By Dr Becci Strawbridge, Institute of Psychiatry, Psychology and Neuroscience, Kings College London
The World Health Organisation (WHO) published updated figures last month: depression is now the leading cause of disability internationally. Rising rates of mental illness, particularly in young people, has received much press exposure recently.
The long-known disparity between physical and mental health includes, still, an imbalance between perceptions, services, resources and funding, and in the research that develops evidence-based medicine. Insufficient ‘parity of esteem’ compounds our challenge in reducing the burden of illness carried by individuals and society. A study that we carried out of influential research outputs suggest that for depression, parity of publication may be declining in more recent years.
While the backdrop may seem gloomy, work is being carried on multiple fronts as part of a call to action in light of the latest findings.
Here at the Institute of Psychiatry, Psychology & Neuroscience, King's College London, we are optimistic for the potential of these actions to thrive and attain parity of esteem between physical and mental health. Recent work ranges from government involvement, service management, public stigma national campaigns and research funding. Celebrity awareness and support continues to rise, which helps to increase mental health exposure and reduce stigma. Similarly, online communities provide active support, promote understanding, and provide transparency of and insight into research evidence.
Similar outcomes from antidepressants and talking therapies
In depression research, one important area surrounds treatment response.
Response to the most commonly available treatments is, at the moment, insufficient. Overall, around a third of people will fully recover, around a third partially recover, and the remaining third will not improve. These rates appear similar across a variety of antidepressant and talking therapies.
A person suffering from a typical physical ailment would presumably be unimpressed with such a low probability of recovery. We also know that response rates get worse as the number of failed treatments increase, and that some people become ‘treatment resistant’, meaning that for whatever reason, most current treatments don’t work for them. Having said that, we have found that even for patients with long histories of many non-effective treatments, depression can be ameliorated with specialist and multifaceted treatment programs. This indicates that it is possible to configure a treatment package that will enable people to recover, but we believe that this will need to be personalised based on a multitude of factors. At the moment, treatment is provided on a largely non-individualised decision process.
Treatment response research focus
Taking the above into account, research into treatment response is therefore focused on the following areas:
• Development of new treatments, especially those targeted for people who do not respond to currently available therapies (that may act through different mechanisms). This indicates a good number of promising avenues including neuro-stimulation and medications targeting inflammation or gut bacteria.
• Predicting, in advance, which treatments will be helpful for different individuals. Working out the factors that associate with a good or poor response, either overall or for specific interventions is key here. So far, research shows associations between various factors (relating to social, demographic, health, psychological and/or biological phenomena) and response to a number of therapies. Detangling this precisely, for every treatment, is a challenge. But it is one that is being addressed. Large investigations and advances in data analysis techniques are helping with this.
• Personalising treatment: We believe that the above evidence is virtually at the stage where it can begin to develop a testable paradigm to direct patients to (hopefully) the most effective treatment. The success of this would enable effective treatment at an earlier stage.
Surviving through to thriving
Seek treatment: evidence suggests that the earlier people seek treatment, across multiple mental health diagnoses, the higher the likelihood of response. Do not despair - now is always the best time to act!
Access treatment: there can be a gap between initially seeking treatment and accessing it, but if you need to push, it will be worth it.
Keep going – and monitoring: both medication and psychological therapies can take some weeks to work but your healthcare professional should be able to advise whether it might be time to try something different.
Self-care: where possible, work on maintaining your mental health. Figuring out what actions or factors predict a better or worse mental health day is a process, and varies between people, but this can have long-term benefits and there are plenty of resources for assisting with it. This is also something that psychological therapies will often focus on.
Access other help where needed. There are a wealth of resources available for all mental health conditions, including charities and other organisations as well as many supportive online fora and digital communities. Some organisations help with clear and objective reporting of scientific research findings, which is valuable when considering how much information available on the internet is not evidence-based.
Maintaining good mental health
Different treatments have different guidelines in terms of when to ‘stop’ treatment – and how. Make sure you speak to a healthcare professional if you are considering stopping treatment for any reason, before taking further action.
Many of the above points on surviving also apply to thriving. Looking after yourself and monitoring your wellbeing can help with identifying triggers of a decline in mental health, knowing if and when further action is needed and enhancing overall quality of life.
About the author
Dr Becci Strawbridge is a researcher at the IoPPN, King’s College London