A recent study using mice to mimic stress and depression in adolescents suggests that the teenage years are a particularly vulnerable time for the brain.  Working with mice who carried an introduced human gene mutation for depression, the researchers exposed some of the adolescent mice to social stress (isolation for three weeks) and kept a control group of mice stress-free.  There were two important findings.  First, the gene mutation for depression had no effect on mouse behavior except among the stressed mice.  Second, they found that the behavior change may be mediated by increases in cortisol (a stress hormone) and decreases in dopamine (a neurotransmitter in the brain).  Morever, after they returned the stressed mice to their preferred social environment, the behavioral abnormalities remained.  This study, and others like it, suggest that once activated during adolescence, the neuro-biological pathway active in depression does not turn off, even after the stressor has passed.

The take-home message?  We have another reason to increase our efforts at promoting healthy family environments for our children, and another reason that insurance companies should stop refusing to pay for marriage counseling.  A loving and secure attachment between married partners is the foundation for well-adjusted and resilient children.  …and possibly a buffer against a life suffering with depression.

Check out a more detailed summary of the study: http://www.hopkinsmedicine.org/news/publications/psychiatry_newsletter/hopkins_brainwise_spring_2013/stress_can_it_bring_more_than_teen_angst

or the study itself: http://www.sciencemag.org/content/339/6117/335.long

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It is scary to be diagnosed with depression.  However, it’s a lot less scary to be diagnosed with depression when you know that your grandmother and your uncle on your mother’s side also had it.  We may live in the age of biological psychiatry, and the NIH may have just announced their plan to map the human brain http://www.neuroscienceblueprint.nih.gov/connectome/, but we are still haunted by a view of brain illnesses that led our forefathers to drill holes in the skulls of depressed persons to let out the evil spirits.  Stigma is alive and well.  But its impact is reduced by the realization that, “It’s not my fault.”  Moreover, people diagnosed with the illness may be more open to the proven treatments (talk therapy combined with medication) when shown evidence that the predisposition is inherited, not a function of personal failure.   Most of my new patients with the illness have no idea that they are suffering from depression; they just know that they are suffering — sometimes for 30 years.  Without treatment.  Blaming themselves.  Concluding that they are worthless and that their situation is hopeless.

If depression runs in your family, do your children a favor.  Save them potentially years of suffering.  Tell them about it.

Symptoms of Depression

The National Institute of Mental Health (NIMH)1 provides this list of symptoms:

* People with depressive illnesses do not all experience the same symptoms. The severity, frequency and duration of symptoms will vary depending on the individual and his or her particular illness.

* Persistent sad, anxious or “empty” feelings

* Feelings of hopelessness and/or pessimism

* Feelings of guilt, worthlessness and/or helplessness

* Irritability, restlessness

* Loss of interest in activities or hobbies once pleasurable, including sex

* Fatigue and decreased energy

* Difficulty concentrating, remembering details and making decisions

* Insomnia, early–morning wakefulness, or excessive sleeping

* Overeating, or appetite loss

* Thoughts of suicide, suicide attempts

* Persistent aches or pains, headaches, cramps or digestive problems that do not ease even with treatment

Statistics for the United States   The estimated one-year prevalence of depression is 7.1% of the population.2  According to the World Health Organization (WHO), globally, “more than 150 million people suffer from depression at any point in time; nearly 1 million commit suicide every year.”3 Depression is the leading cause of disability, or lost years of productive life.4  Mental illness accounts for over 15 percent of the burden of disease, more than the disease burden caused by all cancers.2  Despite all this, and unlike cervical, colon, prostate and breast cancer, there are no guidelines for depression screening in primary care settings.  

What depression is

It is a treatable, medical illness.

It is still depression, and still treatable, even it if occurs in reaction to a life event.

In some people it is a chronic illness, like hypertension.  Just as for hypertension, treatment is lifelong.

It runs in families, although no simple genetic cause has been identified.

With no available medical test, it is diagnosed through clinical interview, clinical observation, and, ideally, family input.

What depression is not

It is not feeling sad for a day or two.

It is not a character flaw.

It cannot be eliminated by willpower.

It is not who you are; rather, it is something that you have.

Treatment for depression is not a crutch.  

Treatment for depression

It has been known for decades that the best treatment for depression is a combination of  psychotherapy (talk therapy) and medication (Weissman et al, 1979; Weissman et al, 1981).  

Psychotherapy for depression consists of education, cognitive-behavioral and interpersonal interventions, and supportive structure.  The goals of the combined treatment are symptom reduction, improved coping and problem solving skills, and other goals unique to the individual.  Ultimately, treatment for depression should increase your ability to manage the illness on your own.  

Antidepressant medication affects the neurotransmitters in your brain to reduce or eliminate symptoms. There are many different antidepressants. You and your psychiatrist will work together to find the best medicine with the fewest side-effects for you. 

If you have depression and are not being treated, you are suffering unnecessarily. Relief is available. Contact me or talk to your family doctor. 

References

1 http://www.nimh.nih.gov/health/publications/depression/symptoms.shtml

2 http://www.nimh.nih.gov/health/statistics/index.shtml

3 http://www.who.int/whr/2003/chapter1/en/index3.html

4 http://www.who.int/mental_health/management/depression/definition/en/

Weissman MM, Prusoff BA, Dimascio A, Neu C, Goklaney M, Klerman GL. The efficacy of drugs and psychotherapy in the treatment of acute depressive episodes. Am J Psychiatry 136(4B):555-558, 1979.

Weissman MM, Klerman GL, Prusoff BA, Sholomskas D, Padian N. Depressed outpatients. Results one year after treatment with drugs and/or interpersonal psychotherapy. Arch Gen Psychiatry 38 (1):51-55, 1981.

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