The Director Discusses:

Personalized, precise, evidence-based treatments: Our strategic plan

Imagine a 27-year-old mother battling a new episode of clinical depression at the beginning of her children’s school year.  Although her two kids love school and are good students, she finds sleep elusive, her mood tearful, and everything overwhelming during what should be, it seems to her, a routine period of transition.  When considering several treatments recommended by her clinician, she and her husband immediately struggle with three questions: “What is the evidence the treatments you mention will work for my depression?” “Are they safe?”  “Why are you recommending them?”  

Questions like these continually motivate faculty and staff at the U-M Comprehensive Depression Center. We routinely ask: “What is the evidence for various treatments? How can we make them more effective? Do treatment combinations work better? Could new strategies be both safer and more effective?   How can we help develop them?”

Scientific advances show convincingly that what may work for this 27-year-old mother is unlikely to be identical to what works for many other depressed or bipolar patients, because the underlying causes of their illnesses are different. “One size will never fit all.”  Specific strategies are required to answer the above questions and develop additional and more improved “evidence-based treatments,” which were addressed in our two most recent issues of our UPDATE newsletter.

Such strategies must start with better understanding of neuroscience and the influence of life stressors; integrate the best evidence from as many robust interdisciplinary studies as possible; make their findings relevant to different clinical providers and practices; continually work toward improvement; and abandon the treatments shown to lack evidence.  Many collaborators must partner together, and patients and families must be included if the plans are to work.

Where do we go from here?  Last summer, the Depression Center adopted a Strategic Plan that builds upon exciting scientific advances and prioritizes the search for personalized, precision treatment discovery.  Its goals will guide us in our second decade, and we invite you to accompany us.

What are our strategies?  “Biomarkers,” biological factors that can be measured in the lab or clinic and can help detect disease or gauge how well treatments are working, need to be combined to steadily unveil the mysteries of how our genes, neurotransmitters, life stresses, medical illnesses, sleep, and many other variables interact in our brains to cause depressions and bipolar illnesses.  Combining biomarkers into an individualized “fingerprint” can help pinpoint the most promising interventions to correct underlying problems.  Then, once the multiple and divergent causes of depressions and bipolar illnesses are identified, treatments most likely to attack the underlying problems can be developed and compared.  We are on the search for the most promising biomarkers that may aid in detecting and monitoring depression and improving treatments.

The trek will be challenging but the destination is worth it.  During our second decade, which has only just begun, the Depression Center will accelerate efforts to identify these personalized treatments and convert these into true breakthroughs. 

Ask your clinicians what you might do to help accelerate these processes, remembering that knowledge heals and research participation is what generates knowledge.  Together, we can produce better answers. 

Merci,

John F. Greden, M.D.

__________
John Greden, M.D., is executive director of the University of Michigan Comprehensive Depression Center, chair of the National Network of Depression Centers, and serves as vice president of the National Board of Directors for the American Foundation for Suicide Prevention (AFSP).