"We will no longer endorse DSM5, as it has fundamental flaws and we are actively seeking a diagnostic system that is evidence based. We need a quantitative method for diagnosing depression. It is critical to realize that we cannot succeed if we use DSM categories as the gold standard."
U.S. National Institute of Mental Health May 2013
Back to the future
In the early ’70s and ’80s, advancements in neuroimaging, specifically CT-scan and later MRI, transformed neurosciences from slumbering specialties, in which screening and diagnosis of brain diseases were performed mostly by clinical decision, into specialties that provided a massive array of direct, fine, visualization of intracranial structures. Neurosurgeons and neurologists were having a feast!
Neurosciences were rapidly changing from purely clinical to accurate and objective. However, neuroimaging was not specific enough to demonstrate persistent structural changes in psychiatric patients. Unfortunately, psychiatrists and other mental health providers had to continue to rely on subjective psychometric assessments to assist with their diagnostic decision. This form of clinical evaluation support persists to this day.
The start of Medibio’s pioneering research
Since the early 2000s, Australian psychiatrist-researchers have investigated and described anomalies in the nocturnal heart rate in patients with depression versus normal individuals. This was the steppingstone to what came next, a granular analysis of sleep, cardiac and mental health symptoms. All combined in one entire and complete mental health platform. This is the focus of Medibio’s continuing research and clinical program.
Why is screening for Depression so important?
Depression is one of the most common mental illnesses in the country. An estimated 17.3 million adults in the US reported having at least one major depressive episode [report by the Substance Abuse and Mental Health Services Administration (SAMHSA)]. That is 7.1% of all adults ages 18 and older.
Depression is also the most common mental health condition in patients seen in primary care. In the absence of screening, it is estimated that only 50% of patients with major depression are identified. To make matters worse, 50% to 70% of patients with major depression have at least one general comorbid or psychiatric condition, examples include anxiety, substance use, obesity, and cardiovascular disease.
Unless directly asked about their mood, patients with affective disorders omit information about depressive symptoms for a variety of reasons, including fear of stigmatization, belief that depression falls outside the horizon of primary care, belief that depression is not a “real” illness but rather a personal flaw, concerns about medical record confidentiality, and concerns about being prescribed antidepressant medication or being referred to a psychiatrist.
Furthermore, it is important to recognize that there is often a delay between the patient first experiencing symptoms and diagnosis. Previous studies have indicated that there is a delay from first experiencing symptoms to diagnosis of around 10 years suggesting that there is a substantial delay from first experiencing symptoms to receiving mental healthcare. Since the duration of untreated illness has been considered a likely predictor of the course of psychiatric disorders, early detection becomes very important.
The Importance of Sleep
It is a common misconception that sleep disturbances are mainly related to insomnia. Many people are under the belief that insomnia is a complete lack of sleep. However, the American Academy of Sleep Medicine states, insomnia is the “persistent difficulty with sleep initiation, duration, consolidation or quality leading to non-restorative sleep”.
The relationship between sleep and emotional/cognitive functioning becomes more evident in psychiatric disorders. Sleep abnormality patterns and disruption of normal sleep architecture in psychiatric disorders are very common, making sleep and psychiatric conditions intrinsically linked.
Broad scientific evidence supports certain sleep disorders consistently linked to certain psychiatric outcomes, while specific psychiatric disorders lead to significant changes in sleep physiology. That is the case of depression where 90% of patients report some form of associated sleep comorbidities. Indeed, insomnia is one of the key sleep symptoms in affective disorders, accounting for 90% of cases compared to hypersomnia which accounts for only 10%.
Given this risk and the high association between sleep disorders and depression, it becomes important to direct efforts toward the detection of these comorbidities.
Medibio’s products (MEB001 and MEBSleep) can improve the detection of clinically significant mental health symptoms and contribute to the early diagnosis and treatment, with the final result of decreasing the social burden and increasing the psychophysical well-being of the population.