Monday, May 18, 2015

Understanding depression?

These are just a few musings about depression research. As a researcher, I am very interested in understanding the direction that the field of major depression is going. There has been an important change with the emergence of RDoCs - which is a series of dimensional symptom ratings that are intended to replace or complement (depending on who you talk to) the broad diagnostic category of Major Depression. I am at a conference today and it strikes me that there has been a large impact of this idea in the research community. It has become popular to say that there are 100s or 1000s of forms of depression, and that by characterizing these carefully and individually, we will be moving towards "precision medicine" approaches. I find this fascinating. It is certainly true that all illness categories are a kind of short-hand describing patterns of pathophysiology (and this case psychology and social interaction as well) that cannot be exactly the same in every person afflicted. This heterogeneity is important and it makes sense (to me) to try to parse it out. This could lead to therapeutic gains. However, what might be even better would be insights that help to integrate and simplify this diversity, providing perhaps a simpler explanation for the diversity of experiences and clinical and neurobiological findings - reflecting the scientific parsimony of Occam's razor. The former approach seems to be currently in vogue, whereas the latter approach appears to have declined over the past few years. However, parsimony always wins in the end.