Depression ... or Just the Blues?

They may wish they were dead, for example, wishing they did not wake up in the morning. Worse, they may think about ways of actively harming themselves, such as by overdosing on pills, cutting themselves, hanging themselves or using a gun.

Those with thoughts of harming themselves are the group of depressed people who need immediate attention from a psychiatrist or from an emergency room staff, and they frequently need to be hospitalized for their protection until the depression comes under better control.

About a quarter of people with major depression make a suicide attempt in their lives and about 6 percent actually die by suicide.

The Roots of Depression

According to the rule book that guides how psychiatrists and mental health professionals classify mental disorder, a person must have five of the above mentioned signs and symptoms for at least two weeks in order to have a major depressive episode. And these signs and symptoms have to cause problems, such as trouble getting to work, trouble functioning at work, trouble in a marriage or trouble in one's social life.

So where does depression come from? Is it something that everybody experiences at some point?

James Potash is an associate professor of psychiatry and co-director of the Mood Disorders Program (http://www.hopkinsmedicine.org/moods) at the Johns Hopkins School of Medicine in Baltimore. If you have questions or comments, please e-mail at moods@jhu.edu. To participate in our studies, call 1-877-MOODS-JH.

Psychiatrists have long struggled with the question of nature vs. nurture in thinking about the origins of depression. And the struggle continues because the final verdict is not yet in.

The "doesn't everybody experience it at some point?" question assumes that difficulties in life -- stressors -- lead to depression, and because everybody faces them, everybody must get depressed.

We certainly see evidence for this: One woman became depressed following divorce and stayed depressed for the next 10 years. Another woman who was a teacher became depressed following being physically attacked by a student.

While the rain falls on everyone, not everyone gets wet. Some people carry umbrellas, while others do not.

Research has shown that there is a genetic susceptibility to depression. The disorder tends to run in families. And identical twins are more likely to both have depression than are fraternal twins, presumably because they share the same set of vulnerability genes, whereas the fraternal twins are only half genetically the same (just like ordinary siblings).

Our group at Johns Hopkins is conducting a study, along with five other research groups at academic medical centers around the country, where we are trying to pin down exactly which of the 25,000 genes that make up our common DNA blueprint are the ones that play a role in depression.

I will explain this work further in future columns. We are currently enrolling people with depression in the study. To participate, you have to have a sibling or a parent who also has had depression (though they will not be enrolled in the study).

We are hoping that genes will unlock doors that will lead us into biochemical pathways in the brain through which depression unfolds.

Once we have access to the inner workings of the illness, we should be better able to design new medications to help the one-third of patients who do not respond to existing antidepressants.

James Potash is an associate professor of psychiatry and co-director of the Mood Disorders Program (http://www.hopkinsmedicine.org/moods) at the Johns Hopkins School of Medicine in Baltimore. If you have questions or comments, please e-mail at moods@jhu.edu. To participate in our studies, call 1-877-MOODS-JH.

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