An incorrect address for s seminar Saturday on adolescent depression was given in Wednesday's Health Calendar. It will be at the Springfield Outpatient Office of the Mount Vernon Center for Community Mental Health, 8314-C Traford Lane, Springfield.
The extreme stress that people endure at the loss of a loved one may have a measurable biological effect on hormone and brain functions and on the immune system in certain susceptible persons.
And "as unlikely an association as it may seem from the surface," says Dr. Markku Linnoila, clinical director of the National Institute of Alcohol Abuse and Alcoholism, the subsequent behavior of grieving persons -- possibly caused more by the biological changes than by the grief per se -- may be related to the stimulus for the compulsions of some alcoholics, gamblers and even arsonists. Biological changes that stem from the grieving process may be similar to the biological process that leads to compulsive behavior.
For example, although it is rare for people middle-aged or older to become alcoholics, says Linnoila, bereavement "provides one of the few situations where there is an increased risk of alcohol abuse in this age group."
In two separate but related studies now under way, Linnoila and British psychobiologist Dr. Alec Roy will attempt to pinpoint the neuroendocrine abnormalities that may govern one person's reaction to the loss of a loved one, or propel another into uncontrollable compulsive gambling. The scientists will look for biological evidence in blood samples suggesting depression and high levels of stress. Medical literature suggests that many compulsive gamblers and compulsive violent offenders may be clinically depressed between bouts of their compulsive behavior.
The specific abnormalities which, for example, might lead a grieving spouse to drink, or an arsonist to set a fire, probably are not precisely the same. In the case of bereavement, the researchers believe there may be a malfunction of the body's stress-control mechanisms, whereas gamblers may be suffering from a deficiency of the neurotransmitter serotonin. Studies already have suggested a change in the levels of serotonin in the case of arsonists, some alcoholics and, most recently, in the nondrinking sons (but not the daughters) of alcoholics.
But if the researchers do find evidence of the biochemical changes they hypothesize are there, it would "tend to support the notion that what goes on in the environment interacts with biology," says Roy.
In the bereavement study, the NIAAA team will collaborate with Dr. Philip W. Gold of the National Institute of Mental Health. Gold and his colleague Dr. George Chrousos have developed a sensitive measurement of of the so-called hypothalamic-pituitary-adrenal axis in the body.
Their studies arise from recent knowledge about how the part of the brain called the hypothalamus regulates the body's endocrine system -- by secreting substances that stimulate other organs, such as the pituitary and adrenal glands, to secrete hormones of their own. Each of these organs has an increasingly specific function in regulating the way the body works and, it turns out, the way the person behaves.
For example, the so-called fight-or-flight response -- originally the survival reaction, and now expressed as a reaction to, say, a boss on the warpath -- causes the hypothalamus to secrete a neuropeptide called corticotropin-releasing hormone, CRH. CRH works on the pituitary to produce ACTH, the hormone that travels in the bloodstream and triggers the adrenal gland to secrete the stress hormones, epinephrine and norepinephrine. These stress hormones put the body in a state of alarm -- blood pressure rising, blood rushing to muscles, heart rate increasing, central nervous system aroused. The blood levels of the adrenal hormone cortisol increases as well.
Scientists also have found high cortisol levels in the blood of patients diagnosed with depression, suggesting a biochemical link between stress and depression.
The CRH test measures the level of cortisol in the blood and already has become useful in distinguishing one pituitary disorder -- Cushing's disease -- from a biochemical depression. Because Cushing's can include depression as well as physical symptoms, a distinct diagnosis had been difficult to make. NIMH laboratory studies have shown, however, that plasma cortisol was seven times higher in depressed patients than it was in those with Cushing's disease.
The work with bereaved patients could further establish the usefulness of the test and at the same time help predict which persons might best benefit from additional therapy during the period of bereavment.
Moreover, says Linnoila, the study "could open up some understanding about the important issues in the emerging field of psychoimmunology, which suggests that the kind of extreme stress that people go through during bereavement could be expected to affect immune system function adversely. Trying to unravel what is going on in this respect could open up some new avenues of understanding of the interactions between the central nervous system and the immune system."
A report issued last year by the National Academy of Sciences documented the increase in serious illness and early death for bereaved persons, especially men. The government scientists believe that some biological predisposition -- an inherited trait, perhaps -- might determine which persons might find bereavement particularly difficult -- those, for example with a history of depression themselves, or whose families have members with histories of depression.
"Because we have this elegant biological test," says Roy, "we want to see if different types of loss have different effects on the bodily response, and whether these are akin to what happens in depression."
"If we get a large enough sample of individuals who do have a family history of depression, we can see whether their reactions at the biological and behavioral level are more profound than the reactions in individuals who have no such family history," Linnoila says.
The study of compulsive gamblers is an outgrowth of previous work by Roy demonstrating correlations between brain chemicals serotonin and dopamine and life events over the preceding six months.
Between gambling bouts, most compulsive gamblers are depressed to a greater or lesser degree, scientific literature reveals. These gamblers are often suffering from a chronic low-level depression, a condition that has been associated with abnormalities in the neurotransmitter serotonin and that appears similar in other compulsive behavior -- including, according to a new study done in Sweden, compulsive fire-setters.
Of the grieving person who turns to alcohol, Linnoila theorizes that it "might be an attempt to self-medicate at that point, to dampen the effect of stress." Alcohol mimics the effects of the soothing brain chemicals, he notes.
So in the same way, he suggests, the gambler and the arsonist -- lacking serotonin themselves -- might be seeking the "rush" from their compulsive activity to compensate for something their own bodies ought to be providing, but for some reason are not. More Information
Volunteers for either the bereavement study or the gambler's study may call 496-0983 or 496-0984 for further information.