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Read more about Raising an Optimistic Child

Raising an Optimistic Child: A Proven Plan for Depresion-Proofing Young Children--for Life
(McGraw-Hill, 2006) by Bob Murray and Alicia Fortinberry

Read more about Creating Optimism

Creating Optimism:
A Proven Seven-Step Program for Overcoming Depression

(McGraw-Hill, 2004) by Bob Murray and Alicia Fortinberry

Depression and Anxiety

Written and researched by Bob Murray, PhD

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Childhood Experience Influences Mood

Sep 17, 2006

Despite all the research that has been done over the last decade showing the prime importance of early childhood experience, there are still those, even in the psychiatric ands psychological professions who remain doubters. There are still parents who ignore the warning signs and give their children over to too-early childcare or insist on pursuing two full-time careers at the expense of their offspring.

Indeed there are still professional therapists telling parents that their own mood and the way that they interact with each other has no real influence on their children. To be frank, this is dangerous nonsense!

Not only their overall relationship, but also their prevailing mood and outlook can be a powerful life-long influence on the way their children view the world and can affect their life-chances. A new study published in the recent issue of the Journal of Personality finds a correlation between adult pessimism and childhood in a low socioeconomic status (SES) family.

By connecting socioeconomic status to pessimism, which in turn has in earlier studies shown to be related to physical and mental health, the current study provides critical information for policy makers and parents concerned with preventing the development of bad coping strategies of children.

Researchers compared optimism and pessimism levels of participants from different socioeconomic backgrounds and found that persons of high SES had a more optimistic outlook on life. This is hardly surprising. Further, it was discovered that the effect of childhood socioeconomic status on pessimism tended to remain in spite of socioeconomic fluidity.

A person from a low SES childhood who moved upwards in status was less likely to be optimistic as an adult than someone from a high SES childhood who remained in high SES. The inverse also held true, as people from a high SES childhood who moved downwards in socioeconomic status were more optimistic than those who remained in low SES.

"Children from the higher SES classes who are subsequently downwardly mobile may have learned successful coping strategies during childhood and consequently developed a sense of mastery and control that protected them in adulthood from the adverse effects of lower SES, whereas children from lower SES backgrounds who are subsequently upwardly mobile may not have had the opportunities to develop those psychological resources, and thus are not able to benefit as much as possible from the later success experiences," concludes the study's lead author.

Our own experience confirms what the researchers have found. However we would emphasize that children from a high-income home where one of the parents was pessimistic or depressed can also suffer from life-long depression or pessimism.

Read more in Journal of Personality

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Epilepsy and Suicide

May 25, 2006

For a long time I have thought that suicide and epilepsy were connected and that the link between them must be very strong. Both are like storms in the brain. I have also observed in my clients that depression and suicide--especially in men are not always apparently linked. On the other hand almost all people that I have seen with epilepsy are also depressed.

Now a team of researchers have found provocative evidence that the brain dysfunction that underlies epilepsy may also determine whether people are at risk for suicide. The study, published online October 10, 2005 in the Annals of Neurology also suggests that depression and suicide may have different brain mechanisms.

"For reasons that are not understood, depression both increases the risk for developing epilepsy and is also common among people with epilepsy who experience many seizures," said lead author Dale C. Hesdorffer, Ph.D., of the Gertrude Sergievsky Center at Columbia University.

It has commonly been assumed that the difficulties associated with living with epilepsy could provoke depression, and in some cases, an increased risk of suicide, the authors write. But is harder to explain the opposite findings, that people who develop depression have a higher risk of later experiencing a first seizure.

While neuroscientists have postulated overlapping brain systems for depression and epilepsy, this evidence is still preliminary. In the present study, the researchers attempted to define more clearly the relationship between depression, suicide, and epilepsy.

"One question we had was whether some symptoms of depression were more important than others for increasing the risk for developing epilepsy," said Hesdorffer. "Suicidal thoughts and suicide attempt were possibilities, because people with epilepsy seem to be more likely to commit suicide than the general population. But we looked at all symptoms of depression."

Hesdorffer and colleagues compared data for both epilepsy and depression in 324 people with epilepsy and 647 control subjects. A history of depression increased the risk of epilepsy, but the startling finding was that people with epilepsy were 4 times more likely to have attempted suicide before ever having a seizure, even after other factors were taken into account like drinking alcohol, having depression, age, and gender.

The individual presence of other symptoms of depression, whether common (e.g., depressed mood) or more rare (e.g., weight change) did not predict a greater likelihood of later seizures. While this finding clearly suggests common underlying brain mechanisms for suicidal behavior and epilepsy, the results also suggest that depression and suicidal behavior may be related to different mechanisms. This confirms my original supposition.

"Increasingly, clinicians treating people with epilepsy ask about current depression, but they may not ask about past suicide attempt or suicidal thoughts," said Hesdorffer. "Our results may alert clinicians to the need to ask this question and offer any needed counseling to prevent the occurrence of later completed suicide."

Read more in the Annals of Neurology

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Male Depresion

Nov 1, 2005

We've been noticing a number of studies recently which have begun to show the depth of the problem of depression in men. Researchers are no venturing to say that, contrary to previous accepted knowledge, men - especially those in their 40s and 50s - may in fact be more prone to depression than women.

The latest finding is that men who slide down the social ladder during their lifetime take the blow much harder than women in the same position, and be more prone to depression. In fact though women were twice as likely to be downwardly mobile they generally avoided the depression and poor psychological wellbeing that researchers found in men in the same position.

Men who experienced a downward social shift were four times more likely to experience depression than men who improved their social status, whereas there was no marked difference in mental health between women who had moved up or down the social ladder.

In the study, researchers from the University of Newcastle upon Tyne used the occupation of the head of the household as the marker for social status, and surveyed men and women born in 1947 in Newcastle from childhood to age 50.

Their findings could be explained by the fact that men born in this era gained much of their self-esteem from their careers, whereas women found fulfilment from other social pursuits outside work, such as children and friendships. It's also possible that women are more emotionally resilient in this type of situation, say the researchers.

The study is published today in the Journal of Epidemiology and Community Health. Lead researcher, Dr Paul Tiffin said: "The Newcastle Thousand Families Study gave us an opportunity to try and understand more about how socioeconomic circumstances throughout life might be linked to mental well-being in middle age. With an increasing emphasis on the promotion of good health, findings such as these are likely to challenge those involved in health and social policy. Having robust mental health is just as important as good physical health - the two are often interdependent. Depression can lead to a vicious circle where poor mental health and lack of engagement with society becomes the norm for an individual.

Dr Tiffin added "Whilst we must be cautious in generalising our findings to other populations, our findings do suggest that it's important for governments and other agencies to consider the wider effect of mass redundancies and drastic economic changes. The tendency is to focus on the financial losses that workers and their families experience but this research shows that the psychological effects should equally be taken into account and acted upon."

Read more in the Journal of Epidemiology and Community Health

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Consumer Demand Boosts Antidepressant Prescription

June 6, 2005

When we talk to doctors we're often told that the reason they reach for the prescription pad so often is that their patients' insist on having a pill for whatever is wrong with them. The media--especially advertising on television and in print--has made them enthusiastic consumers of certain medications. This is especially true of antidepressants and drugs for childhood ADHD.

Now researchers funded by the National Institute of Mental Health (NIMH), have found that is indeed the case. According to their study requests from patients for medications have a "profound effect" on physicians prescribing for major depression and adjustment disorder (where a person has abnormal difficulty getting over a major life stressor such as an auto accident). These findings indicate that direct-to-consumer (DTC) marketing of prescription medications for depression may exert significant influence on treatment decisions.

The study appears in the April 27, 2005, issue of the Journal of the American Medical Association.

"The use of direct marketing for treatment of depression may boost familiarity with potential treatments of the disorder," said Thomas R Insel, MD, director of the National Institute of Mental Health. "However, we must ensure that treatment is based on evidence-based science rather than evidence-based marketing."

Critics of direct-to-consumer marketing fear the advertisements lead to over-prescribing. Proponents believe they can serve a useful educational function. This study addresses this issue of over- or under-prescribing. The researchers randomly assigned actors portraying patients with symptoms of major depression or adjustment disorder to make 298 unannounced visits to 152 family physicians and general internists recruited from solo and group practices and health maintenance organizations in California and New York.

Actor-patients were randomly assigned a disorder and a type of medication request based on the assumption that the direct-market approach could encourage patients to seek effective care. They made brand-specific requests for Paxil, saying they learned about the medication from a commercial; or general requests for medication, not a specific brand, saying they viewed a television program about depression which "got them thinking." Actor-patients assigned "none" made no request concerning medications.

Two visits were spread over several months so as to avoid detection by the participating doctors; 13% of the time, the doctors suspected the actor-patient was from the study. Researchers collected results through a review of actor-patient written reports, audiotapes from the visits, medical charts, and written prescriptions or drug samples.

Actor-patients exhibiting major depression who made brand-specific requests (53%) or general requests for medication (76%) were more likely to receive a prescription than those who made no request (31%). Although both brand-specific and general requests significantly increased prescribing in both major depression and other disorders, brand-specific requests had a more pronounced effect on prescribing for adjustment disorder than for major depression.

"Although several small trials suggest that antidepressants may deliver modest benefits to patients with minor depression, there is no evidence to support their use in adjustment disorder, especially when patients describe a clear event as the cause of their depression, and exhibit mild symptoms for only a short period of time," says Dr Richard L Kravitz, lead investigator on the study.

In addition to prescribing practices, the study found that those who made a request for medication were more likely to receive minimally acceptable initial care (any combination of antidepressant, mental health referral, or follow-up visit within two weeks). And physicians were more likely to consider and record a mental health diagnosis (depression 88% compared to 65% and adjustment disorder 50% compared to 18%) if the actor-patient made a request for medication.

Read more in JAMA

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Obesity and Childhood Depression

May 1, 2005

In the fight against childhood and adult obesity, the underlying causes of eating disorders are often ignored. Lifestyle factors such as diet and exercise are usually stressed as the main culprits.

A surprising study by researchers from the University of Texas and the Oregon Research Institute published in the April edition of the Journal of Consulting and Clinical Psychology throws doubt on the received wisdom that obesity is primarily caused by high-fat foods and lack of exercise. Their study of teenage girls found that the real predictors for obesity in adulthood are suffering from depression, engaging in radical weight-control programs and having obese parents.

The researchers followed 496 girls for five years. They were regularly questioned about their eating, exercise and dieting habits. They were also asked about their parents weight.

They found that those girls who engaged in what the researchers called "compensatory" behavior--vomiting and laxative abuse--or who suffered from depression were most likely to become obese. Those with obese parents were also likely to become overweight. Those who regularly indulged in high-fat foods or who rarely exercised were the least likely to become obese.

The researchers warned, however that their study did not mean that high-fat foods were safe or that exercise wasn't important.

Read more in the Journal of Consulting and Clinical Psychology

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Light Up Your Life!

May 1, 2005

Seasonal Affective Disorder (SAD) is a widespread form of depression that is made worse by a lack of sunlight. Now researchers have found that bright light can help alleviate the symptoms of all kinds of depression. In fact it may be as effective as psychotherapy or antidepressants!

In a review of previous studies researchers at the North Carolina University School of Medicine found strong evidence that even exposure to artificial broad-spectrum light for most types of depression. Their paper appears in the April edition of the American Journal of Psychiatry.

Light therapy usually involves sitting in front of white florescent lights for 15 to 90 minutes a day with eyes open but not looking directly at the light source. Dawn simulation, a variation of this treatment recreates the timing and intensity of normal sunrise.

Though therapists who use these methods claim that depressive symptoms can start to diminish within weeks there has as yet been concrete evidence to back up these claims and the North Carolina researchers urge caution. It may be a placebo effect--anything new can have a beneficial effect for a short time but the patient may well relapse once the novelty has worn off.

Read more in the American Journal of Psychiatry.

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Contraceptive Pill Linked to Depression

April 1, 2005

In our practice we have noticed that many female clients who began taking the pill, or HRT, became more depressed than they had been before they started. Other therapists have also noticed this effect.

Now research indicates the truth behind this observation. The Alfred Psychiatry Research Centre studied 60 women, and found that those taking the pill containing both oestrogen and progesterone were almost twice as likely to be depressed as those who did not.

Center director Professor Jayashri Kulkarni is urging clinicians to be aware of the psychiatric side effects of the pill. But she says more research is needed to understand how hormones effect moods. "When you have an outside agent it is going to have two possibilities," she said. "One is have a direct impact in the brain itself and may in fact trigger those chemicals that might be depressiogenic.

"Or it could actually impact on the natural hormone production and have a pathway that then triggers off depression that way."

Read more in ABC News Online

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Epilepsy and Depression

March 1, 2005

Studies increasingly show that depression is the root cause of a vast number of 'physical' ailments from diabetes to dementia. Now it seems that epilepsy may, at least in part, be caused by the mood disorder.

Researchers have noted a higher incidence of depression among patients with epilepsy than the general population or others with chronic conditions such as diabetes. For a long time, depression was thought to be a complication of epilepsy.

But there is evidence that the connection between epilepsy and depression may be a two-way street, according to research carried out in Sweden and the United States and reviewed at the annual meeting of the American Association for the Advancement of Science (AAAS).

"People with a history of depression have a 3 to 7 times higher risk of developing epilepsy," said Dr. Andres Kanner, a specialist on epilepsy at Rush University Medical Center in Chicago. "This kind of information is forcing us to take a second look at the interaction between depression and epilepsy."

Since depression affects about 15% percent of the U.S. population and epilepsy about 0.5 to 1 percent, session organizers said, knowledge of any relationships between the two disorders could help physicians find ways to improve care for both groups. The two-way relationship between epilepsy and depression could mean common pathogenic mechanisms are at work, Kanner said.

Studies with rats that are genetically prone to epilepsy show abnormal secretion in the brain of neurotransmitters such as serotonin, norepinephrine, GABA and dopamine. The abnormal secretion patterns of serotonin and norepinephrine in these animals are similar to abnormal patterns for the same neurotransmitters seen in patients with depression, Kanner said.

He summarized the evidence for common biological pathways in a paper published in January in the journal Epilepsy Currents.

Common pathways between depression and epilepsy might account for recent data suggesting that patients with a psychiatric history may not respond as well to medication or surgery for treatment of their seizures, Kanner said. He and his colleagues recently studied 90 patients whose seizures failed to respond to antiepileptic medication and underwent brain surgery to remove tissue that was the focus of the seizures. Patients with a lifetime history of depression were less likely to become seizure-free, the researchers found. Kanner said that suggests depression could be a biological marker for a more severe form of epilepsy.

Epilepsy, marked by unprovoked seizures, is caused by recurrent electrical 'storms' in the brain. More than 2.5 million Americans of all ages are living with epilepsy, which can develop at any time of life but especially in early childhood and old age, according to the Epilepsy Foundation. Possible links between depression and epilepsy have been noted since around 400 B.C., when Hippocrates, the Greek physician, reportedly observed, "Melancholics ordinarily become epileptics and epileptics melancholics." Galen, another Greek physician, later wrote a treatise titled "Epilepsy and Melancholy."

Whatever biological links the two disorders may share, clinicians and patients alike need to be more aware of the significant incidence of depression among those with epilepsy.

Read more in the Epilepsy Currents

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Landmark Study Confirms Uplift Principles

February 7, 2005

In follow-up questionnaires the Uplift Program has been shown to be 94% successful in alleviating depression and anxiety, compared to the 30-40% rate claimed for antidepressants, and most other forms of therapy. We have always attributed it's success to our focus on teaching participants the how-to of creating really supportive relationships because relationships are what human beings are all about. A lot of research has recently supported our stand.

Now, however a landmark study by Virginia Commonwealth University researchers has found that women who feel more loved and supported by their friends, relatives and children are less at risk for major depression. Depressed men respond to good relationships by a more round about route because they are more sensitive to the adverse health effects of social isolation than are women, the researchers conclude. Women are also, because of social conditioning and perhaps genetics, better at relationship-forming than men. Men often need to be re-educated in forming supportive connections to other people in order to improve their physical and mental health.

The VCU study appears in the February issue of the American Journal of Psychiatry.

Women in this twin study were more sensitive than the men to the depressongenic effects of low levels of social support, particularly from the co-twin, other relatives, parents and spouses. "In women, social support was a robust predictor of risk for depression," said Kenneth S Kendler, MD, a professor of psychiatry and human genetics in VCU's School of Medicine and lead author on the study. "Women who saw themselves as more loved and cared for and objectively well integrated in positive social groups were well protected against later episodes of major depression."

Researchers interviewed opposite-sex fraternal twin pairs registered with VCU's Mid-Atlantic Twin Registry. The first interview was conducted between 1993 and 1996, and the second between 1994 and 1998. At the time of the second interview, subjects were 21 to 58 years old. According to Kendler, studying opposite-sex fraternal twin pairs was ideal because the population included women and men who were conceived at the same time, developed in the same uterus and raised in the same family. Factors that may otherwise differ across women and men were ruled out because this population was examined, Kendler said.

Researchers examined the relationship between baseline levels of social support -- assessed for six key social relationships -- and the general level of social integration. The risk for future episodes of major depression was also assessed.

Kendler said these results are consistent with previous literature suggesting that on average, interpersonal relationships are more central to and more valued by women than by men. Women are also more likely to seek emotional support in their social network than are men.

Note: Our next Uplift Program intensives are April 16-17 (San Francisco) and June 17-19 (Sydney). ED

Read more in the American Journal of Psychiatry

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The Antidepressant Storm Rages On

January 11, 2005

The British Medical Journal said Friday of last week it had given US regulators confidential drug company documents suggesting a link between the popular antidepressant Prozac and a heightened risk of suicide attempts and violence.

The BMJ reported in its January 1 issue that documents it received from an anonymous source indicated that Prozac's manufacturer, Eli Lilly & Co, was aware in the 1980s that the drug could have potentially troubling side-effects.

The documents, reportedly missing for a decade, had formed part of a 1994 lawsuit against Eli Lilly on behalf of victims of a workplace shooting in Louisville, Kentucky. Joseph Wesbecker, the gunman who killed eight people and himself in 1989, had been prescribed Prozac a month before the shootings.

The BMJ said one of the records, dated November 1988, reported that fluoxetine, the generic name for Prozac, had caused "behavioral disturbances" in clinical trials. The journal had turned the documents over to the US Food and Drug Administration, which had agreed to review them. The journal said the office of US Congressman Maurice Hinchey, a Democrat from New York, also was examining the documents to determine whether Eli Lilly had withheld data from the public and the FDA.

"This is an alarming study that should have been shared with the public and the FDA from the get-go, not 16 years later," Hinchey was quoted as saying.

In October, FDA ordered that all antidepressants carry warnings that they "increase the risk of suicidal thinking and behavior" in children.

Separately a new book by Jerome Kessler, former editor of the New England Journal of Medicine claims that the major pharmaceutical comapnies have been hiding the true effects of their antidepressants for years and indeed have invented illnesses --such as "executive dysfunction", which has no medical basis at all--to sell more of the drugs. Prominent New York psychiatrist Peter Breggin goes even further and claims of SSRIs such as Prozac "Not only do these drugs not work, they are dangerous." He adds: "If anybody is up to their eyes in conflicts of interest it is the psychiatrists" who prescribe the drugs.

The NY District Attorney Eliot Spitzer is taking the large drug companies to court over their cover-ups.

Stay tuned, we are following this story.

Read more in the British Medical Journal

Read more in The Australian newspaper, December 16, 2004 "Busting Big Pharma" (not available online without payment)

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Antidepressants May Increase Risk of Abnormal Bleeding

December 6, 2004

Well, we now know that selective serotonin reuptake inhibitors (SSRIs) can cause brain tumors, can lead to suicide in children (and perhaps in adults as well), can produce psychotic episodes, are highly addictive, result in loss of libido, may actually cause depression and only really work for 30% of the people who take them. You'd think that would be enough. No so.

Now researchers have found that new users of SSRIs have an increased risk of being admitted to the hospital for abnormal bleeding, according to an article in the November 22 issue of The Archives of Internal Medicine.

According to the article, case reports and observational studies have shown a relationship between SSRI use and abnormal bleeding. It is believed that serotonin plays a role in blood clotting, and because SSRIs affect serotonin levels, they may be associated with an increased risk of bleeding, the article states.

Welmoed E E Meijer, PhD, of Utrecht Institute for Pharmaceutical Sciences, the Netherlands, and colleagues estimated the risk of abnormal bleeding associated with antidepressant use among 64,000 new antidepressant users. The data analyzed were collected from 1992 through 2000. Individuals were classified according to the degree (high, intermediate, or low) of serotonin reuptake inhibition of the antidepressants they were taking.

Among study participants, there were 196 cases of abnormal bleeding (including abnormal uterus bleeding and gastrointestinal bleeding). The risk of hospitalization increased with the use of drugs providing intermediate (twice as likely) and high (2.6 times as likely) degrees of serotonin reuptake inhibition.

"We found a significant association between degree of serotonin reuptake inhibition by antidepressants and risk of hospital admission for abnormal bleeding," the authors write. "Antidepressants with a high degree of inhibition of serotonin reuptake were associated with a 2.6-fold increased risk of bleeding events compared with antidepressants with a low degree of serotonin reuptake inhibition," the researchers conclude.

Any one for the Uplift Program?

Note that it is important to consult a healthcare practitioner or physican and never come off antidepressants without their advice.

Read more in The Archives of Internal Medicine

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Depression Treatment Boosts Employee Productivity

December 6, 2004

Recently we have been bringing the Uplift Program into a wide range of businesses from medium sized building firms to fortune 500 giants. Corporations are increasingly worried about the loss depression causes in terms of productivity and profits.

Now a two-year study has shown that programs such as the Uplift improved productivity at work by an average of 6 percent, or an estimated annual value of $1,491 per depressed full-time employee.

The study showed that these programs reduced absenteeism by 22 percent in two years, saving the companies an estimated $539 for each depressed full-time employee.

The study published in the journal Medical Care is among the first research to "demonstrate that improving the quality of care for any chronic disease has positive consequences for productivity and absenteeism," say Kathryn Rost, PhD, of University of Colorado Health Sciences Center and colleagues.

"Over the short term, improvements in productivity generally benefit the majority of American employers who pay salaries rather than reimburse workers for piecework or by commission. And over the longer term, improvements in productivity may translate into employee raises," Rost explains.

The study included 326 full- or part-time blue-collar and white-collar workers who were diagnosed with depression at the start of the study. The workers were randomly assigned to receive either standard or "enhanced" depression treatment.

Patients on the enhanced treatment plan were regularly contacted by a care manager who discussed their symptoms and provided extra information about depression treatment. The care manager also encouraged the patients to stick with their treatments.

Rost and colleagues measured the effect of the two treatment regimes at six-, 12-, 18- and 24-month intervals during the study. They calculated productivity from patients' reports of their effectiveness at work and absenteeism as the total number of work hours lost due to illness or doctor visits.

Consistently employed patients benefited the most from the enhanced treatment, making the largest gains in productivity while reducing their rate of absenteeism and the severity of their depression, the researchers found.

Read more in Medical Care

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Errant Enzyme Linked to Bipolar Disorder

November 6, 2004

The link between depression (unipolar disorder) and manic-depression (bipolar disorder) has been the subject of a lot of conjecture and study recently. Are they entirely separate diseases, or is bipolar a variant of unipolar disorder? The answer is important both for the development of medications and appropriate therapies.

A new study has now found that the disturbed thinking, impaired judgment, impulsivity, and distractibility seen in mania, a destructive phase of bipolar disorder, may be traceable to overactivity of protein kinase C.

The finding explains how even mild stress can worsen cognitive symptoms, as occurs in bipolar disoder, which affects two million Americans.

Abnormalities in the cascade of events that trigger PKC have also been implicated in schizophrenia the researchers led by Amy Arnsten, PhD report in the October 29, 2004 issue of Science.

"Either direct or indirect activation of PKC dramatically impaired the cognitive functions of the prefrontal cortex, a higher brain region that allows us to appropriately guide our behavior, thoughts and emotions," explained Arnsten. "PKC activation led to a reduction in memory-related cell firing, the code cells use to hold information in mind from moment-to-moment. Exposure to mild stress activated PKC and resulted in prefrontal dysfunction, while inhibiting PKC protected cognitive function."

"In the future, drugs that inhibit PKC could become the preferred emergency room treatments for mania," the researchers added. "All current treatments--lithium, valproate, carbamazepine and antipsychotics--take days, if not weeks, to work. That's because they're likely acting far upstream of where a key problem is, namely in the PKC pathway. Since PKC inhibitors could act more directly, they might quench symptoms more quickly. Patients could carry PKC inhibitors and take them preventively, as soon as they sense a manic episode coming on."

The fact that the current anti-psychotic drugs used to treat mania ultimately reduce PKC activity suggests that PKC may be a final common target of these treatments and may play a key role in bipolar disorder. Susceptibility to bipolar disorder may involve variants of genes that code for a key PKC precursor and for a stress-sensitive signaling protein that normally puts the brakes on PKC activity.

The new study shows how PKC triggers cognitive symptoms in response to stress. When the stress-sensitive messenger chemical norepinephrine binds to receptors on cell membranes in the prefrontal cortex, it activates PKC through a cascade of events. The enzyme then travels out to the cell membrane, opening ion channels that heighten the cell's excitability, and stoking protein machinery that propels neurotransmitters into the synapse. PKC also moves into the cell's nucleus, where it turns-on genes.

The researchers traced impairment to a reduction in memory-related firing of single cells in the prefrontal cortex, which was reversible by a PKC inhibitor. Genetic and biochemical studies indicate that PKC may also be overactive in the brains of patients with schizophrenia. Antipsychotics, which are used to treat bipolar disorder as well as schizophrenia, block receptors in the brain that activate PKC.

Read more in Science

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Suicide Determined at Birth?

October 1, 2004

A lot of research has recently been carried out on suicide: why do people take their lives? What is the relationship between suicide and depression? Now a Swedish report, published in the British medical journal The Lancet claims that the likelihood of a person committing suicide is partly determined as early as before birth.

The Swedish team looked at 700,000 adults and found low birthweight and being born to a teenage mother meant a two-fold rise in suicide risk. The report also said risk increased for shorter babies. The authors, from the National Centre for Suicide Research and Prevention in Stockholm, said it proved genetics played an important role in suicides.

The researchers followed the adults, who were all born between 1973 and 1980, and assessed the proportion of suicides and attempted suicides between 10 and 26 years of age. The overall suicide rate in Sweden in 1999, when the follow-up exercise finished, was around 20 per 100,000 of the population.

Babies weighing 2kg or less were more than twice as likely to commit suicide as adults than those weighing between 3.25kg and 3.75kg, according to the findings. Children born to mothers under 19 years old were also more than twice as likely to commit suicide as those born to women aged 20 to 29.

The report said babies 47cm and under were significantly more at risk of suicide than those 50cm to 51cm. Suicide risk also increased for those born to mothers who did not proceed beyond secondary school or had had at least three other children.

Dr Danuta Wasserman, who led the research, said: "This study does not give the definitive answer to why people commit suicide but it does underline the important role pre-birth and maternal factors play. I think genetics and environmental factors play a role.

"But it is clear we need to give mothers more support during pregnancy, I think that is the most important message."

The report said factors such as nutrition and alcohol and drug abuse played a key role in determining birth weight and length. And Dr Wasserman, also suggested maternal mental ill-health might affect growth.

The interesting thing about this report is that it highlights the fact that the environmental factors that cause a person's depression, anxiety and suicide can in fact be his or her mother's environment. A depressed or anxious mother can pass on the neurochemicals resulting from those mood disorders directly to her foetus. The developing brain of the foetus can therefore be pre-programmed for depression and anxiety. Mostly mood disorders are the result of relationship problems in early childhood--abuse, criticism, teasing, ostracism, abandonment, parental divorce among them. Almost by definition the mothers described in the report will have had relationship problems, probably in their childhoods. The echoes of these will pass to the unborn children. I suspect the same thing is true of a suicidal impulse. BM

Read more in The Lancet

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Pain Common Side Effect of Depression

September 1, 2004

In fact physical symptoms are nearly as common as emotional ones in patients suffering from depression, according to Indiana University School of Medicine research published in the August 2004 issue of the Journal of General Internal Medicine.

Patients with depression frequently talk to their physicians about symptoms such as headache, back or muscle pain, stomach ache and dizziness instead of symptoms more commonly associated with depression such as fatigue, lack of motivation and moodiness, says Kurt Kroenke, MD, professor of medicine in the Division of General Internal Medicine and Geriatrics at IU.

"Depression is a risk factor for symptoms of pain," he said. "The most reports of pain--such as muscle pain, headaches, leg pain--are two or three times more common in people with depression." What's more physical symptoms also may serve as a barometer for physicians to gauge the effectiveness of common antidepressant treatments, he said.

"Physical symptoms may not respond to common antidepressant treatment as much as the emotional symptoms," says Dr. Kroenke. "Even though the physical symptoms may be related to or aggravated by the depression, they can linger longer than the emotional symptoms."

The study examined the prevalence, impact on quality of life and outcome of physical symptoms in patients with depression during nine months of antidepressant therapy. A total of 573 depressed primary care patients at 37 clinic settings were assessed at one, three, six and nine months. In more than a third of the patients, the physical symptoms persisted longer than the depression symptoms.

This ties in neatly with the point we made in our book Creating Optimism that depression can manifest either as a "mood disorder" such as being sad or anxious or mask itself as a physical complaint and may, in a large number of sufferers, cycle between one and the other. We believe that all most antidepressants do is make depression change symptoms, not go away.

On this point Dr Kroenke comments: "While physical symptoms showed, on average, some improvement with antidepressant treatment, the improvement was typically less than was reported for emotional symptoms," he said. "Most of the improvement for the physical symptoms occurred within the first month of treatment, while the emotional symptoms continued to improve over a nine-month period."

A related study by Dr Kroenke also revealed a correlation between the severity of pain as reported by the patient and the success of treatment for depression. The more severe the pain at the beginning of treatment, the less responsive depression is to antidepressant medication.

Read more in Journal of General Internal Medicine

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Even Toddlers Get the Blues

June 26, 2004

Your 3-year-old isn't her usual spry self. She no longer brightens at the sight of you first thing in the morning. She refuses to eat, and she hasn't been this cranky since she first started teething. Instead of tagging along with her older siblings or contentedly scribbling in her favorite Blues Clues coloring book, she gazes blankly out the window, listless and dejected. Could she be depressed?

Like most people, you probably assume preschoolers are too young to get the blues. Indeed up until the early 1990s that was the commonly heald view of most mental health professionals. But new research shows clinical depression knows no age. Depression--and even thoughts of suicide--are as likely to affect toddlers and adolescents as they are adults.

In an ongoing National Institute of Mental Health study, researchers at Washington University School of Medicine revealed that children experience the same symptoms of depression often found in adults, and with the same severity. Children are more depressed than ever before, prompting a major Surgeon General report on children's mental health.

According to the National Mental Health Association, one in three American children suffers from depression. Unlike the reddish, raised bumps of chickenpox or the leaky nose of the common cold, the symptoms of depression are not so concrete and, consequently, often go unnoticed by unsuspecting parents.

What are the signs of childhood depression? What behaviors should parents look out for? Toddlers who are depressed are persistently irritable, withdrawn and lethargic, says Dr. Elizabeth Rody, child and adolescent psychiatrist and medical director for Magellan Behavioral Health's New Jersey Regional Service Center. "Depressed children lose interest in activities that once captivated them," says Rody. "Like adults who are depressed, an overwhelming sense of hopelessness and doom prevails."

Other symptoms parents should be aware of include:

  • Excessive crying and persistent sadness
  • Lack of enthusiasm or motivation
  • Increased agitation and irritability
  • Chronic fatigue and lack of energy
  • Withdrawal from family, friends and activities once enjoyed
  • Changes in eating and sleeping habits (significant weight loss or gain, excessive sleep, insomnia)
  • Frequent complaints of physical problems, such as stomachaches and headaches
  • Lack of concentration and memory loss
  • Major developmental delays (in toddlers--not walking, talking or expressing self)
  • Pay that involves harm toward self or others, or that revolves around sad or morbid themes

It's not unusual for children to feel down in the dumps from time to time. Knowing this, how can parents tell normal fluctuations in mood apart from serious depression? The answer is in the duration of the depressive behavior. According to "Mental Health: A Report of the Surgeon General," children who are depressed experience depressive episodes that last on average from seven to nine months, although some child development experts say depressive behaviors lasting beyond two weeks warrant further investigation.

on the National Institute for Mental Health website

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Stress and Trauma Increase Risk of Depressive and Anxiety Disorders

May 11, 2004

The idea that stress or adversity (major and potentially traumatic events experienced during one's lifetime) affect health and wellbeing is widely accepted by the public and by many researchers and physicians. Evidence has accumulated linking exposure to recent stressful events with psychological distress, most typically with depressive symptoms.

However R Jay Turner, PhD, and Donald A Lloyd, PhD, of Florida State University, Tallahassee, investigated whether lifetime exposure to adversity was a risk factor for the later onset of depressive and anxiety disorders. The researchers conducted a 1,803 interviews among a sample of individuals aged 18 to 23 years living in a southern Florida community.

Participants were interviewed and were assessed for major depression, dysthymia (a mild, chronic form of depression), generalized anxiety disorder, social phobia, panic disorder, alcohol abuse and dependence, drug abuse and dependence, posttraumatic stress disorder, and antisocial personality disorder. Interviewers also asked about specific kinds of stressful events or traumatic incidents over the course of the participants' lifetimes.

The researchers found that the level of lifetime exposure to adversity was associated with an increased risk of developing depressive or anxiety disorders. The researchers write: "As previously reported, these results indicate that exposure to major and potentially traumatic events is commonplace among young people, at least in South Florida. The typical African American in the sample had experienced more than nine such events, and the remaining three groups [Cuban, Hispanic, and non-Hispanic white] averaged more than six. A total of 26 of the 33 events examined were associated with significantly increased risk for a depressive or anxiety disorder."

This latest research has added to the growing body of data which confirms that on-going depression has its origins in childhood trauma, and in particular in a failure of relationships early in life over which the child has no control.

in The Archives of General Psychiatry

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Depression Sufferers Fear Stigma at Work

April 3, 2004

A new study by researchers at the University of Michigan Depression Center confirms what we have found when we have worked for major corporations, namely that many workers feel that they will be penalized if they openly acknowledge that they suffer from depression.

The study looks at the way employees suffering from the disease believe they are seen by their employers and by their fellow workers. The researchers found there is a difference between the way employers believe they respond to depressed workers and what employees say they experience in the workplace.

Previous research has found that the rate of depression in the workplace is as high as 30% (almost twice the rate of the population as a whole). The present study reported that a majority of the workers who suffer from depression said there was a stigma attached to the illness, even when their treatments succeeded in alleviating symptoms. For example, only 41% of the employees felt they could acknowledge their illness and still get ahead in their careers, the researchers said.

This, of course is tragic since openly acknowledging the problem is the first step to a cure because it is only then that the sufferer can reach out for the help that he or she needs.

Of those polled, 65% of the benefit managers said their firms offer employee assistance programs for workers who suffer from depression, but only 14% of depressed employees have used the service, the study said. In fact, the researchers concluded, only 18% of middle managers had received the training necessary to identify workers with depression and help them--even though 85% of them said that it was part of their job! Only 11% of benefit managers had offered screenings for depression, even though they acknowledged the huge losses in productivity associated with the illness.

"Before employees can be treated, they need to first understand that they have an illness," Thomas Carli, a psychiatrist and a member of the University of Michigan Depression Center told The New York Times. Carli added that providing inexpensive screening, disease education, and management training programs can go a long way to helping depressed workers and the companies they work for. He said such initiatives "can have a tremendous impact on worker productivity and overall employee wellbeing." According to the university, depression costs companies as much as $52 billion annually due to absenteeism and lost or reduced productivity.

One of the problems of depression is that it can mask itself so effectively that even physicians find it difficult to accurately diagnose. For example it can somatize (mimic a "physical" illness) and symptoms can include aches, pains, headaches, and backaches, chronic fatigue, chronic pain and fibromyalgia. Often this means that corporations are unwittingly spending huge sums on treatments which do not attack the real problem.

When the Michigan researchers interviewed depressed workers, they found that 82% had difficulty concentrating, 83% said they lacked motivation, and 24% complained of chronic physical pain that made it uncomfortable for them to work. Additionally, 50% said they had missed one to three days of work per month because of their illness.

The study concluded that once depression is treated, the individual's work performance is indistinguishable from coworkers' who do not have the disorder.

in WTop News. Reported in the The New York Times

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Pill-Popping Pre-Schoolers

April 3, 2004

Where are we going as a society?! The use of Paroxetine and other antidepressant medications continues to grow by about 10% annually among children and adolescents, according to a study published in the April issue of Psychiatric Services. The study profiles trends of prescription antidepressant use in children and adolescents using prescription claim information from a random, nationwide sample.

The findings tie in with an earlier Harvard study which found that the rate of depression among children was increasing by 23% a year!

The study examined antidepressant use among approximately two million commercially-insured, pediatric beneficiaries 18 years and younger from 1998 to 2002. The fastest growing segment of users were found to be preschoolers aged 0-5 years, with use among girls doubling and use among boys growing by 64%.

For the entire sample, antidepressant use increased from 1.6% in 1998 to 2.4% in 2002, a 49% increase. Over the course of the study, the growth in use was greater among girls (68%) than boys (34%) and, for each gender respectively, growth was higher among younger boys and older girls.

"A number of factors acting together or independently may have led to escalated use of antidepressants among children and adolescents," said Tom Delate, PhD, Director of Research at the firm which carried out the study. "These factors include increasing rates of depression in successive age groups, a growing awareness of and screening for depression by pediatricians and assumptions that the effectiveness experienced by adults using antidepressant medications will translate to children and adolescents."

Throughout the five-year period of the study, selective serotonin reuptake inhibitors (SSRI's) were the most commonly dispensed antidepressants, while tetracyclics were the least. SSRI's include paroxetine (also known as Paxil ©), Prozac © and Zoloft ©. Use of Paroxetine increased 113% and 91% in females and males, respectively, over the study period. The US Food and Drug Administration (FDA) has recommended that Paroxetine not be used in children and adolescents because, among youths, its efficacy has not been established for depression and its use is associated with increased risk of suicidal thinking and suicide attempts. Of the SSRIs, only Prozac has been approved by the FDA for treating depression in children and adolescents.

Authorities in the UK have come to a similar conclusion.

in Psychiatric Services

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Where You Live Influences Your Mental Health

September 21, 2003

The study found that boys who moved to neighborhoods with less poverty scored better on several measures of mental health as well, according to researchers led by Tama Leventhal, PhD, and Jeanne Brooks-Gunn, PhD, of the National Center for Children and Families at Columbia University in New York.

Their study appears in the American Journal of Public Health.

"Moving to Opportunity," a project that the Department of Housing and Urban Development sponsored in Baltimore, Boston, Chicago, Los Angeles and New York, assigned families living in public housing in neighborhoods with poverty rates exceeding 40 percent to one of three randomly chosen groups.

The first group received federal Section 8 housing vouchers to subsidize rent in the private market, but usable only in areas where less than 10 percent of the residents were poor. They also got special counseling to assist with their moves. A second group received Section 8 vouchers to move to the neighborhoods of their choice, which tended to be moderately poor. The third group did not receive vouchers and remained in public housing in very poor neighborhoods.

The "Moving to Opportunity" project began in 1994, and Leventhal and Brooks-Gunn interviewed 550 families in New York City between 1998 and 2000. More than 90 percent of the parents were women, half were African American and about 45 percent were Latina. Their average age was about 35.

Parents in the first group reported less physical and social disorder (trash, graffiti, public drinking, abandoned buildings and public drug use and dealing) and more satisfaction with their neighborhoods compared to the group that stayed in the housing projects. They also had fewer symptoms of distress and depression and their children were significantly less likely to report problems related to anxiety and depression.

Those in the second group, who received the Section 8 vouchers to relocate to neighborhoods of their choice, moved to better neighborhoods. But the differences in localities were only half as great as those recorded by the group that moved to low-poverty neighborhoods. Both parents and children showed a slight improvement in mental health measurements compared to the group that did not move, but not as much improvement as the first group.

Boys did better on some mental health standards, but the researchers found no significant group differences for girls. They speculate that girls may have been somehow more sheltered from the effects of the neighborhood.

While "Moving to Opportunity" appeared to have had a beneficial effect on mental health, Leventhal and Brooks-Gunn say, it had no effect on parental employment, welfare receipt or income. The advantages of moving to a low-poverty neighborhood may be attributed to reduced community violence and disorder or improved community resources--better schools, health services, housing, parks and sports facilities.

Read more in the American Journal of Public Health

Breaking Up is Bad for Your Health

September 21, 2003

A new study shows romantic breakups can literally add insult to injury by piling humiliation on top of loss, dramatically increasing the risk of depression.

In the largest study to date to rate the role that stressful life events play in triggering depression, anxiety, or a combination of both, researchers found the risk of depression doubled in months when an episode of humiliation occurred along with a serious loss.

"For example, if your marriage breaks up, that's a loss, and it's reasonable to expect that you will experience aspects of grief, including sadness and loss of appetite," says researcher Kenneth S Kendler, MD, professor of psychiatry at Virginia Commonwealth University.

"If your marriage breaks up and your husband moves into a house a few doors away with a woman half his age, and he shows off his new girlfriend to your friends and family -- that's grief combined with humiliation. Most cases of combined loss and humiliation involved romantic breakups."

Using a five-point scale, researchers rated the impact of various stressful life events based on interviews with a group of 7,322 male and female twins that were divided into four broad categories:

  • Humiliation (such as a breakup sparked by infidelity)
  • Entrapment (an event that makes a person feel trapped in a bad or worsening situation)
  • Loss (death of a loved one)
  • Danger (fear that a traumatic event will occur)

They then matched the event ratings against episodes of depression, anxiety, and mixed depression/anxiety reported by the participants in the previous year. The study found the risk of depression or mixed anxiety/depression was significantly higher in months in which there were high ratings for both loss and humiliation, especially if a romantic breakup was involved.

For example, the risk of depression in a month in which there was a breakup that was initiated by the other person or prompted by an infidelity or violence was about 22% compared with a 10% risk of depression in a month when a loved one died but no humiliation occurred.

"Love can make our life wonderful, but it also can make us miserable," says Kendler.

Other findings of the study include: An episode of anxiety was much more likely to occur in the month following a month with high scores for loss and danger. High ratings of entrapment, in contrast, were only predictive of mixed bouts of depression and anxiety within the month that the event occurred. However although the effects of loss and humiliation in increasing the risk of depression were limited to the month in which the events occurred, the impact of danger on the risk of triggering mental illness was more prolonged.

Read more in Archives of General Psychiatry

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Obesity, Depression Team up to Increase Heart-endangering Inflammation

September 21, 2003

Among a large group of German men ages 45 to 74, obese men had significantly higher concentrations of a protein called CRP compared with non-obese men. CRP serves as a signal of artery inflammation and high levels of the protein may be a good predictor of future heart disease.

The news is that depression seems to add to obese men's heart woes: CRP levels were higher in the most depressed obese men than in the less depressed obese men, according to Karl-Heinz Ludwig, PhD, of the GSF National Research Center for Environment and Health and colleagues.

Depression did not affect CRP levels among non-obese men, however, suggesting that a combination of obesity and depression may be more risky for some men. "We cannot provide a convincing explanation why the association between CRP and depression was much stronger in obese than in non-obese participants. However, it may be that both conditions--obesity and depression--share a common ground which, in onsequence, makes depressed, obese subjects in particular susceptible for coronary heart disease," Ladwig says.

The association between obesity and depression remained strong even after accounting for other factors that can affect CRP levels, including smoking, alcohol consumption and physical activity, according to the researchers.

Twenty-three percent of the 3,205 men included in the study were identified as obese. On the whole, the group of obese men was not any more depressed than the non-obese group, Ladwig says.

Read more in Brain, Behavior and Immunity

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"PTSD Counseling A Waste Of Time"

September 21, 2003

As ordinary citizens struggled to rebuild their lives after the collapse of the World Trade Center towers, well-meaning mental health professionals swarmed New York City to provide aid to the expected millions who would surely need support. These grief and crisis counselors delivered interventions that they believed would mitigate psychological distress and prevent the emergence of posttraumatic stress disorder (PTSD).

The most widely used PTSD intervention, psychological debriefing, seeks to prevent symptoms by having trauma survivors share memories or relive the experience. Unfortunately, a number of scientific studies have raised substantial concerns about the actual impact this and similar methods.

A new report examining the current body of research on the efficacy of psychological debriefing found "no convincing evidence that debriefing reduces the incidence of PTSD, and some controlled studies suggest that it may impede natural recovery from trauma."

The report, "Does Early Psychological Intervention Promote Recovery From Posttraumatic Stress?" appears in Psychological Science in the Public Interest. The authors are Richard J McNally, Harvard University; Richard A Bryant, University of New South Wales; and Anke Ehlers, Institute of Psychiatry, King's College London.

While most people who participate in psychological debriefing say it was helpful, controlled studies showed little or no effect on the onset of PTSD. "These reports that the method is helpful may reflect little more than polite expressions of gratitude for attention received," the authors wrote. "Most studies show that individuals who receive debriefing fare no better than those who do not receive debriefing."

According to the authors, the vast majority of trauma survivors recover from initial posttrauma reactions without professional help. Other factors, such as a family history of mental illness, one's social network of family and friends, and varying ways in which people process stressful stimuli appear to be more directly correlated to the manifestation of PTSD.

"The efficacy of interventions designed to mitigate acute distress and prevent long-term psychopathology, such as PTSD, needs to be evaluated against the effects of natural recovery," the authors wrote.

PTSD typically follows a "horrific, life-threatening event such as combat, rape, or earthquakes" and is characterized by re-experiencing symptoms, emotional numbing, avoidance of reminders of the trauma, and hyperarousal.

We've always believed that PTSD has it's roots in childhood trauma. Standard PTSD interventions can tend to retraumatize the victim. It would be more effective if therapy focussed on the earlier underlying traumas. BM

Read more in Psychological Science in the Public Interest

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Hostility, Depression May Boost Heart Disease Protein Level

August 13, 2003

Mild to moderate levels of depression symptoms combined with feelings of hostility in healthy men may raise their levels of a protein that is associated with clogged arteries and a greater risk of heart attack, according to new research published in Psychosomatic Medicine.

The new findings suggest "the possibility that men who are hostile and exhibit depressive symptoms, even in the mild to moderate range, are at heightened risk for cardiac events," according to Edward C Suarez, PhD, of Duke University Medical Center. "Although studies have shown that hostility and depressive symptoms are associated with greater risk of heart disease, the reasons for these associations are not well understood. It is increasingly apparent, however, that inflammation in the bloodstream is linked with heart disease."

Previous studies indicate that the protein, called IL-6, is at least a marker of inflammation, and may even be involved in the inflammatory processes that cause artery thickening and buildup. However, researchers know little about IL-6's relation to psychological risk factors, Suarez says.

Suarez examined the link between depression and hostility and IL-6 levels in 90 healthy, nonsmoking men ages 18 to 45. After giving a blood sample, the participants answered two questionnaires to determine their level of depressive symptoms and hostility.

Men who scored highest on both questionnaires, indicating increased symptoms of depression and higher levels of hostility, had IL-6 levels that were two to five times higher than men who scored low on both questionnaires or scored high on only one questionnaire.

The association between the psychological factors and IL-6 held steady even after accounting for other factors associated with IL-6, such as age, body weight, cholesterol levels, and blood pressure. Suarez is currently studying the relationship between IL-6, hostility and depression in women.

Read more in Psychosomatic Medicine

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Depression and Genetics Shortens Life-span

July 8, 2003

Researchers at the University of Pittsburgh have completed the first survey of the entire human genome for genes that affect the susceptibility of individuals to developing clinical depression.

George S Zubenko, MD, PhD, professor of psychiatry at the University of Pittsburgh School of Medicine and his team have located a number of chromosomal regions they say hold the genetic keys to a variety of mental illnesses, including major depression and certain addictions. The survey was done in 81 families identified by individuals with recurrent, early-onset, major depressive disorder (RE-MDD), a severe form of depression that runs in families.

The U. Pitt team's findings are published in the American Journal of Medical Genetics.

Finding the genetic roots of depression is important for many reasons. Depression is the second-leading cause of disability worldwide, affecting nearly 10 percent of the population. And while scientists have made significant progress developing new drugs to treat it, studies that identify specific risk genes may lead to even more effective drugs designed to target depression in specific individuals.

Twin studies have demonstrated that genetic factors typically account for 40 to 70 percent of the risk for developing major depression, but finding those genes has proven to be a challenge because, as in most diseases, there are likely numerous genes involved and only individuals with certain combinations of those genes develop the disorder.

Of equal interest is a secondary finding that longevity in the families who carry these genes is significantly reduced.

The survey revealed 19 loci--small regions on chromosomes where genes reside--that appear to influence susceptibility to depressive disorders. And at least some of the 19 depression vulnerability loci appear to work in concert to affect a person's risk of developing depression.

"Women are twice as likely as men to develop depression, and genetic differences appear to account for some of that disparity," said Dr Zubenko. Sex-specific loci were common and preferentially affected the vulnerability of women to developing unipolar mood disorders. Evidence of at least one male-specific risk locus also was found. The sex-specific effects of particular risk genes for depression may result from the interactions of these genes and their products with sex hormones.

These findings suggest there are important differences in the molecular pathophysiology of mood disorders in men and women, or in the mechanisms that determine resistance to stressful stimuli. They may also help explain the vulnerability of women to depression during times of significant hormonal fluctuation including puberty, menstrual cycling, pregnancy and childbirth and menopause. Conversely, age-related reductions in hormone levels may contribute to a reduced proportion of familial cases of depression among depressions that arise later in life.

Remarkably, deceased members of the 81 families died at an age eight years younger than the general population and over 40 percent died before the age of 65. This difference in mortality was spread across the life-span, including a five-fold increase in the proportion of children who died in the first year of life and several-fold increases in deaths by suicide, homicide and liver disease. However, most premature deaths occurred from "natural causes" including heart disease, cancer and stroke.

"Tracking down the risk genes in these regions is an obvious priority, and we expect that the research will connect clinical depression and other medical disorders at their most fundamental levels," said Dr Zubenko.

These observations provide an important new perspective on the biology of depression and its treatments that focuses on cell signaling pathways rather than particular neurotransmitters. "The identification and characterization of susceptibility genes and their products will provide new opportunities for drug development and disease prevention, new information about the biology of mood and its regulation, and new insights into the interactions of mental illness and the human life span," said Dr Zubenko.

We have always said that there was probably a genetic predisposition for some forms of depression, and this has been authenticated by this study. The important thing to remember that the remaining 30-60% of cases of depression may have no genetic background. Also it has been shown over and over again that genes are influenced--switched on and off--by environmental (ie. mostly relationship) conditions. BM

Read more in the American Journal of Medical Genetics

Read more about Dr Zubenko's research on the University of Pittsburgh School of Medicine website

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Dr Bob Murray is a widely published psychologist and expert on emotional health and optimal relationships. Together with his wife and long-term collaborator Alicia Fortinberry, he is founder of the highly successful Uplift Program, and author of Raising an Optimistic Child (McGraw-Hill, 2006) and Creating Optimism (McGraw-Hill, 2004).

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