The puzzle pieces of a depression

Why do some people develop a depressive disorder while others do not? That is the question that keeps Hanna van Loo busy on a daily basis. She is currently doing a study that focuses on the role of genes and environmental factors in a depression. ‘There is no one depression gene. There are many genes that contribute to an increased risk of depression.’

_{Text: Jaap Ploeger, Corporate Communication / Photos: Henk Veenstra}

Depressive disorder

When symptoms of depression, such as sombreness, loss of interest, and feelings of worthlessness, control someone’s life for longer than two weeks medical specialists call this a depressive disorder. The average patient with depression does not exist. The cause may lie in a major incident, a trauma from the past, or, for example, another disorder such as autism that can trigger loneliness and a depression. Van Loo, who is a psychiatrist, an assistant professor, and a researcher at the UMCG, tries to understand as well as possible how the depression came to be in each individual. This insight offers clues on how to solve the depression. External factors such as relationships, work, and the home situation are also included in the diagnosis.

Genes and environment

At the moment, Van Loo focuses on genetic vulnerability. Some people have relatively many genes that contribute to an increased risk of depression and other people fewer. However, that does not mean that people who have more of those genes will therefore always develop a depressive disorder. For a large part, the risk is not just in your genes but also in your environment. Van Loo: ‘At the outpatient clinic, we are not researching genes yet, but we do ask after the family history in terms of psychiatric disorders. This could also be a bipolar disorder, schizophrenia, or an addiction. In my research, I look at whether genes, in addition to an immediate effect, also have an indirect effect via the environment. Could it be that a parent with a genetic vulnerability was less available during the upbringing, and that because of that the child has a higher risk of developing a depression? That’s what I would like to know. It’s also a puzzle to see what kind of interaction there is, because it’s never just the genes or just the environment. That’s what makes my research so interesting.’

Complex disorder

Van Loo: ‘Typical for patients with a depression is that they start to have sombre thoughts: this will never go away anymore, nothing helps me. I’m worthless. So then you have to persuade people to have faith in the treatment. Their joy and good mood will return but not immediately, it takes time. So it’s important to coach people well in that.’ That is also what fascinates her about this job, because it is a complex disorder. It is never simple. She sees people of both young and old ages, from successful in life to economically less fortunate. Someone can slide into a depression because of work pressure, a need to perform, or because of ongoing financial worries and the resulting stress. Van Loo tries to comprehend the patient’s environment but also wants the patient to understand, so that they can work on a solution together.

Lifelines

She draws on the wealth of data from the Lifelines study in the Northern Netherlands. ‘The goal of Lifelines is to understand who is at risk of developing chronic and complex disorders in the long run, such as depression. During the coronavirus pandemic, for example, we could measure the state of mind among Lifelines participants for a longer period of time’, says Van Loo. ‘This showed us that loneliness during lockdowns could trigger a depression.’ Lifelines is also a treasure trove of information for her research into the relation between genes and depression.
‘We have an anonymized database with the genes of almost all participants and through questionnaires and studies we can see if there are any links with the development of their mental health over the years. This could possibly help us better understand who we’re dealing with at an earlier stage of a treatment. Eventually, we want to be able to identify a depression early, and see who is in need of a more intensive track. Or we choose to let time do the healing and don’t start the patient on medication just yet. In the long run, the genes and environment research may lead to more precise tests to find out why a particular person slipped into a depression.’

Human being at the centre

Van Loo loves working with people and in doing so looks at what makes someone’s life valuable and important. ‘There are many psychiatrists that keep working until their retirement age and maybe even after that because every person you talk to is again interesting and engaging’, she says, ‘and it’s perhaps different for a doctor whose patients have the same symptoms every time. We try to really get to know a person, because it’s crucial to understand as well as possible what a person is like in order to find a fitting treatment.’ In addition, it is very satisfying for Van Loo to work in a multidisciplinary team. Her colleagues all have their own specialism from which they look at a patient, enabling them to make a diagnosis that is as clear as possible. Van Loo: ‘In the future, this method will allow us to treat depression even better and perhaps even prevent it.’

More information

Hanna van Loo