A Conversation with Helen Mayberg.

Abstract

Dr. Mayberg: Depression is a very common psychiatric condition, one of the most common that we have. It’s diagnosed by an interview, not by a laboratory test or a scan. It’s a condition that’s characterized by a disturbance in one’s mood, generally a profoundly and distressing low mood that’s accompanied, in most cases, by a sense of not feeling pleasure: anhedonia. It has an admixture of many other symptoms that affect our drives—like sleep, or appetite, or one’s libido—and activities, as well as interests and thought. Thinking can get slow or confused. People feel like doing less. They may feel anxiety. They may have sensations in the body that, at their core, are disturbances in drive states, emotion, and putting thought to action. Despite being extremely common and accounting for much of the world’s disability, the good news is that there are many treatments, and have been. There are a number of evidence-based psychotherapies like interpersonal psychotherapy or cognitive behavioral therapy that can be quite effective. There’s a multitude of medications and have been since the late ’50s, heralded now by the serotonin reuptake inhibitors, but also drugs like tricyclics or mixed serotonin and norepinephrine drugs. We have new medications like ketamine that are being tested that are not even of the old classes. And we have somatic treatments, like using magnetic therapies like TMS [transcranial magnetic stimulation]. Most importantly, the best treatment that there is is actually electroconvulsive therapy, but it’s generally reserved for people who are extremely ill and have not responded to medication or psychotherapy.