Personality Risks For Recurring Depression / Genes Altered Forever

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Personality Risks For Recurring Depression / Genes Altered Forever

Saturday, November 13, 1999

[Depression is the most common mental health problem in the United

States, affecting an estimated 17 million people. It is particularly

pervasive amongst homes with disabled families members.]

Individuals with certain personality styles - those who are aggressive

and those who have low dependency on other people - are at higher risk for

recurrent bouts of major depression, according to a new University of

Washington study. The results will be presented at the annual meeting of the

Association for Advancement of Behavior Therapy in Toronto at noon today.

The study comes from the laboratory of UW psychology professor Neil

son, who died last June. Jackie Gollan, his collaborator on the project

and lead author of the study, will discuss the findings as part of a panel

looking at preventing and predicting relapse of depressed patients.

Gollan and son also found that people at risk for relapsing

reported lower levels of satisfaction or pleasure from their activities than

did people who remained well. The study also indicated that a patient's

level of negative or dysfunctional thinking at the end of treatment was not

predictive of relapse.

" Depression is a recurrent disease for a lot of people just like

cancer, " said Gollan. " People who receive cognitive behavioral psychotherapy

for depression tend to feel less depressed when they complete it. However,

other factors in their lives beyond their mood need to be identified if we

are to help them stay well. We need to consider who people are and how they

interact with others to understand how patients remain nondepressed. "

Gollan earned her doctorate in clincial psychology at the UW and is now

a clinical psychology intern at Brown University Medical School in

Providence, R.I.

Researchers are anxious to identify risk factors for recurrent

depression because relapse rates among patients who respond to treatment are

alarmingly high. Studies have shown that between 50 percent and 80 percent

of patients successfully treated with cognitive behavioral therapy suffer a

relapse, often within two years of remission. Cognitive behavioral therapy

is the standard treatment for depression, often in conjunction with

anti-depressant medication.

Individuals with clinical or major depression, the most serious form of

the disorder, often can't function, perform at work, need to be hospitalized

and may attempt suicide.

In the new study, Gollan and son followed 78 patients who had

recovered from major depression for two years to monitor changes. The

patients all received 20 sessions of cognitive behavioral therapy for their

depression and were considered symptom-free for at least two months before

being accepted into the study. The researchers utilized a variety of

interview questionnaires and self-report forms to measure depression,

dysfunctional attitudes and pleasant activities at the beginning and end of

treatment and every six months during the two-year follow-up. Personality

styles were measured before and after treatment.

At the end of the study, 34 people, or 44 percent, had relapsed. Gollan

said there seems to be different subsets of people who are at-risk for

recurrent bouts of depression. One of those groups is made up of individuals

who have a low dependency on other people. People with low dependency are

usually independent people who may have little or no social support system,

she said.

" Low dependency increases risk for relapse while moderate dependency

encourages recovered patients to seek out social relationships that may

function, over time, to reduce relapse risk, " she said.

People who exhibited aggressive, hostile styles at the end of treatment

also were more likely to relapse, " perhaps because they don't make good

friends and turn off people, " Gollan explained. " In their professional

careers they have channeled aggression in productive, socially acceptable

ways to their advantage and use people to their advantage. They also are

pathologically independent and independence may be a risk factor if you have

depression. "

She added that clinicians working with depressed patients need to pay

more attention to the enjoyment and satisfaction people get from activities

rather than on the type and number of activities they engage in.

" We need to focus on how the activities feel, " Gollan said. " We don't

know why, but it is becoming clear that people are less at risk for relapse

when they do things they enjoy rather than working on overcoming their

negative thinking patterns. The treatment should be tailor-made to the

depressed patient. "

Gollan said the study focused on looking at broad personality styles or

patterns rather than clinical personality disorders because many of the

people who relapse from depression would not meet strict guidelines for a

personality disorder. " We felt assessing personality style on a continuum of

severity might generate a broader understanding about factors that predict

relapse. "

The study was funded by a grant from the National Institute of Mental

Health.

* * *

Genes Can Be Altered Forever

Reuters - Researchers said Thurs. they used gene therapy for the first

time to permanently change a rat's genes-so permanently that the changes

were passed on the the animals' pups and even to a third generation.

They said the advance was both promising and frightening, as scientists

are wary of making permanent changes when they tinker with the genes of

human beings.

The team at the University of Florida was trying to correct a defect

that causes the laboratory rats to have high blood pressure. The eventual

goal would be to use gene therapy to treat people with high blood pressure.

Writing in the American Heart Association journal Circulation,

molecular physiologist Mohan Raizada and colleagues said this was the first

time anyone had managed to alter so-called germ cells-which are passed on

from generation to generation-with useful genes.

Genes With a Purpose Scientists know that retroviruses can permanently

alter DNA. Retroviruses that have no known function are found throughout the

genomes-the genetic collection-of animals ranging from pigs to people.

Other studies have shown random pieces of inserted genes can be passed

on, but with no therapeutic effect.

" The neat part of this study is we're able to show both the effects on

high blood pressure as well as on the organs involved in the control of

blood pressure, " Raizada said in a statement.

" We have shown that this form of gene therapy not only prevents these

animals from developing high blood pressure but also prevents a lot of other

types of ... changes in the heart, the kidney and the arteries. "

The gene therapy targets angiotensin, one of the hormones that helps

regulate blood pressure. Scientists used a virus known as a retrovirus to

deliver the gene to the rats' cells.

Retroviruses, which include the AIDS virus, inject their genetic

material right into a cell, and this one seems to have placed it in the

nucleus of the cells, the researchers wrote.

The gene reprogrammed the cells so they no longer produced a receptor,

a kind of docking port, for angiotensin to hook into and act upon.

" Our observations are very exciting in the sense that, for the first

time, there is a possibility of permanent control of high blood pressure

involving gene therapy, " Raizada said.

" Where that leads to as far as human therapy is concerned is far away.

We have many hurdles to jump. "

Besides the ethical hurdle of permanently altering a person's future

offspring, Raizada said there were more practical barriers.

His team's studies used specially-bred rats that they knew would

develop high blood pressure.

" But in humans, there are no gene markers to define that a person is

going to develop high blood pressure, " he said.

" The key would be to find therapies that would reverse high blood

pressure once it has been established. "

More than 50 million Americans have high blood pressure, which can lead

to heart disease and which is a major risk factor for heart attacks, kidney

disease and stroke

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