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FDA-cleared, non-medication depression treatment
Breaking the Cycle: Depression and Genetics
Jules Washington
Medically reviewed on 11/16/2020 by
Dr. Kimberly Cress
Texas Regional Medical Director
Do you have your father's nose or your mother's eyes? Perhaps stubbornness is a common family trait, or you all have a similar sense of humor. Many traits run in families, so it's natural to wonder, is depression genetic, too? Depression and genetics are correlated in some ways, but you are much more than your DNA. If you have a parent or sibling with depression, that doesn't mean you'll inevitably develop depression, too. In fact, recent research suggests you could even positively influence the genetic legacy you pass onto future generations.
The Relationship between Depression and Genetics
Depression can sometimes arise in response to events in our lives: the COVID-19 pandemic, stress, chronic pain, or bereavement, for example. So, to what extent is depression genetic? Only 40 percent of the population's tendency toward depression can be explained by genes. There is no single gene for depression. At least 44 gene variants contribute to the risk of depression from one generation to the next, and research is ongoing to better understand. Even if you were to inherit many of these, you still might not develop depression. Instead, the chance depends on:
- How many of these genes you inherit (each one makes a tiny contribution to the risk of depression)
- Which specific genes you inherit (some matter more than others)
- How this genetic blueprint interacts with other personal factors (such as stress, chronic pain, or illness)
As a result, even if your child were to inherit all these genetic variants from you, he or she would not necessarily develop depression.
How Genes Can Contribute
The genes identified in depression studies are integral parts of the nervous system. They influence how nerve cells grow and send signals to brain regions that influence mood. They control the function of chemical messengers called neurotransmitters (such as serotonin), which are altered in depression. Some genes influence the immune system, which is also linked to our mood. So, could you change the genetic code you pass onto future generations? Possibly. A relatively new scientific field called epigenetics explores how the events in our lives switch the expression—or readability—of our genes without changing the DNA code itself. These life events include early adversity in childhood, trauma, or prolonged stress. Tiny chemical tags are added to or removed from our DNA in response to these events. The chemical tags turn depression genes on or off.
Subsequently, epigenetic changes can be passed down to the next generation. That means it may be possible to pass on positive epigenetic changes by taking positive steps that actively support your health. These include surrounding yourself with strong social support, engaging in physical activity where possible, and treating symptoms of depression.
Why Depression Seems to Run in Families
If you have a sibling or parent with depression, you have two to three times the chance of developing depression yourself. However, this isn't solely related to the DNA you share. We know this partly due to studies of identical twins. Even though they have almost no difference in their DNA, if one twin develops depression, the other twin frequently doesn't. Instead, it's our experience and environment that matter. Shared life experiences within families can often place closely related people at higher risk for depression. These shared experiences could include early adversity or neglect in childhood, trauma, family pressures, or addiction.
If you have depression just as another member of your family does, your shared experiences could also explain this, rather than your shared DNA. Further, depression often affects not only the person with depression, but their family, too. Family life can feel unsettled, compounded by the financial, social, and physical issues that accompany depression. Finding the right treatment could restore balance to your own life as well as the lives of your loved ones.
Breaking the Cycle of Familial Depression
If you're ready to begin your treatment journey, empower yourself to take the next steps. Imagine waking up refreshed each morning with hope for the day ahead, passion for the interests you hold, and positive energy to see you through time spent with family and friends. If you have persistent stress, counseling might help you and your family. Consider speaking to your doctor about treating any underlying medical conditions, such as chronic pain or sleep apnea, that exacerbate depression. Or perhaps you'd benefit from an antidepressant medication. If those common approaches don't work, another way to break the cycle of depression and genetics is transcranial magnetic stimulation (TMS).
TMS therapy is a non-invasive and non-drug depression treatment that applies highly focused magnetic pulses to brain regions that are crucial in the regulation of mood. It's been cleared by the FDA for the treatment of Major Depressive Disorder and Obsessive Compulsive Disorder. TMS can help to relieve some, or even all, of the symptoms of depression in many patients. Whichever treatment path you choose, remember: even if depression has been part of your family's history, it doesn't need to be part of your future.
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Starting any medical treatment for the first time can leave you with questions, especially if you’re looking forward to the benefits it may bring. It’s no different when you’re preparing for your nasal esketamine treatment. Your previous mental health treatments may have consisted solely of taking antidepressants at home or visiting a therapist’s office for cognitive behavioral therapy (CBT), so nasal esketamine is probably a new treatment experience for you. If you're wondering what it's like to start nasal esketamine and get ready for your first session, keep reading. Getting Started with the Nasal Esketamine Treatment As with any new treatment, you’ll first talk to your primary care provider or psychiatrist about whether nasal esketamine is a good fit for you. Alternatively, you can schedule your esketamine nasal spray consultation with a treatment center (such as Greenbrook) that has certification by the FDA’s Risk Evaluation and Mitigation Strategy (REMS). At Greenbrook's REMS-certified nasal esketamine treatment centers, our Greenbrook-affiliated psychiatrists and psychiatric nurse practitioners will review your medical history and also conduct our own assessment to help determine whether nasal esketamine treatment is right for you. Certain conditions, including blood vessel disease and a history of psychosis, may make treatment a risk for you. Make sure you discuss all previous and present conditions with your doctor or nasal esketamine provider before beginning treatment. If the medication is deemed a good fit, you’ll receive your prescription from the Greenbrook-affiliated provider. Your Greenbrook Care Team will put together a personalized care plan for the weeks and months to follow. Keep in mind that you will need to take a standard (oral) antidepressant along with your nasal esketamine treatment. There are two important regulations to note when it comes to preparing for treatment: Each treatment is followed by a mandatory two-hour observation period. This means you will need to plan to stay at the center for at least two hours following your self-administration of the esketamine nasal spray. You cannot drive during the rest of the day after treatment and must arrange for transportation. These regulations are mandatory. It may be helpful to sit down and plan out several weeks’ worth of transportation once you know your treatment schedule. In addition, if you’re wondering what to bring for the treatment, we recommend entertainment such as an audiobook or playlist of favorite songs and a pair of headphones. You may want them during the two-hour observation period. What to Expect During Nasal Esketamine Treatment On the day of treatment, you’ll need to stop eating any food two hours before your appointment and stop drinking all fluids 30 minutes before you come in. Your Greenbrook Care Team will confirm that you are prepared for the two-hour observation period and that you have a ride home. You’ll get the opportunity to practice using a “trainer sprayer” that mimics the real nasal esketamine sprayer but does not release any medication. The Care Team will encourage you to use the restroom and set up your preferred environment in your private treatment bay or room. Some patients like reduced lighting, for example, while others don’t request light adjustments. You’ll complete a depression scale before each treatment session. Your Greenbrook provider will confirm that the dose kit is yours, show you how to administer it, and then hand it to you. Each sprayer contained 28mg of Spravato esketamine nasal spray. Patients usually start with two sprayers (56mg) and soon increase to 84mg (three sprayers) per treatment. But, your dosage maybe vary. Should you be left with a metallic taste by the spray, the Care Team will offer suckers to help make the flavor dissipate. After your dose, you’ll be encouraged to lie back in your comfortable recliner. While most patients enjoy a quiet setting, Greenbrook is prepared to accommodate patients with a more animated reaction to the medication. You may feel sleepy, dizzy, mildly dissociated, and/or nauseated during treatment. Greenbrook's Care Team is readily available if you need assistance. How to Prepare for after your Nasal Esketamine Treatment Most side effects begin to wane in the second hour of observation, but if you’re wondering, “Is it safe to drive immediately after nasal esketamine treatment?” the answer is a resounding no. In addition to the mandatory ride home, you will need to block off time to rest and let side effects fully dissipate. This extended rest period is especially important in the first weeks of treatment when you’ll have treatment twice a week. Do not drive or operate machinery of any kind until the day after treatment. Just take it easy, relax, and take care of yourself. If you’re unsure what activities you can do or should avoid during this time, talk to your Care Team for more information. While side effects tend to dissipate completely after a good night’s sleep, many nasal esketamine patients begin feeling relief from depression symptoms within hours of their treatment. Other Tips in Preparing for Your Nasal Esketamine Treatment At Greenbrook, we make every effort to schedule your treatment in the afternoons or whenever it is most convenient for you. We encourage you to see each treatment session as an opportunity to relax and take care of your mental health. If you have any questions or concerns, talk to your doctor or the Greenbrook Care Team. At Greenbrook, we’ll help you feel at ease when preparing for each treatment session. Schedule A Free Consultation To get started with nasal esketamine, schedule your free consultation today.
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