Scars in depression: is a conceptual shift necessary to solve the puzzle?

Wichers, Marieke; Geschwind, Nicole; Os, Jim van; Peeters, Frenk

doi:10.1017/s0033291709990420

Cited by 76 publications

(72 citation statements)

References 46 publications

(51 reference statements)

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“…Further, it might be that any scarring already occurred before T0 in those with previous episodes, limiting further scarring. Thus, although it may still be too early to discard the idea that scarring occurs altogethermaybe scarring does occur, but in a subtle way (Wichers et al 2010), in subgroups we did not investigate, or in outcome measures we did not investigate (Burcusa & Iacono, 2007;Bhagwagar & Cowen, 2008) -our study suggests there is no robust scarring effect. In contrast to the scarring effects, the vulnerability effects observed in the present study were robust and substantial.…”

Section: Discussionmentioning

confidence: 79%

Functioning before and after a major depressive episode: pre-existing vulnerability or scar? A prospective three-wave population-based study

et al. 2018

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Background. The vulnerability hypothesis suggests that impairments after remission of depressive episodes reflect a pre-existing vulnerability, while the scar hypothesis proposes that depression leaves residual impairments that confer risk of subsequent episodes. We prospectively examined vulnerability and scar effects in mental and physical functioning in a representative Dutch population sample. Methods. Three waves were used from the Netherlands Mental Health Survey and Incidence Study-2, a population-based study with a 6-years follow-up. Mental and physical functioning were assessed with the Medical Outcomes Study Short Form (SF-36). Major depressive disorder (MDD) was assessed with the Composite International Diagnostic Interview 3.0. Vulnerability effects were examined by comparing healthy controls (n = 2826) with individuals who developed a first-onset depressive episode during first follow-up but did not have a lifetime diagnosis of MDD at baseline (n = 181). Scarring effects were examined by comparing pre-and post-morbid functioning in individuals who developed a depressive episode after baseline that was remitted at the third wave (n = 108).Results. Both mental (B = −5.4, S.E. = 0.9, p < 0.001) and physical functioning (B = −8.2, S.E. = 1.1, p < 0.001) at baseline were lower in individuals who developed a first depressive episode after baseline compared with healthy controls. This effect was most pronounced in people who developed a severe episode. No firm evidence of scarring in mental or physical functioning was found. In unadjusted analyses, physical functioning was still lowered post-morbidly (B = −5.1, S.E. = 2.1, p = 0.014), but this effect disappeared in adjusted analyses. Conclusions. Functional impairments after remission of depression seem to reflect a preexisting vulnerability rather than a scar.

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Section: Discussionmentioning

confidence: 79%

Functioning before and after a major depressive episode: pre-existing vulnerability or scar? A prospective three-wave population-based study

et al. 2018

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“…There is the primary underlying vulnerability to develop depression that exists prior to the occurrence of any depressive episode and the increased secondary vulnerability to develop further episodes following the first MDE that may be partly due to scarring effects arising from this first episode [65,66,67]. We were unable to identify whether the presence of a self-contempt bias in individuals with remitted MDD is due to primary or secondary vulnerability.…”

Section: Discussionmentioning

confidence: 99%

“…We were unable to identify whether the presence of a self-contempt bias in individuals with remitted MDD is due to primary or secondary vulnerability. These are inextricably linked such that secondary vulnerability develops from primary vulnerability and may increase in a cumulative fashion over the life span [65]. …”

Section: Discussionmentioning

confidence: 99%

Proneness to Decreased Negative Emotions in Major Depressive Disorder when Blaming Others rather than Oneself

et al. 2012

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Background: One widespread view holds that vulnerability to major depressive disorder (MDD) is linked to overall increases in negative emotionality. In contrast, cognitive attribution theories emphasize the importance of blaming oneself rather than others for negative events. Thus far, the contrasting predictions of these models have not been directly compared. Following the attributional perspective, we tested the hypothesis that people with remitted MDD show no overall bias towards negative emotions, but a selective bias towards self-blaming emotions relative to those emotions associated with blaming others. Sampling and Methods: We compared a remitted MDD and a control group on a novel experimental test that allowed us to directly compare proneness to specific emotions associated with different types of self-blame (guilt, shame, self-contempt/disgust) and blame of others (other-indignation/anger, other-contempt/disgust) whilst controlling for negative valence and medication status, and excluding comorbidity. Results: In agreement with our hypothesis, individuals with remitted MDD exhibited an increased self-contempt bias (difference between contempt/disgust towards self and others) but no increased proneness to any other negative emotion or overall increases in perceived negative valence of stimuli. Moreover, the remitted MDD group exhibited reduced contempt/disgust towards others. Conclusions: Our results corroborate the prediction that vulnerability to MDD is associated with an imbalance of specific self- and other-blaming emotions rather than a general increase in negative emotions. Based on the composition of our sample, we speculate that self-contempt bias may be particularly characteristic of melancholic MDD subtypes and could be useful for stratification of depression in the future.

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“…The studies including healthy family members suggest that hyperactivity of the HPA axis is not only a reflection of current mood state [19]. A new approach to this problem is the scar theory [20], describing long-lasting changes in the function of the brain (cognition, biological) following depression, increasing the risk for developing future depressive episodes. The premorbid regulated ‘set-point’ of the HPA axis is thought to be changed through depression by, for example, epigenetic changes in DNA methylation in depressed suicide victims [21] and children of mothers who were depressed during pregnancy [22].…”

Section: Assessment Of Glucocorticoid Sensitivity In Relation To Moodmentioning

confidence: 99%

Glucocorticoid Sensitivity in Mood Disorders

Spijker

Rossum

2011

Neuroendocrinology

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In this review, we provide an overview of recent literature on glucocorticoid (GC) sensitivity in mood disorders. Assessing GC sensitivity is often performed by measuring the cortisol awakening rise (CAR), by challenging the hypothalamic-pituitary–adrenal (HPA) axis using a dexamethasone suppression test (DST) or a dexamethasone/cortisol-releasing hormone test (DEX/CRH); more recently by measuring cortisol as a retrospective calendar in scalp hair. The main findings in mood disorders are higher mean cortisol levels in hair samples and a higher CAR, showing a hyperactivity of the HPA axis. This is in line with the mild resistance for GCs previously observed in challenge tests during mood episodes. GC sensitivity is partly determined by polymorphisms in the genes encoding receptors and other proteins involved in the regulation of the HPA axis. We shortly discuss the glucocorticoid receptor, as well as the mineralocorticoid receptor, the cortisol-releasing hormone receptor-1, and the glucocorticoid receptor co-chaperone FKBP5. Data clearly indicate genetic changes, along with epigenetic changes which influence the set-point and regulation of the HPA axis. Early trauma, as well as influences in utero, appears to be important. Future research is necessary to further clarify the biological background and consequences of an individual’s cortisol exposure in relation to mood.

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Scars in depression: is a conceptual shift necessary to solve the puzzle?

Cited by 76 publications

References 46 publications

Functioning before and after a major depressive episode: pre-existing vulnerability or scar? A prospective three-wave population-based study

Functioning before and after a major depressive episode: pre-existing vulnerability or scar? A prospective three-wave population-based study

Proneness to Decreased Negative Emotions in Major Depressive Disorder when Blaming Others rather than Oneself

Glucocorticoid Sensitivity in Mood Disorders

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