A new kind of depression that is “med resistant”.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10273022/

Before I delve into this, I will remind you that there was a landmark study published almost a year ago where more than 160,000 individuals with clinical depression were tracked for medication efficacy, specifically SSRI’s. The study found that roughly 15% of patients responded well to SSRI’s, while the other 85% did not have symptom improvement with SSRI’s. SSRI’s are the Prozac, Lexapro, Citalopram, and Zoloft medications. We were sold the lie that serotonin was the primary neurotransmitter player in depression and the birth of the “Prozac Revolution” occurred in the mid 1980’s. Pharma has raked in billions on the theory that serotonin agents will “cure” depression.

Now we have this study. There is apparently a “new” kind of depression. A cognitive type of depression. They evaluated 1007 people and only a small percentage had any improvement in depression with an SSRI. “global cognitive impairment and significantly decreased brain response to a cognitive task as well as worse response to standard pharmacotherapy, defining what may be categorized as a cognitive biotype.” They then determined if they lacked executive function and cognitive function ability.

This study was done in two parts. The first was from December 2008 thru 2013. Then they did a secondary “analysis” was done from June 10, 2022, and April 21, 2023.

The results suggested that this new cognitive impairment type of depression exists, and it is non-responsive to SSRI medications. They are attributing this new kind of depression to why patients now suffer from cognitive impairment and poor executive dysfunction. My question is why the secondary analysis was done nearly 9 years after the original study completed?

My professional thoughts here: first, SSRI therapy rarely works well. I have far more patients with a long SSRI failure list than I do a success rate. Second, the most common issue I see these days is brain fog, forgetful, cannot focus, angry, irritable. Hmmmm. Sounds just like what they are describing in this second analysis done over the last year. But WHY? Why did we not see this kind of impairment beforehand? Why did this suddenly appear over the last couple of years during the pandemic?

My concern here is that while there are certain attributes that are correlated to depression, the level of cognitive impairment and ADHD type symptoms are new. I have worked in psych for almost 12 years. I have NEVER seen the symptoms we see current day in depressed patients before. Again I ask……what changed???? Is this journal article a cover up for why the study last fall showed an abysmal 15% success rate with SSRI use in depression? Are they suggesting “oh well, that is because those people had a DIFFERENT kind of depression and SSRI’s do not work for it’. Or, did something change the human brain over the last few years? And they would rather attribute it to cognitive impairment depression and add a new kind of depression to the diagnosis list rather than discussing WHAT caused this new cluster of symptoms?