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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 36. This is the beginning of the thread.
Posted by violette on November 28, 2010, at 20:57:52
If Depression Isnt in Your Genes, Then Where the Heck Is It?
By Michael D. Yapko, Ph.D.
A highly publicized study published in the Journal of the American Medical Association last year (June 17th issue) challenged earlier research suggesting that depression is caused by a depression gene.
The new study reaffirmed other research associated with the Human Genome Project which also clearly indicated the lack of a single depression gene as the cause of depression. In fact, the search for a depression gene has made it clear that not only has no such depression gene been found, but no single gene will be found.
What has been found, however, is that there is a heritability, a genetic predisposition. But it is a relatively weak one that is highly modifiable by environmental factors. This is the new field called epigenetics, the study of how environmental conditions including social interaction affects gene expression.
For the people who continue to hold out hope for a purely biological cure, this is an inconvenient truth. As I have said in previous blogs, depression is much more of a social condition than a biological one, and just as there will never be a drug that cures poverty or racism, there will never be a drug that cures depression.For the people who blame their genes for their depression, they have lost scientific support for their belief that theres nothing they can do because of their presumed genetic destiny.
Lets face it directly: Depression is mostly a socialized phenomenon. We learn ways of thinking, coping, relating, being, that increase our vulnerability and put us at a higher level of risk. Depression has many causes, some of which are biological to be sure, but most of which are psychological and social. Consider these facts:
Depression is striking people at younger and younger ages.
As societies westernize, the rates of depression go up.
As relationships decline in quantity and quality, depression increases.
As people learn prevention skills, they show remarkable ability to prevent episodes from developing in the first place.
As they go through psychotherapy to learn better coping skills as well as other mood management skills, they have fewer and less severe episodes and their brains change in measurable ways.Just how much convincing does someone need to understand that focusing on the biology of depression alone isnt nearly enough?
So, if depression isnt in your genes, then where is it? It isnt anywhere and, paradoxically, its everywhere. Its in your thought processes, its in your relationships, its in your lifestyle, its in your diet, its in your level of physical wellness, its in your style of decision-making shall I go on? Yet, what people write to me about is almost always biology. They ask medication questions, they ask biochemistry questions, and they blog about herbal remedies and dietary supplements. Is this an unrealistic search for the magic cure? I think so.
With the evidence so strong that depression is largely a social phenomenon, and when the research highlights you dont have a depression gene to blame, it means people can no longer be passive, taking a drug and sitting around waiting for it to work.
The evidence is unambiguous that the more passive you are, i.e., the less you do to take active steps to help yourself out of depression, the worse youre likely to feel. Its why Im a huge advocate of active, skill-building approaches based on sound therapeutic principles affirmed by good science that shows these methods work. Ill be describing some of these in future blogs.
Posted by Conundrum on November 28, 2010, at 21:20:13
In reply to JAMA-.will never be a drug that 'cures' depression, posted by violette on November 28, 2010, at 20:57:52
My social condition, having a caring family, friends, safe neighborhood, caused my anhedonia?
If I could will myself out of anhedonia I could. Maybe some types of depression respond to therapy and changing the way you few the world. Anhedonia is the loss of pleasure. It can be the result of life situations and stress, but when there is no stressful situation, what is left? Physiology. So far no therapy has helped or come close to touching that. However just 2.5 mg prozac will make me motivated and sort of interested in things. One dose of Pristiq adds some color in my life. I think that says a lot.
> If Depression Isnt in Your Genes, Then Where the Heck Is It?
>
> By Michael D. Yapko, Ph.D.
>
> A highly publicized study published in the Journal of the American Medical Association last year (June 17th issue) challenged earlier research suggesting that depression is caused by a depression gene.
>
> The new study reaffirmed other research associated with the Human Genome Project which also clearly indicated the lack of a single depression gene as the cause of depression. In fact, the search for a depression gene has made it clear that not only has no such depression gene been found, but no single gene will be found.
>
> What has been found, however, is that there is a heritability, a genetic predisposition. But it is a relatively weak one that is highly modifiable by environmental factors. This is the new field called epigenetics, the study of how environmental conditions including social interaction affects gene expression.
> For the people who continue to hold out hope for a purely biological cure, this is an inconvenient truth. As I have said in previous blogs, depression is much more of a social condition than a biological one, and just as there will never be a drug that cures poverty or racism, there will never be a drug that cures depression.
>
> For the people who blame their genes for their depression, they have lost scientific support for their belief that theres nothing they can do because of their presumed genetic destiny.
>
> Lets face it directly: Depression is mostly a socialized phenomenon. We learn ways of thinking, coping, relating, being, that increase our vulnerability and put us at a higher level of risk. Depression has many causes, some of which are biological to be sure, but most of which are psychological and social. Consider these facts:
>
> Depression is striking people at younger and younger ages.
> As societies westernize, the rates of depression go up.
> As relationships decline in quantity and quality, depression increases.
> As people learn prevention skills, they show remarkable ability to prevent episodes from developing in the first place.
> As they go through psychotherapy to learn better coping skills as well as other mood management skills, they have fewer and less severe episodes and their brains change in measurable ways.
>
> Just how much convincing does someone need to understand that focusing on the biology of depression alone isnt nearly enough?
>
> So, if depression isnt in your genes, then where is it? It isnt anywhere and, paradoxically, its everywhere. Its in your thought processes, its in your relationships, its in your lifestyle, its in your diet, its in your level of physical wellness, its in your style of decision-making shall I go on? Yet, what people write to me about is almost always biology. They ask medication questions, they ask biochemistry questions, and they blog about herbal remedies and dietary supplements. Is this an unrealistic search for the magic cure? I think so.
>
> With the evidence so strong that depression is largely a social phenomenon, and when the research highlights you dont have a depression gene to blame, it means people can no longer be passive, taking a drug and sitting around waiting for it to work.
>
> The evidence is unambiguous that the more passive you are, i.e., the less you do to take active steps to help yourself out of depression, the worse youre likely to feel. Its why Im a huge advocate of active, skill-building approaches based on sound therapeutic principles affirmed by good science that shows these methods work. Ill be describing some of these in future blogs.
Posted by Phillipa on November 28, 2010, at 21:22:17
In reply to JAMA-.will never be a drug that 'cures' depression, posted by violette on November 28, 2010, at 20:57:52
In my case a predisposition for anxiety as all family has it and those deceased. And lots of thyroid illness and autoimmune. Those are genes Phillipa
Posted by merpmerp on November 28, 2010, at 21:27:35
In reply to Re: JAMA-.will never be a drug that 'cures' depression, posted by Conundrum on November 28, 2010, at 21:20:13
Conundrum, you say 2.5 mg of Prozac helped you? Could you write a bit more about your experiences with that?
I am trying to learn more about the efficacy of lower doses of antidepressants because I think my doctor has me overmedicated and I need to educate myself to be able to discuss this with her.
Posted by morgan miller on November 28, 2010, at 21:54:42
In reply to JAMA-.will never be a drug that 'cures' depression, posted by violette on November 28, 2010, at 20:57:52
But there are and will be drugs that alleviate depression and prevent depression from wreaking havoc on people's lives and brains.
Posted by morgan miller on November 28, 2010, at 21:59:00
In reply to Re: JAMA-.will never be a drug that 'cures' depression, posted by Conundrum on November 28, 2010, at 21:20:13
>My social condition, having a caring family, friends, safe neighborhood, caused my anhedonia?
It's a piece of the puzzle, I emphasize, a PIECE. Hard to accept, but it is.
>If I could will myself out of anhedonia I could.
It's not about willing yourself. I think Violette's message is that undoing some of the emotional damage done during development may help us get better. It takes a whole lot of hard work in therapy for this to be possible though.
Posted by Tomatheus on November 28, 2010, at 22:44:07
In reply to JAMA-.will never be a drug that 'cures' depression, posted by violette on November 28, 2010, at 20:57:52
I think that this article was originally published in a PsychCentral blog:
Tomatheus
Posted by FluffMama on November 28, 2010, at 23:09:39
In reply to JAMA-.will never be a drug that 'cures' depression, posted by violette on November 28, 2010, at 20:57:52
I found the below article fascinating.
"Research has also shown a strong association between [blood] Type O and unipolar disease, characterized by deep depression without mania."
And there's more. . . Type B blood? More prone to depression.
http://www.dadamo.com/knowbase/PATHbase/depict.cgi?16
So don't listen to all ya hear about it being "all in your head" - it's in your head alright, but most accurately, in your blood. :)
Yes, there is no specific gene for depression. But you will be more prone to bipolar disorder or depression if you are of a certain Blood Type, and babies don't chose Blood Types.
Posted by emme on November 29, 2010, at 6:48:11
In reply to JAMA-.will never be a drug that 'cures' depression, posted by violette on November 28, 2010, at 20:57:52
Not in a SINGLE gene? That doesn't rule out a strong biological component to depression - perhaps the primary component for a subset of the depressed population. How about a combination of genes? How about different causative factors for different people?
The rest of the article simply doesn't follow from the first 3 sentences. The author is lumping all cases of depression together and making IMHO a rather large and unjustified leap from research failing to verify a single gene to depression being primarily a social phenomenon. For some, maybe yes. For others, probably not. How would the author explain those people who are helped tremendously by medication?
Frankly, I'm horrified by the tone of the article. I'm all in favor of trying a variety of strategies (lifestyle, talk therapy, medication) to deal with depression. Whatever works. But really, the "blame the victim" attitude in the article is just not necessary.
Posted by merpmerp on November 29, 2010, at 9:37:48
In reply to Re: JAMA-.will never be a drug that 'cures' depression, posted by emme on November 29, 2010, at 6:48:11
Well said, emme.
Posted by merpmerp on November 29, 2010, at 9:40:37
In reply to But different blood types show varied tendencies, posted by FluffMama on November 28, 2010, at 23:09:39
Dude... that's fascinating. I actually don't know my blood type. But wow, now I'm curious. Thanks for posting that! :D
Posted by SLS on November 29, 2010, at 9:43:00
In reply to JAMA-.will never be a drug that 'cures' depression, posted by violette on November 28, 2010, at 20:57:52
Hi Violet.
What was it about this article that appealed to you so much that you chose to post it?
Anything specific?
- Scott
Posted by Conundrum on November 29, 2010, at 10:34:20
In reply to Re: JAMA-.will never be a drug that 'cures' depression » Conundrum, posted by merpmerp on November 28, 2010, at 21:27:35
You might want to look at this thread, specifically the part about low dose prozac. It is pretty technical, but basically a lower dose of prozac seems to increase norepinephrine and dopamine more than a higher dose which seems to increase more serotonin. You will still get serotonin in this low dose, but there is more of a kick.
The way I take 2.5mg is approximate. An acute dose of prozac has a half life of about 2-3 days, chronic dosing even longer. So I just take a 10mg pill, break it in half, and then take it every other day. So thats approximately 2.5 mg a day. For me, the motivating effects stop and get worse than before it seems, if I start to take it every day. It would be interesting to see if other people respond to this low dose of prozac. It really helps with motivation and interest and keep your mind focused on one thing.
http://www.dr-bob.org/babble/neuro/20090701/msgs/904542.html
Posted by merpmerp on November 29, 2010, at 10:46:45
In reply to Re: JAMA-.will never be a drug that 'cures' depression » merpmerp, posted by Conundrum on November 29, 2010, at 10:34:20
Thank you very much for your response, and the link, which I will read through when not at work.
I have heard that about Prozac (lower doses have a relatively stronger effect on dopamine and norepinephrine than higher doses). I have come to wonder if maybe this approach would work for me. The first time I was on Prozac, as I've said, it was a miracle. But I have some reason to believe that the generic formulation I was on was a weaker one than brand name or other formulations. So maybe I was getting the Dop + Norep effect.
Posted by Conundrum on November 29, 2010, at 14:34:38
In reply to Re: JAMA-.will never be a drug that 'cures' depression » Conundrum, posted by merpmerp on November 29, 2010, at 10:46:45
Yeh I take a generic too, but I don't think it is weaker, since I have to take such a low dose. Maybe weaker is better.
> Thank you very much for your response, and the link, which I will read through when not at work.
>
> I have heard that about Prozac (lower doses have a relatively stronger effect on dopamine and norepinephrine than higher doses). I have come to wonder if maybe this approach would work for me. The first time I was on Prozac, as I've said, it was a miracle. But I have some reason to believe that the generic formulation I was on was a weaker one than brand name or other formulations. So maybe I was getting the Dop + Norep effect.
Posted by linkadge on November 29, 2010, at 14:35:19
In reply to Re: JAMA-.will never be a drug that 'cures' depression, posted by Tomatheus on November 28, 2010, at 22:44:07
Keep in mind, this is one man's interpretation of the current evidence. The pendulum swings back and forth.
Just because one specific gene has not yet been identified, does not mean that there isn't a genetic basis for depression. It can be the interaction of several genes and the environment.
And at this point, there's really no way of knowing to what extent any one individual's depression is related to genes or environment.
So, this guy saying that depression is a "social disorder" is based on a series of assumptions. For some people, yes, but for others no.
Until we understand the full extent of interaction between genes and the environment, there's really no way for anyone to say.
Linkadge
Posted by ed_uk2010 on November 29, 2010, at 15:06:32
In reply to Re: JAMA-.will never be a drug that 'cures' depression, posted by linkadge on November 29, 2010, at 14:35:19
Depression isn't a single disease entity, it's not a specific illness like Parkinson's disease. Depression is a clinical syndrome - a collection of symptoms. There are many different types of depression, there are many different causes.... and there are many different treatments which are effective in different patient groups. There will never be a drug that 'cures' depression. There may be a drug which cures a specific subgroup of patients, but that's different.
Posted by jane d on November 29, 2010, at 17:20:55
In reply to JAMA-.will never be a drug that 'cures' depression, posted by violette on November 28, 2010, at 20:57:52
It's here and it's free. Not sure how a blog entry about this got confused with the real thing.
http://jama.ama-assn.org/cgi/content/full/301/23/2462#relation_type_129
Posted by emme on November 29, 2010, at 17:32:03
In reply to The real JAMA article says no such thing, posted by jane d on November 29, 2010, at 17:20:55
Thanks for posting that. I was wishing for the article itself, but didn't have time to hunt for it and didn't expect it to be freely accessible. I don't think anyone is confusing the blog with the original article. I think we're all reacting to what the blog-writer did with the article.
emme
Posted by Phillipa on November 29, 2010, at 19:34:02
In reply to Re: The real JAMA article says no such thing, posted by emme on November 29, 2010, at 17:32:03
The blood typing I know I'm type A through giving blood and the cross and typing? So does this mean no depression only anxiety? Just curious as had read the same article. Phillipa
Posted by FluffMama on November 29, 2010, at 21:53:48
In reply to JAMA-.will never be a drug that 'cures' depression, posted by violette on November 28, 2010, at 20:57:52
This is clearly a community of depressed people seeking healing and in particular, this specific board is labeled, "MEDICATION" board. By posting something like this, which is controversial at best, and dangerous at worst for suffering human beings hoping desperately for assistance, I am curious as to what your purpose was in posting it? It could be seen as motivating, I suppose, for those who need therapy but are depending only on medication, but it seems pretty extreme.
Were you just wanting different opinions on the article or is this also your opinion, that no medication will ever be found to relieve depression because there is no ONE gene found that is linked to it? (although there are clearly multiple genes linked to depression - see my post on Blood Type differences). If this is your opinion, perhaps it is best not posted on a board labeled MEDICATION, or else it seems rather "in your face" to people trying to manage their depression with MEDICATION.
I welcome your clarification.
Posted by Willful on November 29, 2010, at 22:39:52
In reply to JAMA-.will never be a drug that 'cures' depression, posted by violette on November 28, 2010, at 20:57:52
From what I read here, the actual study says that there is no depression "gene." Or, more precisely, no single depression gene, or series of such genes, has yet been found `~except~ one, which is relatively weak.
Everything else in the piece quoted above is the blogger's personal opinion. which he has been advocating for a long time-- ie since before this study was done.
Now, first of all, there are many studies, often with contradictory claims and results. So there is no certainty that others studies do not or will not exist that "prove" just the contrary.
Second, and more importantly, no one of any real scientific credibility has really claimed that there's one depression gene.
There may be many genes which singly or in combination could either cause or greatly predispose someone to depression--
and, it's entirely possible that these genes have not yet been discovered, and that this weakly predisposing gene will be but one among many.
Furthermore, just because something is not caused by a gene, or is caused by a gene interacting with social or interpersonal forces, does not mean that a biological (ie drug) cure would not be possible. I really see no reason why a drug couldn't greatly affect feelings that were originally caused by interactions or social conditions.
So all in all, I'd say that we just have one individual's personal opinion that depression is caused by environmental factors and that drugs aren't the answer.
It's not a study, and it's not even a logical argument. It's just an opinion in any area where there are many opinions but no clear evidence.. I don't think it changes the debate or gives any closure.
Willful
Posted by jane d on November 30, 2010, at 5:12:39
In reply to Re: The real JAMA article says no such thing, posted by emme on November 29, 2010, at 17:32:03
> Thanks for posting that. I was wishing for the article itself, but didn't have time to hunt for it and didn't expect it to be freely accessible. I don't think anyone is confusing the blog with the original article. I think we're all reacting to what the blog-writer did with the article.
>
> emmeI didn't think that you had. And I'm grateful to Tomatheus for posting the source of the blog since the original poster did not.
JAMA now lets you read the research articles for free after six months. I believe some of the other journals do the same.
Posted by europerep on November 30, 2010, at 18:15:17
In reply to JAMA-.will never be a drug that 'cures' depression, posted by violette on November 28, 2010, at 20:57:52
>As I have said in previous blogs, depression is much more of a social condition than a biological one,
Hm, ok, so we know so little about depression, but we do already know that it's more of a social tha of a biological condition? How? How can that be measured or determined? People say the brain is the most complex "thing"/organism/whatever in the whole universe, so how could one suppose that there are not lots of things that could malfunction in there?
There are people who profit, in a personal way, from making such claims, I believe. it makes you feel *soo* good about yourself when you see that you lead a healthy, successful life, and it would be very inconvenient to learn that part of that is just 'luck'..
Posted by bleauberry on November 30, 2010, at 19:53:50
In reply to JAMA-.will never be a drug that 'cures' depression, posted by violette on November 28, 2010, at 20:57:52
Depression is in the damage that mercury molecules do.
Depression is in the damage that lead molecules do.
Depression is in the damage that aluminum molecules do.
Just for starters. Not to mention all that crap in food ingredient labels you can't even pronounce and don't know what it is.
Believe it, for sensitive individuals, FDA red food color causes depression, but FDA yellow is even worse.
Lyme, borrelia, bartonella, babesia, candida....all notorious for going undetected and wreaking havoc on depression.
Gluten can cause depression. People have seen their long standing depression and fatigue magically disappear in days after stopping all wheat products. Dairy is the next one. Sometimes corn, soy, tree nuts.
I'm just sayin. It happens.
I mean, I could sit here all night and list things that cause biological depression, but other more knowledgable folks do it much better than I. The point is, no, there will never be a single med directed at genes, serotonin, or whatever, that will cure depression, because there are too many variable causes of depression for any single agent to cover them all.
If we would only spend half the time trying to make an accurate diagnosis of where the depression is coming from (not really hard to do) compared to the time we spend titrating on and off medicines year after year, we would we way way way advanced in the game. Cure depression? First identify the culprit. Is it a metal? Is it an infection? Is it a gene? These really aren't hard to figure out. It aint rocket science. It's just that nobody does it because it is so much easier to pull out a prescription pad and say see you in a month.
I'm not sure how it happens, but somewhere along the journey in science men try to compartmentalize everything into a neat little picture, with no idea actually of what they are talking about and no ability to even prove it or duplicate it. Nothing is like that.
IMO
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