{"id":1095,"date":"2008-04-15T09:30:29","date_gmt":"2008-04-15T09:30:29","guid":{"rendered":"http:\/\/blog.beliefnet.com\/beyondblue\/2008\/04\/earlyonset-and-chronic-depress.html"},"modified":"2008-04-15T09:30:29","modified_gmt":"2008-04-15T09:30:29","slug":"earlyonset-and-chronic-depress","status":"publish","type":"post","link":"https:\/\/www.beliefnet.com\/columnists\/beyondblue\/2008\/04\/earlyonset-and-chronic-depress.html","title":{"rendered":"Early-Onset and Chronic Depression: Project GenRED"},"content":{"rendered":"

\"mondimore_web.jpg\"
\nIn a recent medical newsletter, I came across this article on Project GenRED, <\/a>a large NIH-sponsored effort to identify genes for recurring major depressive disease, which “operates on the premise that genes for early-striking disease are probably more obvious than later types.”
\nThis is all great news for me and many of you, because chronic depression or recurrent depression, is often in a category all by itself, because we have to live with symptoms just as those who have cancer, diabetes, or arthritis. Here’s what the article said:<\/p>\n

When Francis Mondimore began to interview patients whose first of many bouts with serious depression came at a fairly tender age\u2014before their 30s\u2014he didn\u2019t expect this response: They were bewildered.?
\nFrom his years in the clinic, psychiatrist Mondimore had hunches about lasting depression. But they didn\u2019t become truth until he joined the Hopkins arm of a large NIH-sponsored effort to identify genes for recurring major depressive disease. \u201cThe Genetics of Recurrent Early-Onset Depression,\u201d or GenRED project, operates on the premise that genes for early-striking disease are probably more obvious than later types. As part of GenRED, Mondimore began assessing patients, recording their history, writing comments. And that\u2019s when his \u201cinterview troubles\u201d appeared.
\nAt fault was the list of standard questions: When was your most severe episode of depression? and When did that episode start? When did it stop? \u201cEvery few patients, I\u2019d get someone who\u2019d look at me blankly and say, \u2018Episode? I don\u2019t know what you mean. There are no episodes; I\u2019ve been depressed as long as I can remember!\u2019 It became clear,\u201d Mondimore explains, \u201cthat the questionnaire didn\u2019t capture everyone\u2019s experience. For some, it\u2019s like asking them exactly when friendship stops and love begins.\u201d\n<\/p><\/blockquote>\n

<\/p>\n

And meetings when Mondimore and colleagues would read each others\u2019 interviews and assign diagnoses became equally troublesome. Of three patients with nearly identical histories, says Mondimore, one would get the diagnosis of a very long single episode of major depression. Another would get labeled with the chronic, low-level symptoms of dysthymia. The third had frequently recurring major depression. \u201cStandard psychiatric descriptions would just fall apart,\u201d he says.
\n\u201cOn the other hand, if you looked at the boxes on the study\u2019s questionnaire marked \u2018chronic\u2019 or \u2018not chronic,\u2019 everyone could agree on that.\u201d
\nFar more than just a relative handful of patients didn\u2019t fit standard categories, Mondimore says. Both GenRED and an earlier, respected nationwide study showed that a significant number\u2014as many as a quarter of those with major depression\u2014live with it without much pause for years. \u201cIt\u2019s not an acute illness for them,\u201d he adds.
\nSo Mondimore, colleague James Potash and a national team examined data from all of GenRED\u2019s 630 families in a new light, picking out only those with the \u201cchronic\u201d box checked. What\u2019s appeared is a new, genuine subtype of major recurring depression, one where genes play an intrinsic part, especially if struggles begin before adolesence. Further, they found, these chronic patients are at greater risk of substance abuse, suicidality and panic disorder.
\nDoes knowing all this affect treatment? \u201cYes,\u201d says Mondimore. \u201cFor one thing, it justifies not trying to taper some patients off antidepressants. But it also means you re-educate them to view their illness more like diabetes, as a problem to be managed over time. If blood sugar levels jump, for example, you don\u2019t ask, \u2018has the insulin stopped working?\u2019 You look at what\u2019s going on in a patient\u2019s life, at what needs to change to get better control.\u201d\n<\/p><\/blockquote>\n","protected":false},"excerpt":{"rendered":"

In a recent medical newsletter, I came across this article on Project GenRED, a large NIH-sponsored effort to identify genes for recurring major depressive disease, which “operates on the premise that genes for early-striking disease are probably more obvious than later types.” This is all great news for me and many of you, because chronic…<\/p>\n","protected":false},"author":17,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[6],"tags":[],"class_list":["post-1095","post","type-post","status-publish","format-standard","hentry","category-mental-health"],"yoast_head":"\nEarly-Onset and Chronic Depression: Project GenRED - Beyond Blue<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.beliefnet.com\/columnists\/beyondblue\/2008\/04\/earlyonset-and-chronic-depress.html\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Early-Onset and Chronic Depression: Project GenRED - 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