by Jonathan Rottenberg, Ph.D
I am reading Siddharta Murkherjee’s, wonderful, Emperor of All Maladies: A Biography of Cancer. One of the stories it tells is about the formation of the National Cancer Insitute in 1937. Here is the current mission statement of the NCI:
* Supports and coordinates research projects conducted by universities, hospitals, research foundations, and businesses throughout this country and abroad through research grants and cooperative agreements.
* Conducts research in its own laboratories and clinics.
* Supports education and training in fundamental sciences and clinical disciplines for participation in basic and clinical research programs and treatment programs relating to cancer through career awards, training grants, and fellowships.
* Supports research projects in cancer control.
* Supports a national network of cancer centers.
* Collaborates with voluntary organizations and other national and foreign institutions engaged in cancer research and training activities.
* Encourages and coordinates cancer research by industrial concerns where such concerns evidence a particular capability for programmatic research.
* Collects and disseminates information on cancer.
* Supports construction of laboratories, clinics, and related facilities necessary for cancer research through the award of construction grants.
which over time became a major institute within the National Institutes of Health.
In other words, the NCI is a national coordinating body for research and training to reduce the menace of cancer.
If we look across the National Insitutes of Health we see that many conditions have an institute. Alcohol has an institute. Drug Abuse does. Diabetes is covered. Stroke. Allergies. Check, check.
But not depression.
Depression is soon to become the emperor of all maladies. Serious depression affects nearly a fifth of the population and it is booming, especially in the young. If you need a call to action, look at the graph below from the National Comorbidity Study Replication, a comprehensive national survey of mental health in the United States. It shows that young people aged 18 to 29 have already experienced as much depression as people aged 60+, even though they have lived for less than half as long on planet earth.
Although it is hard to quantify the suffering caused by depression, it is straightforward to make sound estimates of its overall burden — for example the financial costs of lost work time and increased use of health care dollars. When you do the math, depression already ranks up there with the most burdensome disorders. The World Health Organization projects that in less than 10 years, depression will be the 2nd most burdensome condition. That’s greater, by the way, than cancer.
A National Institute on Depression makes sense not only because there is an urgent public health need but because there is so much about depression that we still don’t know. In my last post, I pointed out one striking example: A recent search revealed only one well-designed prospective study of the depressive prodrome (i.e., warning symptoms that herald depression). And much of our knowledge about depression isn’t well coordinated. We don’t do a good job of even knowing what we already know.
Poor integration of existing knowledge is one of the major limitations of the current national approach to depression. Thus, in addition to giving a new NID the broad mission along the lines of the NCI, it would be important for the NID to allow room for many approaches, not only the exclusive focus on genes and brains that has yielded relatively modest results so far but cognitive, sociological, and anthropological perspectives as well.
In our times of fiscal retrenchment, it’s easy to shoot down any new initiatives. But at the same time, wouldn’t keeping our current approach to depression be far riskier to the public health? and more costly in the long run? The time is right to make a modest investment to expand federal research on depression and bring together the work that’s currently done in several NIH insitutes (Mental Health, Aging, Child Health and Development) into a stand-alone National Insitute of Depression. If not now, when?