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May 17, 2011
Wall Street Journal by Melinda Beck
Successfully treating a mother with depression isn't just good for the mom; it also can provide long-lasting benefits for her children's mental health, new research shows.
About 1 in 8 women can expect to develop depression at some point in her life. Incidences peak in the childbearing years, with as many as 24% of women becoming depressed during or after pregnancy. More than 400,000 infants are born to depressed mothers each year in the U.S.
And decades of research have borne out the old expression "when Mama ain't happy, ain't nobody happy." About half of kids with depressed mothers develop the condition—three times the typical risk.
Sadness isn't the only symptom. Children of depressed mothers are more likely to be anxious, irritable and disruptive than other kids.
Take the Edinburgh Postnatal Depression Scale, which was developed to screen postpartum women for depression.
A study in the American Journal of Psychiatry in March shows, however, that when a mother's depression is successfully treated, her children get progressively better, too—even a year after the treatment ends. And the faster she responds to treatment, the faster her children do, as well.
"These findings should alert us. If you have the disease, get into treatment, because it can have a big impact on your family," says psychiatrist Madhukar Trivedi from the University of Texas Southwestern Medical Center in Dallas, a co-author of the study. Only about half of people who fit the criteria for major depression get treatment, he says.
Evidence is growing that depression in fathers affects children, as well. A study in the journal Pediatrics last month of 1,746 new fathers found 7% had an episode of major depression in the past year. The depressed dads were only half as likely to read to their children—but four times as likely to spank them—as the dads who weren't depressed.
Researchers are still trying to understand the complex biological and psychological ways depression travels through families. Genes play a big role, but a child's environment and experiences can influence whether those genes are switched on or off. How children learn to cope with feelings and setbacks is yet another variable. Some kids with long family histories of depression remain resilient, for reasons psychologists hope to understand and learn from.
Children are particularly vulnerable to parents' depression in the first year of life when their brains are rapidly forming connections. When parents are withdrawn or unresponsive, attachment and bonding are affected.
"As early as two months of age, the infant looks at the depressed mother less often, shows less engagement with objects [and] has a lower activity level," a report last year in the journal Pediatrics says.
The American Academy of Pediatrics, or AAP, has urged pediatricians to screen all new mothers for signs of postpartum depression with a 10-question survey.
"It's like when the flight attendant says, 'Put on your own [oxygen] mask first'. You can't really help your children unless you're feeling healthy yourself," says Therese Borchard, who writes the Beyond Blue blog about living with depression and has battled it herself while raising young children.
Researchers are still debating at what age children experience depression of their own. It can manifest in different ways at different ages.
Young children tend to have anxiety first, then develop depression around puberty, then start substance abuse by late adolescence, says Myrna Weissman, an epidemiologist at Columbia University who has long studied depression in families.
Children of depressed parents often have difficulty regulating their own emotions, and many feel responsible for their parents' well being.
"They're stressed out because they're thinking, 'What can I do to make mommy happy?'" says Carol Berkowitz, a former president of the AAP. "It impacts their self-esteem and it's the child caring for the parent, rather than the other way around."
For her 2006 book, "The Ghost in the House: Motherhood, Raising Children and Struggling with Depression," journalist Tracy Thompson surveyed nearly 400 depressed mothers and found their interactions with their children generally fell into three categories. They withdrew, emotionally or physically; they were chronically irritable; and they were unable or unwilling to set limits, mostly to avoid conflict.
Almost 90% of the surveyed mothers—recruited through newspaper ads—had grown up with a depressed parent.
Ms. Thompson, whose own mother was depressed, struggled with it for years herself and was hospitalized at 34. She recovered but suffered severe postpartum depression after her first daughter was born a few years later. That daughter was diagnosed with depression at age 7, Ms. Thompson says. But they both feel much better now, which she attributes to medication, exercise, good sleep and the help of a support group. "There is all kinds of medication out there ," Ms. Thompson says. "You have to experiment until you find one that works."
About 70% of depression sufferers can be helped substantially with antidepressants, talk therapy, cognitive-behavioral therapy or a combination of these, according to the National Institute of Mental Health.
After much debate, the American College of Obstetricians and Gynecologists now generally recommends that pregnant women who are severely depressed stay on their antidepressants. But ACOG urges mothers to discuss the pros and cons of quitting their medication with their doctors.
In the latest study, the final part of a government-funded trial, 151 mothers were treated with a single antidepressant, usually citalopram (brand name: Celexa).
Of the 80 remaining at the one-year follow-up, nearly half had a remission of their depression within three months and another third had a remission by one year. A fifth didn't respond to treatment and 17% of their children who weren't depressed earlier had developed the condition.
Psychotherapy that helps mothers also helps their children, studies have shown. In one randomized, controlled trial of 47 mothers at the University of Pittsburgh, those who received nine weeks of psychotherapy had significantly lower levels of depression than the control group, as did their children. The results were published in the American Journal of Psychiatry in 2008.
Meanwhile, many depressed mothers wonder how much to tell their children about their illness. At a minimum, most feel it's crucial to tell children that their parents' depression isn't their fault and not their responsibility to fix.
Beth Vesel, a literary agent, says she knew too much about her mother's severe mood swings and felt she had to take care of her.
Raising her own son, now 16, Ms. Vesel says, "I always ask myself, 'Would it help him to know this?' His job should be to live his own life." So far, she says, he shows no signs of depression.
Ms. Thompson, whose severely depressed mother kept insisting that nothing was wrong, has made it a point to be more open with her children.
She says her younger daughter, now 10 and already "hot-wired" for depression, recently asked her what it was like when she was feeling anxious as a child.
"I sat down and told her about how I used to hold onto a piece of white cloth because it made me feel better," Ms. Thompson says. "And I said, 'You're different. You have a parent who understands and you will have better ways of coping with this than I did.'"
Write to Melinda Beck at HealthJournal@wsj.com