Depression in Mothers
Depression in Mothers
A Landmark, 30-Year Study Rewrites the Book on Mothers’ Depression and Its Impact on Their Children
From The Quarterly, Spring 2015
These days, when Myrna Weissman, Ph.D., addresses her colleagues in medicine about her life’s work––the study of depression, and the impact of a mother’s depression on her children––she has to go out of her way to remind them how much things have changed since she was a graduate student in the mid-1970s.
The conventional wisdom back then, she says, “was that children didn’t get depressed, and that depression, generally, was a disorder of menopausal women.” In 1978 a major medical journal published an article that asserted, “The notion of a syndrome of childhood depression rests largely on surmise.”
In large part because of studies performed by Dr. Weissman and her fellow scientists over the past three decades, we now know how wrong those assumptions were.
Children indeed can become depressed, and depression itself–– which affects women about twice as often as men––typically begins in the years just after puberty and peaks before age 35. This period includes the prime childbearing years for women. The fact remains that women can become depressed during menopause, but what Dr. Weissman and her colleagues discovered was that, for many women, the disorder begins earlier in life.
The other ground-shifting finding to emerge from Dr. Weissman’s work is that, in many cases, the children of depressed mothers are themselves negatively affected by their mothers’ condition. Just as important, when depressed mothers are successfully treated, the mental health of their children also improves. It’s a discovery that points directly to a way to prevent depression in the rising generation.
A Life’s Work
Dr. Weissman trained at Yale University to be an epidemiologist —an expert in the prevalence and patterns of diseases in large populations. She is now Professor of Epidemiology in Psychiatry at Columbia University and Chief of the Division of Epidemiology at the New York State Psychiatric Institute. A three-time recipient of NARSAD Distinguished Investigator Grants (1991, 2000, 2005), Dr. Weissman is also a member of the Foundation’s Scientific Council.
After graduate school, she became involved in an effort to discover the rates of psychiatric disorders in the community. “At the time, there was no authoritative population data, for instance, on the prevalence of depression or anxiety disorders,” Dr. Weissman says. She helped conduct a survey of some 18,000 people in New Haven, Connecticut and four other communities around the U.S. that showed depression was more common and began much earlier in life than was previously believed.
“As an epidemiologist,” she recalls, “I was interested in the early signs of the disorder and in prevention.” With that in mind, in 1982 Dr. Weissman embarked on a study that would define her career and change conventional wisdom. She calls it “the high-risk study.” Its purpose was to enroll patients with moderate to severe depression and to follow their offspring over time––and do the same with an age-matched group of non-depressed healthy people who would serve as controls. The idea was to watch the children of depressed parents, their mothers especially, to see whether the children developed depression or other psychiatric symptoms more frequently than children of nondepressed parents.
This “first wave” of the high-risk depression study showed that depression was “highly familial,” says Dr. Weissman––meaning that having a mother or father with moderate to severe depression significantly raised the odds that a child would also develop symptoms. The other main finding was that depression symptoms were uncommon before puberty but that there was a big rise after puberty, in adolescence.
The Long View
Ten years later Dr. Weissman and her colleagues repeated the study, following the same patients and controls, as well as some new recruits. “The findings were sustained,” she remembers. “It wasn’t that we began to see children in the low-risk population start to get depressed at the 10-year mark; just as in the first wave, we saw that the rates were always higher in the high-risk group.” Moreover, children of depressed parents, when they began to show symptoms, did not show symptoms of other psychiatric ailments. “It was specific: they had depression.”
At the 20-year mark, Dr. Weissman and her colleagues once more revisited the families enrolled in the high-risk study. This time the scientists began to incorporate newly available tools in an attempt to understand the biology of depression. At this interval, in addition to exams and interviews with participants, brain-wave studies called EEGs were performed. In later iterations of the study–– at the 30- and 35-year marks, respectively—MRI scans were performed and DNA collected from those willing to donate samples. These technologies are now central in efforts by Dr. Weissman and her colleagues to identify biomarkers––biological indications of depression—to aid diagnosis and treatment.
The original results of the high-risk study have held up across the decades. Not only is the study rare for its longevity, that very longevity has made it possible to study the children of the children of the original high-risk parents, and now their children too. “Our findings have been confirmed by us and reconfirmed by others,” Dr. Weissman says.
The other major fruit of the high risk study, regarding the impact of a mother’s depression on the mental health of her children, is explained in the accompanying story.
When Mom Gets Better, So Do Her Kids
In 2006, a large federally-funded study focusing on treatment of depressed people was completed. Called STAR*D (Sequenced Treatment Alternatives to Relieve Depression), it involved more than 4,000 patients who had not been helped by a first round of treatment with antidepressants. While the study was in progress, Dr. Weissman and her colleagues started an offshoot study, called STAR*DChild. It focused directly on the question of how the successful treatment of depressed mothers affected their children.
The results, reported over a period of years since 2006, have been clear: when mothers are treated and their depression lifts, their children benefit, both in the near-term and over the long haul. In studies of this kind, a reduction in depression symptoms to the point that few remain, is considered a “remission.”
Not only is the degree of remission important, so too is the timing. In the STAR*D-Child study, children with depressed moms fared best when their mothers responded to treatment within three months. But the effects were also positive for children whose mothers responded to treatment a few months later. In a 2011 report, Dr. Weissman and colleagues noted that one year after remission, 77 percent of mothers were still in remission. Overall, more than two mothers in three got better within a year when they were given the proper treatment and follow up.
The best news about this research concerns the children of these mothers. “Externalizing” behaviors and other psychiatric symptoms decreased significantly in children whose mothers got better, whether early or later on. The conclusion in 2011 was no different than what the same team offered in 2006, at the time of their first report: “These findings support the importance of vigorous treatment for depressed mothers in primary care or psychiatric clinics and suggest the utility of evaluating the children, especially children whose mothers continue to be depressed.”
Dr. Weissman hopes to see psychiatric care integrated with primary care, to treat depressed mothers and so many others who otherwise might go undiagnosed and untreated. As the co-developer of an important and increasingly popular form of psychotherapy called IPT, she believes such integration is a realistic possibility.
IPT stands for interpersonal psychotherapy, and a person can be helped by it in as few as three sessions. The first session is devoted to evaluating a person’s specific problems; the second session, to finding a way to support the person, if needed over an extended period, for instance by telephone; in the third session, patients with persisting symptoms are assigned to regular treatment. For Dr. Weissman, the point is that many who need help can be helped quickly. “Treatment doesn’t need to be a long-term affair,” she says.