What if We Treated Depression like Cancer?

By Bergina Isbell, MD

Led Life Concierge Psychiatry

. https://www.ledlifellc.com/

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What if We Treated Depression like Cancer?

Understanding the Stages of Depression and Emerging Treatments

During my residency, a Senior Consultant remarked that clinical depression is “like cancer of the soul.” This analogy has gained traction among providers, prompting a reevaluation of how we approach depression. Michael Otto’s 2022 article, “Stage Models for Major Depression,” outlines the progression of depression across distinct stages, enabling clinicians to tailor interventions to individual needs (1).

Stages of Depression

Stage 0: Presymptomatic Risk Phase
This initial stage involves risk factors that predispose individuals to mood disorders, typically without any symptoms.

Stage 1a: Onset of Prodromal Phase
Individuals may notice subtle changes, such as irritability, sadness, fatigue, and sleep disturbances, which can be overlooked as stress-related.

Stage 1b: Progression of Prodromal Phase
Symptoms intensify, leading to a more pronounced depressive mood and functional decline.

Stage 2: Major Depressive Episode
Individuals experience their first full episode, with clinically significant symptoms lasting weeks or longer, substantially impacting daily functioning.

Stage 3a: Progression of Residual/Remitted Phase
This phase may involve relapse, with individuals returning to healthy functioning followed by a return of depressive symptoms.

Stage 3b: End of Residual/Remitted Phase
Individuals may experience dysthymia or recurrent depressive episodes, leading to increased distress and functional impairment.

Stage 4: Chronic and Severe Major Depressive Illness
Characterized by recurrent, severe episodes and repeated treatments that fail patients, individuals in this stage may struggle to manage their condition, often facing significant disability.

Emerging Treatments

Twenty years ago, treatment options for depression were limited, but now innovative therapies have emerged.

• Spravato (Esketamine): An FDA-approved nasal spray that offers rapid relief for those unresponsive to traditional antidepressants, crucial in crisis situations.
• Transcranial Magnetic Stimulation (TMS): A promising non-invasive procedure for Treatment-Resistant Depression (TRD), stimulating nerve cells in the brain to alleviate severe symptoms.
• Zurzuvae (Zuranolone): For women facing Postpartum Depression, this medication has shown remarkable efficacy, with symptom improvement occurring in days rather than weeks.

Conclusion

By viewing depression as a multifaceted condition, encompassing risk, symptoms, and severity, we can enhance treatment decisions. The advancements represented by Spravato, TMS, and Zuranolone provide hope and a brighter future for individuals and families affected by depression.

Reference

1. Otto MW, Birk JL, Fitzgerald HE, Chauvin GV, Gold AK, Carl JR. Stage models for major depression: Cognitive behavior therapy, mechanistic treatment targets, and the prevention of stage transition. Clin Psychol Rev. 2022 Jul;95:102172.