Yesterday I attended psychiatry grand rounds, where Andy Miller presented his latest research. Andy has been a pioneer in the field of psychoneuroimmunology and an exponent for the view that major depression reflects systemic inflammation. (I have published a review of this literature recently in Frontiers in Psychology which is available for download).
Andy discussed his data suggesting that treatment refractory depression (that is, depression that doesn’t respond to an SSRI) are more likely to show elevations in inflammatory markers. Andy then discussed his findings on the brain function of those with elevated markers of systemic inflammation. He spent a lot of time on the dopaminergic areas of the brain.
Andy’s brain imaging suggests that individuals with systemic inflammation look a lot like Parkinson’s patients. As most everyone knows, Parkinson’s disease occurs when big centers for dopamine in the brain die. Andy had additional data that less dopamine is released in response to drugs like amphetamines (a big trigger for dopamine release) in those individuals exhibiting systemic inflammation.
Moreover, when given the opportunity for reward, in those with systemic inflammation, there is less activity in brain reward areas, which also is about less dopamine release. So Andy’s data makes a strong case that those individuals with depression who are unresponsive to SSRIs exhibit systemic inflammation, which somehow suppresses the dopamine system in the brain.
Then I remembered the drug adds I saw on TV the night before. “If your depression is still with you despite taking your antidepressant as prescribed, ask your doctor about Seroquel.” Of course, Seroquel is a drug which sits on the receptor for dopamine and blocks access. Whatever else Seroquel might do, it is definitely a damper on dopamine.
Seroquel is being marketed aggressively for treatment resistant depression. In fact, when I went in for my yearly physical, I was checked in electronically. I responded to the questions regarding changes in insurance, and then came the advertisement for Seroquel. “If your depression is still with you despite taking your antidepressant as prescribed, ask your doctor about Seroquel.”
I queried my physician about his awareness of this marketing. He indicated that his practice was given the check in devices for free and he did not know about the advertisement. I guess the marketing is everywhere.
I wonder how many psychiatrists believe that Seroquel is the next step for treatment resistant depression. How many psychiatrists know about Andy Miller’s data? How many internists, who may be the biggest prescribers of drugs to treat depression, are aware of just how confused the field of psychiatry is?