www.psychceu.com: Breaking Ground, Breaking Through: The Strategic Plan for Mood Disorders Research

Table of Contents
EXECUTIVE SUMMARY ..................................................................................................1
The Nature and Impact of Mood Disorders ....................................................................1
The Scope of the Problem .............................................................................................2
Scientific Opportunities for Research on Mood Disorders ................................................5
Developing the NIMH Strategic Plan for Mood Disorders Research...................................6
Basic and Clinical Neuroscience: Foundation for Discovery ......................................7
Dimensions of Age and Disease .. ...........................................................................9
Treatment, Prevention, and Services: Improving Outcomes ................................... 10
Expanding and Strengthening the Research Foundation.........................................12
The Nature and Impact of Mood Disorders....................................................................15
Mood Disorders Research at NIMH: A 50-Year Perspective .............................................17
About Strategic Planning at NIMH ...............................................................................19
Current Status of the Field...........................................................................................24
Triggering the Mood Changes in Depression and Bipolar Illness .............................24
The Connection Between Neurochemistry and Mood Disorders ............................24
Specific Brain Regions Are Affected in Mood Disorders.......................................25
Thought Processes Affect Mood Disorders ..........................................................26
Using Computers to Model Mood Disorders ........................................................27
Finding the Genes Involved in Mood Disorders ......................................................28
Gene-Environment Interactions .........................................................................29
Animal Models .................................................................................................29
Behavioral Models of Mood Disorders ...................................................................31
Studying Depression in Rodents........................................................................32
Non-Human Primate Models of Depression ........................................................33
Animal Models of Mania ...................................................................................34
Neurobiology and Drug Action..............................................................................35
Communication Between Cells . .........................................................................36
Communication Within a Cell ............................................................................37
i
DIMENSIONS OF AGE AND DISEASE ...........................................................................55
TREATMENT, PREVENTION, AND SERVICES: IMPROVING OUTCOMES............................85
Opportunities for Progress ..........................................................................................39
Opportunities to Discover a Genetic Basis of Mood Disorders ................................40
Opportunities to Understand the Neural Basis of Mood and Emotion ....................42
Brain Structure and Mood Disorders .................................................................44
Opportunities to Discover New Drug and Physiologic Treatments ...........................45
Biomarkers.......................................................................................................46
Pharmacogenetics and Its Contributions to Drug Discovery
and Drug Utilization ........................................................................................47
Research Priorities .....................................................................................................47
Current Status of the Field ..........................................................................................56
Mood Disorders in Children ..................................................................................56
Developmental Factors ......................................................................................56
Hormones .......................................................................................................57
Anxiety ............................................................................................................57
Family Risk Factors for Early-Onset Depression .................................................58
The Influence of Gender on Mood Disorders ..........................................................58
Aging and Depression ..........................................................................................60
Cognition and Depression in the Elderly ...........................................................60
Psychosocial Factors in Geriatric Depression ......................................................61
Depression and Caregiving ................................................................................62
Depression and Illness in the Elderly ................................................................62
Comorbidity: Depression and Other Medical Illnesses.............................................63
Coronary Heart Disease ....................................................................................63
Diabetes ..........................................................................................................64
Neurological Disorders and Stroke ....................................................................64
Cancer..............................................................................................................65
HIV/AIDS .........................................................................................................66
Opportunities for Progress ..........................................................................................67
Opportunities to Identify Depression and Bipolar Disorder During Development......67
Opportunities to Develop New Therapies for Children and Adolescents ..................68
Opportunities to Understand the Influence of Gender ...........................................70
Depression and the Reproductive Cycle .............................................................72
Opportunities to Improve Mental Health for the Elderly ........................................73
Opportunities to Understand Mood Disorders as Diseases of the Brain and Body ....74
Research Priorities .....................................................................................................77
Current Status of the Field...........................................................................................86
ii
EXPANDING AND STRENGTHENING THE RESEARCH FOUNDATION ............................111
APPENDICES ............................................................................................................117
Clinical Trials.......................................................................................................86
Pharmacological Therapy .....................................................................................87
Depression .......................................................................................................87
Bipolar Disorder ..............................................................................................89
Somatic Treatments for Mood Disorders ...............................................................89
Psychosocial Therapy Development .......................................................................90
Depression .......................................................................................................90
Bipolar Disorder ...............................................................................................92
Issues for Treatment.............................................................................................93
Measurement....................................................................................................93
Prevention of Suicidal Behavior ........................................................................94
Delivery of Services .............................................................................................94
Primary Care ....................................................................................................94
Barriers to Care ................................................................................................95
Issues Facing Racial and Ethnic Minority Groups ...............................................96
Children and Adolescents ..................................................................................97
Opportunities for Progress ...........................................................................................98
Opportunities to Improve and Expand Clinical Trials ............................................98
Increasing Participation Diversity in Clinical Trials ...........................................99
Opportunities to Develop New Psychosocial and Behavioral Therapies .................100
Opportunities for the Prevention of Mood Disorders ............................................102
Using Non-Traditional Dissemination Methods to Increase Accessibility to
Psychosocial Interventions ..............................................................................104
Research Priorities ............................................................................................104
Research Training ....................................................................................................112
Disseminating Research Results ................................................................................112
Research Priorities . ..................................................................................................113
Appendix A: National Advisory Mental Health Council (NAMHC) .................................117
Appendix B: Mood Disorders Workgroups ..................................................................119
Appendix C: NIMH Staff Participants .........................................................................127
iii

Breaking Ground, Breaking Through: The Strategic Plan for Mood Disorders

                     Research marks the advent of a new era in the long quest to understand, treat, and prevent mental disorders. Prepared by staff of the National Institute of Mental Health (NIMH) working in close collaboration with members of the National Advisory Mental Health Council, scientists, health care providers, advocates, and persons who themselves live with mood disorders, the plan builds on the remarkable progress of the past half century. Thanks to research, an array of treatments exist today that are highly effective in the acute treatment and long-term management of major depression and bipolar disorder—illnesses that we now know tend to be recurrent and cyclical for a majority of persons who have the conditions.
                    Research has demonstrated a strong genetic component to mood disorders, particularly bipolar disorder, and is beginning to elucidate the nature of brain-gene-environmental interactions that often appear to trigger a latent vulnerability or susceptibility to mood disorders. We now recognize the frequency with which depression tends to co-occur with diverse general medical illnesses—including, for example, cancer, coronary heart disease, diabetes, many neurological illnesses, and HIV/AIDS—and the importance of appropriate treatment of depression to overall health outcomes.
                    For all our knowledge and clinical capabilities, it nonetheless is humbling to consider how much we do not know about the basic neurobiological mechanisms involved in the regulation and dysregulation of mood, the ways in which yet unknown genes are triggered by the environment or behavior, or how our treatments exert their positive effects—or too frequently fail to achieve lasting benefits.
                   What we do not yet know figures centrally in a public health reality that, only 6 years ago, was surprising to many policymakers and citizens: the finding by the World Health Organization, in its landmark Global Burden of Disease study, that major depression and bipolar disorder are, respectively, the first- and sixth-ranked causes of years lived with disability for people in the developed world. To the extent that mood disorders hobble workers’ productivity while demanding massive expenditure of societal resources, these disorders are not only a clinical and public health challenge but also a threat to the economic well-being of the global community.
                 Breaking Ground, Breaking Through reflects the best collective thinking of some 200 experts about how we can fill in the gaps in our knowledge and reduce the individual,
family, community, and worldwide burden of these illnesses. In issuing a research strategic plan, NIMH remains committed to the hallmark of the U.S. biomedical research enterprise, that is, the support of independent investigator-initiated research. The Institute also recognizes the need to take stock of where we stand today and help establish a road map for future research. Accordingly, this plan has identified scientific needs and opportunities in ten domains, extending from basic molecular and neurobiological research to studies of service delivery systems and barriers to care. Given its breadth, the plan clearly envisions a scientific assault that will benefit from the participation of diverse disciplines and approaches: molecular genetics and basic behavioral science; cognitive and affective neuroscience and epidemiology; developmental psychology and translational research; clinical investigation, including novel approaches to clinical trials; and health services/systems research.
                   It is our privilege to express, on behalf of NIMH, deep appreciation to all those who participated in the development of this strategic plan. We would especially like to thank Dr. Dennis Charney, Scientific Director, and Dr. Karen Babich, Project Director of this strategic plan. Without their expert guidance, this complex project would not have succeeded. We fully intend that this plan will serve the Nation and the world as a tool not only to break new scientific ground, but also, by assigning highly visible priority to scientific excellence in the conquest of mental disorders, to break through the hurtful and damaging stigma that should never again be unjustly borne by those who live with mood disorders.
Thomas R. Insel, M.D
Richard K. Nakamura, Ph.D. Director Deputy Director

Cost of the 5 unit course is $66

All material included in this course is either in the public domain, or used with express permission.

APA Ethics

We do adhere to the American Psychological Association's Ethical Principles of Psychologists. Our courses are carefully screened by the Planning Committee to adhere to APA standards. We also require authors who compose Internet courses specifically for us follow APA ethical standards.

Many of our courses contain case material, and may use the methods of qualitative research and analysis, in-depth interviews and ethnographic studies. The psychotherapeutic techniques depicted may include play therapy, sandplay therapy, dream analysis, drawing analysis, client and therapist self-report, etc. The materials presented may be considered non-traditional and may be controversial, and may not have widespread endorsement within the profession. www.psychceu.com maintains responsibility for the program and its content.