Do you feel like more of an anxious insomniac or an exhausted emotionless robot? Your answer could vastly change how your depression is treated.
Depression is the most common mental illness and the leading cause of disability in the United States, according to the CDC, affecting nearly one in three women at some point in their lives. This prevalence makes treating and curing depression a top priority. But doing so has proven to be quite difficult, as the illness can present itself differently from one person to the next. One reason for this may be that what people simply call "depression" could actually be four different mental illness, with different brain signatures, symptoms, and treatments, according to a new study published today in Nature Medicine. (P.S. Take a look at your brain on depression.)
If you've ever complained about exhaustion, angry outbursts, or even joint pain, chances are one of the first things your doctor did is screen you for depression. (Some doctors are even suggesting that you get screened for depression annually.) Part of that is likely because depressive symptoms are so common. But the other half of the equation is because the symptoms are so wide ranging, and even then, getting an accurate diagnosis is difficult because the answers are very subjective. For instance, answering "yes" to the question "Do you no longer get joy from activities you used to enjoy?" could mean you are experiencing serious depression. Or it could mean you're just bored, hungry, or having a grouchy day. Plus, the more symptoms you report, the trickier it can be to find the right treatment. Researchers from Cornell decided to tackle this problem by scanning the brains of 333 people with depression (as well as 378 people without depression). After analyzing the images, they were able to recognize four distinct subtypes of the mental illness, providing an objective way (no weird Q&A session needed) to diagnose depression and, hopefully, treat it appropriately.
Labeled "biotypes" 1 through 4, each subtype lit up different parts of the brain and was associated with different emotions and symptoms.
Biotype 1 = This type of depression is characterized by anxiety, insomnia, and fatigue.
Biotype 2 = The primary symptoms here are exhaustion and low energy.
Biotype 3 = This subset of depression is marked by an inability to feel pleasure as well as slowed movements and speech.
Biotype 4 = Those in this group experience mostly anxiety with insomnia along with the inability to feel pleasure.
Lead researcher Conor Liston, M.D., a neuroscientist and psychiatrist at Weill Cornell Medicine, says he recognizes these science-y sounding names and definitions can be difficult to understand, and he hopes they will become more relatable, descriptive, and concrete as additional research is done and clinicians verify the categories. For now, though, dividing "depression" into these four subcategories is particularly important because it sheds light on how to best treat depression, says Liston. (There are SO many other ways to treat depression besides jumping straight into antidepressant drugs, so make sure you're asking about your options.) Depression therapies range from lifestyle methods such as talk therapy and exercise, medicinal treatments such as prescription antidepressants, medical treatments such as transcranial magnetic stimulation or, in particularly tough cases, electroshock therapy. Up until now, deciding which therapies would work best for which patient has been a matter of trial and error, but this new Cornell research will help doctors match the type of depression someone has to the best treatment for that version specifically. "For example, we can now predict with high accuracy whether or not a patient will respond to transcranial magnetic stimulation therapy, which is significant because it takes five weeks to know if this type of treatment works," says Liston.
But don't expect to receive tests diagnosing your depression subtype just yet. "At this stage, the tools we have developed for diagnosing subtypes of depression in individual patients are not yet ready for widespread clinical use—more testing needs to be done," he says. In the meantime, however, it can't hurt to talk to your doctor about which specific symptoms of your depression are hindering your life the most. Even without brain scans this information could help them adjust your treatment plan and help you feel better faster.