Depression Rates Are Lower in Children Whose Mothers Are Successfully Treated
• Science Update
When women treated for depression become symptom-free, their children are less likely to be diagnosed with depression, according to a study published in the March 22/29 issue of the Journal of the American Medical Association. The study showed that children of mothers who achieved remission of symptoms had an 11 percent drop in diagnosis of depression. There was an 8 percent increase in diagnosis of depression among children whose mothers did not become symptom-free. The study alerts health professionals and patients of the need to vigorously treat depressed mothers and to evaluate their children for symptoms.
The study, STAR*D-Child, examined 151 mother-child pairs, including children 7-to-17 years old, in 19 clinical settings across the country. STAR*D-Child is an ongoing part of a larger clinical trial called Sequenced Treatment Alternatives to Relieve Depression (STAR*D), also funded by NIMH. The trial was conducted in real-world healthcare settings to determine how to successfully treat depression in adults who didn't become symptom-free after their first treatment or in whom the first treatment caused side effects.
Other studies have produced strong evidence that children of depressed parents are two to three times more likely than others to have major depression or other anxiety or disruptive disorders. Genes play a major role in depression that starts young, but environmental factors — the presence of a parent with depression, for example — may influence whether or not a child develops symptoms. This study included a mix of children who were depressed and children who were not depressed at the outset of the trial.
In children who were depressed when the study began, 33 percent of those whose mothers went into remission over the three-month period went into remission themselves. Their symptoms improved only after their mothers' symptoms improved by at least 50 percent. Only 12 percent of children with depression at the outset of the study achieved remission when their mothers did not become symptom free.
Of the children who entered the study free of depression, none whose mothers went into remission were diagnosed with depression during the three months. In contrast, 17 percent of those whose mothers did not go into remission were diagnosed with depression at the three-month mark.
All of the mothers began by taking the antidepressant citalopram, a selective serotonin reuptake inhibitor. Those for whom citalopram was not successful were switched to other drugs randomly assigned.
Researchers who evaluated the children after three months of the study did not know which treatments the mothers had been taking. Thirty-three percent of the mothers went into remission before the three-month assessment, and, of these, 92 percent had been taking citalopram; two had been switched to extended release venlafaxine-XR, and one to a combination of citalopram and bupropion.
The researchers will continue to follow the children for a year after their mothers go into remission during the study, or for two years if their mothers do not go into remission.
Weissman MM; Pilowsky DJ; Wickramaratne PJ; Talati A; Wisniewski SR; Fava M; Hughes CW; Garber J; Malloy E; King CA; Cerda G; Sood AB; Alpert JE; Trivedi MH; Rush JA; for the STAR*D-Child Team. Remissions in Maternal Depression and Child Psychopathology: A STAR*D-Child Report . JAMA. 2006;295:1389-1398.
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