Depression: myths and reality

According to the official statistics of the World Health Association, 350 million people need medical care in connection with depression in the world. And the number of people who make such a diagnosis is constantly growing ... Novosibirsk scientists have received a grant of the Russian Scientific Fund for the study of the tendency to depression and the characteristics of the organization of oscillator networks of the brain. The purpose of the project is to study the predisposition to depression in the preclinical stages and the study of the individual characteristics of this pathology at the clinical stages. The predisposition to depression depends on both genetic factors and on the personal characteristics of people and is reflected in the mechanisms of the brain.

This integrated project, in which genetics, physiologists, and psychologists have already participated, have already appeared the first results. We asked the Veda to tell about them. scientific. sore. Laboratory of differential psychophysiology of the Institute of Physiology and Fundamental Medicine, Head. Laboratory of biological markers of social behavior of man at the Humanitarian Faculty of NSU, Art. scientific. sore. Institute of Cytology and Genetics SB RAS Alexander Savostyanov .

The lady on the watch reacts very kindly to the surname "Savostyanov": they are used to the streams of women who come to the professor. And the point, of course, is not that Alexander is a female favorite. It’s just that the epicenter of his attention is now a disease, which is more often fixed in women. Moreover, the further, the more often.

But Alexander begins our conversation by debunking myths: it turned out that the number of patients has not increased recently, and women have been sick no more than men:

“Indeed, in the last twenty years in the world there has been an increase in the number of patients with diagnoses depression, autism, hyperactivity and a number of mental illnesses. But indirect data tells us that the number of cases is most likely not fundamentally changed. However, the number of people who seek psychiatric help changed. And here the awareness of the population and the level of diagnosis are already affected. In addition, it should be borne in mind that 15 years ago, an appeal to a psychiatrist could be perceived by people surrounding the patient as something shameful. The patient could subsequently have problems with hiring as a result of only the fact that he underwent psychiatric treatment. Fortunately, such problems remained in the past. Nevertheless, today we are not identifying all patients. In our clinic, 70% of patients with depression are women. But if you analyze the problem comprehensively: taking into account cases of suicide, alcoholization and other knowing consequences attached to depression, it turns out that men who are patients with depression are no less than women. At the same time, in large cities of Russia, the percentage of sick (or rather, who turned for help) is the same as in the West. If you look at small cities and the village population, then we will see a significant decrease in the number of such patients. ”

However, you should not rush to rejoice at the village population. The study of the Institute of Physiology and Fundamental Medicine showed that the risk of depression in the rural population of the Novosibirsk region is no less than that urban. “One of the factors in the development of depression is neurotism - individual sensitivity to negative experiences,” Alexander explains the received data. - High indicators of neuroticism are also found in absolutely healthy people. However, the risk of developing depression in people with increased neuroticism is greater than in people with its low meanings. In women, neuralism indicators are usually higher than in men. So neuroticism is on average more pronounced in people living in rural areas than those who live in the city. And the Siberian Mongoloids (Yakuts, Tuvans, Yukagirs and Evenki) during psychological testing show great meanings of neuroticism than Caucasians. The last fifty years of the village population of our country has been actively migrating to the cities. And then the question arises, who leaves and who remains. Most often, people who are afraid of changes remain in the villages, afraid to meet troubles, that is, people with higher neuroticism. As a result, we get such a psychological drift: those who are more inclined to depression are more likely to live in the village. It turns out that in the villages of people with a predisposition to depression more than in cities, regardless of their standard of living, salaries, etc. At the same time, life in the village is objectively more difficult. ”

Another thing is how villagers are fighting depression. They, as you know, can not be addressed to doctors, but to alcohol, that they do not save them from depression, but only adds problems in life. As a result, in the villages, compared to the city, there is a lower percentage of people who applied for medical help in connection with depression, but a greater level of suicides, alcohol poisoning, domestic killings, etc.

A separate question is what depression is. And this question, as it turned out, is also connected by many myths. For example, many in our country believe that these are just a sad mood or insoluble problems in life (loss of work, loss of loved ones). “People with depression often (our view) can be good in life - no“ reasons for sadness ”. However, they are constantly in a poor emotional state, and the solution of one or another everyday problem does not lead to their recovery, ”says Satostyanov. - For example, there is such a concept “depressive rumination” - repeated obsessive memories, thoughts. I myself worked with the case when a traumatic episode occurred in the patient more than 15 years ago. Then a person somehow allowed this episode, and for 15 years he did not bother him, and suddenly ... memories that actually deprive him of his performance began to happen to him. Until the fact that the memories are so distinct that he is forced to sit down and try to cope with them right where it happened is on the asphalt on the street or on the floor at the workplace. A completely different story is light depression. In this case, the lack of light is an annoying event. To this type of depression, women are more sensitive, simply due to the features of the work of their hormonal system. This is the rare case when a change in external conditions really solves the problem of depression. And between the risk of depression and, for example, we do not observe the socio-economic crisis of direct dependence. ”

Depression is a multifactorial phenomenon. Actually, that is why scientists needed a multidisciplinary team of specialists to study this issue. In addition, Alexander notes: at the level of neurophysiology, it is clear that we call depression a whole group of various diseases that cause a similar “poor” state.

Currently, Alexander is inclined to suggest that in the case of depression, the genetic characteristics are put on the climatic and cultural conditions of life. “To date, it has been established that only on the basis of genetic analysis to predict the risk of developing in a person of any mental illness it is impossible-genes, especially associated with behavioral characteristics, always behave differently in different environment.”

Nevertheless, during this study, it was possible to detect some connections between the work of specific genes and the tendency to depression.

“In 1996, a group of researchers, led by Claus-Peter Lesch (Klaus-Peter Lesch), associated the risk of depression with genetic polymorphisms of the serotonin system,” says Alexander. Serotonin is a substance that plays the role of a mediator in nerve cells. In popular articles, it is often called the “hormone of happiness”, which, as Alexander notes, is completely wrong. After all, hormones enter the bloodstream, and mediators are released with direct contact of one nerve cell with another. At the same time, serotonin is also in the blood, but it does not directly affect our emotional state. Blood serotonin regulates the work of the gastrointestinal tract and blood coagulation. In the brain, serotonin is not associated with a feeling of happiness, but with the arbitrary control of emotions. At the holiday, you try to have fun, at work - to be collected and serious, etc. Disorders in the operation of the serotonin system increase the risk of suicides. Such violations can cause crimes committed as a result of mental illness, as well as depression or anxiety disorders. Serotonin is tolerated by nervous fiber with a special protein (serotonin conveyor), the structure of which can vary in different people, which is determined genetically. Simply put, such a protein can be either long (l) or short (s). Three situations are genetically possible: a person has only a long conveyor (LL genotype), only short (SS) or both options at once (LS). Moreover, according to Western studies, in the presence of a LL version (homozygotes with a more actively working and synthesizing more protein-transporter by allele) the risk of depression is lower than with other genotypes. But at the same time, according to the data obtained in South Korea and Japan, in these countries there is a directly opposite dependence between incidence and genotype. In Japanese and Korean individuals with the LL genotype, an increased tendency to depression is observed. In different regions of China, the dependence between the genotype and incidence is very different. In our studies, we have received different dependencies between this allele polymorphism, personal characteristics and the risk of developing mental illness for different peoples of Siberia: Russians, Tuvans, Yakuts and Evenks. We see a complex interaction between the genetic characteristics of a person and the conditions of his life, which can change the influence of the gene, including the opposite.

The results of the tests for recognizing emotions (both people and emotionally colored sentences) turned out to be very interesting. It turned out that people homozygous in the allele of a short conveyor serotonin (SS genotype) are poorly recognized by other people's emotions ... This applies to both photographs of faces and text. For example, during the implementation of experimental tasks, participants were proposed to find a spelling error in sentences, some of which described other people's emotions with different sign. If people with the LL genotype showed a differentiated brain and behavioral reaction to sentences of different emotional coloring (different speed, different brain activity), then the carriers of the SS genotype were looking for a spelling error, not paying attention to the emotional coloring of the sentence.

“We observed such reactions in all people with a certain genotype, regardless of their ethnicity, living in a big city or village. At the level of the brain reaction, a clear connection of the carrier of a certain genotype with sensitivity to emotions is visible. But at the same time, when both groups were given a simple game testing the rate of shooting at targets, the carriers of the SS genotype showed significantly higher results: that is, the recognition rate of unemotional stimuli, the speed of psychomotor reaction in them with people with LL and LS genotypes. ”

The texts were given to subjects not only in their native, but also in a foreign language. For native speakers of the Russian language, the proposals were in Russian and English, for the Tuvans - in Russian, Tuvan and English, the Yakuts were tested in Russian, Yakut and English. The brain reactions to the emotional coloring of the English text had practically no subjects. A similar reaction was recorded for the Tuvan and Russian text of the Tuvans. But the Yakuts, it would seem, are paradoxical: the brain reacted to sentences in English and Yakutsk, as a foreign text, and in Russian - as in his native language. The researchers see the reason that mainly students of the University of Medicine, who speak Yakutsk, participated in the experiment, but very rarely encounter written texts in their native language.

Another discovery of these tests: the brain of a native of a small Siberian village reacts to a neutral expression on the face in the same way as an aggressive one. “This is not surprising,” Alexander cools and surprise Alexander. - A resident of the big city is constantly meeting strangers. And the ability to recognize hidden aggression, an implicit threat from another person is a survival factor. In the Tuvan steppe, a stranger is a rarity. And this forces the indigenous inhabitants to consider for themselves dangerous for any stranger who clearly does not show emotion. ”

The Caucasians have the probability of meeting L-allel (“a gene, possibly associated with high emotional sensitivity”)-55%, and in Mongoloids-21%. The probability of meeting S-allel (possibly associated with reduced emotional sensitivity) in Mongoloids-73%, in Caucasians-39%. The meeting in the allele population is more than 70% suggests that it is associated with some adaptive sign. At the same time, in the Nemodsky regions of Yakutia and Tyvs, the incidence of this allele can be more than 90%, while the probability of finding it in a German resident is about 5%.

As a result, in a city where there are many people, the ability to distinguish between the emotions of others is a factor that reduces the risk of depression. And in small cities, on the contrary, this ability increases risks.

The behavior of heterozygot Alexander jokingly illustrates a joke about the successful name of Izyaslav: "Where it is necessary, it seemed to be fame, and where it is necessary." In people born in large cities (for example, in Novosibirsk), the carriers of the LS genotype behave like people with high emotional sensitivity, and in Tuvan small settlements - as a low one. The question is very relevant what is happening with the carrier of the heterozygous genotype if he moves from a small settlement to a metropolis, being already an adult. “This is really a very important and relevant issue,” my interlocutor instantly becomes serious. - We are observing in Siberia a significant growth of the Turkish -speaking Mongoloid population. If the trend remains, then after 30 years, every second resident of the Great City will be Mongoloid. In Tyu, for example, high birth rate (an average of 3.5 children for each woman), a dry climate unusable in a significant area and, as a result, active migration from small settlements to large cities. And such migration is alarming in that people are adapted to one conditions, and they are forced to live in others. This is the reason for the growth of not only psychiatric complications, but also criminal and suicidal episodes. ” Perhaps, this explains the leading position of Kyzyl (the capital of Tyvs) in youth suicides and a high level of domestic injuries.

In reality, according to the expert, no less acute problems are facing the beer of the LL genotype, which has gone, for example, to extract diamonds to Yakutia. Currently, a group of scientists of the Institute of Physiology and Fundamental Medicine plans to examine Russian workers working in a shift method in northern Siberia. “Modern life is such that we constantly have to change the habitat: today you are working in Tyuy or Forests of the Amazon, tomorrow in Moscow or Munich, and it is important to understand what is happening to us when changing the habitat,” my interlocutor means the relevance of research. - That is, we see two ways of social adaptation. The first, well suitable for large cities, is when “we need to think a lot before you do nothing.” The second is when it is necessary to move quickly and it is not necessary to distinguish between the emotions of others. ”

One of the first problems that the team encountered: traditional tests are not suitable for the indigenous peoples of Siberia. For example, the subject can say that he has a normal mood, and immediately notice that his soul died ...

Depression can be identified not only according to the results of surveys and conversations with a psychologist, but also on MRI and electroencephalogram. Moreover, paradoxically, it is best seen in the absence of a functional load of the brain. In 2001, an amazing brain system was opened: in the absence of tasks, it actively worked, when an external load appeared, she freezed. The system is called default (DMN). Its violations are associated with diseases such as senile dementia and autism. Moreover, by the fall of the level of activity of the DMN, senile dementia can be seen before it manifests itself in behavior. The group, in which Alexander works, managed to show that the activity of DMN is also connected with the "pondering of social relations." The high risk of depression is usually associated with an increased level of activity of the default system. However, some patients may observe the opposite dependence when the disease is accompanied by the disappearance of the activity of the default system at rest. It was suggested that people with increased activity of default systems have a tendency to ruminations and high sensitivity to negative experience. The latter probably more often demonstrate a decrease in the ability to have fun.

These deviations are clearly visible on functional MRI and Meg. Геннадию Георгиевичу Князеву, научному руководителю проекта, удалось продумать такую математическую методику обработки данных, которая позволяет видеть те же процессы на ЭЭГ И это было необычайно важно. Ведь у МРТ и МЭГ наряду с большим количеством плюсов есть существенные минусы: дорого и немобильно. Дру-гое дело электроэнцефалограмма: «Я совсем недавно снимал ЭЭГ в юрте, в степи, когда до ближайшего населенного пункта было несколько десятков, а то и сотен километров. А могу снять и на пеньке в глухой тайге», — приводит примеры Савостьянов. Есть у ЭЭГ и другие существенные преимущества: ее временное разрешение — две миллисекунды против нескольких секунд для томографа.

Интересный вопрос — что происходит с мозгом человека, когда последний начинает лечиться от депрессии. «Вероятнее всего, при лечении запускается процесс переосмысления травматических событий, — поясняет Александр. — Например, для борьбы с руминациями есть два метода: первый -попытаться запретить себе думать о плохих событиях (ни к чему хорошему такой метод не приводит, депрессия только усиливается), второй — переоценить событие в положительном ключе (оторвало ногу, но остался жив). Практически вся религиозная психотерапия — это варианты переосмысления негативного опыта — такие, чтобы человек увидел в плохих событиях какой-то высший, положительный смысл. Более того, у людей, которые выходят из депрессии, падает восприимчивость и к положительным, и к отрицательным эмоциям. Но при этом много энергии тратится на «внутреннюю речь», процессы переосмысления. То есть фактически во время лечения больной может начать отличаться от здорового еще сильнее, чем до терапии, но такие отличия связаны с процессом его выздоровления».

Пока перед участниками исследовательской группы вопросов больше, чем ответов. И пока исследование остается чисто научным. По словам Александра, на практические результаты можно надеяться лет через пять: ранняя диагностика, персонализированный подбор лечения (сегодня препараты от депрессии помогают лишь примерно в 70% случаях, а 10% ухудшают состояние больного). «В настоящее время перед нами большая мозаика; некоторые пазлы мы уже собрали и видим часть картины, что-то предполагаем, что-то только предстоит узнать. Многие двери уже открыты, но теперь надо узнать, что за ними находится», — весьма романтично заканчивает нашу беседу Александр Савостьянов.

Александр Савостьянов
Talked Julia Cherny