May is Mental Health Awareness Month. As a way to bring attention to mental health and to decrease the negative stigma, we will be bringing you a short series including the prevalence of people affected by mental health, the SCIENCE behind mental health, available resources and some personal stories because YOU ARE NOT ALONE! Please follow along this month and help us to bring awareness to this important topic.
If you suffer from mental illness, know you’re not alone
Approximately 322 million people worldwide suffer from depression and 264 million suffer from an anxiety disorder.1 The World Health Organization (WHO) states that, globally, depression will be the number one leading cause of disease burden by the year 2030, surpassing ischemic heart disease.2 Depression isn’t the only mental illness to make the top 20 causes of global burden of disease, the list also includes anxiety disorders, schizophrenia, dysthymia, and bipolar disorder.3 The CDC reports that 26% of adults in the United States (US) struggle with mental illness, 25% will experience some form of mental illness this year alone and 50% will at some point in their life.2 From 1999 to 2014, the US had a 24% increase in the suicide rate jumping from 10.5 to 13 people out of every 100,000.4 Mental Illness is quickly becoming a pandemic. It was estimated that mental illness causes close to 8 million deaths per year, 14.3% of total deaths worldwide.5 All of these numbers are scary, but don’t feel helpless. By decreasing the stigma around mental illness more people may be encouraged to reach out to get the help they need before it’s too late. Talk about the importance of mental health, share your story, and help us create a world where mental illness is taken just as seriously as physical illness.
1. World Health Organization. (2017). Depression and Other Common Mental Disorders – Global Health Estimates.
2. Tucci V, Moukaddam N. We are the hollow men: The worldwide epidemic of mental illness, psychiatric and behavioral emergencies, and its impact on patients and providers. J Emerg Trauma Shock. 2017;10(1):4‐6. doi:10.4103/0974-2700.199517
3. Vos, T., Barber, R. M., Bell, B., Bertozzi-Villa, A., Biryukov, S., Bolliger, I., Charlson, F., Davis, A., Degenhardt, L., Dicker, D., Duan, L., Erskine, H., Feigin, V. L., Ferrari, A. J., Fitzmaurice, C., Fleming, T., Graetz, N., Guinovart, C., Haagsma, J., … Murray, C. J. L. (2015). Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990-2013: A systematic analysis for the Global Burden of Disease Study 2013. The Lancet, 386(9995), 743–800. https://doi.org/10.1016/S0140-6736(15)60692-4
5. Walker, E. R., McGee, R. E., & Druss, B. G. (2015). Mortality in Mental Disorders and Global Disease Burden Implications: A Systematic Review and Meta-analysis . JAMA Psychiatry, 72(4), 334–341. https://doi.org/10.1001/jamapsychiatry.2014.2502
Mental illness is real and science can prove it
You’ve probably heard someone refer to mental illness as a chemical imbalance in the brain when defending it to someone who doesn’t believe it’s a real disease. But what does that mean? Let’s break it down. The cells in your brain, called neurons, communicate with each other via juxtacrine signaling (check out our cell signaling post) through a group of chemicals called neurotransmitters. This means that one neuron will release a certain neurotransmitter into a tiny space between the two neurons, called the synapse, the neurotransmitter will bind, or grab onto, receptors on the second neuron, telling it to do or to stop doing something. Then that first neuron will absorb or “reuptake” any extra neurotransmitter left in the synapse between them. Neurons also have support cells called astrocytes that can help recycle this leftover neurotransmitter. The brain is very much a waste not, want not system.
Some neurons are classified by the neurotransmitter that they release. One such neurotransmitter is called serotonin, and research has shown that people who suffer from depression have lower levels of serotonin. The exact reason why this causes depression is still mostly a mystery – learning the secrets of the brain is no easy task. Thankfully that hasn’t stopped researchers from coming up with ways to make living with depression more doable, and they accomplished this with the development of drugs called SSRIs, Selective Serotonin Reuptake Inhibitors. Earlier I mentioned that the neuron releasing the neurotransmitter will take back any extra from the space between the two neurons. These SSRIs work by preventing this reabsorption, allowing the neurotransmitter, serotonin, more time to talk and bind to receptors on the other neuron. This helps make up for the lower levels of serotonin released in the brains of people who suffer from depression. Scientists believe that imbalances in other neurotransmitters like dopamine, glutamate, and norepinephrine also contribute to the symptoms of various mental illnesses, including depression.
Currently, diagnosing mental illness is largely based on a discussion of symptoms and meeting a set number of criteria outlined in a large manual called the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, or DSM-5. This approach, however, is somewhat subjective and can lead to misdiagnosis and people not receiving the treatment they need. The lack of a “biological” diagnostic tool (sometimes referred to as biomarkers) for mental illnesses like depression, anxiety, and ADHD also contribute to the stigma surrounding them. Brain biopsies (taking a small sample from the brain) are not exactly risk free. Luckily researchers are currently working on other ways to measure someone’s neurotransmitter levels. In 2018, one such group of researchers found that the blood of people with major depressive disorder (MDD) had significantly different levels of certain proteins involved in neurotransmitter systems. This opens up the possibility of using someone’s blood to diagnose them with MDD, which will hopefully help make sure no one falls through the cracks seen with only symptom-based testing.
We are far from understanding everything about the brain in a “normal” state, which makes it near impossible to know exactly what is happening in the brains of people suffering from mental illness. But with the evidence we do have, it’s clear that mental illness is real and has a biological cause. This cause may not be the same for all people or be caused by the same alterations in neurotransmitter release which is why there are many different treatment options for mental illness; however, we do know that these drug treatments work. So, never be ashamed to take medication to help fix those neurotransmitter levels and never let anyone make you feel like you are making up your mental illness. Check back in two weeks to learn about available resources for anyone experiencing mental illness and remember to check in on the people you love, especially as quarantine is taking a toll on everyone’s sanity!
1. Pan, J. X., Xia, J. J., Deng, F. L., Liang, W. W., Wu, J., Yin, B. M., Dong, M. X., Chen, J. J., Ye, F., Wang, H. Y., Zheng, P., & Xie, P. (2018). Diagnosis of major depressive disorder based on changes in multiple plasma neurotransmitters: A targeted metabolomics study. Translational Psychiatry, 8(1). https://doi.org/10.1038/s41398-018-0183-x
2. National Institutes of Health (US); Biological Sciences Curriculum Study. NIH Curriculum Supplement Series [Internet]. Bethesda (MD): National Institutes of Health (US); 2007. Information about Mental Illness and the Brain. Available from: https://www.ncbi.nlm.nih.gov/books/NBK20369/