In a recent medical newsletter, I came across this article on Project GenRED, a large NIH-sponsored effort to identify genes for recurring major depressive disease, which "operates on the premise that genes for early-striking disease are probably more obvious than later types."
This is all great news for me and many of you, because chronic depression or recurrent depression, is often in a category all by itself, because we have to live with symptoms just as those who have cancer, diabetes, or arthritis. Here's what the article said:
When Francis Mondimore began to interview patients whose first of many bouts with serious depression came at a fairly tender age—before their 30s—he didn’t expect this response: They were bewildered.From his years in the clinic, psychiatrist Mondimore had hunches about lasting depression. But they didn’t become truth until he joined the Hopkins arm of a large NIH-sponsored effort to identify genes for recurring major depressive disease. “The Genetics of Recurrent Early-Onset Depression,” or GenRED project, operates on the premise that genes for early-striking disease are probably more obvious than later types. As part of GenRED, Mondimore began assessing patients, recording their history, writing comments. And that’s when his “interview troubles” appeared.
At fault was the list of standard questions: When was your most severe episode of depression? and When did that episode start? When did it stop? “Every few patients, I’d get someone who’d look at me blankly and say, ‘Episode? I don’t know what you mean. There are no episodes; I’ve been depressed as long as I can remember!’ It became clear,” Mondimore explains, “that the questionnaire didn’t capture everyone’s experience. For some, it’s like asking them exactly when friendship stops and love begins.”
And meetings when Mondimore and colleagues would read each others’ interviews and assign diagnoses became equally troublesome. Of three patients with nearly identical histories, says Mondimore, one would get the diagnosis of a very long single episode of major depression. Another would get labeled with the chronic, low-level symptoms of dysthymia. The third had frequently recurring major depression. “Standard psychiatric descriptions would just fall apart,” he says.“On the other hand, if you looked at the boxes on the study’s questionnaire marked ‘chronic’ or ‘not chronic,’ everyone could agree on that.”
Far more than just a relative handful of patients didn’t fit standard categories, Mondimore says. Both GenRED and an earlier, respected nationwide study showed that a significant number—as many as a quarter of those with major depression—live with it without much pause for years. “It’s not an acute illness for them,” he adds.
So Mondimore, colleague James Potash and a national team examined data from all of GenRED’s 630 families in a new light, picking out only those with the “chronic” box checked. What’s appeared is a new, genuine subtype of major recurring depression, one where genes play an intrinsic part, especially if struggles begin before adolesence. Further, they found, these chronic patients are at greater risk of substance abuse, suicidality and panic disorder.Does knowing all this affect treatment? “Yes,” says Mondimore. “For one thing, it justifies not trying to taper some patients off antidepressants. But it also means you re-educate them to view their illness more like diabetes, as a problem to be managed over time. If blood sugar levels jump, for example, you don’t ask, ‘has the insulin stopped working?’ You look at what’s going on in a patient’s life, at what needs to change to get better control.”
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Does knowing all this affect treatment? “Yes,” says Mondimore. “For one thing, it justifies not trying to taper some patients off antidepressants. But it also means you re-educate them to view their illness more like diabetes, as a problem to be managed over time. If blood sugar levels jump, for example, you don’t ask, ‘has the insulin stopped working?’ You look at what’s going on in a patient’s life, at what needs to change to get better control.”
Thank God!!! Isn't this exactly what we have been screaming for; an acceptance of our disease as being no different from other physical ailments? This sounds like at least a step in that direction, one which might lead to earlier intervention and/or better and more advanced treatments(Dare I say an eventual cure?)
Acceptance would be such a gift along with ending the blame to those of us suffering with depression or BPD for the demise of families and relationships. In so many articles I've read, even medical ones, our behavior is held responsible for that destruction and loss. "It destroys families, wrecks havoc on the home life..." While other illnesses rouse compassion in others, why doesn't ours? All kinds of illnesses effect the dynamics between people. I've lived with a terminal cancer patient, a diabetic father, a daughter with epilepsy and a mother with chronic heart disease. Did I ever have to do things that were uncomfortable when they needed care? Sure. Would it ever have been appropriate to begrudge them because of the adaptations we had to make to accommodate their care? No. Would I have continued to be angry at them once their diagnoses were given about the behavior I saw when they were in the throes of symptoms? Of course not. I'm still grieving for the changes in my family, and I've come to realize seeing me as the bad guy who ruined our home life is not the case. The last thing we need is guilt!
Therese,
In case I have never told you I appreciate all the "research" you do for those of us who suffer depression and other ailments.
You always give us just enough of an article to make the decision if it is something we might want to read further and then you provide the way to the complete article.
Just wanted to thank you for the hard work you do.
Nan
This is a life I do not care for ...seems every minute I have to keep boosting my moral...I did not ask for this...my children, grown, do not understand and get angry with me. I can fake smiles so well I need an award...
Dear Margaret, from your mouth to God's ears! Yes, a step in the right direction to be sure. There are a lot of people in my life that I have to be strong for. Am I ever lucky God has broad shoulders!!! I've been keeping his e-mail busy lately, and gaining inspiration in the quiet moments, and counting you BB readers among my blessings! (\oo/)
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