When Treating Depression, Entire Family Called On
Genetics researchers have yet to pinpoint a specific gene or genes for depression. But researchers do know that people with depression in their family are more vulnerable to the condition. This is most likely due to both genetic factors — and the struggle of having a depressed family member. As scientists work to figure out the genetics of the illness, families and therapists are figuring out ways to cope.
Untreated depression can be "a family calamity," says Dr. William Beardslee, a professor of psychiatry at Harvard Medical School and longstanding researcher of the effects of severe parental mental illness on children. Nearly 16 million children under the age of 18 are living with an adult who had a bout of major depression in the last year, according to a recent report from the National Academy of Sciences.
Parents may function reasonably well for a time, but when a bout of depression hits, parenting can becomes rocky, says Beardslee. Then the child may experience "a change in parent's attention, a change in parent's praise, and a change in parent's focus," he says. That can make children angry, sad or wary.
Depression In Families
All scientists can say for sure is that depression in the family increases the risk of any one individual member. According to the National Academy of Sciences report, 2 to 4 percent of young children with a parent who has depression will have depression themselves. As many as four in 10 adolescent children of depressed parents will have depression. And, children of depressed parents are more likely to be substance abusers.
So genes do matter, and having a depressed parent also matters, and that's why researchers are developing new strategies for families.
Genetics can be an indication of vulnerability, says Beardslee. It may take an environmental problem like a divorce or an experience of violence or poverty to spark depression. And sometimes, parents' problems can make their children more likely to develop depression.
Getting Support Is Key
Parents with depression can reduce the risk to their children by getting treatment. Families can go in for family therapy, an approach pioneered by Beardslee and supported by the National Academy of Sciences report. If there's a full awareness of the depression, the family can figure out ways to make sure the child is able to get emotional support from the other parent, a friend or relative when the other parent is going through a bad spell.
"What we've found works well is participant support groups," says Peter Ashenden, head of Depression and Bipolar Support Alliance. "People get to meet other individuals with the same or similar experiences," he says, and families can see how other families have coped.
Challenges To Healing
Getting the right kind of professional help can be challenging, though money isn't always the obstacle you might think. Most health insurance policies that cover mental illness include family therapy, says Julie Totten, head of Families for Depression Awareness.
But a problem she does see is that doctors often only treat the patient, not the family.
"It's not something that medical professionals often talk about as an option," she says. "That's how our medical system is set up, to treat the patient and not the family."
She says it can be a big problem convincing family members with depression to get help.
"Expect them to say 'no,' " she says."Then keep working at it, get other people involved, because if someone is depressed their first answer is going to be no, they don't want to do anything because they're feeling so down."
Totten's own brother had depression. She tried to convince him to get help, but he wouldn't. He eventually committed suicide, which prompted her to found Families for Depression Awareness.
The big stumbling block to getting help is stigma. "People don't really talk about it enough," says Totten. "You don't say to your neighbor, 'my brother is really depressed.' "
Groups like Depression and Bipolar Support Alliance guarantee anonymity for people who use their Web site because they understand the importance of this, says Ashenden, the head of the organization.
"We know it from our people that are reaching out to us. There's a fear in people's voice when they're calling us."
9(MDAyNzUwMDI2MDEyNTA3MTU5NzcyNTQyNA004))
ARI SHAPIRO, host:
This is MORNING EDITION from NPR News. I'm Ari Shapiro.
RENEE MONTAGNE, host:
And I'm Renee Montagne. In Your Health today, we have two stories that examine relationships involving family and friends. Later, we'll hear about how friendships form on college campuses.
Now, we turn to the family and depression. Depression often runs in families and can cast a big shadow on how a family functions. As scientists work to figure out the genetics of the illness, families and therapists are figuring out ways to cope. NPR's Joanne Silberner reports.
JOANNE SILBERNER: Forty-six-year-old Mary Margaret Thicke(ph) works at a home improvement store in the Midwest. She started having symptoms of depression in the sixth grade, bouts of unremitting sadness, wanting to be alone, crying all the time. No one knew why. She remembers her five brothers and sisters calling her a crybaby. Finally, at the age of 32, she saw a therapist, who asked her whether anyone in her family had symptoms of depression.
Ms. MARY MARGARET THICKE (Employee, Home Improvement Store): At that point, I had looked into my family history and found that depression had been running in my family through multiple generations.
SILBERNER: For her, it was good news.
Ms. THICKE: When I learned that, it was a great relief that I now knew that it wasn't a character issue. It was a genetic predisposition, a genetic illness. And it was like a weight lifted off of me. I'm like, oh, thank God.
(Soundbite of laughter)
SILBERNER: Scientists were working on the genetics of depression. They know there's a relationship, says Dr. Bill Beardslee, who is a professor of psychiatry at Harvard Medical School.
Dr. BILL BEARDSLEE (Psychiatry, Harvard Medical School): There're going to be certain families with six, seven, eight, nine, 10 first-degree relatives that are going to be much more likely, on average, to have kids with depression than, say, a family with only a few first-degree relatives.
SILBERNER: But it takes more than genes.
Dr. BEARDSLEE: Most of the genetics that I know of is really about the intersection between genes and environment in multiple ways.
SILBERNER: Traumas like divorce, violence or poverty can act on vulnerable children. And when parents themselves have depression, that, too, creates a tough environment for kids.
According to the National Academy of Sciences, 16 million children under 18 live in households with a depressed adult. For parents with depression, says Beardslee…
Dr. BEARDSLEE: The first thing they should do is think about getting help for themselves, because depression is quite painful. As one mother said to me, depression attacks the soul. And with that level of suffering, it's very hard to do anything.
SILBERNER: Not just therapy for themselves. Beardslee's clinical research shows that family therapy can be particularly helpful. Mary Margaret Thicke has forgiven her siblings for calling her a crybaby. Some of them were later diagnosed as well. She's sure that if they had realized she had an illness, they wouldn't have put her through such a tough time.
Even if family members recognize the illness and realize that treatment is needed, it can be hard to convince a depressed person to go through with it, says Julie Totten. She's head of a group called Families for Depression Awareness.
Ms. JULIE TOTTEN (Families for Depression Awareness): Expect them to say no, in other words. And then you've got to keep working on it. Get other people involved. If someone's depressed, their first answer is going to be no, because they don't want to do anything because they're feeling so down.
SILBERNER: That happened with her older brother. She knew something was wrong. When they were in their mid-20s, her brother became moody and withdrawn. She took him to a funny movie, and he didn't laugh. She tried to get him to talk to a doctor, and he wouldn't. He eventually killed himself.
What keeps people from getting help, says Totten, is the shame and the stigma.
Ms. TOTTEN: People don't really talk about it enough. And you don't say to your neighbor, my brother's really depressed. What do you think I should do about it? You know, it's kind of more an embarrassing topic.
SILBERNER: But dealing with the depression is key to family health, says Harvard's Beardslee.
Dr. BEARDSLEE: Depression impairs the capacity to hear and understand conversation, to make reasonable decisions. It causes people to withdraw from social relationships. So unrecognized and untreated, it can be a family calamity.
SILBERNER: A calamity that doesn't necessarily have to happen.
Joanne Silberner, NPR News. Transcript provided by NPR, Copyright National Public Radio.
