Re: Daphne Merkin's "My Life in Therapy"

[Lupita]

Dear Dr. G

The Chrinic Major Depression that you talk about in your post #17, does it come with the genes, or it is originated by constant negative stimulus during childhood?

Is it controled with antidepressants? Is it just being bron with bad cerebral chemistry? Not enough dopamine or serotonine?

Thank you.

Lupita

[Dr. Richard Grossman]

Hi Lupita,

At this point, unfortunately there are no definitive answers to your questions.  But here are some random thoughts to consider:

In a study of identical twins raised apart (e.g.  same genes, different upbringing) if one twin had been diagnosed with major depression the probability that the other had been diagnosed with major depression was about 68% (if I remember the number accurately).  Being raised together increased probabilities slightly (into the low 70% region).  Finally, concerning non-twin siblings raised together—if one sibling had been diagnosed with major depression, the probabilities that another sibling had been diagnosed was approximately 15% (don’t quote me on any of the numbers!).  While this doesn’t directly speak specifically to your question about chronic depression, it does suggest that genetics for many people plays a very large role in the predisposition to depression.

I believe a particularly difficult childhood may re-wire the brain in such a way to make it prone to depression.  Still, it is impossible to completely disentangle genetics in these situations.  (Some people with very difficult childhoods emerge unscathed.)

Because anti-depressants don’t work for a number of weeks, but blood levels of anti-depressants plateau in a number of days, we know it isn’t the level of serotonin or dopamine per se that makes depression better.  The most popular theory is that given enough time, anti-depressants re-wire the brain in specific ways, and this re-wiring is what helps people feel better.

People with chronic depression may take one or more medications, participate in therapy (cognitive behavioral, interpersonal, and others), and/or receive electroconvulsive therapy (ECT).    The important thing is to find some treatment or some combination of treatments that work for you and relieve suffering.   Andrew Solomon's  excellent book, Noonday Demon, discusses all of the possible treatments.

Best,

Richard

[Lupita]

Thank you Dr. G for taking the time to answer my question.

Just today, Sunday, before going to church, I was practicing for my GRE reading on the NY times. I got this article.
A gene that regulates serotonine related with people who had the tendency to fall into depression  after the loss of a job or similar events.

 http://www.nytimes.com/2009/06/17/science/17depress.html

Which supports completely what you were saying in the post before.

Thank you again.

Lupita

[sunblue]

Always found the issue of the role of genetics in depression fascinating and perplexing.  Based on Dr. G's post, a set of twins (who were raised apart no less) have a fairly high rate of sharing a depression diagnosis.  Yet, in the case of non-twin siblings, even if they're raised together in approximately similar family circumstances (even negative ones), one sibling may be diagnosed with major depression while the other does not.  Unfortunately, I've found the difficult issue to maneuver is what % of major depression is attributed to genetics and which to life circumstances...Because in many cases, major depression is accompanied by difficult life circumstances, it's difficult to determine what came first---the depressive chicken or the egg?  Why do some siblings escape negative family upbringings essentially unscathed while others are significantly affected with major depression or similar disorders? Does gender play a role?  Birth order?  Or is it just plain luck?

Interesting issues for sure....and so difficult to explain to non-affected siblings what it's like to be affected by depression.  Thanks for the post.