Designing a good clinical study of Depression
In practice less than half of young people affected by severe depression in the the UK get seen and most of these young people have to wait few months for therapy. This not an acceptable situation.
Neuro-imaging cannot reveal a characteristic representation of the depressed brain for all young people with depression. Although the diagnosis of depression can be made clinically there are other factors at play within the individual like the presence of other physical or mental health problems and adverse or challenging social circumstances.
May be we should be looking at resilience or gratitude or positive emotions affecting the brain in neuroimaging? We prescribe pills that modify serotonin levels in the brain. However brain cells are sensitive to changes in oxygen and glucose levels and maybe we should be boosting a young person's level of activity to optimise the delivery of glucose and oxygen to the frontal lobe of the brain.
Neuroimaging and EEG studies in under 18 year olds is usually very difficult to do in practice as ethics committee would not usually grant permission. However the 18 year -25 year group experience alot in the way of mental illness e.g. anxiety, depression, substance use disorder and psychosis and post-traumatci stress disorder and obsessive compulsive disorder. Most of these young people would be seen by their General Practitoner, GP and prescribed medication and maybe those that are employed and/or engaged in physical activity will be more likely to recover form depression.
We really need to treat depression at a young age successfully and give young people the tools they need in looking after themselves and getting on with others in order to remain well.
I would like to identify a group of 20-150 young people aged 18-25 years, seeing their GP in primary care for depression. One group would receive the usual treatment whilst the other group woud be recruited on to a training programme to boost physical activity, optimise sleep and diet. There would be 20-150 young people in each group. I start with 20 as this would be the size of the pilot study which would be proposed initially to the ethics committee.
Depression would have be diagnosed properly using an established diagnostic interview both by the research team in addition to the GPs initial assessment.
Outcome measures would include rating scales to measure depressive symptoms i.e. Mood and Feelings Questionnaire MFQ.
We could also look at psychimetric tests for positive qualities inlcuding compassion, gratitide, motivation and determination. Psychometric testing usually such a dominant part of trials. However biological markers can be studied. Sleep and pulse reading could be tracked using the EEG or FitBit/sleep lethysmography.
We would also need to know a young person's baseline use of social media and gaming and see if it is altered during the duration of the study.
In addition we could conduct functional neuroimaging of blood flow in the brain and glucose uptake in the frontal lobe and hippocampus. Finally there would be the options of looking at the electophysiological functions of the brain through the EEG. The use of a lumbar puncture to look at the level of Serotonin and its Metabolites in the cerebrospinal fluid may be a step too far.
In addition we would gather data from young people about their diet and sleep patterns and precise levels of physical activity.
THE INTERVENTION would be a structured programme of physical training working towards specific training goals for specific sport such as running, swimming or sailing. The young person would have to set specific goals for themselves and work towards, whilst adhering to a prescribed diet and sleep routine. The young person would have access to a coach in order to have confidential discussion about training and their feelings and challenges. The young person would still be seeing their GP and counsellor in primary care, as would be the cae for the young people placed in the non-intervention group.
Data could be collected again at 4-6 weeks, three months, six months and 12 months. The coach and the medical team would feed the data back to the patient in a constructive way that would help the young person look at the data and strive to improve it. Could this training approach stimulate greater motivation and recovery.
ADMITTEDLY I DO NOT HAVE ALOT OF RESEARCH EXPERIENCE AND THERE ARE CONFOUNDING FACTORS. HOWEVER IT MUST BE POSSIBLE TO MOVE FROM THIS TO THE PROVISION OF A MORE STRUCTURED PROMPT SUPPORTIVE INTERVENTION/PSYCHOSOCIAL INTERVENTION FOR DEPRESSION IN YOUNG PEOPLE.
FINALLY I HOPE TO UNDERSTAND HOW WONDERFUL INSIGHTS IN NEUROSCIENCE CAN BE TRANSLATED INTO CLINICALLY USEFUL INTERVENTIONS FOR MANY PATIENTS.
HAS THIS STUDY BEEN DONE ALREADY?