Family History of TRD May Be Significant Risk Factor for the Disorder
Patients with a family history of treatment-resistant depression (TRD) were found to have an increased risk of suicide mortality and antidepressant resistance, according to recent cohort study results published in JAMA Psychiatry.
“More intensive depression treatments, such as add-on pharmacotherapy or non-pharmacotherapy might be considered earlier, as opposed to antidepressants alone, for treating the symptoms of individuals with TRD,” authors noted.
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Researchers assessed data from the Taiwan national health insurance (NHI) database (N = 26,554,001) between January 2003 and December 2017. The data covers nearly the entire population of Taiwan; The Ministry of Health and Welfare’s Taiwan Health and Welfare Data Science Center audited and released the NHI Research Database (NHIRD) for research purposes. Authors identified first-degree relatives of individuals with TRD (n = 34,467) and arranged a 1:4 comparison group (n = 137,868) of first-degree relatives of individuals without TRD, matched by birth year, sex, and kinship. TRD was defined as having experienced at least 3 distinct antidepressant treatments. Data analysis was performed from August 2021 to April 2023 using modified Poisson regression analyses.
A total of 172,335 participants were included, 49% of which were female. First-degree relatives of people with TRD had lower incomes, more physical health issues, and a higher risk of suicide compared to control individuals. These relatives also had an increased risk of developing TRD (aRR, 9.16; 95% CI, 7.21-11.63) and were at a higher risk for various psychiatric disorders, including schizophrenia (aRR, 2.36; 95% CI, 2.10-2.65), bipolar disorder (aRR, 3.74; 95% CI, 3.39-4.13), major depressive disorder (aRR, 3.65; 95% CI, 3.44-3.87), ADHD (aRR, 2.38; 95% CI, 2.20-2.58), autism spectrum disorder (aRR, 2.26; 95% CI, 1.86-2.74), anxiety disorder (aRR, 2.71; 95% CI, 2.59-2.84), and obsessive-compulsive disorder (aRR, 3.14; 95% CI, 2.70-3.66). Sensitivity and subgroup analyses confirmed the reliability of these findings.
“Future research should use a consensus definition of the TRD phenotype, use larger samples, and incorporate various omics data to advance understanding of the complex pathogenesis of TRD,” authors concluded.