What is in the future for depression?

The future is very bright for the treatment of depression. In response to the customs and practices of their patients from a variety of cultures, physicians are becoming more sensitized to and knowledgeable about natural remedies. Vitamins and other nutritional supplements like vitamin D, folate, and vitamin B12 may be useful in alleviating depression, either alone or in combination with an antidepressant medication. Another intervention from alternative medicine is St. John's wort (Hypericum perforatum). This herbal remedy has been found to be helpful for some individuals who suffer from mild to moderate depression. However, St. John's wort being an herbal remedy is no guarantee against developing complications. For example, its chemical similarity to many antidepressants disqualifies it from being given to people who are taking those medications. We are close to having genetic markers for bipolar disorder. Soon after, we hope to also have them for major depression. That way, we can know of a child's vulnerability to depression from birth and try to create preventive strategies. For example, we can teach parents early warning signs so that they can get treatment for their children, if necessary, to ward off future problems.

The new world of pharmacogenetics holds the promise of actually keeping the genes responsible for depression turned off so as to avoid the illnesses completely. Also, by studying genes, we are learning more about the matching of patients with treatment. This kind of information will be able to tell us which patients do well on which types of drugs and psychotherapy regimens.

We are learning more about the interactions of the neurochemicals, the chemical messengers in the brain, and their influence on depression. Moreover, new categories of neurochemicals, such as neuropeptides and substance P, are being studied. As a result, we will soon be able to develop new drugs that should be more effective with fewer side effects. We are also learning startling things about how maternal stress early in pregnancy can profoundly affect the developing fetus. For example, we now know that maternal stress can greatly increase the risk for the fetus to develop depression as an adult.

Further information is also being discerned about how to most effectively make treatment of depression available and acceptable to all who need it. This is particularly important for children and adolescents, minorities, individuals who are economically disadvantaged or live in rural areas, the elderly and for people with developmental disabilities, who are known to suffer from lack of adequate access to mental-health treatment that is knowledgeable and respectful of what may be their unique needs and preferences. While sadness will always be part of the human condition, hopefully we will be able to lessen or eradicate the more severe mood disorders from the world to the benefit of all of us.