Mood Disorders Study Aims at Understanding Relapse

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Mood disturbances are characterized by feelings of sadness, despair, and discouragement resulting from and normally proportionate to some personal loss or tragedy. It is when things are out of proportion that help is needed.

“Everybody gets depressed. It’s a normal human emotion to be down if you’ve received bad news. If someone dies, if you get ill, or even something like moving house might normally cause someone to get somewhat depressed,” says Dr. Peter Bieling, Operational Services Manager for the Regional Mood Disorders Program at St. Joseph’s Healthcare. “The trick is how long does it last and how deep does it go, if the depressed feeling lasts this could indicate a clinical depression. While people are depressed it’s as if they are wearing a pair of sunglasses that filter only bad information for them, and for their loved ones, and for the world. And they easily get stuck in those patterns of only looking at the worst.”

The Mood Disorders Program offers a full consortium of services for those who are stuck – inpatient, outpatient and consultation. The program fosters a relationship between academic health care and clinical practice, with priorities on care, teaching and research.

About 800 outpatients are seen each year with as many consultations provided for patients in the community being treated by family doctors. The inpatient services helps up to 100 patients a year.

The numbers indicate that depression is a common condition. In fact, there’s a one in five chance of suffering a depressive episode.

“The point at which you should start to think of getting help is when the sad mood lasts every day for 14 days. That’s what it takes to get a clinical diagnosis of depression,” says Bieling. “As practitioners we always wish that people would go to the doctor earlier. They always wait too long. And we know some portion of those people, probably half, will go on to have another episode, possibly followed by a third episode of depression.”

It is the cause and prevention of those relapses that is the focus of a study now underway at St. Joseph’s Healthcare.

The “First Episode of Mood Disorder” study hopes to identify factors that predict illness severity and relapse, and hopefully find interventions.

“It is very clear that mood disorders are multi-determined. With mood disorders we don’t know the exact trigger. We can’t say it’s a chemical thing for you and it’s a social thing for you and it’s stress thing for you. And yet we know that mood disorders will express itself from all those areas,” says Bieling. “In other words you don’t get someone who is depressed who is not having changes in their brain. It seems that some people have a sort of vulnerability, often around stress. Maybe that vulnerability is conferred genetically; maybe it’s based on their past history. And then, some life-event, some stressor that speaks to that vulnerability starts a cycle. You can think of that cycle as a chemical cycle, you can think of it as having to do with thoughts and feelings, but once started it seems to perpetuate itself in some people.”

The study hopes to begin to disentangle these different systems – stress, life events, and biology – from the start of the illness. Many people are not properly diagnosed or do not begin treatment for years after they are ill and that complicates things from a research perspective. It’s very difficult to disentangle the effects of stress from the effects of what’s happening bio-chemically. “First Episode” aims to catch people very early, at the first episode of depression. At that time researchers hope – as quickly and efficiently as possible – to get a kind of picture of the person, including literally a picture of their brain. Researchers will also investigate their life circumstance, what’s been happening to them, and their personality make-up.

“First Episode” researchers hope that after five years of following these participants they will be able to determine what factors were known about that person when they first joined the study that would have allowed them to predict who gets better and who doesn’t. “Once we know that we can figure out ways to fix this,” says Bieling. “We can get to the point early and eliminate the cause and prevent further episodes.”

The study, lead by Glenda MacQueen, is funded by a grant from the Canadian Institutes for Health Research. “First Episode” hopes to recruit 200 participants who will receive constant monitoring to assess the state of their illness, even when they might otherwise be considered well and would be discharged from normal clinical care.

But Bieling says the study relies on St. Joseph’s. “It’s something that we couldn’t just do from a research grant; it’s simply too large. We need the hospital infrastructure to provide some of the staff, supports, and treatments. It’s a nice synergy in that, as we treat our patients, we are able to use the hospital support to build knowledge. The ultimate hope is that once you figure out what is the thing that leads to relapses, you can develop an intervention that would directly impact that factor or set of factors.”

For more information on the ‘First Episode’ project call Helen Begin at extension 5426.