stigma of depression. There are counselors available via phone, email, or text who can provide crisis intervention.
Samaritans: Though the name sounds religious, this is a secular organization that provides crisis intervention for those in need.
Campaign Against Living Miserably (CALM): England-based charity aimed to reduce depression and crisis among males.
Lifeline: This organization provides mental health support and crisis intervention through free, anonymous, and confidential phone calls across Australia.
Kids Help Line: Hotline provides crisis intervention and mental health support for young Australians ages 5-25.
If your location is not listed here, please search for resources local to your area, or contact your doctor, family, or friends for help.
Please remember that you are not alone and that you can get through this.
See all the press releases from the congress (post embargo) here.