Pg. 97 Depression and Disease
Depression has a widespread and devastating impact on health. It is associated with disturbances in the endocrine, cardiovascular and immune systems as well as affecting bone health. The risk of coronary artery disease is three times higher among men with a diagnosis of depression; interestingly, there is no increased risk for women. After they have had a heart attack, depressed patients have a 3.5 increase in cardiovascular mortality. Applying new criteria developed by the World Bank, Harvard University, and the World Heath Organization, researches found that major depression is the leading cause of disability and lost days from work in developed countries, including the United States.
Pg. 101 Learning How Depression Works
We are much more successful at treating depression than understanding what causes it. Thomas Insel and Dennis Charney of the National Institute of Mental Health have identified some of the most important priorities for much-needed research on the biology and successful therapy of depression. These are their recommendations:
- Explore the identification of the genes that predispose to depression.
- Describe the systems of the brain involved in the regulation of mood; how the brain changes during the development of severe depression is unknown.
- Define the processes by which the brain recovers from depression, whether with the aid of psychotherapy or medication.
- Identify the experiences that put an individual at risk for depression. These include stress, loss, and abuse, whether in childhood or in adult life; often the impact of these experiences seems to be dormant for years but takes a dreadful toll later in life.
- Fill the need for new treatments: Existing medications take at least three to four weeks to reduce symptoms and require long-term administration to prevent relapse.
- Create better strategies for identifying the individuals at risk for suicide. Targeted, sex-specific methods of treatment are essential.
- Teach physicians that depression is a component or cause of widespread disability and that the treatment of cardiovascular disease, a compromised immune system, and diabetes, among other illnesses, must addresses depression as a cardinal component of illness.
- Significantly improve the treatment of the depressed patient by physicians: Only 25 percent of patients receive appropriate medicine therapy.
The first principle in combating depression is to acknowledge feelings of apathy, loss of pleasure, sadness or even apparently baseless general feelings of irritability and easily provoked anger. Our usual patterns of behavior change too – sometimes in unanticipated directions. Changes in sleep patterns or appetite, an upswing or dip in sexual activity, are all signs that “we are not ourselves”.
Marianne J. Legato, MD, Ph. D. (hon. c.), FACP is an internationally renowned academic, physician, author, lecturer, and pioneer in the field of gender-specific medicine. She is a Professor Emerita of Clinical Medicine at Columbia University College of Physicians & Surgeons and an Adjunct Professor of Medicine at Johns Hopkins Medical School. Dr. Legato is also the Director of the Foundation for Gender-Specific Medicine, which she founded in 2006 as a continuation of her work with The Partnership for Gender-Specific Medicine at Columbia University. She received an honorary PhD from the University of Panama in 2015 for her work on the differences between men and women.
At its core, gender-specific medicine is the science of how normal human biology differs between men and women and how the diagnosis and treatment of disease differs as a function of gender. Dr. Legato’s discoveries and those of her colleagues have led to a personalization of medicine that assists doctors worldwide in understanding the difference in normal function of men and women and in their sex-specific experiences of the same diseases.
She began her work in gender-specific medicine by authoring the first book on women and heart disease, The Female Heart: The Truth About Women and Coronary Artery Disease, which won the Blakeslee Award of the American Heart Association in 1992. Because of this research, the cardiovascular community began to include women in clinical trials affirming the fact that the risk factors, symptoms, and treatment of the same disease can be significantly different between the sexes. Convinced that the sex-specific differences in coronary artery disease were not unique, Dr. Legato began a wide-ranging survey of all medical specialties and in 2004, published the first textbook on gender-specific medicine, The Principles of Gender-Specific Medicine. The second edition appeared in 2010 and the third edition, dedicated to explaining how gender impacts biomedical investigation in the genomic era, won the PROSE Award in Clinical Medicine from the Association of American Publishers in 2018. A fourth edition is forthcoming.
She also founded the first scientific journals publishing new studies in the field, The Journal of Gender-Specific Medicine, and a newer version, Gender Medicine, both listed in the Index Medicus of the National Library of Medicine. She has founded a third peer-reviewed, open access journal, Gender and the Genome, which focuses on the impact of biological sex on technology and its effects on human life.
Dr. Legato is the author of multiple works, including: What Women Need to Know (Simon & Schuster, 1997), Eve’s Rib (Harmony Books, 2002), Why Men Never Remember and Women Never Forget (Rodale, 2005), Why Men Die First (Palgrave, 2008), The International Society for Gender Medicine: History and Highlights (Academic Press, 2017), and most recently, The Plasticity of Sex (Academic Press, 2020). Her books have been translated into 28 languages to date.
As an internationally respected authority on gender medicine, Dr. Legato has chaired symposia and made keynote addresses to world congresses in gender-specific medicine in Berlin, Israel, Italy, Japan, Panama, South Korea, Stockholm, and Vienna. In collaboration with the Menarini Foundation, she is co-chairing a symposium on epigenetics, Sex, Gender and Epigenetics: From Molecule to Bedside, to be held in Spring 2021 in Italy. She maintains one of the only gender-specific private practice in New York City, and she has earned recognition as one of the “Top Doctors in New York.”
