We are in a mental health crisis, a ‘moonshot’ is needed

Kara Margolis, Tribune News Service

On New Year’s Day, Master Sgt. Matthew Livelsberger reportedly blew himself up in a Tesla Cybertruck in an apparent suicide outside the Trump International Hotel in Las Vegas. Despite having a successful career as a Green Beret and being the father of a baby born just last year, Livelsberger reportedly suffered from severe post-traumatic stress disorder and depression. This is just one high-profile example of how depression and anxiety disorders, ineffectively treated, can have lethal consequences. Rates of PTSD combined with anxiety disorders or diagnoses of depression increased by 177% and 138% in only five years, from 2019 to 2023, according to the most recent edition of the Medical Surveillance Monthly Report, a peer-reviewed journal of the Armed Forces.

Skyrocketing rates of depression and anxiety are also being seen in civilian adults and, alarmingly, in our nation’s children. According to a recent behaviour risk survey from the Centers for Disease Control and Prevention, almost 40% of children in ninth through 12th grade experienced persistent feelings of sadness and hopelessness, and 20.4% seriously considered attempting suicide. Compounding this crisis in mental health is our inability to treat depression and anxiety effectively in most people. Selective serotonin reuptake inhibitors, such as Prozac, Zoloft and Paxil, the first line of medical therapy for these mood disorders, induce symptom improvement in only half of those people taking them and place only a third into remission.

Unintended side effects of SSRIs, including anxiety itself, suggest that SSRIs may actually cause some of the symptoms they are meant to reverse. In pregnant women, SSRIs cross the placenta and are absorbed into breast milk; they may affect fetal development and cause disorders of gut-brain interaction. In short, we need better therapies for depression and anxiety, and we need them as soon as possible. Disturbingly, however, the budget provided for mental health research by the National Institutes of Health, the nation’s premier source of funding for medical research, actually decreased last year. Emerging research in mental health is showing how little we know and thus how much work needs to be done, including in how SSRIs work. SSRIs increase serotonin, which has been called the “happy hormone” due to its anti-depressive and anti-anxiety effects.

Since Prozac made a splash in the 1980s, the general scientific consensus has been that SSRIs enter the bloodstream and help anxiety and depression by increasing serotonin directly in the brain. While serotonin is found in the brain, more than 90% of our bodies’ serotonin actually is found in the gut. Furthermore, SSRIs are systemically absorbed, leading to an increase in serotonin levels in not only the brain but also the gut.

This leads to a key question — when SSRIs help anxiety and depression, is that because they increase the serotonin in the brain, or because they increase the serotonin in the gut? In other words, might it be better to target anxiety and depression by focusing on the gut, thus increasing efficacy of the SSRIs and reducing their harmful side effects? I recently published a study in animals that shows that increasing serotonin specifically in the gastrointestinal tract improves anxiety and depression. This suggests that a medication that can increase serotonin in the gut, while not entering the bloodstream, may be a more effective treatment for anxiety and depression while also avoiding fetal exposure in women taking SSRIs. (Pregnant women should not stop taking SSRIs when their physicians think they are required, as maternal depression itself can have its own negative effects.)

It is critical, however, that studies focusing on how the gut affects mental health be at the forefront of political and scientific policies. With a new presidential administration, there must be a key focus on prioritising mental health initiatives. The formation of the bipartisan Senate Mental Health Caucus has been a very positive start. An even more robust effort, similar to the White House initiative “Cancer Moonshot,” would be required. This revolutionary initiative is building new collaborations and programs across all parts of the cancer community, including the federal government, private companies, health care providers, patient groups, philanthropies and the general public.

Many facets of Cancer Moonshot could be implemented in the mental health sphere. These could include investments in widespread screening and preventative programs; access to quality, coordinated care; the implementation of navigation services to enable patients to more easily acquire services; and prioritized research funding directed toward new treatments and preventative measures. Importantly, all of these measures consider equity for all populations and also consider military members and children specifically.