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Thursday, July 5th, 2012
My fellow Parents.com blogger Jill Cordes recently wrote a fascinating blog post entitled “Should Depressed People Procreate?”. Jill articulates not only her own story, but also some important points that resonate with me as a researcher (especially one who studies both genetics and depression). Her thinking is very much in line with current models of gene-environment interplay which reinforce the idea that DNA does not typically mean destiny.
Here’s the bottom line. For some rare diseases (or traits), single genes do, in a sense, act in a “deterministic” way. However, for the majority of human traits and diseases, genes are just part of the mix. The environment is critically important as well. Now while this sounds commonsense, it’s important to realize that this conclusion comes about after decades of research using a wide range of genetically-informative designs. Beyond that, over the last decade much progress has been made in studying the actual ways in which genes and environment come together. And this is where the story gets really interesting.
While there is no one gene that is known to cause depression, researchers have studied what have been called “candidate genes” – genes that biologically would play a role in the complex process of developing depression. One of these genes (sometimes called the “serotonin transporter gene” or 5-HTTLPR) has received particular attention because a number of studies suggest that variations in it (known as polymorphisms) affect how people react to stress (a key environmental risk factor for depression) – the “risk” version predicts depression in response to stress versus resilience (those without the “risk” version tend to not get depressed). However, this doesn’t mean that those with the “risk” version are destined to be depressed. In studies of adolescents, researchers have used psychosocial interventions to try to improve kids’ environments – particularly the family environment. And what seems to be happening is somewhat amazing – kids who have the “risk” version of the gene have the best response to the intervention. This has led to an intriguing idea (known as the “differential susceptibility” theory) that “risk” versions of genes don’t necessarily convey risk per se for depression and other behavioral/emotional disorders – rather they moderate sensitivity to the environment. When the environment is bad, those “risk” genes can lead to disorder. However, when the environment is good, those same “risk” genes lead to a very positive reaction to the environment.
So I was really knocked out by Jill’s thoughtful piece, as she laid out how, in her own life, she knows exactly how to take on the “bad gene” and in fact make it work for her and her family. And research certainly is backing up her approach.
Image of DNA via Shutterstock.com
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Tuesday, December 27th, 2011
In my last post, I provided a brief overview of the many reasons why moms are at risk for depression. It’s thus critical for every mom to be aware of the signs of depression – especially those that may not be as obvious as others.
A trusted source for information on depression is the National Institute of Mental Health. I recommend having a look at their discussion of women and depression, which includes a list of the basic symptoms, which I quote here:
- Persistent sad, anxious or “empty” feelings
- Feelings of hopelessness and/or pessimism
- Irritability, restlessness, anxiety
- Feelings of guilt, worthlessness and/or helplessness
- Loss of interest in activities or hobbies once pleasurable, including sex
- Fatigue and decreased energy
- Difficulty concentrating, remembering details and making decisions
- Insomnia, waking up during the night, 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
This list of symptoms may seem straightforward at first glance, but in my experience, it isn’t. So here are the key points I suggest you keep in mind:
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- The vast majority of women show only some of these symptoms – you don’t need to have all of them to be depressed
- While sadness may be what first comes to mind when you think about depression, note that most of these symptoms are not about sadness per se – and even in terms of sadness, this doesn’t always get expressed as crying (it can be more “quiet” than that, especially in terms of feeling empty inside). It’s important to think about other feelings that you may be experiencing – like guilt and hopelessness – that go beyond sadness
- There are a number of physical symptoms – irritability, anxiety, restlessness, fatigue, even aches and pains. While these can be caused by a number of things, it’s important to remember that they can be signs of depression, especially if you have other symptoms as well
- Some of the symptoms can be expressed very differently – sleep problems can involve insomnia OR excessive sleeping, you can experience overeating OR appetite loss. The reason for this is not clear, but be aware that any problem with sleep or eating can be tied to depression. A loss of energy and lack of interest in things that are important to you are also important signals to be aware of – though for some women increasing anxiety may dominate.
- There are a number of cognitive symptoms. It can be difficult to focus, concentrate, and make decisions. Especially important are changes in these symptoms in conjunction with some of the other symptoms (e.g., being sad and finding you are becoming more indecisive than usual)
In terms of diagnosing depression, a clinician will be looking for a constellation of these symptoms (which as described above can be very different from one woman to the next), along with the duration (for a major depressive episode, the typical benchmark is two weeks of having a number of symptoms most of the time). That said, depressive symptoms can wax and wane, and it’s important to start to recognize some of the signs – especially if it seems like they are increasing – even if you don’t have a full “episode.” So it’s very important to learn these signs, monitor yourself over time, and be aware if some of these symptoms are coming together at the same time. At that point it would be worth discussing with your primary care physician, who ideally would refer you to a mental health specialist for evaluation if necessary. This last step is very important, as depression is treatable using a number of approaches (both talk therapy as well as drug therapy). Most of all, I am a firm believer in trusting your gut instincts. If you don’t feel like yourself, get yourself checked out. Depression is a serious disorder and seeking treatment when necessary often leads to very positive changes in a woman’s life. And in my next post, I will discuss how it can lead to positive changes in your parenting as well.
Click here to read Part One of this series
Image of depressed woman via Shutterstock.com
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Monday, December 26th, 2011
Depression is a common disorder. Who is at highest risk? Women of child bearing (and rearing) age. How common is it? Some studies suggest that 1 in 3 women may experience depression at some point in their life. Given this, I am writing a three-part series on moms and depression (in the near future I will do a similar series on dads and depression) – starting with the fundamental questions of why moms are at high risk, and which moms are at highest risk.
Let’s start with the first question: why do so many moms get depressed? A first reason is that women in general are at higher risk for depression than men (or technically speaking, higher risk for being diagnosed with depression). This gender difference becomes evident during adolescence (the most typical developmental period for the first onset of depression) and women are around twice as likely as men to experience depression. It’s not entirely clear why this is the case. There has been of course lots of research on female hormones and how they might partly explain this phenomenon, but to date the specifics remain elusive. That said, the bottom line is that being a female increases your risk of developing depression, starting during the teen years.
A second reason is the very real phenomenon of postpartum depression. Although the reported rates of postpartum depression can vary widely across studies, it is clear that a significant number of women experience some level of depressive symptoms after birth, and many (somewhere between 5% and 20%) experience some form of detectable postpartum depression.
A third reason is that the stress of being a mom can also increase the risk of depression. The sources of stress can be many and include physical stresses – for example, lack of sleep. Many women take on a number of new tasks and responsibilities with a new baby (whether they are working or not) and depression often results from accumulating stresses.
These are three basic reasons why many moms experience symptoms of depression. But what about the next question: why do some moms get depressed when others don’t?
One of the key factors is genetics. Although it’s not possible to screen for genetic risk for depression – especially since it is assumed that many genes contribute to risk for depression – some of the most persuasive work over the past decade has shown that specific “candidate” genes exert their influence during times of stress. So even though every mom has a lot of stress, one’s genetic make-up makes some women more likely to be susceptible to feeling depressed in the face of stress. Embedded in this risk is the very strong effect of having grown up with a depressed mom, which substantially increases the risk of developing depression, especially depression with an early onset (in the teen years).
A second important factor is the history of depression prior to becoming a mom. One of the features of depression is that it is likely to recur – each episode of depression increases the risk for a future episode (which often times is more severe than the last one). So if a woman has suffered from depression prior to becoming a mom, she is at higher risk of having another episode sometime in the future – including the time period when she is raising a child.
To review, there are two key points for moms (or moms-to-be). First, if you are female, you have a higher risk for depression than males (which is important to keep in mind because depression is so common). So any mom is, in some sense, at elevated risk for developing depression. But moms who have a family history of depression (especially in their mom) and/or have experienced prior depressive episodes are at especially high risk. Given all this, my next post will focus on how to recognize the signs of depression – especially those that might not be that obvious.
Image of sad woman via Shutterstock.com
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Monday, June 20th, 2011
My last two posts discussed recent studies that indicate how maternal depression can have a direct environmental effect on children. Today, I focus on the flip side: if moms get treatment that reduces their depression, there is good evidence that there are immediate benefits for their children.
Dr. Judy Garber and colleagues have added to this literature in a recent paper published in Child Development. They tracked parents (over 70% were moms) who were in treatment for depression along with their children (between 7 and 17 years of age) multiple times over a two-year period. The key take-home messages for parents were:
- reductions in parent depression were associated with immediate reductions in children’s depressive symptoms
- children of treated parents also showed improvements in social and academic functioning
- part of the improvement was due to parents becoming more accepting (and less critical) of their children
This study did not focus on a particular type of treatment for depression — treatment included drugs, therapy, and combinations. The key thing is that a mom finds a treatment that works for her – getting treatment only has a positive impact on children if the level of depression is lowered. In addition, anyone who has suffered from depression (or knows someone who has) understands that depression is episodic, so being vigilant about the recurrence of symptoms (and getting a head start on treatment) is also really important for moms.
As many moms indicated in multiple eloquent comments in response to my last post (see the Parents magazine facebook page to read these), fighting depression is not easy, and can be even tougher if you have children. The good news is that the courage and strength shown by depressed moms, and their attempts to help themselves by getting treatment, can directly and immediately also make life better for their children.
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Friday, June 17th, 2011
In my last post, I discussed a recent study that provided new evidence on how kids with depressed moms are at risk for depression. Another study (from the same issue of the Journal of the American Academy of Child and Adolescent Psychiatry) has provided novel evidence that some of this risk is environmental. First I’ll explain what they found — and then discuss why it’s important.
The researchers examined families in which children were conceived by assisted reproduction. In some families, the mom was biologically related to her child; in others, she wasn’t. From the scientific perspective, this is a modern twist on the adoption study method. The study could then look at the links between maternal depression and symptoms of depression in their kids when there was — and wasn’t — a genetic relationship between them.
They found significant associations between moms’ levels of depressive symptoms and those in their children, both in childhood and in early adolescence. These associations were not influenced by the genetic relationship — they were similar whether or not the mom was the biological mom. The conclusion is that there is an enviromental effect of being exposed to mom’s depression.
I feel that it is really important to highlight environmental pathways these days. So much of the scientific climate has been directed to genetic effects (on nearly everything). Certainly genes will play a role in determining which children and adolescents go on to suffer from recurrent or severe depression. There is also a long history of interest in “gene-environment” interaction — some youth may be genetically resilient to exposure, whereas others may be highly sensitive to it. All that said, there have been a number of studies over the last two decades that demonstrate purely environmental effects on depressive symptoms in children and young adolescents (I’ve done some of this work myself). And the important thing about that replicated finding is that is suggests there may be immediate ways of changing the environment to improve the emotional well-being of kids who have a depressed mom.
In my next post, I will focus on research that shows what happens to kids when their moms get treated for depression. Teaser: it’s a good thing for them.
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