Evidence Based Critical Appraisal Topic
Genetics and Depression in Women
Leena Kunwar Leon
University of Mary
Due: 8/13/2015
Case Study
D.W is a 27year old female who present to your clinic with her husband complaining of "My
husband thinks I need help". Patient has both side family history of depression. Also, patient
states she has lost interests on her usual activities. No previous PHQ was completed, you
received PHQ score of 18, which is moderate to severe depression. Patient is not any medication
other than birth control and daily multi vitamin. Patient denies suicidal ideation, is asking for
genetic testing for depression.
Background
According to Cancro (2011), depression is a disease that must be distinguished from unhappiness
or an appropriate response to a loss or injury. Sadness in the face of unhappy events is not an
illness. Depression is not just a disease of mood. It is characterized by a loss of energy, by
fatigue, social withdrawal, confusion, cognitive dulling, a loss of ability to enjoy the activities
that normally please the individual, and changes in sleep, libido, and appetite (Cancro,2011).
Much more than mood is involved. While depression is more frequent in women, it is an equal
opportunity disease, striking all socioeconomic classes, races, and age groups(Cancro,2011). It
appears to be on the increase in frequency, but this may reflect greater public awareness
of depression as an illness and not just as a condition of life that must be borne. On the other
hand, the stresses of contemporary life are such that it would not be a surprise if depression were
actually on the increase(Cancro,2011).
PICO Question
In comparison to male what makes female genetically more venerable to depression?
Articles
Cancro, R.(2011). Depression. Exceptional Parents. 41(8) 31-2. Retrieved from http://701ezproxy2.bismarck.lib.nd.us:2243/ehost/detail/detail?vid=18&sid=ced16406-8ad4-43c69c0c562371ddb47d%40sessionmgr110&hid=109&bdata=JnNpdGU9ZWhvc3QtbGl2ZQ%3d
%3d#AN=2011232901&db=ccm
Rusbya, J.S.M., Harrisb, J.M., Taskera, F. (2013). Female interpersonal dependency: genetic and
environmental components and its relationship. Department of Psychological Sciences.
Retrieved from http://701ezproxy2.bismarck.lib.nd.us:2243/ehost/detail/detail?vid=20&sid=ced16406-8ad4-43c69c0c562371ddb47d%40sessionmgr110&hid=109&bdata=JnNpdGU9ZWhvc3QtbGl2ZQ%3d
%3d#AN=2012352967&db=ccm
Procopio, D.O., Saba, L.M., Walter, H., Lesch, O., Skala, K.(2013). GeneticMarkers of
Comorbid Depression and Alcoholism in Women. Department of Pharmacology. 37(6),
896-904. Retrieved from http://701ezproxy2.bismarck.lib.nd.us:2243/ehost/detail/detail?vid=21&sid=ced16406-8ad4-43c69c0c562371ddb47d%40sessionmgr110&hid=109&bdata=JnNpdGU9ZWhvc3QtbGl2ZQ%3d
%3d#AN=2012127869&db=ccm
Article I
Rusby et.al (2013), conducted a study including female twin to see if that female interpersonal
dependency is significantly associated with clinical depression but is only marginally related to
childhood environmental factors. The study was survey with multiple choice question and
answer (Evidence level 1). All subjects were volunteer male and female monozygotic(MZ) and
dizygotic (DZ) twins. the study doesn't indicate if the study was randomized or single or double
blind. A total of 4427 replied giving a response rate of 63%, of which 90% were female and
10% male. MZ and DZ twins accounted for 56% and 43% of the cases and in 1% zygosity was
undetermined. The subject age ranged from 19 to 87 years. After including only paired same-sex
twins, reared together, of known zygosity and white ethnicity, the number of complete twin pairs
available for the genetic analyses were 824 MZ and 607 DZ female and 92 MZ and 34 DZ male
pairs. No genetic analysis using the male pairs was made because of the low numbers available.
The genetic analysis of the dependency data for females was based on a series of EQS model
computations using the normal theory maximum likelihood estimation procedure.
Similar to previous research, Rusby et.al (2013) concluded that the additive genetic component
of female interpersonal dependency being estimated at 49% for the younger and 41% for the
older groups. It was also confirmed that this dependency is not associated with the shared, or
family environment, C, but is dependent on the random environment, E.
The study was approved and financially supported and funded by the Department of
Psychological Sciences, Birkbeck University of London, Department of Health via the National
Institute for Health Research Comprehensive Biomedical Research Centre Award to Guy’s & St
Thomas’ NHS Foundation Trust in partnership with King’s College London. The author's
indicated that they no affiliation with any of the sponsor organization, no financial benefit was
received.
Article II
A study by Procopio et.al (2013), analyzed the association of adenylyl cyclase genes (ADCY1–
9), which are implicated in both Alcohol dependence and mood disorders, with alcoholism and
comorbid depression. The total of 1,152 subjects were examined with the genetic locations of
the 9 ADCY genes. Also out of 1, 152 subjects only 323 were included in the study. In the study
authors divided the subjects into four types of alcoholism. Out of IV different types, Type III
alcoholism is distinguished by co-occurrence of symptoms of depression and by affecting
predominantly females. The study was double blind ( Evidence level II), but selective of sample
( Alcoholics with depression).
The authors concluded that four different haplotypes were associated with the type III alcoholism
in females. "One haplotype was in a genomic area in proximity to ADCY2, but actually within a
lincRNA gene, 2 haplotypes were within ADCY5, and 1 haplotype was within the coding region
of ADCY8 (Procopio et.al, 2013). Next, 3 of the 4 haplotypes contributed independently to Type
III alcoholism (are co-occurance of depression) and together generated a positive predictive
value of 72% and a negative predictive value of 78% for distinguishing women with a Lesch
Type III diagnosis versus women designated as Type I or II alcoholics (Procopio, et.al, 2013).
In the study, the authors do not provide the definitive inclusive and exclusive criteria used to
include subjects in the study. Also, it is unclear how the authors collected the subjects. This work
was supported in part from the ONB-Jubilaeumsfonds (HW, OL), Austria by grant No. 13705;
Banbury Fund (BT), and NIH/NIAAA R24AA013162 (BT). the authors had no financial benefit
from the study results.
Clinical Bottom Line
These studies provide genetic information regarding depression and comorbidies such as
alcoholism and dependency. As a provider, it should be noted when screening for depression,
one may need to screen for alcohol use or dependence. The study by Procopio et.al (2013)
suggests that people with alcoholism and depression have haplotypes that makes these both to
co-exists. It is vital to be non judgmental while screening the patient.