Doug Thompson illustration
Not long ago, permanent relief from clinical depression was considered unrealistic. People suffering from lifelong major depressive disorders and those affected by a crisis, including job or relationship loss, winter weather, or the holiday blues, were treated so that symptoms could be eased or managed, perhaps indefinitely. But Richmond-area doctors are extending new hope, saying that through scientific discoveries and ongoing clinical studies, more depression patients can anticipate a full recovery.
"The goal has always been to improve symptoms. Now the aim is for recovery and remission with reduced medication side effects," says Laurie Burke, a psychiatric nurse practitioner at Dominion Clinical Research in Midlothian.
Nationwide, about 17 million Americans, approximately 13 percent of men and 21 percent of women, struggle with depression, according to Dr. Susan G. Kornstein, executive director of VCU School of Medicine's Mood Disorders Institute, in the Near West End. But despite the higher number of women affected, clinical research traditionally has focused on men. That has changed in the last two decades, she says, adding that analysis of clinical trials by gender shows "very different results in men versus women." Still, only about one-third of these depression patients get diagnosed or treated properly, Kornstein says. Depression symptoms include changes in mood, sleep or appetite, trouble concentrating, decreased energy, feelings of worthlessness, and thoughts of death or suicide.
Among the discoveries in recent years, researchers concluded that it's possible to stimulate the growth of new brain cells, contrary to previous theories, says Dr. W. Stanley Jennings Jr., a psychiatrist at Richmond's Tucker Psychiatric Clinic since 1985. "I was trained 30 years ago that you just lost brain cells … after you were born. In the past decade, we learned that we were wrong," he says. "We [now] have the workings of the understanding of how the environment causes depression, and how antidepressants might actually work."
The knowledge that chronic stress kills brain cells and that antidepressants such as Prozac stimulate cell growth — rather than providing a temporary mood lift by increasing the brain's supply of serotonin, a neurotransmitter — has enabled physicians to use the drugs more effectively, Jennings says. Doctors also have begun to use transcranial magnetic stimulation, a process that stimulates the brain through intense magnetic pulses. "With those treatments we can stimulate the brain to grow much the same way you would stimulate the muscle to grow by exercising," he says. Researchers believe such treatments can repair parts of the brain that have been damaged by chronic stress.
"Until these new treatments came out, I had never seen somebody who had been depressed for 20 years get better," Jennings says. "I have seen that happen, and it is a chilling and thrilling vicarious experience."
Locally, medical researchers are studying new approaches to treating depression symptoms. These efforts include a clinical trial of a medication that is designed to work in concert with an initial antidepressant. Dominion Clinical Research in Midlothian is one of the sites in the national study and is still seeking adult participants. The goal of the free 12-week study is to test the effectiveness of the medication in "trying to get people to have no symptoms left whatsoever," Burke says.
Another step forward in treatment is assisting patients who suffer from periods of depression. This includes a study at VCU's Mood Disorders Institute, which is working to discover treatment strategies to aid female patients who struggle with severe bouts of depression surrounding their menstrual cycle. The study, funded by the National Institutes of Health, looks at the effectiveness of taking medication at the onset of symptoms. Previously, drugs used to manage premenstrual depression were taken for multiple weeks, but Kornstein says the current study has women taking medication for as few as three to five days.
"Our preliminary data suggests that this new approach is effective but this will be the definitive study," she says.