Marie-Josée Brouillette came to speak at a Treatment Conference on depression in those living with HIV. She was willing to look at depression from two angles – as both a biological phenomenon as well as a psychosocial one – in the brain and in the mind. She discussed both approaches to it, beginning with the more naturalistic route –delving into the intricacies of brain anatomy and scans to determine the precise location of depressive symptoms. She described the latest research in very accessible terms and discussed hormones effortlessly and breathlessly in easy terms for the lay listener.
Brouillette linked biological research with common folk knowledge, explaining just why eating turkey makes one sleepy, (It’s the trypthophan in the turkey,) and linking it all once again to depression.She discussed potential biological reasons for depression in HIV, from High viral loads, to the side effects of medication, all the way to neuro-AIDS, a condition of psychiatric symptoms from cerebral infection.
Then she covered the psychology of depression in HIV, from Freud to the modern era. From a psychological standpoint, Brouillette said that depression can often be associated with “crisis points” for people living with HIV, for example, when a person first learns of their status, when they disclose it to family and friends or when the start medication. There can be other crisis points at later dates, such as when new illnesses or symptoms arise, when end-of-life planning. Not all are necessarily associated with progression of AIDS; sometimes a crisis point can happen when a person’s illness improves and they must return to work or school.
Still others can come from changes in body image, self esteem and sense of desirability. Brouillette stressed that each crisis point is experienced differently depending on one’s personal circumstances.
Then she posed the question to the audience, is it in the brain or in the mind? Most nodded that it could be both. Dr. Brouillette displayed recent genetic research showing that people with one variation in a certain gene are much more likely to get depressed. Environment did have an effect, but 40% of the probability of depression was found to depend on only one variation in this one gene—a piece of DNA that controls how much of the Serotonin Transporter is made, which is a protein that moves the mood-altering hormone serotonin. While Brouillette acknowledged that the number of stressful life events had an effect, she argued that much of the risk for depression was genetic in origin.
Dr. Brouillette believes that considering depression as a primarily genetic illness helps to removes the blame from the sufferer – it is not their fault, nor the result of a weaker personality, she argues. Some people are predisposed to respond to stressful life events with depressive symptoms, and others are may do so without much incident. This does not remove a person’s personal agency, because, as she puts it, “An explanation is not an excuse.” She believes that understanding the origins of depression can empower its sufferers to think of themselves as different individuals with individual needs., and to seek the coping strategies that work best for them.
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