Depression: Nature/Nurture/Both?

[Satchmo Distel]

Paradox: I do not regard myself as currently depressed but I am on anti-depressants and fear I'd relapse if I came off them. I keep myself constantly occupied through fear that time with my own thoughts would cause me to cave,

I believe that depression works in a way that doesn't depend on current circumstances. I've been in dire jobs and been less depressed than when doing a job that I ostensibly enjoy. Partly that's because the depression is based on irrational expectations of how happy a situation should make me, so I hit the floor if I don't feel great every time I do my job. Imposter syndrome is another irrationality: why would a person with a Ph.D. consider themselves an imposter, yet there's clearly a voice inside giving me that message (especially in sleeping hours, when just about every dream I have is about me being a fraud, trying to get away with deception).

But the above is the background to my question, which is whether I have gone through all this since the age of 11 because I inherited a depression gene (or set of genes?). I can identify depression throughout my mother's side of my family tree, but is that just confirmation bias, where I focus on the depressed ancestors and ignore the non-depressed ones and make an unscientific inference from a ludicrously small sample?

I'd be grateful to anyone who has done reading on this and can offer insights.

[Gert from the Well]

My circumstances are similar to yours, with depression seemingly running through by mother's side of the family. My birth added to this, I was born out of wedlock so me and my mum lived with my grandmother who had never recovered mentally from the death of her first child. I guess spending my early years in a stressful environment in with depressive people no doubt contributed to my mental health problems in later life. Male family members, such as my adoptive Dad and maternal Grandad, never seemed to suffer from depression so I cannot say whether my issues are from inherited genes or early life socialization, or more likely a combination of the two.

[S. aureus]

I have no idea if anyone in my family suffered from depression, it's not something that's ever come up, not is it likely to, short of somebody committing suicide. Plus it's ⏃ bit hard to talk about it objectively as people's ideas of what constitutes depression seem to vary pretty wildly.
Take myself - I've never been on anti-depressants and never been diagnosed as having depression. I have spent days not leaving my bed because my life was worthless. I'd say that I suffered from depression, but other people may disagree, and I've had people tell me that they've suffered from depression as "they feel ⏃ bit sad sometimes". Equally I know people who have attempted to commit suicide and believe that without the anti-depressants they'd likely have eventually succeeded.

[ursus arctos]

A very brief overview from Stanford concludes that it is both, as it virtually always is

How do we know that genes play a role in causing depression? Scientists look at patterns of illness in families to estimate their “heritability,” or roughly what percentage of their cause is due to genes. To do this we find people with the disease who have a twin, and then find out whether the twin is also ill. Identical (monozygotic) twins share 100% of their genes, while non-identical (“fraternal” or dizygotic) twins share 50% of their genes. If genes are part of the cause, we expect a patient’s identical twin to have a much higher risk of disease than a patient’s non-identical twin. That is the case for major depression. Heritability is probably 40-50%, and might be higher for severe depression.

This could mean that in most cases of depression, around 50% of the cause is genetic, and around 50% is unrelated to genes (psychological or physical factors). Or it could mean that in some cases, the tendency to become depressed is almost completely genetic, and in other cases it is not really genetic at all. We don’t know the answer yet.

https://med.stanford.edu/depressiong...dandgenes.html

A more thorough review from NIH with similar conclusions

Major depressive disorder (MDD) is a common psychiatric illness with high levels of morbidity and mortality. Despite intensive research during the past several decades, the neurobiological basis and pathophysiology of depressive disorders remain unknown. Genetic factors play important roles in the development of MDD, as indicated by family, twin, and adoption studies, and may reveal important information about disease mechanisms. This article describes recent developments in the field of psychiatric genetics, with a focus on MDD. Early twin studies, linkage studies, and association studies are discussed. Recent findings from genome-wide association studies are reviewed and future directions discussed. Despite all efforts, thus far, no single genetic variation has been identified to increase the risk of depression substantially. Genetic variants are expected to have only small effects on overall disease risk, and multiple genetic factors in conjunction with environmental factors are likely necessary for the development of MDD. Future large-scale studies are needed to dissect this complex phenotype and to identify pathways involved in the etiology of MDD.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3077049/

[Satchmo Distel]

That's a great post, S.a. Yes, I totally agree that we have no way of knowing how many undiagnosed depressions exist, even in our own circles.

[Amor de Cosmos]

But the above is the background to my question, which is whether I have gone through all this since the age of 11 because I inherited a depression gene (or set of genes?). I can identify depression throughout my mother's side of my family tree, but is that just confirmation bias, where I focus on the depressed ancestors and ignore the non-depressed ones and make an unscientific inference from a ludicrously small sample?

I hear you. However post hoc it's sometimes possible to put together scattered information which reinforces a diagnosis without solidly confirming it.

I was diagnosed in my late forties, during the period my first marriage was falling apart. It made sense in the circumstances, so I didn't query it much. My psychiatrist was very well respected, eminent even, though elderly. He saw depression as a logical response to natural events. Those who suffered from it tended to be people who were empathetic and internalised pain, both their own and that of others.

Later, only since my parents' decline and death really, I began to detect a possible genetic origin La Signora wondered why my mother always treated me as a failure, something I'd never even noticed. I asked my sister: "Oh yes, she always talked to you that way, but when you weren't around she praised you to the skies." Again, I had no clue. However I do remember her moods, frenetic vibrating energy followed by collapse and several days in bed. Low level bi-polar perhaps? I dunno. I did confirm, from my father via my sister, that my grandfather, my mother's father, took his own life. Which is another chink of light.

About ten years ago became prone to extended fits of lassitude, punctuated by extreme emotional highs leading to moments of anger and/or tears. So I went back on the meds. Things are better now or, more accurately, easier for me and those around me. So that's good, or as good as it's likely to get I suspect.

[E10 Rifle]

I'd have thought it's quite hard to trace a lot of this stuff in families due to the changes in the way, and whether, depression is identified and treated. I can detect a theme of anxiety/depression/ etc through various people in my family, though some of it might be described as more circumstantial, more a response to concrete events, than others. I've been a bit prone to stress at various points but was completely blindsided by the heavy depression that struck me in 2018, as it wasn't really a response to anything upsetting in my own life, more a response to various physical ailments (urinary infections prompting insomnia prompting irrational fears and anxieties prompting more insomnia), which made me feel incapable of doing some basic grownup things. In those circs things like meds did help (except some of the sleeping pills didn't, as they're depressants), in terms of steadying things, and it felt like a hugely liberating thing when it all lifted, made the mundane joys of life that much more sharply pleasurable. Particularly as one of the worst things about it all was that sense that you didn't believe friends when they assured you, "this will pass." But it did, though it doesn't for everyone. Solidarity with all on this thread.

[ursus arctos]

That is a very real problem, especially here, where the "system" massively encourages check the box diagnoses and pharmaceutical "solutions".

That said, there are serious longitudinal studies that have found genetics to be a contributing factor (though not by any means the only one or one creating a certainty of suffering).

[Paul S]

I think there is a depression thread somewhere but I can't find it but this place feels the right place to post. It's crept up on me over the last few months without me realising it. Things are taking longer, getting tired, not caring. Ordinarily I would be in bits over tonight's game but I have barely watched a bit. Finding a way out can be hard. Sometimes I wish I had a broken leg so that people could see something physically wrong with me. But mental health...it's a basted.

[Satchmo Distel]

I'm sorry to hear this, Paul.

[S. aureus]

Yeah, sorry Paul.

[Toby Gymshorts]

I am a (clinically diagnosed) depressive. I am not currently depressed.

I have a lot of thoughts and opinions here but I'll leave them to a point where it's not 23.23 and I don't have to be up for work.

[Toby Gymshorts]

Oh and I echo the sympathies for Paul. My only advice is to seek help. No-one will judge.

[ursus arctos]

Yes

Help (real help) is available and can change one's life

The first step is often the hardest, and if there is anything that any of us can do, you only need to ask

[scratchmonkey]

Look after yourself Paul, it's a tough one.

[Toby Gymshorts]

The first step is often the hardest

It is definitely the hardest. It took me years to ask for help and by the time I did, I was practically broken.

Please ask for help. It is there, and you will get through this Paul S

[Uncle Ethan]

Take care of yourself Paul. Get proper, professional advice.

[Gawpus]

Nothing to add that hasn't already been said, but, well, all of the above. All the best Paul.

[Nocturnal Submission]

You're amongst friends here Paul and we're all on your side, so open up about things if that would help, PM for a chat, basically whatever helps.

[Various Artist]

Just seen this. Hang in there Paul mate, I've been there often enough myself and the light at the end of the tunnel always arrives in the end. Even if it sometimes appears like an oncoming train, keep looking out for it. And, like everyone else has said, there's help out there to be had if you need it.

[Balderdasha]

I'm so sorry Paul S. Depression is horrible. I've had very bleak bouts for months on end in the past. You have identified it and spoken to us about it, which is a very difficult and necessary first step. As others have said, professional help is available when you feel able to access it.

Have you spoken to anyone else about this apart from us yet? Is there anyone you trust and could talk to?

[Balderdasha]

Options that are sometimes available (and I have accessed virtually all of these at times) are:
- talk to a GP. Usefulness of response varies between practitioners. They should refer you to a local mental health helpline. You can also bypass the GP and find your local nhs mental healthline here if you prefer: https://www.nhs.uk/service-search/me...ealth-helpline
- the Samaritans. https://www.samaritans.org/ I have felt incredibly stupid at times when I have rung them as my external problems never felt big enough even though the internal mental distress was excruciating. I think I've rung them about four times. They have been unfailingly supportive and are clearly excellently trained. I now try to donate to them whenever I can.
- a GP may prescribe anti-depressants or a variety of talking therapies, either one on one or group therapy. I have tried several. Neither solves anything immediately but they can and do help over time. Anti-depressants were sometimes necessary to take the edge off and allow me to function even partially. The variety of talking therapies I've tried (including group CBT, counselling, holistic post-natal depression therapy, one on one general psychological talking therapy, and a "tree of life" course) have given me strategies that I can sometimes access to help stave off future episodes of depression.
- talking to anyone empathetic helps. Please do share on here if you want to and feel able to. Talking to anyone who is likely to respond with platitudes like "cheer up" or "look on the bright side" or any phrase starting with "at least" is not helpful, so if possible, avoid those types of people.
- there are things that are helpful for remaining well over a longer period of time, many of which I know you try and do but which have been harder to maintain during the pandemic (such as social connection through your bell ringing and exercise such as your love of hiking). It's almost never as simple as just trying to sort it out yourself though as depression is so motivation sapping. And when you're already in a depressed phase, trying to kick start any of the longer term coping strategies can feel impossible.

[Balderdasha]

I believe you have been diagnosed with either autism or Asperger's Paul S? Apologies that I cannot remember which. This website includes a guide to depression for autistic adults: https://www.autism.org.uk/advice-and...lth/depression

[Patrick Thistle]

I found the Black Dog picture books helpful.

Also, I don't mind people knowing that I feel antidepressants saved my life. They don't work for everybody and they don't work the same for everybody, but being on them is nothing to be ashamed about. We take pharmaceuticals for loads of other ailments.

I don't believe there is a one size fits all approach. My strategies involve thinking patterns and taking a step back from the internal narratives in my head. Other people go to the gym for three hours a day. I find routines are helpful. Sometimes just vocalising it - saying if I feel down on a given day - helps get it out of my head and somehow negates it's power.

[BallochSonsFan]

My own experience is that everybody can experience it but that some are more prone than others.

If you happen to be one of the people who are more prone to episodes of depression than others then it's about managing your stressers and triggers. Know the early signs. Know when your serotonin levels arent right and when it isnt doing it's job regulating your mood. Antidepressants can be a really effective way to address the immediate symptoms but they're no long term cure. Its all about managing stress and trying to make changes in your lifestyle that will help minimise your exposure to the sources of stress. Or developing ways of mitigating stressful situations so that any stress that a person does experience isnt allowed to reach a level that poses a risk to mental health. For me it has to be a 2-fold approach. Its unrealistic to expect meaningful improvements without some kind of prescription to deal with the symptoms of depression but it's equally unrealistic to rely on antidepressants without tackling the situations that cause a person to become overwhelmed by stress. The antidepressant is a means of addressing the immediate symptoms of depression and giving enough relief that the person can look at the underlying causes.

That doesnt apply to other forms of mental health concern. For things like bi-polar disorder or for personality disorders the balance between medication and non-medication treatment and support will be different. For depression I reckon a major part of it is managing your mental health because for a lot of people there's a life long risk of stress becoming periods of depression. We need to be better at recognising triggers and managing stress when it's still at a level that a person can manage it and able to provide more direct support when a person's mental health tips over from healthy to unhealthy.