Review Article Pol J Public Health 2015;125(2): 116-120

Review Article Pol J Public Health 2015;125(2): 116-120

Review Article Pol J Public Health 2015;125(2): 116-120 Marta BeMBnowska, Jadwiga Jośko-ochoJska What causes depression in adults? Abstract The problem of depression in adolescents is discussed increasingly more often. A lot of researchers devote their careers to investigating this subject. The issue becomes vital, since the number of young people with depressive symptoms is constantly on the rise. The diagnosis can be difficult, as many a time the changes so typical for the puberty period appear. They include mood swings, explosiveness, propulsion disorders, puissance, insomnia, concentration problems etc. These might be the first symptoms of depression as well. It is impossible to point to one cause of depression because it is a disease conditioned by many different factors, ranging from independent factors like genetic, biological, hormonal, through the influence of the fam- ily or the environment influence and socio-cultural components. Early depression symptoms, long time exposure to stress, challenges or adversities – things every young person has to deal with - are a breeding ground for risky behaviors among adolescents. Teens are more likely to reach for different kinds of stimulants like alcohol, cigarettes or drugs etc. It has also been proven that anti-health behaviors may cause depression in the future. Keywords: adolescent depression, risk factors, adolescents, behavior, anti-health. DOI: 10.1515/pjph-2015-0037 INTRODUCTION How mothers negative emotions affect the fetus during pregnancy? Depression in adolescents is a particular example of Since early pregnancy, the mothers’ emotions significant- an emotional and behavioral disorder, typical for the puberty ly affect the formation of synapses and the neurotransmitters period. It is associated with changes in the endocrine system secreted by the mother modify the development of a child’s that normally happen during that age. Those changes are due brain. Under the influence of stress during pregnancy, the to the development of new cognitive functions and taking mother’s body may release stress hormones the presence of new roles in society. During that period, a child achieves an which can affect the whole life of the unborn child. Depend- emotional autonomy and formal independence from their ing on how strong the negative emotions are and how long family [1]. Every young person considers that period of they last, it leads to a modification of synapses in the fetus’ life as extremely difficult. They need a greater understand- brain and exerts a destructive effect on neurons and glial ing from their family and the environment, as well as more cells [4]. attention to unusual behavior. Severe chronic stress by inhibiting the neurogenesis Not all young people are equally exposed to depression. and by contributing the atrophy of neurons, causes many The results confirm the participation of many factors that anatomical and pathophysiological changes: reduces the lead to depressive disorders and affect the progression of number of neurons. It also deteriorates the communication the disease. The studies also show gender differences in the between neurons, decreases neuroplasticity, entailing de- prevalence of depression. In children, the prevalence of de- pressive symptoms [5]. pression is equal in both genders. Some significant differenc- With use of fMRI (functional Magnetic Resonance Im- es appear along with maturation (depression symptoms are aging), besides significant destructive changes in the brain, more frequent in girls), clearly these differences are revealed it was also found that children of women who have expe- between 13 and 15 years of age, and reach its peak at the rienced severe stress and negative emotions both during age of 15-18 years, so this group is at a higher risk to suffer pregnancy and after birth, often also have enlarged amyg- from depression especially in the population of girls [2]. daloid nucleuses (brain structures that regulating emotion- There is no single source of depression. It is a multifacto- al reactions and responsible for feelings of anxiety, panic rial disease, which means it might be caused by a range of and aggression). The stronger the maternal stress is, the greater factors, including genetic, hormonal, biological, as well as the volume of amygdaloid nucleus in the child [6]. the impact of family and other socio-cultural factors [3]. The Chair and Department of Environmental Medicine and Epidemiology, Medical University of Silesia in Katowice, Poland © 2015 Medical University of Lublin. All rights reserved Pol J Public Health 2015;125(2) 117 The infants whose mothers suffered from depression also Biological causes show a decreased activity of EEG (electroencephalogra- The biological reasons are associated with disorders at the phy) of the left hemisphere, mainly of the left frontal lobe. level of the neurotransmission in brain including substanc- The stronger the negative emotions of the mother are, es such as serotonin, norepinephrine, dopamine, gamma – the lower is the EEG activity in the child’s brain [7]. aminobutyric acid (GABA), cerebral nerve growth fac- It is also shown that epigenetic changes in the form of tor (BDNF – brain-derived neurotrophic factor) and others H3K14 hyperacetylation in the promoter of the gene BDNF [14,15]. (brain-derived neurotrophic factor) in the prefrontal cortex It is assumed that the reduced production of these neu- are responsible for emotional memory. This means that the rotransmitters can cause symptoms of depression, and may experience of the fetal period may disappear in emotional be responsible for the emergence of suicidal thoughts and memory for many years, sometimes for the rest of one’s life actions. and may be the cause of unexplained fears [8]. Research studies carried out at the University of Pisa Genetic causes in Italy confirm that serotonin deficiency plays a significant role in the development of depression. It was also shown that Scientific research proves that the mother’s depression kynurenine seriously affects the central nervous system by and her anxiety during pregnancy can be inherited and can increasing the expression of the “tryptophan-kynurenine” cause anxiety and depressive disorders in the newborns [9]. and in this way determines the serotonin deficiency. The lay- It is estimated that the people, whose first-degree relatives out “tryptophan-kynurenine” also affects the formation of suffer from depression are 1.5 to 3 times more likely to de- anxiety disorders, psychotic symptoms and depressive dis- velop depression. According to some studies, depression can orders. Kynurenine pathway of tryptophan metabolism leads be associated with genes occupying a fixed position on chro- to the formation of multiple active metabolites, which act an- mosome 8, 15 and 17 [10]. tagonistically relative to each other. At first, the amino acid The scientists also conducted studies of the nervous tissue is metabolized to formylkynurenine, which is converted to in deceased people who had suffered from depression before the kynurenine. Two enzymes are involved in this reaction: death. The results have shown that depression contributes 2,3 tryptophan dihydrooxygenase [TDO], activated by stress to the formation of a gene MKP-1 (mitogen-activated pro- hormones and indoleamine 2,3 dioxygenase [IDO], activated tein kinase phosphatase-1), which was 2 times more active by pro-inflammatory cytokines. The increased expression in patients than in the healthy group. An increased expression of genes producing cytokines (IFN γ, TNF-α) may deter- of MKP-1 located in the hippocampus, as a result of stress, mine a genetic predisposition to the formation of depression initiated depressive behaviors. On the other hand, chronic (by activation the pathway of IDO), and environmental stim- antidepressant treatment with normalized the expression of uli activate the TDO path at hormonal level. It is suggested MKP-1. Using these results, it can be concluded that stress that the system “tryptophan-kynurenine” may be one of the remains one the main factors causing depression. It increases main sites of interaction between genetic and environmental the expression of the MPK-1 gene [11]. factors involved in the pathophysiology of depression [16]. Recent research published in the Journal of Inherited Met- abolic Disease, conducted among children with congenital Social factors and lifestyle disorders of glycosylation (CDG) confirm a higher incidence This can include family problems, traumatic experiences, of social-emotional disorders, such as symptoms of depres- all kinds of stress, addiction, being overwhelmed with daily sion, social withdrawal and somatic disorders in children duties, insomnia, etc. diagnosed with CDG, compared to healthy children, chil- dren with mitochondrial disorders and other types of meta- Influence of family bolic diseases. In more than two thirds of the children with Here, it is both the relationships between parents them- CDG it was observed a variation in the abnormal behavior selves, as well as their relation with children. There might identification test -The Child Behavior Checklist (CBCL). be conflicts, divorce, alcoholism in the family, including the The authors emphasize the importance of psychological mental health disorders and domestic violence of a sexual screening tests among patients with disorders of glycosyla- or moral nature. According to an article published by Journal tion, as a group of an increased risk of developing socio- of the American Academy of Child &

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