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April 7, 2013

Generational Depression

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Psychiatrists at Columbia University in New York report that children are at an increased risk for depression if their parents and grandparents also suffer from the illness. This ScienCentral News video has more.

Inherited Blues

When Karen Zipern graduated from college she took a job in media relations in New York City. At the end of each day, she returned to her apartment, locked the door to the outside world, and began to cry.

The transition from the familiarity of college, to a wide-open future overwhelmed Karen. "I couldn't stop crying," she remembers. She could only find comfort when she was cocooned in her apartment with her dog and a stack of books.

This was the first of several episodes of major depression Karen faced through her adult life. Though she tried antidepressants and other psychiatric therapies, she says depression "was always just around the corner."

Jill Jacobson and her daughter both suffer from depression.
Karen, who is now 48 and an administrative director at Columbia University Medical Center, suspected her mother also suffered from depression, but the two rarely shared their feelings. In the Zipern family the standard was to grit your teeth and work through your "blue days." Over the last few years however, Karen's experience with depression helped her mother Sydell, 73, her sister Jill, 52, and her niece Carly, 22, to acknowledge they had a heightened susceptibility to depression and that major life changes could trigger the illness in each of them. Two years ago, almost simultaneously, when Sydell sold her home of 50 years, Jill began menopause, and Carly got caught in slump at college, all three women were diagnosed with major depressive disorder.

Major depressive disorder, or MDD, affects 18.8 million adults in the United States annually, according to the National Institute of Mental Health's 2000 statistics. Columbia University Medical Center psychiatrist Myrna Weissman says families like the Zipern's are not unique. Depression is an illness that often runs in families and can be triggered by genetic as well as environmental factors.

In the first published three generational study of major depressive disorder Weissman and her colleagues followed 47 grandparents, their 86 children and 116 grand children and included participants who were both diagnosed with depression and considered normal. The researchers report in the Archives of General Psychiatry that children whose grandparents and parents suffer from the illness have "more than a five-fold increased risk of any psychiatric disorder."

"If two generations are affected with depression, the grandparents and the parents, those grandchildren," says Weissman, "have very high rates of psychiatric problems."

Those psychiatric problems were primarily anxiety disorders in girls and behavioral or disruptive disorders in boys. Anxiety and disruptive disorders are precursors to depression. Children with these disorders sometimes develop depression at puberty or later, but having a precursor disorder does not guarantee someone will later have MMD. By the end of the twenty-year study nearly 60 percent of the third generation in the depressed families had developed at least one psychiatric disorder. However, many of the study's third generation participants were still pre-pubescent, and it is not known how many might become depressed as adults.

Weissman and her colleagues visited the families multiple times to assess each generation for depression as they aged. The research team did not know which families had a history of depression and which did not. As an additional precaution, they asked the families to assess their home environment, including family relationships, financial situations, and work related stress, which are all factors that can bring on depression and could have potentially influenced the study's results.

"Confounding factors are very important because it could be that there's more marital problems in the depressed families or more poverty or more parenting problems," says Weissman. But the study confirmed the strongest predictor for having a precursor disorder or having depression was a having a family history. Weissman specifies however that even if a person has a predisposition to MDD, environmental factors are needed to bring on the illness.

"Depression has a genetic component to it, but the environment is probably necessary to bring out the expression of it," says Weissman.
Mount Sinai Medical Center psychiatrist Eric Hollander says early childhood trauma, abuse, loss of a parent are negative factors that can lead to adult depression. He also says some people with precursors to depression, especially anxiety disorders, have genes "associated with certain temperaments that can really be seen from a very very early age, even birth."

That's not surprising to the Zipern family. They all consider themselves to be extremely sensitive people. "Everyone in my family sort of intuitively understands depression," says Karen.

Karen's niece Carly, the youngest and most recently diagnosed with depression, is grateful her family no longer considers their inherited blues a stigma, but rather as something they can talk openly about to find comfort.

"You can see things in other people that you can't see in yourself. So I can point something out to my mom or I can point something out to my aunt, and they can do the same for me, and that's comforting," says Carly.

This research appeared in the January 2005 issue of the Archives of General Psychiatry and was funded by the National Institute of Mental Health.

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