Brain Tissue Signals Increased Risk Of Inherited Depression

In cases of familial depression, changes in tissue thickness in key brain structures in the right half of the brain may increase a person's risk for developing depression, according to NIMH-funded researchers. Similar changes in the left half of the brain were linked to the severity of a person's existing depression or anxiety symptoms. Based on their findings, the researchers proposed a possible mechanism for how these brain changes affect depression risk in the Proceedings of the National Academy of Sciences.
Background
Some types of depression run in families, and certain changes in brain structure and function have been observed in people with the disorder. However, until recently, scientists have been unclear on the exact relationship between these brain changes and depression.
Building on previous research with a three-generation study population, Myrna Weissman, Ph.D., and Bradley Peterson, M.D., both of Columbia University College of Physicians & Surgeons and New York State Psychiatric Institute, and colleagues used magnetic resonance imaging (MRI) to assess brain changes in 131 people, ages 6-54. Roughly half of these participants were considered at high risk for major depressive disorder (MDD), due to having at least one parent or grandparent in the study diagnosed with the illness. The other half, considered at low risk, had no family history of the illness.
Results of the Study
From pre-scanning interviews, the researchers found that people in the high-risk group were more likely than those in the low-risk group to report having MDD or an anxiety disorder at some point in their lives. MRI scans showed that, on average, those in the high-risk group had 28 percent thinner brain tissue across a broad range of brain structures in the right half of the brain. These changes were observed in young children in the high-risk group and in older high-risk individuals who had never suffered from MDD or an anxiety disorder themselves.
The brain areas most affected by this thinning govern attention and the ability to process emotional or social cues (such as faces or family pictures). In tests involving these right-brain tasks, the researchers found that thinner tissue in these areas was linked to greater inattention and poorer performance in immediate and delayed visual memory.
Similar patterns of tissue thinning in the left half of the brain appeared to be related to the severity of a person's existing MDD or anxiety disorder symptoms in both the high- and low-risk groups. This thinning was not as pronounced as the thinning in the right half of the brain, and the difference in tissue thickness between the high- and low-risk groups was not statistically significant.
Significance
The findings strongly suggest that changes in tissue thickness in the right half of the brain directly affect a person's inherited risk for developing MDD. The pattern of tissue thinning appears to be related to problems with attention and processing of emotional or social signals. Such problems may increase a person's vulnerability to developing mood or anxiety disorders, according to the researchers.
That the thinning was present in people at high risk, but who had never had MDD or an anxiety disorder, as well as in high-risk children who had not been diagnosed with depression, shows that these brain changes likely come before illness onset and that they occur very early in life, possibly before birth, say the researchers. Furthermore, while thinning in the right half of the brain contributes to risk, thinning in the left half of the brain appears to be required in order for a person to show symptoms of these illnesses.
What's Next
More research is needed to determine if the inherited risk for MDD is purely genetic, if there are specific environmental factors necessary for triggering genetic risk, or whether there is a combination of factors involved. Increased understanding of how risk translates into developing MDD or other mental disorders may lead to new methods of diagnosing, treating, or preventing these illnesses.

Black America Urged To Confront Depression

Experts in mental health, Members of Congress and other prominent African Americans converged at the Congressional Black Caucus Foundation’s 2007 Annual Legislative Conference to shed light on issues surrounding %26quot;Black Women Surviving Unmet Mental Health Needs.%26quot; Rep. Julia Carson (D – IN) together with the Depression Is Real Coalition hosted this special session with keynote speakers Eddie Levert, legendary singer of The O’Jays, and Terrie M. Williams, mental health advocate and acclaimed author.
Eddie Levert, for the first time, passionately lent his voice and visibility to the cause of mental health in Black America and demonstrated his commitment to speaking out about the effect of depression as witnessed and experienced in his family.
"Black women have always taken care of us — their men, their children, and their community. I have seen first-hand the damaging effects of depression, and it’s past time we support our women and educate the black community to recognize depression for what it is — a medical illness that is nothing to be ashamed of," said Levert.
According to a survey conducted by Mental Health America, 63 percent of people in the African American community believe depression is a personal weakness, while only 31 percent believe it is a medical health problem.
"One thing about black women is that they are survivors," said Rep. Carson. "But we need to do more than survive — we need to solve a growing crisis among black women who remain silent about this disease in an effort to appear strong. I want black women to find the healing they deserve which will help our families and communities prosper like never before."
"Black women are significantly impacted by mental health problems and yet are reluctant to acknowledge that depression is a serious, biologically-based disease," said Altha Stewart, MD, president of the American Psychiatric Foundation, a founding member of the Depression Is Real Coalition. "Depression can be especially devastating because it is linked to other medical conditions experienced by black women in high numbers, including obesity, high blood pressure and heart disease. And, left untreated, depression can be fatal. We need to do all we can to encourage black women to confront their depression and ensure they get the health care they need."
Depression disproportionately impacts black women:
– Depression among black women is almost 50% higher than it is among white women.
– Of black women suffering from depression, only 7% receive treatment compared to 20% of white women.
– Black women are twice as more likely to suffer from depression than black men.
Terrie M. Williams, author of the forthcoming book Black Pain: It Just Looks Like We’re Not Hurting, commented, "My hope is that black women and all of Black America will take a painfully honest look at a silent killer in its own community — depression. The worst part is that we ourselves are often unaware that we suffer from depression, or – if we know it – too ashamed to admit it and seek help. And until we address the reality of this illness, many of us can’t begin to tear down the other obstacles that hold us back."
In addition to Dr. Stewart, experts who joined today’s panel include Rahn Bailey, MD, National Medical Association; Lynne Saunders, National Alliance on Mental Illness; Gina Villani, MD, National Urban League; and Angela M. Burks, JD, Kelley School of Business, Indiana University.
Panelists addressed a number of issues surrounding mental health and black women, including health care disparities; depression and its link to breast cancer; workplace depression; the role of families in mental health care; as well as the racism, gender bias, poverty, and social disadvantages women of color experience that can lead to depression and stress.
The Depression Is Real Coalition, a group of seven preeminent medical, advocacy and civic groups, co-sponsoring today’s braintrust, has made it its mission to dispel popular misconceptions that trivialize one form of mental illness in particular, depression — as "just the blues" or dismiss it entirely as an "imaginary disease." Depression affects more than 19 million Americans per year.
The Depression Is Real public education campaign is sponsored by The American Psychiatric Foundation (a philanthropic and educational subsidiary of the American Psychiatric Association), the Depression and Bipolar Support Alliance, the League of United Latin American Citizens, Mental Health America, the National Alliance on Mental Illness, the National Medical Association, the National Urban League and is made possible through the support of Wyeth.

Postpartum Depression is Real for Fathers, Too

Traditionally, postpartum depression among women was thought to be primarily due to hormonal changes that occur during pregnancy and childbirth, but new studies suggest that it is not just mom who gets the “baby blues.” New fathers are also at risk for depression after childbirth.
Researchers performed an analysis of 43 studies that involved over 28,000 new fathers. About 10% of men whose partners who are pregnant or have recently given birth report symptoms of depression. This is about twice the usual rate of depression in men. The peak period for paternal postpartum depression is when the baby is 3 to 6 months old, according to the study published in the current issue of the Journal of the American Medical Association. About 25% of fathers reported depression during this time.
Read: Postpartum depression is Part of Mental Health Awareness
Further research suggests Dad's depression may express itself differently than Mom's. Men are more likely to be irritable, angry, or withdrawn instead of the sadness that is typically seen with female depression. Family members should look for these behaviors as "red flags," the authors write.
Research authors Gregory Simon, a psychiatrist with Group Health Research Institute in Seattle, and James Paulson of the Eastern Virginia Medical School say they still need more research to determine the cause. The most likely reason is the onset of stress that occurs with any major life change. Paulson says, “Going from being a single person to a parent is a real shock, and certainly both parents trying to cope with a big change in life can be stressful.”
Other factors that may play roles in the increase in depression symptoms include financial stress, relationship changes between partners, and sleep deprivation. Behavioral changes in the child also occur during this period, such as crying or being more demanding for attention. Paulson also speculates that the timing of the depression correlates with the ending of maternity leave, which is typically between 6 weeks and 3 months after childbirth.
While many fathers may try to ignore the signs of depression, the authors warn against it. Depression from either parent can have a “cascading effect “ throughout the entire family. "There's evidence growing that depression in fathers is negative for children, and increases the risk of emotional and behavioral problems," says Paulson. Women are also more likely to become depressed when the male shows symptoms.

How Culture May Affect Depression Diagnosis

A new study of depression from the Center for Addiction and Mental Health examines the widely held expectation that East-Asian people emphasize physical symptoms of depression, and offers clinicians valuable insight into cultural context when assessing a patient, leading to more accurate diagnosis.
New data may help doctors more accurately diagnose patients who may be suffering from depression.
The expectation that East-Asian people emphasize physical symptoms of depression (e.g. headaches, poor appetite or aches/pains in the body) is widely acknowledged, yet the few available empirical studies report mixed data on this issue. A new study from the Centre for Addiction and Mental Health (CAMH) debunks this cultural myth, and offers clinicians valuable insight to into cultural context when assessing a patient, leading to more accurate diagnosis.
Lead by CAMH Clinical Research Director Dr. R. Michael Bagby, in collaboration with Dr. Andrew Ryder, Concordia University, Steven Heine, University of British Columbia and a number of collaborators from Second Xiangya Hospital of Central South University, People’s Republic of China, this study recruited more than 200 participants, half from an outpatient clinic in China, and half from a clinical research department outpatient clinic at CAMH, and tested two central hypotheses: 1. East-Asian participants will emphasize somatic or physical symptoms of depression more than North American participants, and 2. North American participants would emphasize psychological symptoms of depression (e.g. report feeling sad, crying spells, or a loss of self-confidence) more than East-Asian participants. Dr. Bagby and his team also wanted to examine the role stigma and alexithymia (difficulty using words to describe emotions) play in how each culture presented and expressed depression symptoms.
This rigorous work is one of only a few studies to address these questions with a direct cross-cultural comparison of clinical patients. Also, it is the only study to use three assessment tools (spontaneous report of problems during unstructured discussion with doctor; clinician-rated symptoms in a structured clinical interview; and a symptom rating scale in questionnaire form) translated into both English and Chinese (Mandarin) and modified to address cross-cultural differences.
As Dr. Bagby explains, “the onset of depression triggers a biological response that takes place within a specific social context, resulting in a cascade of somatic and psychological experiences that are interpreted through a particular cultural lens. Careful translation and adaptation of our assessment tools helped us clarify if different approaches lead to different symptom profiles and conclusions about patients.”
Overall, the data demonstrate a consistently greater level of psychological symptom reporting in the North American sample, regardless of assessment tool. This suggests a tendency for Western cultures to emphasize psychological symptoms of depression (psychologization), rather than a tendency for those from East-Asian cultures to emphasize physical symptoms (somatization).
East-Asian participants did report a significantly higher level of somatic symptoms when reporting through the spontaneous interview and structured clinical interview. Also, these participants reported higher levels of stigma and alexithymia. A refined examination of this link revealed that the observed cross-cultural differences in somatic symptom scores relates, in part, to cultural differences in internally versus externally oriented thinking. This suggests that people who do not frequently focus on their internal emotional state are more likely to notice somatic symptoms.
While this data may help clinicians be more aware of how culture can impact how people talk about their illness, this data does not constitute a norm for depression worldwide. More work should be done to understand the interaction of biology, culture and individual differences in predicting variations in how people present symptoms of depression.

Red Clover May Relieve Depression in Older Women

Depression and anxiety are common among older women, and those who want to avoid drugs as treatment may want to consider red clover. A new study from Austria found that symptoms of depression were reduced by about 80 percent after older women took the supplement for 90 days.
The randomized, double-blind, placebo-controlled trial enrolled 109 post-menopausal women older than age 40 who received either a red clover supplement (80 mg of red clover isoflavones) or a placebo. The supplement used in the study contained isoflavones in their aglycone form, and specifically the compounds biochanin A, formononetin, genistein, and daidzein.
Among the women who took red clover, anxiety was reduced by 76 percent and depression by 78 to 80 percent. Women in the placebo group experienced a decrease in anxiety and depression of about 21 percent.
Whenever the topic of treatment with red clover is raised, some people voice concern about the possible risk of breast cancer, as red clover contains phytoestrogens. Based on data gathered during a recent (2009) European Food Safety Authority working group that investigated isoflavones, the experts concluded that red clover-derived isoflavones do not increase the risk of breast cancer and in fact provide real relief for post-menopausal women.
Red clover has been the subject of much scientific investigation. Some research has suggested that the herb may help protect against heart disease, with red clover isoflavones showing an ability to increase “good” high-density lipoprotein (HDL) cholesterol in pre- and post-menopausal women.
Other studies have suggested that red clover isoflavones may slow bone loss in pre- and post-menopausal women, but this has not been definitively determined. Red clover is also being investigated for its possible use in preventing cancer. Traditionally, red clover ointments have been used to treat eczema, psoriasis, and other skin problems.
Results of this new study may be good news for older women who suffer with depression and who want to avoid treatment with a prescription drug. Women who are interested in red clover to treat depression should talk to a knowledgeable professional. It is important to remember that extracts of red clover isoflavones are not the same as the whole herb. In fact, extracts of red clover isoflavones are only a small, highly concentrated part of the entire herb.