Depression After Childhood Abuse May Be Linked To A Specific Gene







 

A new study suggests that a variant of a recently discovered gene may double the risk of lifelong depression after childhood abuse.


 

 

CHRONIC DEPRESSION AFTER CHILDHOOD ABUSE MAY BE LINKED TO A NEW GENE

The age-old debate about “nature versus nurture” has become increasingly complicated as we continue to learn more about the impact of individual genes on our risk for various illnesses.  While it has become widely accepted that specific genetic patterns may predispose some of us to a very high risk of certain physical illnesses, such as cancer and cardiovascular disease, the potential linkage between specific genes and the risk of mental illness has been less clear.  At the same time, however, it has long been known that some mental health disorders, including depression, anxiety disorder, panic disorder, bipolar disorder, and schizophrenia, tend to run in families, which suggests that there may be at least some genetic component to these illnesses.

Over the past 5 years, fundamental new research has begun to suggest that certain genes may indeed be associated with an increased risk of specific mental illnesses.  However, most mental health experts believe that having a specific form of a gene linked to mental illness does not, by itself, mean that an affected individual faces a 100 percent risk of developing a mental illness.  Getting back to that “nature versus nurture” debate once again, it appears that having a genetic variant associated with a specific mental health illness probably predisposes an affected person to develop that particular mental health disorder, but does not guarantee that this will happen.  More specifically, an individual person’s experiences and environment during early life (i.e., the “nurture”) appear to have a significant impact on whether or not genes associated with an increased risk of mental illness (i.e., the “nature”) will actually lead to the development of mental illness.

Now, a newly published clinical study provides strong evidence that a specific form of a single gene can significantly increase the likelihood of major depression in adults following physical abuse during childhood, while another variant of this same gene appears to decrease the risk of chronic depression in similarly abused adults.  This intriguing research study appears in the current issue of the Archives of General Psychiatry.

This new research study was inspired by previous research with laboratory animals that identified a network of neurons in the brain that use chemicals called endocannabinoids to communicate with each other.  (If the word “endocannabinoid” sounds vaguely familiar, it is because these naturally occurring neurotransmitters in the brain also have counterparts in the plant world, most notably in cannabis, or marijuana, plants!)  Previous research has also suggested that the endocannabinoid system in the brain may play an important role in adaptation to stress, including the moderation of our mood following stressful events.

In this new study, two groups of patient-volunteers were included.  The first group consisted of 1,041 young adult female twins in the United States, while the second group consisted of 1,428 Australian adults known to be addicted to heroin. (An additional 506 Australian volunteers without heroin addiction participated in this study as the control group for the heroin-addicted volunteers.)  The presence of depression, and in particular, depression with anhedonia (a term that indicates the inability to enjoy experiences that most of us find pleasurable), was assessed among all of these patient-volunteers.  The absence or presence of a history of physical abuse, by a parent or caregiver, during childhood was also evaluated.  Testing of the gene which codes for the human endocannabinoid receptor in the brain was performed on all of these research volunteers, as well.

The findings of this study were highly significant.  Not surprisingly, the study volunteers who reported having experienced significant childhood physical abuse had a much higher incidence of depression when compared to those volunteers who did not experience physical abuse as children.  Among the volunteers who had experienced significant physical abuse during childhood, a single, specific variant of the endocannabinoid receptor gene appeared to be highly protective against anhedonic depression when compared to volunteers who possessed the more common variant of this gene.  Specifically, only 29 percent of abused volunteers with this less common variant of the endocannabinoid receptor gene experienced anhedonic symptoms, while 57 percent of the previously abused volunteers with the most common form of this same gene were found to have symptoms of anhedonic depression.

The findings of this study strongly suggest that certain naturally occurring variants of specific genes may either increase or decrease the risk of mental illness (and in the case of this clinical study, major depression with anhedonia) following stressful experiences earlier in life.  Not only do this study’s findings suggest a method of screening patients who might be at significantly increased risk for major depression following stressful events in their early lives, but the linkage of a specific gene within the brain’s endocannabinoid system with depression following traumatic childhood experiences may someday allow for a more effective treatment for post-traumatic major depression, using medications targeted at the specific genetic variation that leads to this increased risk of depression following childhood trauma.


At this time, more than 8 percent of Americans are unemployed.  According to the Bureau of Labor Statistics, however, the unemployment rate for veterans who served on active duty between September 2001 and December 2011 is now more than 12 percent.  A new website, Veterans in Healthcare, seeks to connect veterans with potential employers.  If you are a veteran who works in the healthcare field, or if you are an employer who is looking for physicians, advanced practice professionals, nurses, corpsmen/medics, or other healthcare professionals, then please take a look at Veterans in Healthcare. As a retired veteran of the U.S. Army, I would also like to personally urge you to hire a veteran whenever possible.

 

For a groundbreaking overview of cancer risks, and evidence-based strategies to reduce your risk of developing cancer, order your copy of my bestselling book, “A Cancer Prevention Guide for the Human Race,” from AmazonBarnes & NobleBooks-A-MillionVroman’s Bookstore, and other fine bookstores!

Within one week of publication, A Cancer Prevention Guide for the Human Race was ranked #6 among all cancer-related books on the Amazon.com “Top 100 Bestseller’s List” for Kindle e-books. Within three months of publication, A Cancer Prevention Guide for the Human Race was the #1 book on the Amazon.comTop 100 New Book Releases in Cancer” list.




Disclaimer:  As always, my advice to readers is to seek the advice of your physician before making any significant changes in medications, diet, or level of physical activity


 

Dr. Wascher is an oncologic surgeon, professor of surgery, cancer researcher, oncology consultant, and a widely published author


 

I and the staff of Weekly Health Update would again like to take this opportunity to thank the more than 100,000 health-conscious people from around the world who visit this premier global health information website every month.  (More than 1.3 million pages of high-quality medical research findings were served to the worldwide audience of health-conscious people who visited Weekly Health Update in 2011!)  As always, we enjoy receiving your stimulating feedback and questions, and I will continue to try and personally answer as many of your inquiries as I possibly can.


 











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Deep Brain Stimulation May Help Severe, Refractory Depression

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DEEP BRAIN STIMULATION MAY HELP SEVERE, REFRACTORY DEPRESSION

Depression is both a common and a potentially very serious mental health disorder.  According to the Centers for Disease Control (CDC), nearly 10 percent of the adult population in the United States can currently be classified as having active depression, and approximately 4 percent of the population currently meets criteria for severe, major depression.

The incidence of depression varies considerably between different groups of people.  For example, women are 70 percent more likely than men to experience depression.  Although depressed women are more likely than men to attempt suicide, men are far more likely to be successful in their suicide attempts.  Other high risk groups include people between the ages of 45 and 64 years, people from ethnic minority groups, people with less than a high school education, people who are divorced and who have not remarried, the unemployed, and those without health insurance.  (Clearly, in view of the still ongoing recession in the United States, the number of people in several of these high-risk categories has increased significantly over the past four years.)

There are multiple effective therapies available or depression, including antidepressant medications, psychotherapy, and electroconvulsive therapy (ECT).  More recently, transcranial magnetic stimulation, vagus nerve stimulation, and other experimental treatments have been evaluated in patients with depression that fails to respond to conventional therapies.  Another recently developed experimental therapy for severe, refractory depression is deep brain stimulation (DBS).  In small pilot studies, small numbers of patients with severe depression, and who have failed every other form of depression treatment (including ECT), have had surgically implanted electrodes placed into their brains, followed by electrical stimulation of their brains through these deep brain electrodes.  While it is too soon to conclude that DBS is both safe and effective in the management of severe, refractory depression, a new prospective clinical research study suggests that DBS may, indeed, produce significant remissions in refractory major depression.  This newly published study appears in the current issue of theArchives of General Psychiatry.

In this small but innovative clinical trial, 10 patients with major depression and 7 patients with bipolar disorder underwent surgical implantation of deep brain stimulation electrodes into both hemispheres of the brain.  Initially, all patients underwent simulated (“sham”) DBS, without the patients’ knowledge.  (This sham stimulation was done to test whether or not the patients’ expectation of benefit, or a true potential benefit simply from having the electrodes surgically placed, might have influenced their depression independent of actually stimulating their brains.)  Following 4 weeks of sham stimulation, all patients then initially received 24 weeks of actual DBS.  Following this period of actual DBS, active stimulation of the deep brain electrodes was then temporarily stopped.  (Once again, this discontinuation of active DBS was not revealed to the patients.)  These patient volunteers were then treated with DBS and monitored for up to 2 years.

In this group of patients who had previously failed, literally, all other forms of conventional therapy for their severe depression, DBS was associated with complete remission of depression in 18 percent (3) of the patients, and a significant improvement in depressive symptoms was observed in 41 percent (7) of the patients after 24 weeks of active DBS.  After 2 years of active DBS, 12 patients remained in the study, and 92 percent (11) of these patients experienced significant improvement in their depressive symptoms, including 58 percent (7) who experienced a complete remission of their depression!

The findings of this small prospective, controlled clinical research study are both dramatic and important, and for several reasons.  First of all, the clinically significant improvement seen in almost all of these patients is extraordinary in view of the severity of their depression and the completely refractory nature of their depressive symptoms.  Secondly this study included several patients with bipolar disorder, a disease which is characterized by alternating episodes of mania (a state of extreme mental and physical hyperactivity) and depression.  (Earlier studies of DBS had suggested that this treatment might not be as effective in patients with bipolar disorder, and might also lead to an increased risk of episodes of mania.  However, in this small pilot study, DBS was as effective in treating the symptoms of depression in patients with bipolar disorder as it was in patients with depression alone.  Moreover, DBS did not appear to increase the likelihood of episodes of mania in patients with bipolar disorder.)

 

Depression is a common mental health disorder, and severe cases of depression can leave patients feeling miserable and hopeless.  In especially severe cases, depressed patients may be unable to function in their daily personal or professional lives.  For some unfortunate patients with depression, suicide or accidental causes of death may also end their lives prematurely.  Based upon the findings of this small, preliminary clinical study, DBS may be a safe and effective treatment option for patients with chronic, severe, and refractory depression.

 

If you are depressed, and you are having thoughts about harming yourself (or harming someone else), please immediately contact your mental health provider, a suicide hotline, your personal physician, a close and trusted friend or relative, or your clergy person.  Even during times when you feel like there is no hope that life will get better for you, it almost always will get better if you get some help.

 


For a groundbreaking overview of cancer risks, and evidence-based strategies to reduce your risk of developing cancer, order your copy of my new book, “A Cancer Prevention Guide for the Human Race,” from AmazonBarnes & NobleBooks-A-MillionVroman’s Bookstore, and other fine bookstores!

On Thanksgiving Day, 2010, A Cancer Prevention Guide for the Human Race was ranked #6 among all cancer-related books on the Amazon.com “Top 100 Bestseller’s List” for Kindle e-books! On Christmas Day, 2010, A Cancer Prevention Guide for the Human Race was the #1 book on the Amazon.comTop 100 New Book Releases in Cancer” list!


Disclaimer:  As always, my advice to readers is to seek the advice of your physician before making any significant changes in medications, diet, or level of physical activity


Dr. Wascher is an oncologic surgeon, professor of surgery, cancer researcher, oncology consultant, and a widely published author


For a different perspective on Dr. Wascher, please click on the following YouTube link:

Texas Blues Jam


I and the staff of Weekly Health Update would again like to take this opportunity to thank the more than 100,000 health-conscious people from around the world who visit this premier global health information website every month.  (More than 1.3 million pages of high-quality medical research findings were served to the worldwide audience of health-conscious people who visited Weekly Health Update in 2011!)  As always, we enjoy receiving your stimulating feedback and questions, and I will continue to try and personally answer as many of your inquiries as I possibly can.


 




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Physicians and Mental Illness

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New research confirms that physicians frequently suffer from mental illness, and are more reluctant than non-physicians to seek help.



PHYSICIANS AND MENTAL ILLNESS

While physicians are less likely than the general population to die from heart disease or cancer, we doctors are significantly more likely to die from suicide than our lay brothers and sisters.  Indeed, a very troubling statistic is that suicide is the second most common cause of death among medical students (accidents are the number one cause of death).

Multiple studies have shown that physicians are at greater risk of developing significant mental health problems when compared to the general population, including depression and bipolar disorder.  Physicians also have higher rates of alcoholism, and other forms of substance abuse, when compared to the general public.  Although the potential reasons behind this higher incidence of mental illness among physicians continue to be debated, most experts agree that doctors with mental health problems are notoriously reluctant to seek help.  They often do not recognize that they are ill, in the first place; and when they do become aware that they are not well, they are less likely than non-physicians to seek professional help.  Moreover, there are still tremendous stigmas associated with mental illness among health care professionals, causing many impaired physicians to avoid reaching out for help.  As if these adverse factors that discourage physicians from seeking help are not already bad enough, most state medical boards require physicians to disclose whether or not they have ever been diagnosed or treated for a mental illness (or substance abuse) as a precondition for initial licensure or renewal of an existing medical license.  (In many cases, disclosing a prior or current history of mental illness, even if the physician is receiving appropriate treatment, can result in very negative professional and financial consequences for physicians who disclose their history of depression or other mental health problems.)

 

 

In view of these disturbing statistics regarding physicians and mental illness, I find the results of a newly published clinical research study to be quite revealing (and disturbing).  In this study, 108 physicians were asked to confidentially complete a 56-item questionnaire that assessed their distress levels and their willingness to accept various forms of assistance for their feelings of severe distress.  This study appears in the current issue of the Archives of Surgery.

Within the preceding year, fully 79 percent of the surveyed physicians had experienced either a serious adverse patient event or a traumatic personal event that left them feeling very distressed.

When asked about their willingness to seek support or assistance regarding stressful issues in their lives, 72 percent of the doctors indicated that they would be willing to seek help for legal problems, while 67 percent would do so after being involved in a serious medical error.  Another 67 percent of the physicians were willing to seek help for substance abuse issues, while 62 percent were open to seeking medical help for physical illness.  Tellingly, only half (50 percent) of the physicians indicated that they would seek help for mental illness, and an equally small number also indicated that they would be open to assistance regarding serious interpersonal conflicts at work.

When asked about barriers to seeking help, 89 percent of the doctors indicated that they did not have time to get help with the causes of their distress, while 69 percent also responded that they were either uncertain about how to get help or that they had experienced difficulty in obtaining assistance.  A total of 68 percent of the physicians also cited lack of confidentiality, a potentially negative impact on their career, and the stigma associated with seeking help as barriers.

Regarding the most likely sources of support that they would be willing to seek, 88 percent expressed a preference for their physician colleagues, while only 48 percent were willing to be seen by mental health professionals, and only 29 percent were open to participating in employee assistance programs.

 

 

The findings of this study are hardly surprising.   The prevalence of major distress and mental health issues among physicians continues to be very high, relative to the general population.  At the same time, only half of the physicians participating in this study indicated a willingness to seek help for mental health problems.  Similarly, only half of these doctors would be willing to seek help for serious interpersonal difficulties (a common marker for certain psychological and personality disorders) in the workplace.  Among the most often cited reasons for not seeking help were “lack of time” and uncertainty about how to obtain help.  Additionally, the physicians who participated in this confidential study expressed serious concerns regarding confidentiality, the potential for negative career impact, and the perceived stigma associated with asking for help for mental health issues.

 

 

From my own experience as a physician over the past 23 years, I can honestly say that these disturbing statistics and findings regarding physician stress, distress, and mental health problems are, if anything, most likely understated.  Within the medical profession, it is no secret that the true incidence of depression, bipolar disorder, personality disorders, interpersonal strife, marital duress, domestic abuse, and divorce is very high among physicians, in comparison to the general population.  Ironically, and unfortunately, however, as bad as the stigma associated with mental illness is in the general public, it is even more severe within the medical profession.

Over the years, I have known numerous physicians with various forms of mental illness and personality disorders, and I cannot recall a single one of them ever voluntarily reaching out to mental health professionals for help.  Sadly, in view of the strong aversion on the part of physicians with mental illness towards seeking help from mental health professionals,  proactive and progressive steps to eliminate the perceived stigma of mental health problems within the medical profession, as well as removing the potentially punitive sanctions that many physicians would otherwise be subjected to if they sought professional help, will be necessary before troubled or impaired physicians can begin to feel free to seek help and support for the problems that torment them.


For a groundbreaking overview of cancer risks, and evidence-based strategies to reduce your risk of developing cancer, order your copy of my new book, “A Cancer Prevention Guide for the Human Race,” from AmazonBarnes & NobleBooks-A-Million,Vroman’s Bookstore, and other fine bookstores!

On Thanksgiving Day, 2010, A Cancer Prevention Guide for the Human Race was ranked #6 among all cancer-related books on the Amazon.com “Top 100 Bestseller’s List” for Kindle e-books! On Christmas Day, 2010, A Cancer Prevention Guide for the Human Race was the #1 book on the Amazon.comTop 100 New Book Releases in Cancer” list!


Disclaimer:  As always, my advice to readers is to seek the advice of your physician before making any significant changes in medications, diet, or level of physical activity


Dr. Wascher is an oncologic surgeon, professor of surgery, cancer researcher, oncology consultant, and a widely published author


For a different perspective on Dr. Wascher, please click on the following YouTube link:

Texas Blues Jam


I and the staff of Weekly Health Update would again like to take this opportunity to thank the more than 100,000 health-conscious people, from around the world, who visit this premier global health information website every month. (More than 1.2 million health-conscious people visited Weekly Health Update in 2010!) As always, we enjoy receiving your stimulating feedback and questions, and I will continue to try and personally answer as many of your inquiries as I possibly can.


 




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