Treating Family Members Can Help Break the Cycle of Depression

By Katie O’Connor

In the 1970s, when Myrna Weissman, Ph.D., was beginning her research on major depression, conventional wisdom held that the disorder occurred primarily in middle-aged and menopausal women and did not occur in children.

In the decades since, the understanding of depression has resoundingly changed. It is widely understood that the disorder can occur in children, and Weissman has spent a great deal of time studying depression within families and how the illness can cycle through the generations. During her session, “Depression in Families: Clinical Opportunities for Breaking the Cycle of Transmission,” Weissman summarized her decades of research, during which she and her colleagues followed families over 38 years. Weissman is the chief of the Division of Epidemiology at the New York State Psychiatric Institute and a professor of epidemiology and psychiatry at Columbia University.

Weissman and her colleagues started with two groups of families: Those at high risk for depression and those at low risk. They found that the children in the high-risk families had higher rates of major depression, anxiety disorders, and substance use disorders. Their risk was about two to six times higher than that of children whose parents did not have depression.

By the third generation, however, the rates started to even out, Weissman found. The percentage of grandchildren with a mood disorder hovered around 10% to 15%, regardless of whether the grandchildren had a parent or grandparent with depression. However, if the grandchildren had both a parent and grandparent with depression, the rate of depression was about 30%. Children who have a parent and grandparent with depression should be targeted for surveillance, Weissman said.

The researchers also found that pediatricians were largely unaware of the psychiatric and behavioral problems of their patients. Further, 60% of the children reported suicide attempts that were not reported by their mothers. “Clinically, this means that it’s a good idea to interview the offspring directly,” Weissman said. “Patient information from informants is useful, but there’s nothing like direct assessment.”

To determine how treatment of parents influences depression risk in the children, Weissman used data from the Sequenced Treatment Alternatives for the Relief of Depression (STAR*D) study. She and her colleagues found that the children of mothers who went into remission after three to six months of treatment had the most positive outcomes. Regardless of treatment type, the mother’s improvement also benefited the child. “Depression is a family affair,” Weissman said. “If you help the mother, you help the child.”

Weissman emphasized that getting a patient’s family psychiatric history can be valuable, though she noted such histories can be difficult to obtain in a clinical setting. She explained that asking patients specifically about symptoms of depression they may have observed in particular family members (such as their mothers or fathers) can yield better results than asking generally about a history.

In response to a question regarding why depression cycles through families, Weissman referenced an editorial she published in The American Journal of Psychiatry last year, titled “Is Depression Nature or Nurture? Yes.”

“We cannot, at this time, determine how much is genetic and how much is environmental, because people who are depressed produce environments that can be toxic,” she said. There are large, ongoing studies aimed at answering that question, she noted. “But at the moment, we can’t say which it is, so we’d better treat what we can.” ■