Illustration: Jaclyn McRae-Sadik.
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Leading researchers come together to tackle mental illness head on

It can take a lot of effort for people living with depression to seek help for their debilitating mental illness. However, for many Canadians, that first prescription or stint on a therapist’s couch is only the beginning of a long, arduous journey to emotional well-being.

In fact, two-thirds of patients will not respond to to their first medication and will have to seek different types of treatment, according to the University of Ottawa’s Dr. Pierre Blier.

Sometimes that can take weeks, months, or even years.

“What we know, and it is clearly established in the literature in the scientific field, is the longer depression is allowed to continue, the lower are the chances of getting people back into remission,” said Blier. “We know that there are some degenerative phenomenon ongoing with depression.”

Blier is a professor in the U of O’s Department of Psychiatry and Cellular/Molecular Medicines, a recipient of the Endowed Chair in Mood Disorders Research at the university’s Institute of Mental Health Research, as well as the recipient of the Canada Research Chair in Psychopharmacology. He’s also a part of the Canadian Biomarker Integration Network in Depression (CAN-BIND), a research project that seeks to more easily match patients to successful treatments.

“CAN-BIND initially started with a clinical study in depression, major depression, to try to identify biomarkers for prediction of response in depression,” said Blier.

Biomarkers are “biological and clinical characteristics that will help guide treatment selection” according to the CAN-BIND website.

According to Blier, the study integrates data from a battery of tests using brain-imaging techniques, genotyping measurements, tests of protein in the blood, as well as questionnaires on personal environmental factors.

“What’s important about CAN-BIND is that there’s going to be really a wealth of data, whether its imaging, proteomics, or genetics, which could eventually lead to predictors of response so that we could actually get people better faster from their depression,” said Blier.

The study has brought together some of the top brains in depression research from across North America, headed by Dr. Sidney H. Kennedy,  a professor of psychiatry at the University of Toronto.

“I’ve always been interested in the relationship between our environment and our genetic makeup, and depression is a prime example of genetic risk interacting with multiple adverse life events,” writes Kennedy about the project.

CAN-BIND has already yielded some interesting findings on how depression works in the human brain. Through the use of functional Magnetic Resonance Imaging, they’ve pinpointed two areas of the brain, the rostral anterior cingulate cortex and the dorsomedial prefrontal cortex, which are “showing potentially promising signs of being able to predict treatment response.” 

The next step is to use these findings with other clinical and genetic findings to develop “a ‘formula’ to predict response,” according to their website.

The CAN-BIND researchers have also found the drug ketamine could be a highly effective treatment for depression. Ketamine, listed on the World Health Organization’s List of Essential Medicines, is mainly used as an anesthesia, and is thought to be a potential alternative for other painkillers. 

“We know, for example, with ketamine that there is a direct effect on suicidal ideation, so we hope not to just decrease morbidity but to decrease mortality as a result of major depressive disorder,” said Blier. He said one upcoming study will look at comparing the effects of ECT and ketamine.

However, their research on ketamine so far has “strong limitations” regarding the long-term effectiveness or safety of this treatment, optimal dose, and interactions with other drugs.

The researchers are currently in the process of analyzing the data collected from their first study.

“Because we have a lot of markers and we’re going to be resorting as well to intelligent, big data analysis because there are so many variables,” said Blier.

Despite the labyrinth of factors involved, Blier and his colleagues at CAN-BIND will hopefully help clear the path for people around the world trying to navigate depression.