Treatment of Maternal Depression in a Medication Clinical Trial and Its Effect on Children.

(Reprinted from the American Journal of Psychiatry 2015; 172:450-459, with permission from American Psychiatric Association Publishing).

Treatment of maternal depression in a medication clinical trial and its effect on children.

OBJECTIVE: Observational studies show that when a depressed mother's symptoms remit, her children's psychiatric symptoms decrease. Using randomized treatment assignment, the authors sought to determine the differential effects of a depressed mother's treatment on her child. METHOD: The study was a randomized double-blind 12-week trial of escitalopram, bupropion, or the combination of the two in depressed mothers (N=76), with independent assessment of their children (N=135; ages 7-17 years). RESULTS: There were no significant treatment differences in mothers' depressive symptoms or remission. Children's depressive symptoms and functioning improved significantly among those whose mothers were in the escitalopram group (compared with those whose mothers were in the bupropion and combination treatment groups). Only in the escitalopram group was significant improvement of mother's depression associated with improvement in the child's symptoms. Exploratory analyses suggested that this may be due to changes in parental functioning: Mothers in the escitalopram group reported significantly greater improvement, compared with the other groups, in their ability to listen and talk to their children, who as a group reported that their mothers were more caring over the 12 weeks. Maternal baseline negative affectivity appeared to moderate the effect of maternal treatment on children, although the effect was not statistically significant. Children of mothers with low negative affectivity improved in all treatment groups. Children of mothers with high negative affectivity improved significantly only for those whose mothers were in the escitalopram group. CONCLUSIONS: The effects of the depressed mother's improvement on her children may depend on her type of treatment. Depressed mothers with high anxious distress and irritability may require medications that reduce these symptoms in order to show the effect of her remission on her children.

Psychopathology and functioning among children of treated depressed fathers and mothers.

OBJECTIVE: Recent findings suggest that remissions of maternal depression are associated with decrease in offspring psychopathology. Little is known about the offspring effects of decrease in paternal depression. METHOD: The offspring of married fathers and married mothers were compared. The analysis was restricted to married parents to control for the confounding effect of single parenthood which was more prevalent among depressed mothers. At baseline all parents met criteria for major depressive disorder (MDD), and participated in a 3 month randomized controlled trial to treat depression with a 6 month follow-up. Married parents (N=43) and their children aged 7-17 years (N=78) were assessed independently through direct interviews of children and parents at baseline and followed for 9 months. Child assessors were blind to the clinical status of parents and uninvolved in their treatment. RESULTS: At baseline, children of depressed fathers, compared to children of depressed mothers, had significantly fewer psychiatric disorders (11% vs. 37%; p=0.012) and less impairment as measured by the Columbia Impairment Scale (6.5 vs. 11.6; p=0.009). Over time, with treatment of parental depression, the prevalence of most child symptoms decreased among children of depressed mothers, but changed little among children of depressed fathers. LIMITATIONS: The main limitation of the study is the small number of fathers and their offspring included in the study. CONCLUSION: Maternal as compared to paternal depression had a greater impact on children. With treatment of parental depression the differential prevalence of child symptoms by parental gender narrowed over time. The clinical implication is that children may benefit from treatment of their depressed parents.

Sex differences in clinical predictors of depression: a prospective study.

BACKGROUND: Estimating the likelihood of future major depressive episodes (MDEs) would assist clinicians in decision-making regarding the optimal length of treatment for MDE. Unfortunately, little data are available to guide clinical practice. METHODS: We followed 200 females and 152 males who responded to treatment for a MDE for 2 years to determine risk factors for future MDE. Cox Proportional Hazard Regression modeled time to first relapse into MDE and mixed effect logistic regression modeled monthly depression status. RESULTS: Females were more likely than males to experience a MDE in any month of the study, and marginally more likely to experience a relapse. By 12 months, 60% of females had relapsed compared to 51% of males (median time to relapse 8 vs. 13 months, respectively). Several factors predicted worse outcome for both men and women: reported childhood abuse, earlier age of onset of first MDE, bipolar disorder, unemployment, and more years of education. For females, but not males, suicidal ideation predicted MDE relapse and both suicidal ideation and prior suicide attempts were associated with more time in a MDE. LIMITATIONS: The naturalistic treatment of participants, exclusion of individuals with current comorbid alcohol or substance use disorder, and a follow up period of two years are limitations. CONCLUSIONS: Women are more vulnerable to relapse and spend more time depressed compared to men. Identification of general and sex-specific risk factors for future depression may provide clinicians with useful tools to estimate need for ongoing pharmacotherapy in MDE.

Children of treatment-seeking depressed mothers: a comparison with the sequenced treatment alternatives to relieve depression (STAR*D) child study.

OBJECTIVE: To estimate the prevalence of current psychiatric disorders among children and adolescents (collectively called children) of mothers entering treatment for depression; to examine maternal predictors of child psychopathology among children of depressed mothers; and to determine consistency of findings with a similar child study ancillary to Sequenced Treatment Alternatives to Reduce Depression (STAR⁎D) from seven United States sites (STAR⁎D-Child). METHOD: Mothers (N = 82) with major depressive disorder (MDD) enrolled in a treatment study in Ottawa (Ontario, Canada) or New York City, and their eligible children (N = 145) (aged 7 through 17 years) were assessed independently when the mother enrolled. RESULTS: Among the children of depressed mothers, 42% had at least one current psychiatric diagnosis, including affective (15%), anxiety (19%), behavioral (23%), and/or substance use (2%) disorders. In all, 40% of the children were rated as impaired by clinical assessors. Mothers' comorbid anxiety disorders predicted the highest rates of current disorders in the child in both studies. The severity of the mother's depression predicted behavioral problems in the child. The current and lifetime rates of psychiatric disorders in the children of depressed mothers were compared to rates found in STAR⁎D Child and findings were consistent. Both studies used similar diagnostic assessments. CONCLUSION: Given the high prevalence of offspring psychiatric disorders, inquiring about the mental health of the children when a depressed mother comes for treatment, and referring children for treatment when appropriate, are important.

Adolescent marijuana use from 2002 to 2008: higher in states with medical marijuana laws, cause still unclear.

PURPOSE: Since 1996, 16 states have legalized marijuana use for medical purposes. The current study provides a scientific assessment of the association of medical marijuana laws (MML) and adolescent marijuana use using national data. METHOD: State representative survey data on approximately 23,000 12-17 year olds were collected by the National Survey on Drug Use and Health annually from 2002-2008. Yearly state-specific estimates of prevalence of past-month marijuana use and perception of its riskiness were statistically tested for differences between states with and without MML by year and across years. RESULTS: States with MML had higher average adolescent marijuana use, 8.68% (95% CI: 7.95-9.42) and lower perception of riskiness, during the period 2002-2008 compared to states without MML, 6.94% (95% CI: 6.60-7.28%). In the eight states that passed MML since 2004, in the years prior to MML passage, there was already a higher prevalence of use and lower perceptions of risk in those states compared to states that have not passed MML. CONCLUSIONS: While the most likely of several possible explanations for higher adolescent marijuana use and lower perceptions of risk in MML states cannot be determined from the current study, results clearly suggest the need for more empirically-based research on this topic.