If you had unlimited finances, access to every possible pharmacologic compound-including experimental ones in clinical trials, or even "drugs" that are otherwise illegal-as well as a highly motivated patient who would be willing to do anything to get better, what treatment for depression would you choose?
Assume, however, that you have to get better as soon as possible; that your job cannot suffer because of your symptoms; and that suicide is absolutely not an option (not that it ever is) because so much depends on you.
That is the situation astronauts find themselves in. NASA is sponsoring a $1.74 million 4 year clinical trial, called the Virtual Space Station, to try to answer this question.
There are, however, three important limitations that astronauts have that do not apply to the general population. First, because of their isolation, actual therapy-a real time dialogue-is not possible. Even over radio there is too long a delay (e.g. 30 minutes) to make it practical.
The second limitation deals with environment. Astronauts must stay in the same rooms indefinitely. There aren't any outdoor walks. They may be trapped with a few other people with whom they will fall into conflict. And, there isn't the benefit of sunlight or other cues for biorhythms. Depending where one is orbiting, sunsets and sunrises can come every 45 minutes-or never.
Third, there is no privacy. Anything you say is recorded and studied. Forever.
One article describes the problems encountered by astronauts on the Russian space station in 1985. The commander "seemed uninterested in the work, and spent hours looking out portholes."
So far, the treatment includes recorded video therapist sessions, in a technique called "problem solving treatment." The astronauts type in their symptoms and feelings, and specific recordings based on those entries provides a plan to combat the symptoms. They are also referred to books, and use role-playing techniques.
It will be interesting to see the ultimate conclusion of the study. Clearly it will have enormous impact on civilian treatment for depression, in ways not obviously anticipated. Here's one: insurance companies might mandate it as first line if it is found to be more effective and cheaper than traditional techniques.
Published On: October 30, 2008