I have an incredible life – loving husband, supportive family, fantastic jobs, great travels, etc. – so why am I depressed? This is the second time I’ve received medical intervention for major depression so you’d think I’d have some insight – but I don’t have anything amazing.
I have no external reason to be depressed. I’m aware of no precipitating event. If I reach, general anaesthetic might be a factor because I had operations within months of each depressive episode.
But my genetic load is probably a bigger influence. My family history is full of depression and alcoholism. In 1st-degree (siblings, parents) and 2nd-degree (grandparents, aunts, uncles, nieces, nephews) relatives, 11 of 12 people have been treated for depression and/or alcoholism. If we move to 3rd degree relatives, the absolute numbers get higher but the proportion is similar. [Note: I won't draw my family tree to maintain a bit of privacy for my family.] I’d also like to point out that my family members continue their high level careers without compromise unless hospitalization is required.
In my family, depression and alcoholism go together and this co-morbidity is recognized in general society. The Mayo Clinic includes a family history of alcoholism as a risk factor for depression. The predisposition to both alcoholism and depression running throughout families has been recognized since the early 1990s (reviewed in Nurnberger et al. 2002). Why would this happen? Some explanations:
- depression can lead to self-medication and resulting alcoholism (On a personal note, I normally don’t drink alcohol but it can suddenly make me feel ‘normal’ and this has been an early warning sign that depression is coming.)
- alcoholism could come first and depression could result from organic brain injury
- there could be common genetic factors between the two disorders
Because depression and alcoholism are common disorders and both are heterogeneous (different forms and risk factors), it will be difficult if not impossible to determine single mechanisms. I’ve spent hours trying to determine a simple way to explain the genetics of depression (or alcohol) but the research is still messy and contradictory.
The study of inheritance of alcoholism seems to be a bit clearer so I’ll share some interesting points. First, twin studies suggest heritability to be 40 – 60% (remember, heritability is the measure of how much variation within a population is due to genes) suggesting some genetic factors. There have also been adoption studies; they’ve shown that adoptees were more likely to become alcoholics as adults if their original biological parents, not their adoptive parents, were alcoholics (Cadoret et al. 1980). There is continuing research but nothing conclusive – the initial studies into the genetics are still at the interesting indications phase.
My experience with depression
Everyone experiences depression in a different way. There are some great descriptions in this cartoon from Hyberbole and a Half and writing by Rob Delaney. There are also some good films and I like the movie Helen – yes, an Ashley Judd movie that speaks to me.
I don’t get sad when depressed. I just turn from a ‘busy bee’ into a sloth. It also happens slowly so I don’t notice when I’ve started to withdraw from events and people. I know I’m depressed when I stop sleeping. I don’t have trouble falling asleep but staying asleep is an issue. It has been so bad that I can only sleep for an hour or so at one time. I’m not anxious or anything – just can’t sleep. Of course, the lack of sleep makes me tired and it speeds up the laziness.
The other big sign that I’m depressed is that suicide becomes an idea – nothing planned or defined but it starts as a whisper. I usually plan out my day every morning = eat breakfast, give class, write report, etc. and when depressed, I go through the same thing but there is an addendum ‘or you could kill yourself’. Luckily for me, I have always recognized these big signs and sought help.
In this past episode, the laziness has been extreme. I didn’t eat for two days because it seemed like too much work. It made me wonder if that is the reason that commit suicide after getting a bit of energy or ‘better’ – because I certainly wasn’t organized or motivated enough to make toast, let alone anything with planning.
Despite days of inactivity lately, I’ve managed to do the minimum amount of work but I still feel guilty about the time wasted. It is time now to start doing more (for example blogging). I now have some medications that seem to be working and my behaviour is getting more positive.
If you think you are experiencing depressive symptoms, please talk to somebody. Your family physicians are a good starting place. And if someone you know is depressed, please give them a break – they can’t just snap out of it but there are some experts out there who can help with some steps to wellness.
- Boden JM and Fergusson DM (2011) Alcoholism and depression Addiction 106, 906-914.
- Nurnberger JLJr, Foroud T, Flury L, Meyer ET. Wiegand R (2002) Is there a genetic relationship between alcoholism and depression? Alcohol Res Health 26(3):233-40.
- Cadoret FJ, Cain CA, Grove Wm (1980) Development of Alcoholism in Adoptees Raise Apart from Alcoholic Biologic Relatives Arch Gen Psychiatry 37(5), 561-3.