Depression Research
at the National Institute of Mental Health
Depression affects more than 19 million American adults, making it the most common
serious brain disease in the United States. An estimated $30.4 billion was lost to the
direct and indirect costs of the illness in 1990. In addition, 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 two-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 two
years in adults (one 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.
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
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. To date, there is no evidence of any adverse effects of long-term antidepressant
use.
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 three-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 one
month and four 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 two 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.
In 1999, NIMH will be involved in planning and presenting 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
three to seven 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 were 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 one and two 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 two 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
Recently there has been an enormous growth in public interest in herbal remedies for
various medical conditions including depression. One herbal supplement, hypericum
or St. John’s Wort, has been promoted
as having antidepressant properties. However, no carefully designed studies of adequate
duration have been done to determine the antidepressant efficacy of the supplement. To
this end, NIMH is currently enrolling patients in the first large-scale, multi-site,
controlled study of St. John’s Wort
as a potential treatment for depression.
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
manic-depressive illness, 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, manic-depressive illness, 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.
- 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
- co-morbidity 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
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