It’s tricky to accurately describe the nuances of depression. But, for those who’ve never experienced it, imagine being constantly trailed by a furious, vindictive squid, ready at any moment to latch on to your skull and squirt your brain full of cold black ink. Essentially, it’s not a lot of fun.
Of course, it has been argued that sufferers have a more accurate worldview. But realising the Sisyphean nature of getting out of bed doesn’t exactly make that task any easier. Nor does it make it any easier to eat well, sleep properly, form relationships or do anything, really. In short, depression’s tentacles find their way into every single aspect of your life. One aspect that’s often overlooked, however, is its effect on learning and memory.
Dr Jim Bolton is a consultant psychiatrist and a member of the Royal College of Psychiatrists. He said: “In my work, I often see people who have gone to a doctor because they’re having memory problems and fear they may be developing dementia or a similar serious brain illness. But after consultation it’s discovered that the root of their problem is that they are depressed.”
Vortioxetine, a new antidepressant already available in America, has been proven to have cognitive enhancing effects on rats, and preliminary trials have shown it provides similar benefits to people suffering from depression. The drug is currently being reviewed by the National Institute for Health and Care Excellence and is expected to be launched in the UK next year.
Dr Andrew Jones is the medical director of Lunbeck, one of the companies involved in producing the drug. He said: “We treated rats with chemicals that deplete other certain chemicals in their brain that impair their memory. What we found is that vortioxetine reverses the deficit we created.” While it’s still early days for the drug, it marks an interesting development in the treatment of depression.
As with all things cranial, the exact relationship between depression and impaired learning is complicated and not fully understood. Jones said: “The systems in the brain that could cause depression and those that are involved in cognition and memory are all interrelated, and those interrelations are very complex. A relative lack of serotonin is likely to be a factor in cognitive problems, but this could be because it has an indirect effect on other brain chemicals known to be involved in learning and memory, such as gamma-Aminobutyric acid and glutamate.”
Bolton reiterated the complexity of the subject: “Depression interferes with our ability to learn and remember information for many, many reasons,” he said, adding that the triggers themselves often seem fairly logical. “If a patient is preoccupied with how low they’re feeling – and with any worries they may have – it’s more difficult to focus. If you can’t focus, then it’s much more difficult to learn.”
This is apparent from an early age; we excel in subjects we enjoy, we don’t do so well in subjects we hate. If you don’t enjoy anything, you’re fucked.
Having difficulty absorbing and retaining information may seem like a small issue when considered next to the literally sickening emotional symptoms of depression. But it’s the accumulative effect of all the probing tentacles that truly ruins lives. Memory problems, in particular, can be fiendishly insidious. Bolton said: “They can affect small things, like not being able to remember somebody’s name after a conversation. But it can have a much greater impact – you may be unable to take in information from a work meeting, manage your finances or even learn from your mistakes.”
Currently, the only way these cognitive problems are treated is by addressing the underlying depression. Bolton said: “If somebody recovers from a period of depression, their concentration, motivation and interest in life should improve, and so their memory and ability to learn usually also improve.”
But it’s not always as simple as that, and, of course, there is no permanent cure for depression. Jones said: “This specific feature of depression can persist even when mood symptoms have been resolved. So even between episodes of depression patients can feel that they are never quite back to their normal selves.” This statement is supported by other studies carried out by independent researchers.
Jones acknowledges that current antidepressants can improve cognitive functioning in the way Bolton described. He’s also keen to stress that vortioxetine doesn’t boost brainpower above the norm, but returns functioning to the state it would be at in a person without depression. Nevertheless, the results from tests have been successful in highlighting the drug’s advantages.
“In simple terms, we assess to what extent the improvement in cognitive tests can be accounted for by an improvement in the underlying depression using a depression score,” he said. “From this we can calculate how much of that can’t be put down to the alleviation of depression. What we see is that roughly 40 to 50 percent of that improvement in cognitive function can’t be accounted for by an improvement in underlying depression.
“The next step for us is seeing if this translates into the everyday lives of patients. We’ll be carrying out more tests, but the indicators that this works to improve cognition beyond standard antidepressants are definitely there. All the studies and data we’ve produced have been closely examined by the Food and Drug Administration and the European Medicines Agency, and are either published or in the process of being published in the public domain. Anyone can independently evaluate vortioxtine, and we would invite them to do so.”
When it comes to depression, the most effective treatment is – and most likely always will be – a combination of learning coping skills, talking therapy and medication. But in light of the World Health Organisation’s prediction that depression will be the biggest burden on the health of society by 2030, it seems obvious that we should consider every possible tool at our disposal, as well as working to develop new ones. After all, that squid’s never going to leave of its own volition.
More on depression: