Study: Relatives of Treatment-Resistant Depression Sufferers Are 9x More Likely to Face Same Battle

Close relatives of people suffering from treatment-resistant depression (TRD) are nine times more likely to develop a major form of depression as well, according to research published this month in JAMA Psychiatry.

Researchers set out to answer a question: Can treatment-resistant depression be transmitted within a family?

The short answer: Yes. 

“Compared with control individuals … first-degree-relatives of individuals with treatment-resistant depression had an increased risk of developing treatment-resistant depression and increased suicide mortality,” according to the study’s authors.

This research has far-reaching implications. Its main takeaway suggests that depressive episodes and chronic depression diagnoses can actually compound within families. The research also implies a new set of genetic triggers that might allow patients to address their own depression episodes earlier and in a much more targeted way.

While the study itself leans on a genetic correlation, it also includes the influence of social, economic, and cultural factors. 

The study analyzed 15 years of national health insurance data from Taiwan (from 2003 to 2017). It covered medical records for both inpatient and outpatient settings, along with prescription information, for the entire population. As the authors describe it, this is the first study at such a nationwide scale. 

Treatment-Resistant Depression

First, what is “treatment-resistant depression” exactly?

The National Institutes of Health in the U.S. defines this specific diagnosis as a case of major depressive disorder that does not respond to two distinct rounds of different antidepressant medication or strategies. Those may include pharmaceutical drugs or sessions with a therapist.

When patients find themselves in this situation, it’s helpful to seek a range of medical and psychiatric advice–and to consider alternative treatment options such as monitored ketamine infusion therapy.  

Here’s the Mayo Clinic on what ketamine therapy can offer patients facing TRD: “Ketamine is a medication that’s delivered through an IV in low doses. It’s used for rapid relief of hard-to-treat depressive symptoms and its effects can last from days to weeks. Usually it’s given in decreasing frequencies over several weeks. The FDA approved an intranasal form called esketamine (brand name: Spravato) that’s given in a physician’s office or a clinic under the supervision of a health care provider to monitor for possible serious side effects and because of the potential for abuse and misuse. Esketamine is for adults who have tried at least two other antidepressant medications that did not adequately control symptoms. Ketamine and esketamine work in the brain in a different way than standard antidepressants, and each is typically used along with an oral antidepressant.”

What Other Risks Are Present for Families?

The results of this research suggest greater ramifications for families, too, beyond just TRD. 

“First-degree relatives of individuals with TRD had lower incomes, more physical comorbidities, higher suicide mortality, and increased risk of developing TRD and higher risk of other psychiatric disorders than matched control individuals, including schizophrenia, bipolar disorder, major depressive disorder, attention-deficit/hyperactivity disorders, autism spectrum disorder, anxiety disorder, and obsessive-compulsive disorder,” according to the authors. 

Family History Can Influence Treatment for Individuals

It may be beneficial to consider alternative treatment options earlier when initial antidepressant treatment fails in depressed patients with a family history of TRD. Antidepressant resistance, according to the study, is a particular concern. 

“Patients with a family history of TRD had an increased risk of suicide mortality and tendency toward antidepressant resistance; therefore, more intensive treatments for depressive symptoms might be considered earlier, rather than antidepressant monotherapy,” as the authors describe.

Alternatives can include monitored ketamine infusion therapy. 

Ketamine infusions for depression are particularly effective in removing suicidal ideation and intrusive thoughts, even after the first treatment. 

“Overall, 69% of participants had a complete alleviation of suicidal ideation following repeated infusions. In treatment-resistant depression, single and repeated ketamine infusions resulted in decreases in suicidal ideation,” according to the Royal Institute of Mental Health Research.