We all know treatment-resistant depression is common (some studies pin the number somewhere in the 30% region of cases), and can be absolutely debilitating to those struggling with it.
Now researchers at Stanford University have cast new light on one part of the puzzling problem by identifying a subtype of depression called the “cognitive biotype.”
Read about the study here, but here’s the takeaway and why it probably explains at least part of the treatment-resistant problem.
Namely, there are likely different subtypes of depression, and one such is newly identified “cognitive biotype.”
Now, first off — we all tend to have both overlapping and unique symptoms associated with our depression, right?
You might sleep more, I might sleep less. You might drown yourself in work, I might drown myself in youtube.
You might be irritable, I might be simply lifelesss.
Those kinds of things.
Well, roughly 27% of people with depression exhibit significant cognitive problems associated with their depression.
These include: the ability to plan ahead, maintain focus, improve goal selection, and limit unwanted or irrelevant thoughts.
Using an fMRI, researchers showed just how clearly these cognitive challenges were related to the parts of the brain involved in those symptoms.
For example, patients with the “cognitive biotype of depression” had much less activity in the dorsolateral prefrontal cortex and dorsal anterior cingulate regions than the control group exhibiting different depressive behaviors.
Those regions are responsible for focus, planning, limiting unwanted thoughts etc.,
Finding this distinction within the ranks of the depressed isn’t surprising.
For example: there are some enormously depressed individuals who are “high functioning” and don’t show any signs of cognitive challenges.
They set goals, achieve them through tremendous focus, and don’t struggle with impulse control.
And yet… they’re still severely depressed.
But in the “cognitive biotype,” the depression is also there, but the cognitive capacity to do those other things is significantly compromised.
And the fMRI results from the Stanford study showed just that — a correlation between participants’ cognitive symptoms and what the brain scans showed.
This discovery doesn’t just have scientific import, it also has profound practical implications.
Traditional antidepressant treatment doesn’t affect said-regions of the brain; therefore, it’s not a surprise that the cognitive biotype depressive might be called “treatment resistant,” at first.
And from experience, we all know this, right?
If you’ve had friends with depression, you probably compare notes and might say, “Wha??! Lexapro didn’t do anything for you? It saved my life!”
So it’s not surprising that a new biotype has been identified because anyone who’s been involved in this knows the trial-and-error in treating depression.
Looking forward, Stanford researchers will explore the most effective way to help folks with this biotype — for example, would transcranial magnetic stimulation help? Cognitive Behavioral Therapy? Which type of medicine?
To the last point, they’re also studying guanfacine, which targets the regions of the brain associated with these challenges.
In fact, guanfacine is already used to treat ADHD, and yes, read about it and you can see why it might help someone with all these symptoms.
Finally, as always, this is a tremendous reminder to skeptical Christians that depressive symptoms can be seen in brain imaging.
This is a medical condition. Doctors can find evidence of cancer, urinary tract problems, respiratory issues, stomach conditions.
Turns out they have been finding, for decades, medical evidence of depression, anxiety and other mental health conditions.
This is not, and never was, a faith issue.
And one final note on the cognitive subtype.
I think that Christians afflicted with this type of depression are more likely to be condemned and judged by their fellow congregants than those who struggle with depression but are nevertheless, “high functioning.”
Church Christians Who Don’t Understand Depression: “Well, Jim might be depressed, but at least he doesn’t let it keep him down! He fights through it and contributes to society with that fancy job and great house!”
Meanwhile, they scoff at the depressed Christian who depends on government assistance to survive: “Why can’t they be like Jim? Jim fights through his depression. Why can’t they fight through theirs? This is a problem of the will.”
No, it’s actually just a different kind of depression.
It’s actually a reflection of a different brain, and aren’t we all fearfully and wonderfully made?
Unfortunately, Christianity in America has been so historically wed to the Protestant Work Ethic that there’s traditionally been very little sympathy offered to other Christians who struggle with focus, achievement, and cognitive issues that are simply reflections of the way God designed our brains, and not a reflection of deficiencies in faith.
In fact, if anything, Jesus warned the successful about the perils of trusting in themselves and their achievements and despising those who couldn’t quite get things together.
There is no sin in depression.
There is every sin in judging others for it.
If you’ve ever been judged for it, believe me, there are loads of other hurt Christians out there, who’ve also been spiritually beaten by being told they lack faith when, in reality, this is a medical condition and has nothing to say about our spirituality.
So please don’t feel alone!
And here are some great resources…
Find a psychiatrist here.
Find a therapist here.
[Photo of Hoover Tower by Jawed Karim].
