The depression gene

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The depression gene

Family history increases risk of the disease threefold.

MOST PEOPLE DON'T LIKE to talk about depression because it's considered a taboo topic. Those who suffer from it have been told to "snap out of it." Such an attitude suggests environmental or behavioral factors solely cause depression, and, therefore, a simple change of habit should resolve the symptoms. This raises the issue of nature vs. nurture: Is depression the result of behavior and environment, or is it a genetic predisposition?

One way scientists evaluate genetic influence on behavioral disorders (such as alcoholism or obesity) is to study twins. By studying people with similar genes, distinguishing between the effects of environment vs. the effects of heredity is easier. For example, two of my patients are identical twin sisters. One sister always has been physically active and watched her diet while the other has not. This difference in behaviors has had a profound impact on both. The "couch potato" sister now suffers from obesity and diabetes, while the athletic sister is frustrated she can't lose those last 20 pounds. I remind her that she has done extraordinarily well, given that her genetic predisposition is to be overweight, like her sister and other family members.

Twin studies on depression have shown the same phenomenon. Does that mean anyone with a family history of depression is destined to become depressed? No, but they may be more vulnerable. In fact, according to the American Psychiatric Association, those who have a father, mother or sibling who have a "major depressive disorder" are up to three times more likely than others to become depressed over time.

Depression can be mild, moderate or severe. Two common symptoms include a sense of sadness or hopelessness and anhedonia (a loss of interest in normally pleasurable activities). There also are physical symptoms, including sleep disturbances, fatigue, headaches and backaches, chest pain, heartburn, constipation and diarrhea. I see patients who have physical complaints suggestive of underlying depression; it doesn't "click" until we delve into it. They know something has not been right, but the symptoms have occurred so insidiously that they didn't recognize them for what they were.

Although naysayers dismiss medication's effectiveness, the severely depressed know better; they quickly see benefits when placed on appropriate regimens. For some, these treatments can be literally lifesaving. However, medications should be used only with ongoing professional counseling.

TREATING MILD DEPRESSION

Often, the passage of time is all that's needed, but these tactics can help, too:

Change your environment
Alter behaviors
Temporarily unload some responsibilities at homeor at work
Talk to a friend
Put your feelings into a journal or onto tape
Get regular exercise
Eat a healthful diet
Don't drink alcohol
Avoid drugs not prescribed by your physician
Aim for eight hours of sleep every night

Contributing Editor Tedd Mitchell, M.D., is the medical director of the Wellness Program at the Cooper Clinic in Dallas.
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