 What is Depression and Can it be Treated?
By Jack Etzel
If you are experiencing depression, the good news is that you’re
not alone. According to the American Psychiatric Association, you’re
in the company of more than 17 million Americans. Even better news is
that it’s treatable. To find out more, we discussed this with an
internationally recognized expert in mood disorders and their
treatment, Dr. Ellen Frank. Dr. Frank is a distinguished professor of
psychiatry and psychology at the University of Pittsburgh School of
Medicine and director of the Depression and Manic Depression
Prevention Program at Western Psychiatric Institute and Clinic.
North Hills Monthly Magazine (NHMM): Is depression a genetic
condition—does it run in families?
Dr. Frank: There’s probably a genetic component, but there is also
a very strong environmental component. Comparing major depression to
other psychiatric disorders, like bipolar disorder or manic-depressive
illness, it’s not that high a percentage, but nevertheless, the
vulnerability factor sometimes runs in families. What kinds of
environmental circumstances a person is exposed to would determine
whether they might actually experience depression.
NHMM: Is age a factor? Dr. Frank: Age does have an impact on the
probability of being depressed. It’s very rare in young children, and
when that does happen, it’s more common in boys than girls. Following
puberty, however, the rate rises rapidly, and it becomes more common
among girls. For the remaining life cycle, women remain at least twice
as vulnerable to depression as men. What happens after the ages of 55
or 60 is less clear. NHMM: How do you differentiate or define
depression and being manic-depressive? Dr. Frank: Depression is
referred to as unipolar. Manic-depressive is no longer a diagnostic
term. Today, it’s referred to as bipolar 1 disorder. This is a
condition in which people experience both episodes of mania as well as
episodes of depression. The mania can be as brief as four or five days
in which someone experiences a marked elevation in mood, increased
energy and activity, rapid speech, a decrease in sleep, poor appetite,
overspending, sexual promiscuity, and in its worst form, a person
could become psychotic. The depression parts of it, which often last
for weeks, include sad, irritable or empty moods; less pleasure in
activities, unrestful sleep, and in its worst form, the person is
preoccupied with death or even has ideas of suicide.
NHMM: There must be a bipolar 2.
Dr. Frank: Yes, that’s a milder form. With bipolar 2, the
individual does not experience the full-blown mania. While they have
somewhat increased moods and energy, perhaps needing less sleep, the
person isn’t likely to get into trouble. And the depression does not
go as deep as in bipolar 1.
NHMM: The recent work in which you and your colleagues are involved
is impressive. Can you share this with our readers? Dr. Frank: Our
idea was that whatever else is going on in the brain in bipolar
disorder, once we get down below the level of individual
neurotransmitters, what we’re seeing is a disturbance that seems to be
related to the body’s clock. If you think about the symptoms of mania
and depression, these are things that have a very regular 24-hour
pattern. For example, we’re sleepy at certain times of the day, we’re
hungry at certain hours, and we likely even sleep through the lowest
parts of our moods. If you disturb that and are awakened at
4 o’clock in the morning and kept awake for 24 or more hours, you can
see a very regular variation in mood.
NHMM: And what does that tell us? Dr. Frank: These are
essentially disorders of the body’s clock. Those with bipolar disorder
seem particularly vulnerable to the onset of new episodes of mania and
depression when their body rhythms get disrupted. We think of people
with depression or with bipolar disorders as having sensitive clocks.
One model for this would be jetlag. Our body clock is challenged by,
maybe, five hours out of our normal time zone. Most of us won’t feel
very well the next day; our mood is low, we can’t sleep at the normal
time and so on. The average person is able to reset their clock within
a few days. If we miss a night’s sleep, we’ll be tired the next day,
but can sleep okay the following night. For those with bipolar
disorder, even one night of total sleep deprivation can be enough to
trigger an episode. They have exquisitely delicate body clocks.
NHMM: Can this be treated? Dr. Frank: Interpersonal and social
rhythm therapy focuses on training people to lead lives that are
characterized by very regular routines that could strengthen their
body clocks. We’ve shown in one big multicenter study in the United
States that people with bipolar depression seem to recover more
quickly when they are treated with this therapy.
NHMM: Is this applicable to unipolar depression as well? Dr.
Frank: Yes, this is one approach to treating unipolar depression.
Other approaches include the use of antidepressant medications, with
ongoing debates on various combinations. NHMM: It’s winter. Do you
have any thoughts about seasonal affective disorder? Dr. Frank: This
happens when the days get shorter, and again, it’s tied to the body’s
clock being affected by the light-dark cycle. This can manifest itself
in oversleeping, overeating and loss of self esteem. The use of
bright-light therapy using light boxes seems to help, but there are
side effects, so you must know how to use it and what you’re doing.
And guess what? People whose body clocks are set by the morning light
are particularly vulnerable in gray cities like Pittsburgh.
For more information or help:
University of Pittsburgh Medical Center
Depression Prevention Program
412-246-5550 Crisis Network/Allegheny County Residents
“Anytime, Any Reason”
1-888-796-8226 |
