Defining depression may seem simple, but it’s actually a complex mental-health disorder that can look different for every person it affects.
That’s why a personalized treatment plan is crucial to alleviate symptoms and promote recovery, said Dr. Diane McIntosh, psychiatrist and chief neuroscience officer at Telus Health, during a session at Benefit Canada’s 2020 Mental Health Summit.
Among nine symptoms of depression described in the Diagnostic and Statistical Manual of Mental Disorders, a person needs to have at least five for more than two weeks for a diagnosis. One of those five symptoms must be either a depressed mood or markedly diminished interest or pleasure. Other symptoms include weight or appetite changes, insomnia or hypersomnia, physical or mental slow down or agitated, fatigue or loss of energy, feelings of worthlessness or excessive or inappropriate guilt, cognitive dysfunction and recurrent thoughts of suicidal ideation or attempt.
“When you take all the possible permutations and combinations of depression, there are about a thousand different ways depression can present,” said McIntosh, noting there’s no single cause of depression.
Whatever the cause, chronic depression and anxiety are now recognized as inflammatory illnesses that can damage brain cells. “But the good news is you can grow new brain cells,” she said. “We do it everyday and, in fact, recovery from depression depends on it.”
Early treatment — within three to six months of onset — offers the best chance of recovery from depression, she noted. When a significant depression lasts for a year, recovery drops to a 10 to 15 per cent chance; at two years, the chance of recovery falls to five per cent. “You can always have improved symptoms, but the likelihood of full recovery decreases with every month and every year that passes.”
A range of treatments, including talk therapy, medication, exercise, social support, meditation and mindfulness, is required to meet each individual’s particular needs. As a psychiatrist, McIntosh focuses on antidepressants because they’re known to work for moderate to severe depression and for anxiety. However, she stressed, not every antidepressant works for everyone.
“That’s because every brain is unique and every antidepressant is unique. Right now, we have 25 antidepressants and more treatments are coming. And we need them all.”
However, adherence to antidepressant medication is a huge barrier to successful treatment, she said. Indeed, 42 per cent of people prescribed an antidepressant quit taking it within a month, 72 per cent stopped within 90 days, 75 per cent didn’t take their medication every day and a large percentage didn’t even start on the drug.
“We need to have [treatment] options available that people are willing to take. [They] should be based on the patient’s needs, severity of illness, other health/mental-health issues, type of symptoms, what worked before, game-changing side-effects, cost and coverage and the patient’s age.”
However, the availability of innovative medications often depends on affordability. Eskatamine, for example, is a new drug administered as a nasal spray that’s as effective as electroconvulsive therapy and has fewer side-effects. McIntosh warned that restrictive formularies that limit options and inhibit access to expensive new drugs is a challenge.
Yet despite the many challenges during the battle for recovery from depression, she underscored the importance of hope. “Patients will keep hoping, no matter the odds, but if their doctor gives up they can become hopeless. I say, never, never, never give up.”
Read more coverage of the 2020 Mental Health Summit.