Focus

Nothing but blue skies

Early intervention helps youth emerge from the cloud of depression

By Kate Harkness

The transition from adolescence to adulthood is a time of great stress as young people take on the pressure and responsibility of independent living, professional employment and adult relationships. While most young people negotiate this transition successfully, many do not. Indeed, young adulthood is the period of greatest risk for the onset of serious mental illness, including major depression. According to recent reports, one in seven young people aged 18 to 25 has experienced a first onset of depression and 50 to 60 per cent of these will experience multiple episodes throughout their lives. The onset of major depression in young people is associated with poor educational attainment, occupational functioning and physical health, and disrupted interpersonal relationships.

Given the devastation wrought by depression, intervening as early as possible is crucial to prevent the often life-long cycling of depressive episodes. Treatment needs to start as soon as the depression begins. Unfortunately, the vast majority of young people experiencing first onset depression do not receive treatment. Intervention must also involve rigorous research. Through targeted, multi-disciplinary research, scientists are identifying the complex interplay of biological, psychological and environmental factors that cause depression with the ultimate goal of refining and improving prevention and treatment strategies.

A new five-year study, The Blue Sky Project, is taking on this research challenge by examining factors that cause the first onset of depression in young adulthood – the first study of its kind. Funded by the Canadian Institutes of Health Research, the study brings together researchers from the Centre for Addiction and Mental Health in Toronto and Queen’s University in Kingston, Ontario.

The Blue Sky Project looks at 18- to 29-year-olds experiencing a first depressive episode and provides thorough assessment, antidepressant medication and close monitoring. The study examines the mechanism through which a genetic predisposition to depression interacts with environmental stress throughout childhood and young adulthood to cause the first onset of depression. Depression runs in families, and a big reason for this is that particular genes are passed down from parent to child. How does this genetic risk turn into depression? And, if we are born with our genes, why doesn’t depression emerge until much later? Exciting new research conducted by scientists around the world has shown that the effect of genes on depression is not direct, but instead acts through the environment. People with an at-risk genetic profile are much more likely to get depressed in the face of stress than people without this profile.

Many types of stress can trigger depression, from severe abuse or neglect in childhood to the break-up of a relationship or job failure in adulthood. However, not everyone who experiences such stressors becomes depressed. Why are some people resilient to stress while others fall into depression? Again, the answer lies in the important interaction between genes and the environment. Specifically, we are testing the hypothesis that individuals with a specific genetic variant in the serotonin system will be more likely to get depressed in the face of stress and will require less severe levels of stress to get depressed, than individuals without this genetic profile. This particular genetic make-up colours a young person’s perceptions of the world, such that he or she reacts to stresses in the environment much more strongly than do other people, with potentially devastating consequences to their psychological well-being for the rest of their lives.

Participants in the Blue Sky Project receive 16 weeks of antidepressant medication and are closely monitored for up to 18 months by a psychiatrist with expertise in treating depression. In this way we are able to see how a genetic sensitivity to stress also affects response to treatment. Currently, the best treatments for depression involve medication or psychotherapies, such as cognitive-behavioural therapy or interpersonal psychotherapy. However, these treatments, either alone or in combination, are only effective in about 70 per cent of clients. It is our hope that the results of this study and other research examining the causes of depression will open the door to even more effective pharmacological and psychological treatments. For example, future psychological treatments could focus on helping young people understand and alter their stress sensitivity. This could involve helping them identify and modify personality characteristics, thought patterns and response styles that may in part be genetically determined and that lead them to be particularly sensitive to stress, as well as helping them identify stressors in their environment so they can develop more adaptive ways of responding to and coping with these triggers.

For information about the Blue Sky Project, call 416 979-4294 or visit www.blueskyproject.ca.

Dr. Kate Harkness is an associate professor at Queen's University in Kingston, Ontario, and co-principal investigator on the Blue Sky Project.

First-ever guidelines for managing teen depression

For the first time, primary care providers in North America will have clear guidelines and a toolkit for managing adolescent depression. North American researchers established the Guidelines for Adolescent Depression in Primary Care (GLAD-PC), targeting youth aged 10 to 21.

Because of long waiting lists to see mental health professionals, family doctors, pediatricians and nurses are becoming the first, and sometimes only, clinicians to identify, manage and treat adolescent depression. However, they often feel inadequately trained, supported or reimbursed for managing this disorder.

GLAD-PC provides guidelines for identifying, assessing, treating and managing adolescent depression in primary care settings. The guidelines and accompanying toolkit are available at no cost at www.glad-pc.org.