The Strategic Plan for Mood Disorders
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 Director
Richard K. Nakamura, Ph.D. Deputy Director