Provided by the National Institute of Mental Health
Depressive disorders affect approximately 19
million American adults. The suffering endured by people with depression and the
lives lost to suicide attest to the great burden of this disorder on
individuals, families, and society. Improved recognition, treatment, and
prevention of depression are critical public health priorities. The National
Institute of Mental Health (NIMH), the world’s leading mental health biomedical
organization, conducts and supports research on the causes, diagnosis,
prevention, and treatment of depression.
Evidence from neuroscience, genetics, and clinical investigation demonstrate
that depression is a disorder of the brain. Modern brain imaging technologies
are revealing that in depression, neural circuits responsible for the regulation
of moods, thinking, sleep, appetite, and behavior fail to function properly, and
that critical neurotransmitters—chemicals used by nerve cells to communicate—are
out of balance. Genetics research indicates that vulnerability to depression
results from the influence of multiple genes acting together with environmental
factors. Studies of brain chemistry and of mechanisms of action of
antidepressant medications continue to inform the development of new and better
treatments.
In the past decade, there have been significant advances in our ability to
investigate brain function at multiple levels. NIMH is collaborating with
various scientific disciplines to effectively utilize the tools of molecular and
cellular biology, genetics, epidemiology, and cognitive and behavioral science
to gain a more thorough and comprehensive understanding of the factors that
influence brain function and behavior, including mental illness. This
collaboration reflects the Institute’s increasing focus on "translational
research," whereby basic and clinical scientists are involved in joint efforts
to translate discoveries and knowledge into clinically relevant questions and
targets of research opportunity. Translational research holds great promise for
disentangling the complex causes of depression and other mental disorders and
for advancing the development of more effective treatments.
Symptoms and Types of Depression
Symptoms of depression include a persistent sad mood; loss of interest or
pleasure in activities that were once enjoyed; significant change in appetite or
body weight; difficulty sleeping or oversleeping; physical slowing or agitation;
loss of energy; feelings of worthlessness or inappropriate guilt; difficulty
thinking or concentrating; and recurrent thoughts of death or suicide. A
diagnosis of major depressive disorder (or unipolar major depression) is made if
an individual has five or more of these symptoms during the same 2-week period.
Unipolar major depression typically presents in discrete episodes that recur
during a person’s lifetime.
Bipolar disorder (or manic-depressive illness) is characterized by episodes of
major depression as well as episodes of mania—periods of abnormally and
persistently elevated mood or irritability accompanied by at least three of the
following symptoms: overly-inflated self-esteem; decreased need for sleep;
increased talkativeness; racing thoughts; distractibility; increased
goal-directed activity or physical agitation; and excessive involvement in
pleasurable activities that have a high potential for painful consequences.
While sharing some of the features of major depression, bipolar disorder is a
different illness that is discussed in detail in a separate NIMH publication.
Dysthymic disorder (or dysthymia), a less severe yet typically more chronic form
of depression, is diagnosed when depressed mood persists for at least 2 years in
adults (1 year in children or adolescents) and is accompanied by at least two
other depressive symptoms. Many people with dysthymic disorder also experience
major depressive episodes. While unipolar major depression and dysthymia are the
primary forms of depression, a variety of other subtypes exist.
In contrast to the normal emotional experiences of sadness, loss, or passing
mood states, depression is extreme and persistent and can interfere
significantly with an individual’s ability to function. In fact, a recent study
sponsored by the World Health Organization and the World Bank found unipolar
major depression to be the leading cause of disability in the United States and
worldwide.
There is a high degree of variation among people with depression in terms of
symptoms, course of illness, and response to treatment, indicating that
depression may have a number of complex and interacting causes. This variability
poses a major challenge to researchers attempting to understand and treat the
disorder. However, recent advances in research technology are bringing NIMH
scientists closer than ever before to characterizing the biology and physiology
of depression in its different forms and to the possibility of identifying
effective treatments for individuals based on symptom presentation.
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One of the most challenging problems in depression research and clinical
practice is refractory—hard to treat—depression. While approximately 80 percent
of people with depression respond very positively to treatment, a significant
number of individuals remain treatment refractory. Even among treatment
responders, many do not have complete or lasting improvement, and adverse side
effects are common. Thus, an important goal of NIMH research is to advance the
development of more effective treatments for depression—especially
treatment-refractory depression—that also have fewer side effects than currently
available treatments.
Research on Treatments for Depression
Medication
Studies on the mechanisms of action of antidepressant medication comprise an
important area of NIMH depression research. Existing antidepressant drugs are
known to influence the functioning of certain neurotransmitters in the brain,
primarily serotonin and norepinephrine, known as monoamines. Older medications—tricyclic
antidepressants (TCAs) and monoamine oxidase inhibitors (MAOIs)—affect the
activity of both of these neurotransmitters simultaneously. Their disadvantage
is that they can be difficult to tolerate due to side effects or, in the case of
MAOIs, dietary restrictions. Newer medications, such as the selective serotonin
reuptake inhibitors (SSRIs), have fewer side effects than the older drugs,
making it easier for patients to adhere to treatment. Both generations of
medications are effective in relieving depression, although some people will
respond to one type of drug, but not another.
Antidepressant medications take several weeks to be clinically effective even
though they begin to alter brain chemistry with the very first dose. Research
now indicates that antidepressant effects result from slow-onset adaptive
changes within the brain cells, or neurons. Further, it appears that activation
of chemical messenger pathways within neurons, and changes in the way that genes
in brain cells are expressed, are the critical events underlying long-term
adaptations in neuronal function relevant to antidepressant drug action. A
current challenge is to understand the mechanisms that mediate, within cells,
the long-term changes in neuronal function produced by antidepressants and other
psychotropic drugs and to understand how these mechanisms are altered in the
presence of illness.
Knowing how and where in the brain antidepressants work can aid the development
of more targeted and potent medications that may help reduce the time between
first dose and clinical response. Further, clarifying the mechanisms of action
can reveal how different drugs produce side effects and can guide the design of
new, more tolerable, treatments.
As one route toward learning about the distinct biological processes that go
awry in different forms of depression, NIMH researchers are investigating the
differential effectiveness of various antidepressant medications in people with
particular subtypes of depression. For example, this research has revealed that
people with atypical depression, a subtype characterized by reactivity of mood
(mood brightens in response to positive events) and at least two other symptoms
(weight gain or increased appetite, oversleeping, intense fatigue, or rejection
sensitivity), respond better to treatment with MAOIs, and perhaps with SSRIs
than with TCAs.
Many patients and clinicians find that combinations of different drugs work most
effectively for treating depression, either by enhancing the therapeutic action
or reducing side effects. Although combination strategies are used often in
clinical practice, there is little research evidence available to guide
psychiatrists in prescribing appropriate combination treatment. NIMH is in the
process of revitalizing and expanding its program of clinical research, and
combination therapy will be but one of numerous treatment interventions to be
explored and developed.
Untreated depression often has an accelerating course, in which episodes become
more frequent and severe over time. Researchers are now considering whether
early intervention with medications and maintenance treatment during well
periods will prevent recurrence of episodes.
Psychotherapy
Like the process of learning, which involves the formation of new connections
between nerve cells in the brain, psychotherapy works by changing the way the
brain functions. NIMH research has shown that certain types of psychotherapy,
particularly cognitive-behavioral therapy (CBT) and interpersonal therapy (IPT),
can help relieve depression. CBT helps patients change the negative styles of
thinking and behaving often associated with depression. IPT focuses on working
through disturbed personal relationships that may contribute to depression.
Research on children and adolescents with depression supports CBT as a useful
initial treatment, but antidepressant medication is indicated for those with
severe, recurrent, or psychotic depression. Studies of adults have shown that
while psychotherapy alone is rarely sufficient to treat moderate to severe
depression, it may provide additional relief in combination with antidepressant
medication. In one recent NIMH-funded study, older adults with recurrent major
depression who received IPT in combination with an antidepressant medication
during a 3-year period were much less likely to experience a recurrence of
illness than those who received medication only or therapy only. For mild
depression, however, a recent analysis of multiple studies indicated that
combination treatment is not significantly more effective than CBT or IPT alone.
Preliminary evidence from an ongoing NIMH-supported study indicates that IPT may
hold promise in the treatment of dysthymia.
Electroconvulsive Therapy (ECT)
Electroconvulsive therapy (ECT) remains one of the most effective yet most
stigmatized treatments for depression. Eighty to ninety percent of people with
severe depression improve dramatically with ECT. ECT involves producing a
seizure in the brain of a patient under general anesthesia by applying
electrical stimulation to the brain through electrodes placed on the scalp.
Repeated treatments are necessary to achieve the most complete antidepressant
response. Memory loss and other cognitive problems are common, yet typically
short-lived side effects of ECT. Although some people report lasting
difficulties, modern advances in ECT technique have greatly reduced the side
effects of this treatment compared to earlier decades. NIMH research on ECT has
found that the dose of electricity applied and the placement of electrodes
(unilateral or bilateral) can influence the degree of depression relief and the
severity of side effects.
A current research question is how best to maintain the benefits of ECT over
time. Although ECT can be very effective for relieving acute depression, there
is a high rate of relapse when the treatments are discontinued. NIMH is
currently sponsoring two multicenter studies on ECT follow-up treatment
strategies. One study is comparing different medication treatments, and the
other study is comparing maintenance medication to maintenance ECT. Results from
these studies will help guide and improve follow-up treatment plans for patients
who respond well to ECT.
Genetics Research
Research on the genetics of depression and other mental illnesses is a priority
of NIMH and constitutes a critical component of the Institute’s multi-level
research effort. Researchers are increasingly certain that genes play an
important role in vulnerability to depression and other severe mental disorders.
In recent years, the search for a single, defective gene responsible for each
mental illness has given way to the understanding that multiple gene variants,
acting together with yet unknown environmental risk factors or developmental
events, account for the expression of psychiatric disorders. Identification of
these genes, each of which contributes only a small effect, has proven extremely
difficult.
However, new technologies, which continue to be developed and refined, are
beginning to allow researchers to associate genetic variations with disease. In
the next decade, two large-scale projects that involve identifying and
sequencing all human genes and gene variants will be completed and are expected
to yield valuable insights into the causes of mental disorders and the
development of better treatments. In addition, NIMH is currently soliciting
researchers to contribute to the development of a large-scale database of
genetic information that will facilitate efforts to identify susceptibility
genes for depression and other mental disorders.
Stress and Depression
Psychosocial and environmental stressors are known risk factors for depression.
NIMH research has shown that stress in the form of loss, especially death of
close family members or friends, can trigger depression in vulnerable
individuals. Genetics research indicates that environmental stressors interact
with depression vulnerability genes to increase the risk of developing
depressive illness. Stressful life events may contribute to recurrent episodes
of depression in some individuals, while in others depression recurrences may
develop without identifiable triggers.
Other NIMH research indicates that stressors in the form of social isolation or
early-life deprivation may lead to permanent changes in brain function that
increase susceptibility to depressive symptoms.
Brain Imaging
Recent advances in brain imaging technologies are allowing scientists to examine
the brain in living people with more clarity than ever before. Functional
magnetic resonance imaging (fMRI), a safe, noninvasive method for viewing brain
structure and function simultaneously, is one new technique that NIMH
researchers are using to study the brains of individuals with and without mental
disorders. This technique will enable scientists to evaluate the effects of a
variety of treatments on the brain and to associate these effects with clinical
outcome.
Brain imaging findings may help direct the search for microscopic abnormalities
in brain structure and function responsible for mental disorders. Ultimately,
imaging technologies may serve as tools for early diagnosis and subtyping of
depression and other mental disorders, thus advancing the development of new
treatments and evaluation of their effects.
Hormonal Abnormalities
The hormonal system that regulates the body’s response to stress, the
hypothalamic-pituitary-adrenal (HPA) axis, is overactive in many patients with
depression, and NIMH researchers are investigating whether this phenomenon
contributes to the development of the illness.
The hypothalamus, the brain region responsible for managing hormone release from
glands throughout the body, increases production of a substance called
corticotropin releasing factor (CRF) when a threat to physical or psychological
well-being is detected. Elevated levels and effects of CRF lead to increased
hormone secretion by the pituitary and adrenal glands which prepares the body
for defensive action. The body’s responses include reduced appetite, decreased
sex drive, and heightened alertness. NIMH research suggests that persistent
overactivation of this hormonal system may lay the groundwork for depression.
The elevated CRF levels detectable in depressed patients are reduced by
treatment with antidepressant drugs or ECT, and this reduction corresponds to
improvement in depressive symptoms.
NIMH scientists are investigating how and whether the hormonal research findings
fit together with the discoveries from genetics research and monoamine studies.
Co-occurrence of Depression and Anxiety Disorders
NIMH research has revealed that depression often co-exists with anxiety
disorders (panic disorder, obsessive-compulsive disorder, post-traumatic stress
disorder, social phobia, or generalized anxiety disorder). In such cases, it is
important that depression and each co-occurring illness be diagnosed and
treated.
Several studies have shown an increased risk of suicide attempts in people with
co-occurring depression and panic disorder—the anxiety disorder characterized by
unexpected and repeated episodes of intense fear and physical symptoms,
including chest pain, dizziness, and shortness of breath.
Rates of depression are especially high in people with post-traumatic stress
disorder (PTSD), a debilitating condition that can occur after exposure to a
terrifying event or ordeal in which grave physical harm occurred or was
threatened. In one study supported by NIMH, more than 40 percent of patients
with PTSD had depression when evaluated both at 1 month and 4 months following
the traumatic event.
Co-occurrence of Depression and Other Illnesses
Depression frequently co-occurs with a variety of other physical illnesses,
including heart disease, stroke, cancer, and diabetes, and also can increase the
risk for subsequent physical illness, disability, and premature death.
Depression in the context of physical illness, however, is often unrecognized
and untreated. Furthermore, depression can impair the ability to seek and stay
on treatment for other medical illnesses. NIMH research suggests that early
diagnosis and treatment of depression in patients with other physical illnesses
may help improve overall health outcome.
The results of a recent NIMH-supported study provide the strongest evidence to
date that depression increases the risk of having a future heart attack.
Analysis of data from a large-scale survey revealed that individuals with a
history of major depression were more than four times as likely to suffer a
heart attack over a 12-13 year follow-up period, compared to people without such
a history. Even people with a history of 2 or more weeks of mild depression were
more than twice as likely to have a heart attack, compared to those who had had
no such episodes. Although associations were found between certain psychotropic
medications and heart attack risk, the researchers determined that the
associations were simply a reflection of the primary relationship between
depression and heart trouble. The question of whether treatment for depression
reduces the excess risk of heart attack in depressed patients must be addressed
with further research.
NIMH is planning to present a major conference with other NIH Institutes on
depression and co-occurring illnesses. The outcomes of this conference will
guide NIMH investigation of depression both as a contributing factor to other
medical illnesses and as a result of these illnesses.
Women and Depression
Nearly twice as many women (12 percent) as men (7 percent) are affected by a
depressive illness each year. At some point during their lives, as many as 20
percent of women have at least one episode of depression that should be treated.
Although conventional wisdom holds that depression is most closely associated
with menopause, in fact, the childbearing years are marked by the highest rates
of depression, followed by the years prior to menopause.
NIMH researchers are investigating the causes and treatment of depressive
disorders in women. One area of research focuses on life stress and depression.
Data from a recent NIMH-supported study suggests that stressful life experiences
may play a larger role in provoking recurrent episodes of depression in women
than in men.
The influence of hormones on depression in women has been an active area of NIMH
research. One recent study was the first to demonstrate that the troublesome
depressive mood swings and physical symptoms of premenstrual syndrome (PMS), a
disorder affecting 3 to 7 percent of menstruating women, result from an abnormal
response to normal hormone changes during the menstrual cycle. Among women with
normal menstrual cycles, those with a history of PMS experienced relief from
mood and physical symptoms when their sex hormones, estrogen and progesterone,
were temporarily "turned off" by administering a drug that suppresses the
function of the ovaries. PMS symptoms developed within a week or two after the
hormones were re-introduced. In contrast, women without a history of PMS
reported no effects of the hormonal manipulation. The study showed that female
sex hormones do not cause PMS—rather, they trigger PMS symptoms in women with a
preexisting vulnerability to the disorder. The researchers currently are
attempting to determine what makes some women but not others susceptible to PMS.
Possibilities include genetic differences in hormone sensitivity at the cellular
level, differences in history of other mood disorders, and individual
differences in serotonin function.
NIMH researchers also are currently investigating the mechanisms that contribute
to depression after childbirth (postpartum depression), another serious disorder
where abrupt hormonal shifts in the context of intense psychosocial stress
disable some women with an apparent underlying vulnerability. In addition, an
ongoing NIMH clinical trial is evaluating the use of antidepressant medication
following delivery to prevent postpartum depression in women with a history of
this disorder after a previous childbirth.
Child and Adolescent Depression
Large-scale research studies have reported that up to 2.5 percent of children
and up to 8.3 percent of adolescents in the United States suffer from
depression. In addition, research has discovered that depression onset is
occurring earlier in individuals born in more recent decades. There is evidence
that depression emerging early in life often persists, recurs, and continues
into adulthood, and that early onset depression may predict more severe illness
in adult life. Diagnosing and treating children and adolescents with depression
is critical to prevent impairment in academic, social, emotional, and behavioral
functioning and to allow children to live up to their full potential.
Research on the diagnosis and treatment of mental disorders in children and
adolescents, however, has lagged behind that in adults. Diagnosing depression in
these age groups is often difficult because early symptoms can be hard to detect
or may be attributed to other causes. In addition, treating depression in
children and adolescents remains a challenge, because few studies have
established the safety and efficacy of treatments for depression in youth.
Children and adolescents are going through rapid, age-related changes in their
physiological states, and there remains much to be learned about brain
development during the early years of life before treatments for depression in
young people will be as successful as they are in older people. NIMH is pursuing
brain-imaging research in children and adolescents to gather information about
normal brain development and what goes wrong in mental illness.
Depression in children and adolescents is associated with an increased risk of
suicidal behaviors. Over the last several decades, the suicide rate in young
people has increased dramatically. In 1996, the most recent year for which
statistics are available, suicide was the third leading cause of death in 15-24
year olds and the fourth leading cause among 10-14 year olds. NIMH researchers
are developing and testing various interventions to prevent suicide in children
and adolescents. However, early diagnosis and treatment of depression and other
mental disorders, and accurate evaluation of suicidal thinking, possibly hold
the greatest suicide prevention value.
Until recently, there was limited data on the safety and efficacy of
antidepressant medications in children and adolescents. The use of
antidepressants in this age group was based on adult standards of treatment. A
recent NIMH-funded study supported fluoxetine, an SSRI, as a safe and
efficacious medication for child and adolescent depression. The response rate
was not as high as in adults, however, emphasizing the need for continued
research on existing treatments and for development of more effective
treatments, including psychotherapies designed specifically for children. Other
complementary studies in the field are beginning to report similar positive
findings in depressed young people treated with any of several newer
antidepressants. In a number of studies, TCAs were found to be ineffective for
treating depression in children and adolescents, but limitations of the study
designs preclude strong conclusions.
NIMH is committed to developing an infrastructure of skilled researchers in the
areas of child and adolescent mental health. In 1995, NIMH co-sponsored a
conference that brought together more than 100 research experts, family and
patient advocates, and representatives of mental health professional
organizations to discuss and reach consensus on various recommendations for
psychiatric medication research in children and adolescents. Outcomes of this
conference included awarding additional funds to existing research grants to
study psychotropic medications in children and adolescents and establishing a
network of Research Units of Pediatric Psychopharmacology (RUPPs). Recently, a
large, multi-site, NIMH-funded study was initiated to investigate both
medication and psychotherapeutic treatments for adolescent depression.
Continuing to address and resolve the ethical challenges involved with clinical
research on children and adolescents is an NIMH priority.
Older Adults and Depression
In a given year, between 1 and 2 percent of people over age 65 living in the
community, i.e., not living in nursing homes or other institutions, suffer from
major depression and about 2 percent have dysthymia. Depression, however, is not
a normal part of aging. Research has clearly demonstrated the importance of
diagnosing and treating depression in older persons. Because major depression is
typically a recurrent disorder, relapse prevention is a high priority for
treatment research. As noted previously, a recent NIMH-supported study
established the efficacy of combined antidepressant medication and interpersonal
psychotherapy in reducing depressive relapses in older adults who had recovered
from an episode of depression.
Additionally, recent NIMH studies show that 13 to 27 percent of older adults
have subclinical depressions that do not meet the diagnostic criteria for major
depression or dysthymia but are associated with increased risk of major
depression, physical disability, medical illness, and high use of health
services. Subclinical depressions cause considerable suffering, and some
clinicians are now beginning to recognize and treat them.
Suicide is more common among the elderly than in any other age group. NIMH
research has shown that nearly all people who commit suicide have a diagnosable
mental or substance abuse disorder. In studies of older adults who committed
suicide, nearly all had major depression, typically a first episode, though very
few had a substance abuse disorder. Suicide among white males aged 85 and older
was nearly six times the national U.S. rate (65 per 100,000 compared with 11 per
100,000) in 1996, the most recent year for which statistics are available.
Prevention of suicide in older adults is a high priority area in the NIMH
prevention research portfolio.
Alternative Treatments
There is high public interest in herbal remedies for various medical conditions
including depression. Among the herbals is hypericum or St. John’s wort,
promoted as having antidepressant effects. Adverse drug interactions have been
reported between St. John's wort and drugs used to treat HIV infections as well
as those used to reduce the risk of organ transplant rejection. In general,
preparations of St. John's wort vary significantly. No adequate studies have
been done to determine the antidepressant efficacy of the herbal. Consequently,
the NIMH has co-sponsored the first large-scale, multi-site, controlled study of
St. John’s wort as a potential treatment for depression. Results from this study
are expected in 2001.
The Future of NIMH Depression Research
Research on the causes, treatment, and prevention of all forms of depression
will remain a high NIMH priority for the foreseeable future. Areas of interest
and opportunity include the following:
NIMH researchers will seek to identify distinct subtypes of depression
characterized by various features including genetic risk, course of illness, and
clinical symptoms. The aims of this research will be to enhance clinical
prediction of onset, recurrence, and co-occurring illness; to identify the
influence of environmental stressors in people with genetic vulnerability for
major depression; and to prevent the development of co-occurring physical
illnesses and substance use disorders in people with primary recurrent
depression.
Because many adult mental disorders originate in childhood, studies of
development over time that uncover the complex interactions among psychological,
social, and biological events are needed to track the persistence, chronicity,
and pathways into and out of disorders in childhood and adolescence. Information
about behavioral continuities that may exist between specific dimensions of
child temperament and child mental disorder, including depression, may make it
possible to ward off adult psychiatric disorders.
Recent research on thought processes that has provided insights into the nature
and causes of mental illness creates opportunities for improving prevention and
treatment. Among the important findings of this research is evidence that points
to the role of negative attentional and memory biases—selective attention to and
memory of negative information—in producing and sustaining depression and
anxiety. Future studies are needed to obtain a more precise account of the
content and life course development of these biases, including their interaction
with social and emotional processes, and their neural influences and effects.
Advances in neurobiology and brain imaging technology now make it possible to
see clearer linkages between research findings from different domains of emotion
and mood. Such "maps" of depression will inform understanding of brain
development, effective treatments, and the basis for depression in children and
adults. In adult populations, charting physiological changes involved in emotion
during aging will shed light on mood disorders in the elderly, as well as the
psychological and physiological effects of bereavement.
An important long-term goal of NIMH depression research is to identify simple
biological markers of depression that, for example, could be detected in blood
or with brain imaging. In theory, biological markers would reveal the specific
depression profile of each patient and would allow psychiatrists to select
treatments known to be most effective for each profile. Although such
data-driven interventions can only be imagined today, NIMH already is investing
in multiple research strategies to lay the groundwork for tomorrow’s
discoveries.
The Broad NIMH Research Program
In addition to studying depression, NIMH supports and conducts a broad based,
multidisciplinary program of scientific inquiry aimed at improving the
diagnosis, prevention, and treatment of other mental disorders. These conditions
include bipolar disorder, clinical depression, and schizophrenia.
Increasingly, the public as well as health care professionals are recognizing
these disorders as real and treatable medical illnesses of the brain. Still,
more research is needed to examine in greater depth the relationships among
genetic, behavioral, developmental, social and other factors to find the causes
of these illnesses. NIMH is meeting this need through a series of research
initiatives.
NIMH Human Genetics Initiative
This project has compiled the world's largest registry of families affected by
schizophrenia, bipolar disorder, and Alzheimer's disease. Scientists are able to
examine the genetic material of these family members with the aim of pinpointing
genes involved in the diseases.
Human Brain Project
This multi-agency effort is using state-of-the-art computer science technologies
to organize the immense amount of data being generated through neuroscience and
related disciplines, and to make this information readily accessible for
simultaneous study by interested researchers.
Prevention Research Initiative
Prevention efforts seek to understand the development and expression of mental
illness throughout life so that appropriate interventions can be found and
applied at multiple points during the course of illness. Recent advances in
biomedical, behavioral, and cognitive sciences have led NIMH to formulate a new
plan that marries these sciences to prevention efforts.
While the definition of prevention will broaden, the aims of research will
become more precise and targeted.
More Than 2,000 Grants and Contracts
In total, NIMH supports more than 2,000 research grants and contracts at
universities and other institutions across the nation and overseas. It also
conducts basic research and clinical studies involving 9,000 patient visits per
year at its own facilities on the National Institutes of Health campus in
Bethesda, MD, and elsewhere. NIMH research projects focus on:
basic research on behavior, emotion, and cognition to provide a knowledge base
for a better understanding of mental illnesses
basic sciences, including cellular and molecular biology, developmental
neurobiology, neurochemistry, neurogenetics, and neuropharmacology, to provide
essential information about the anatomical and chemical basis of brain function
and brain disorders
neuroscience and behavioral aspects of acquired immune deficiency syndrome
(AIDS) and behavioral strategies to reduce the spread of HIV (human
immunodeficiency virus)
interventions to treat, prevent, and reduce the frequency of mental disorders
and their disabling consequences
mental health services research, including mental health economics and improved
methods of services delivery
comorbidity among mental disorders and with substance abuse and other medical
conditions, such as depression and heart disease
the prevalence of mental disorders
risk factors for mental disorders
differences in mental health and mental illness among special populations
children and adolescents who suffer from or who are at risk for serious mental
disorders and learning disabilities
psychotherapies and pharmacotherapies for specific disorders
At the beginning of the 21st century, NIMH stands poised to surmount the burden,
loss, and tragedy of mental illnesses that afflict millions of Americans.
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