Studies comparing concordance rates for major depression between monozygotic and
dizygotic twins suggest a heritability of about 37%,5 which is much lower than the
heritability of bipolar disorder or schizophrenia. Some aspects of the normal personality,
such as avoidance of harm, anxiousness, and pessimism, are also partly heritable.6
Kendler et al.7 showed that although depression is due in part to heritable depressionprone
personality traits, it is also the result of heritable factors that are independent
of personality. Early-onset, severe, and recurrent depression may have a higher heritability
than other forms of depression.8 It is clear from studies of families that major
depression is not caused by any single gene but is a disease with complex genetic features.
Studies of pedigrees with multiple cases of major depression have identified
chromosomal regions with linkage to the disorder, and some of these loci have been
replicated in more than one study, although no single chromosomal region has been
replicated in every family study of genetic linkage in depression. Holmans et al
found evidence of linkage of recurrent, early-onset depression
to chromosome 15q25-q26, but the population
attributable risk was small.
No specific molecular risk factor has been reliably
identified. One common polymorphic variant
of the serotonin-transporter–linked polymorphic
region (5-HTTLPR), which affects the promoter of
the serotonin-transporter gene, causes reduced
uptake of the neurotransmitter serotonin into the
presynaptic cells in the brain. Some studies have
shown that this polymorphism confers a predisposition
to depression, but it also confers a predisposition
to an anxious and pessimistic personality.
10 Brain imaging reveals functional differences
in emotion-related areas of the brain among carriers
of the different common polymorphisms of
5-HTTLPR, although a direct relation to depression
is unclear. In a large, prospective epidemiologic
study, Caspi et al. found that 5-HTTLPR
predicted depression only in association with defined
life stresses. Some environmental factors
could confer a predisposition to depression by affecting
the genome epigenetically — for example,
increased maternal care in rodents causes an epigenetic
change in the promoter region of the glucocorticoid-receptor gene.