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

Abstract

Objective Observational studies show that when a depressed mother’s symptoms remit, her children’s symptoms decrease. Without random assignment of mother’s treatment, we cannot conclude that the child’s improvement is due to the mother’s treatment. The objective is to determine the differential effects of a depressed mother’s treatment on her child. Methods Randomized double-blind 12-week clinical trial of escitalopram, bupropion, or the combination in depressed mothers (N=76), and independent assessment of their children (N=135) ages 7–17 years. We hypothesized that mothers on combination treatment would have significantly earlier onset and higher rate of remission than on either monotherapy. The mothers’ outcome would be reflected in their children. Results There were no significant treatment differences in mothers’ depressive symptoms or remission. However, children’s depressive symptoms and functioning improved significantly if their mothers received escitalopram (vs. bupropion and combination). 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 on escitalopram (vs. bupropion and combination) reported significantly greater improvement 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. Mother’s baseline negative affectivity appeared to moderate the effect of mother’s treatment on children, although the effect was not statistically significant. Children of mothers with low negative affectivity improved on all treatments. Children of mothers with high negative affectivity improved significantly only if the mother was on escitalopram (vs. bupropion and combination). 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.

Depression and parenting: the need for improved intervention models

“…Building on these findings from Star*D a further medication trial examined the effects of escitalopram, bupropion and a combination of the two antidepressants on parenting and child outcomes. Findings from this study suggest that escitalopram monotherapy to treat maternal depression was associated with both significant improvements in child depressive symptoms and in parenting functioning (39). Of note was that parenting functioning was measured by maternal self-report and through report from the child.…”

Brief Psychotherapy for Maternal Depression: Impact on Mothers and Children

“…7 In another pharmacotherapy trial for maternal depression, the association between maternal and child symptoms was mediated by improved parental functioning. 8 …”

“…Indeed, in prior trials, offspring had non-clinical mean symptom scores 12 or included samples where fewer than half of mothers had children who met criteria for psychiatric disorders at baseline. 8, 13 Thus, only a subset of families in prior studies carried very high risk for poor outcomes, defined as having members from at least two generations who concurrently met syndromal psychiatric disorder criteria. This methodologic consideration matters because co-occurring psychiatric illness in both members of the dyad is associated with greater family burden, 14 decreased treatment-seeking among ill mothers, 1,15 and worse outcomes in ill youth.…”

“…16 We therefore compared interpersonal psychotherapy for mothers (IPT-MOMS), a brief version of interpersonal psychotherapy 17 specifically addressing mother–child relationship problems, 11 to brief supportive psychotherapy (BSP), 18 a manualized treatment that acts as an active control for non-specific aspects of psychotherapy. Because prior work suggested that improvements in parenting may drive child outcomes over and above changes in maternal depressive symptoms, 8, 19 we hypothesized that IPT-MOMS, a treatment targeting mother–child relationship problems, would yield greater improvements in maternal depression symptoms and functioning and hence better child outcomes compared to BSP, an active comparator 20 that does not target specific mother–child factors.…”

The adaptive brain in mental health: overcoming inherited risk factors

“…One strategy uses pharmacological or other treatments of depression in the mothers, which can enhance the interaction with the child and improve the child's behavioural symptoms. 27,28 Early treatment of children whose symptoms do not improve despite the mother's remission is another potential strategy. 27 However, pharmacological approaches to early life treatment in mothers or children may elicit long-term adverse effects.…”