DEPRESSION-
Depression Is a Stress-Sensitive Mental Disorder.
Tracking stress-induced changes in mood could be a key intervention.
Reviewed by Kaja Perina
KEY POINTS-
Depression is a debilitating psychiatric disorder with a lifetime prevalence of 16%.
Large-scale genomic studies indicate that more than 200 risk genes contribute to depression.
Depression is a disorder that involves an interaction between an individual with a susceptible genotype and exposure to life stressors.
A promising strategy to prevent depression is to use smartphones to monitor changes in voice/speech patterns in response to life stressors.
Depression is a debilitating psychiatric disorder characterized by one or more depressive bouts lasting for at least two weeks and resulting in a depressed mood, lack of interest in pleasurable activities, reduced energy levels, sleep disturbances, decreased ability to concentrate, feelings of worthlessness, and recurrent thoughts of death and possibly suicidal ideation. This combination of symptoms causes great distress and results in impairments in normal functioning at home, at school, and in the workplace based upon the criteria listed in the Diagnostic and Statistical Manual, 5th Edition, Text Revision (DSM-5-TR, American Psychiatric Association, 2023). The heterogeneity of depression is underscored by the fact that 681 combinations of symptoms satisfy the DSM-5-TR criteria for a diagnosis of depression.
Depression is moderately influenced by one’s genetic makeup (~40 percent), and females are almost twice as likely to be diagnosed with depression as males. The lifetime prevalence of depression is approximately 16 percent, and the disorder occurs across racial and demographic groups and in countries across the globe.
The median age of onset of a first depressive episode is in the early twenties, and the peak risk period extends into the 40s. However, depression is also a significant problem in adolescence, especially in girls around the time of puberty. A typical depressive episode in an adolescent can last for approximately six months and can exert negative effects on academic performance and social functioning. An additional concern regarding depression in adolescents is the significant risk for suicide.
Gene X Environment Interactions and Depression
Several large-scale genomic studies involving data from more than two million participants have provided insights into the genetic basis of depression. These studies indicate that depression is a complex multi-factorial disease and that each of the more than 200 risk gene variants for depression identified thus far contributes a very small amount to the eventual development of a depressive phenotype. That still leaves a significant role for environmental factors, and the principle among them is exposure to stressful stimuli.
One of the first well-controlled studies of stressful life events and depression was published more than 50 years ago. The findings from this early study indicated that depressed patients experienced approximately three times as many stressful life events (e.g., increase in marital discord, marital separation, serious illness of the patient or a family member, death of a family member, etc.) in the 6 months prior to the onset of a depressive episode compared to controls over a comparable time period.
A powerful approach that has been taken to identify connections between stress and depression is to study identical and fraternal twin pairs. Kenneth Kendler and his colleagues at Virginia Commonwealth University have been at the forefront of this experimental approach and have shown conclusively that a causal relationship exists between stressful life events and the onset of depression based on data collected from 1,898 female twin pairs in the Virginia Twin Registry.
Ratings of 15 classes of stressful life events and the onset of depression over a one-year period were noted by the team of researchers. Using in-person and telephone interviews, researchers asked first about 11 types of personal stressful experiences (e.g., assault, the breakup of a relationship, financial difficulties, etc.) and four types of network stressors (e.g., difficulty getting along with a person, death of a person in one’s social network, etc.) that occurred in a specific month during the previous year. Questions regarding specific symptoms associated with depression were only presented after information on stressful life events was collected to avoid any undue influence of discussing depressive symptoms on recollection of specific life stressors.
Across all categories of stressful life events, the occurrence of a major life stressor was significantly associated with the onset of a depressive episode within the next one to two months. This relationship was highly significant and held true for identical as well as fraternal twins. Of the 15 types of stressful life events, 11 were associated with the onset of a depressive episode in the same month, and two others were associated with a depressive episode in the following months. There was no evidence to suggest that an episode of depression precipitated the occurrence of a stressful life event.
Personalized Interventions to Reduce the Risk of Depression
In an ideal world, it would be advantageous to simply reduce the occurrence of stressful life events in individuals at risk of developing depression. Unfortunately, that is not within the realm of possibility. Current antidepressant medications are not highly effective and have significant side effects. Cognitive behavioral therapy (CBT) is effective in treating depression but is time-intensive and requires highly-trained therapists. At present, most individuals who develop depressive symptoms do not receive follow-up care, adequate treatment, or strategies for dealing effectively with life stressors. Despite this bleak state of affairs, there is hope on the horizon.
George Slavich of UCLA and his collaborators have proposed using smartphones and wearable devices to track voice/speech patterns and activity levels frequently and non-invasively in individuals at risk of developing mental disorders, including depression. With appropriate attention to privacy concerns and ethical issues, real-time collection of speech and activity measures has the potential to track individual responses to stress in order to serve as an early warning of the risk of disease occurrence. With an uptick in stress levels, smartphones could provide just-in-time notifications of personalized interventions to aid in managing stress levels more effectively and preventing a downward spiral of depressive symptoms.
Some elements of this scenario may seem far-fetched. Still, the science behind measuring stress-induced changes in voice/speech patterns has been validated, and just-in-time interventions have been carefully studied for their effectiveness in preventing depression. This novel approach emphasizes early detection and prevention of depression by targeting a crucial underlying cause of the disorder—stress.
If you or someone you love is contemplating suicide, seek help immediately. For help 24/7, dial 988 for the National Suicide Prevention Lifeline, or reach out to the Crisis Text Line by texting TALK to 741741.
DEPRESSION-
Depression Is a Stress-Sensitive Mental Disorder.
Tracking stress-induced changes in mood could be a key intervention.
Reviewed by Kaja Perina
KEY POINTS-
Depression is a debilitating psychiatric disorder with a lifetime prevalence of 16%.
Large-scale genomic studies indicate that more than 200 risk genes contribute to depression.
Depression is a disorder that involves an interaction between an individual with a susceptible genotype and exposure to life stressors.
A promising strategy to prevent depression is to use smartphones to monitor changes in voice/speech patterns in response to life stressors.
Depression is a debilitating psychiatric disorder characterized by one or more depressive bouts lasting for at least two weeks and resulting in a depressed mood, lack of interest in pleasurable activities, reduced energy levels, sleep disturbances, decreased ability to concentrate, feelings of worthlessness, and recurrent thoughts of death and possibly suicidal ideation. This combination of symptoms causes great distress and results in impairments in normal functioning at home, at school, and in the workplace based upon the criteria listed in the Diagnostic and Statistical Manual, 5th Edition, Text Revision (DSM-5-TR, American Psychiatric Association, 2023). The heterogeneity of depression is underscored by the fact that 681 combinations of symptoms satisfy the DSM-5-TR criteria for a diagnosis of depression.
Depression is moderately influenced by one’s genetic makeup (~40 percent), and females are almost twice as likely to be diagnosed with depression as males. The lifetime prevalence of depression is approximately 16 percent, and the disorder occurs across racial and demographic groups and in countries across the globe.
The median age of onset of a first depressive episode is in the early twenties, and the peak risk period extends into the 40s. However, depression is also a significant problem in adolescence, especially in girls around the time of puberty. A typical depressive episode in an adolescent can last for approximately six months and can exert negative effects on academic performance and social functioning. An additional concern regarding depression in adolescents is the significant risk for suicide.
Gene X Environment Interactions and Depression
Several large-scale genomic studies involving data from more than two million participants have provided insights into the genetic basis of depression. These studies indicate that depression is a complex multi-factorial disease and that each of the more than 200 risk gene variants for depression identified thus far contributes a very small amount to the eventual development of a depressive phenotype. That still leaves a significant role for environmental factors, and the principle among them is exposure to stressful stimuli.
One of the first well-controlled studies of stressful life events and depression was published more than 50 years ago. The findings from this early study indicated that depressed patients experienced approximately three times as many stressful life events (e.g., increase in marital discord, marital separation, serious illness of the patient or a family member, death of a family member, etc.) in the 6 months prior to the onset of a depressive episode compared to controls over a comparable time period.
A powerful approach that has been taken to identify connections between stress and depression is to study identical and fraternal twin pairs. Kenneth Kendler and his colleagues at Virginia Commonwealth University have been at the forefront of this experimental approach and have shown conclusively that a causal relationship exists between stressful life events and the onset of depression based on data collected from 1,898 female twin pairs in the Virginia Twin Registry.
Ratings of 15 classes of stressful life events and the onset of depression over a one-year period were noted by the team of researchers. Using in-person and telephone interviews, researchers asked first about 11 types of personal stressful experiences (e.g., assault, the breakup of a relationship, financial difficulties, etc.) and four types of network stressors (e.g., difficulty getting along with a person, death of a person in one’s social network, etc.) that occurred in a specific month during the previous year. Questions regarding specific symptoms associated with depression were only presented after information on stressful life events was collected to avoid any undue influence of discussing depressive symptoms on recollection of specific life stressors.
Across all categories of stressful life events, the occurrence of a major life stressor was significantly associated with the onset of a depressive episode within the next one to two months. This relationship was highly significant and held true for identical as well as fraternal twins. Of the 15 types of stressful life events, 11 were associated with the onset of a depressive episode in the same month, and two others were associated with a depressive episode in the following months. There was no evidence to suggest that an episode of depression precipitated the occurrence of a stressful life event.
Personalized Interventions to Reduce the Risk of Depression
In an ideal world, it would be advantageous to simply reduce the occurrence of stressful life events in individuals at risk of developing depression. Unfortunately, that is not within the realm of possibility. Current antidepressant medications are not highly effective and have significant side effects. Cognitive behavioral therapy (CBT) is effective in treating depression but is time-intensive and requires highly-trained therapists. At present, most individuals who develop depressive symptoms do not receive follow-up care, adequate treatment, or strategies for dealing effectively with life stressors. Despite this bleak state of affairs, there is hope on the horizon.
George Slavich of UCLA and his collaborators have proposed using smartphones and wearable devices to track voice/speech patterns and activity levels frequently and non-invasively in individuals at risk of developing mental disorders, including depression. With appropriate attention to privacy concerns and ethical issues, real-time collection of speech and activity measures has the potential to track individual responses to stress in order to serve as an early warning of the risk of disease occurrence. With an uptick in stress levels, smartphones could provide just-in-time notifications of personalized interventions to aid in managing stress levels more effectively and preventing a downward spiral of depressive symptoms.
Some elements of this scenario may seem far-fetched. Still, the science behind measuring stress-induced changes in voice/speech patterns has been validated, and just-in-time interventions have been carefully studied for their effectiveness in preventing depression. This novel approach emphasizes early detection and prevention of depression by targeting a crucial underlying cause of the disorder—stress.
If you or someone you love is contemplating suicide, seek help immediately. For help 24/7, dial 988 for the National Suicide Prevention Lifeline, or reach out to the Crisis Text Line by texting TALK to 741741.
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