I’ve written a piece in today’s health pages about deep brain stimulation (DBS) treatment for depression, in which electrodes are placed at specific points in a patient’s brain, attached to a battery in the chest: it acts, roughly speaking, as a pacemaker for the brain, regulating the hyperactive “sadness” circuits. It’s a fascinating and promising procedure, and offers genuine hope to millions of intractable, treatment-resistant cases – the analogous treatment for Parkinson’s has been used on hundreds of thousands of patients worldwide – although there’s a lot of research still to be done.
I wanted to write a bit about the wider issue of depression, though, rather than the DBS treatment. I spoke to three researchers in the field, and a recurring theme was that we still don’t think of depression as an illness, but as a sort of weakness or personal failure. Dr Andrea Malizia, who’s a psychiatrist at Bristol University, was particularly keen to make it clear that this is an organic disease: “If you look at mood disorders compared to, say, cardiac problems or cancer, they have similar rates of disability and mortality associated with them.” The suicide rate for severely depressed patients is about 15 per cent, he says. “But the funding is far smaller than for other diseases: you don’t see people outside supermarkets shaking tins for depression.”
One of the problems, he says, is that the disease is called “depression”. “Calling it depression is very confusing,” he says, because we use the term for ordinary sadness as well as for the “malignant sadness” of depression. “We don’t have the same confusion with pain,” he says. “We don’t have a problem with confusing healthy pain, the pain that means you and I still have both our hands because we haven’t burned them away on a gas stove, with the pain of nerve disease, dysfunctional pain.”
But we do, it seems, with depression. “For some reason we have a certain amount of arrogance of the mind, that things like motivation, concentration, well-being, energy and so on should be things that we are able to control.”
There is a particular problem with depression and other psychiatric disorders, which is that they manifest when people are young, he says. “If you look at psychiatric disorders in general, dementia and things aside, by the time people are 25 about 80 to 85 per cent of those disorders have manifested themselves. They manifest at a crucial time in life, when it’s easy to get confused that it’s not just someone who is ill, but that it’s somehow who they are, that it’s a character flaw.”
What’s really exciting about the DBS treatment is not so much its efficacy or otherwise, says Prof Helen Mayberg, a neurologist at Emory University in Atlanta, Georgia, but that it represents a “paradigm shift” in how we think about depression. If we can target highly specific parts of the brain, treat it like the fantastically complex “wiring network of billions of neurons organise into units, choreographed, communicating with each other with exquisite precision” that it is, then we can start thinking about the brain as an organ that goes wrong, like a kidney. “We used to think of it as a weakness of character, and thank God we got rid of that, or at least we’re trying,” she said. “Now, we think of it as a circuit disorder.”
Hopefully this attitude will spread beyond the medical profession. The idea that we should be able to “snap out” of depression is damaging and false: “we” aren’t in control of it. As Dr Malizia says: “Clearly some people can live with depression. Winston Churchill did; probably Dr Johnson did. But those are the exceptions; this sort of great willpower allows you to overcome it, it doesn’t cancel it. It’s like the people who climb mountains with no legs. The rest of us can’t do that.”