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Biomarker could help boys at risk of major depression

Early warning British brain scientists have identified a 'biological signpost' for clinical depression and say it could help identify those are at risk of developing the debilitating mental illness.

In a study in the Proceedings of the National Academy of Sciences (PNAS) journal, the team found that teenage boys who have a combination of depressive symptoms and raised levels of the stress hormone cortisol are up to 14 times more likely to develop major depression than those who show neither trait.

The findings suggest teenagers could in future be screened for such signals, and those at highest risk could be helped to develop the kind of coping strategies and "brain fitness" to help them avoid becoming depressive.

"We're very bad about looking after our mental health, and yet the problems of mental health are extremely common," says Professor Barbara Sahakian of Cambridge University who worked on the study.

"Depression is one of the greatest global burdens of disease — it's a much bigger problem than heart disease or cancer and it's much more expensive."

Depression affects around 350 million people worldwide and at its worst can blight patients' lives for decades, affecting their relationships, work and ability to function. It can also lead to suicide, which alone leads to a million deaths a year.

"Depression is a terrible illness," says Professor Ian Goodyer, a child and adolescent psychiatrist who led the research team. "(And) we now have a very real way of identifying those teenage boys most likely to develop clinical depression."

He says armed with such knowledge, doctors and other carers could target prevention strategies at depression-vulnerable boys and "hopefully help reduce their risk of serious episodes of depression and their consequences in adult life".

According to the World Health Organisation, prevention programmes — including boosting cognitive, problem-solving and social skills in children — have been shown to reduce depression, and earlier intervention is more effective.

Depression triggers

Different factors are thought to influence the development of depression, including genetics, brain chemistry, lifestyle and upbringing. Key triggers for the condition can include stressful life events, medical illness and alcohol abuse.

For their study, Goodyear's team measured levels of cortisol in saliva from two large separate groups of teenagers. The first group of 660 provided samples on four school mornings within a week and then again 12 months later. A second group of 1198 teenagers gave samples over three school mornings.

Using self-reports, collected over 12 months, of any symptoms of depression — such as feeling sad or anxious — and combining them with the cortisol results, the researchers then divided the teenagers into four sub-groups ranging from those with normal levels of cortisol and low symptoms of depression in Group 1 through to those teenagers with more cortisol and high symptoms of depression in Group 4.

Tracking the teenagers for three years, the team found that those in Group 4 were on average seven times more likely than those in Group 1, and two to three times more likely than in the other two groups, to develop clinical depression.

Further analysis showed that boys in Group 4 were 14 times more likely to develop clinical depression than those in Group 1, and two to four times more likely to develop it than either of the other two groups.

Commenting on the findings, John Williams, head of neuroscience and mental at the Wellcome Trust charity which helped fund the study, noted that depression is "incredibly costly to society" and cited a 2011 European College of Neuropsychopharmacology report that said mood disorders cost Europe alone more than 110 billion euros (AU$167 billion) a year.

"We desperately need ways to identify people at high risk of depression early so we can potentially prevent its onset and treat it early to reduce its burden. In this context, (this) study ... is a landmark in the field," he says.