Study: If Depressed Moms Don't Take Their Meds Then Their Kids Will Go Crazy

That's pretty much the broad argument being made by this new study published in this month's American Journal of Psychiatry. The study was part of the NIH-funded STAR-D study of depression treatment in adults and is known at STAR-D Child. This new study (.pdf here) sought to assess the relationship between maternal depression and the symptomology of their children. Children were not being treated with medications as part of this study (at least not so far as I could glean from the paper).

Fifty-seven percent of mothers saw their depression remit during the study. There was no placebo arm to this study, so you could infer a placebo effect of perhaps 20 percent for this group and you'd get an effect size of about 37 percent (arguably better than other treatment outcomes elsewhere in the STAR-D trial itself). It is not clear what medications the moms were taking as STAR-D was a multi-year, multi-stage trial with several different anti-depressants employed. There was even an arm that included psychotherapy.

So researchers here weren't examining whether Med X worked for mom and child, but whether addressing a mother's depression had an effect on the child's psychosocial functioning.

Study authors concluded:

"The STAR*D study showed that continued efforts to treat depression until remission is achieved are likely to benefit adults with nonpsychotic major depressive disorder. The present study revealed that continued treatment of maternal depression until remission is achieved is associated with decreased symptoms and improved functioning in the offspring. Clinicians who treat adult patients might choose to inform depressed mothers about the potential benefits of remission for their children. Child clinicians may consider recommending treatment for maternal depression as an adjunct to child treatment when children of depressed mothers seek treatment."

The results of STAR-D were not nearly as clear cut as researchers paint them here and in fact were the subject of much hand-wringing by some in the mental health world. That said, I can easily see pharma companies using the "take anti-depressants for the good of your child" line in advertisements and I can easily envision doctors telling this to patients, despite the fact that improvements for the children seemed to be rather small scale and despite the fact that the best anti-depressant in the STAR-D trial only worked 30 percent of the time.

According to the study, children self-reported fewer psychological symptoms as their moms improved and their mothers reported the same basic trend with their offspring.

But perhaps most telling is that researchers assessed the children for themselves.

Table 5 of the study shows how children's psychological status, as measured by the Children’s Global Assessment Scale, progressed during the study as their mom's depression remitted or didn't. Kids whose moms were early remitters (the study's terminology) had a baseline C-GAS of 70.26 and had improved to 78.68 at 12 months. Kids whose moms were described as late remitters went from 68.37 to 73.88 while kids whose mom did not achieve remission thru STAR-D depression treatments went from 69.61 to 72.71.

I'm not particularly adept with kid's psychosocial rating scales, but I find it astonishing that the researchers are touting the positive benefits of treatment when kids whose moms improved and kids whose moms didn't largely wound up in the same assessment category on the C-GAS:

"80-71 No more than slight impairments in functioning at home, at school, or with peers; some disturbance of behaviour or emotional distress may be present in response to life stresses (eg., parental separations, deaths, birth of a sib), but these are brief and interference with functioning is transient; such children are only minimally disturbing to others and are not considered deviant by those who know them."

So if all three groups of kids wound up in largely the same place on what's a fairly loose assessment scale, then the researchers argument amounts to what exactly?

I'm certainly not arguing against depression treatment of any kind here, but I am pointing out that its effects aren't as great as you might expect. For moms and their kids.

It'll be interesting to see if others in the media pick up on this study and, if they do, how they report its results.