Presentation myrna weissman 2.12.13a

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  • 1. Depression in Families:Treating Mothers, Helping Children Myrna M. Weissman, Ph.D.Professor of Epidemiology in PsychiatryDepartment of Psychiatry, College of Physicians & Surgeons, Columbia University Mailman School of Public Health Chief, Division of EpidemiologyNew York State Psychiatric InstituteBrain & Behavior Research Foundation Webinar: February 12, 2013. 2:00pm

2. 2 3. Depression runs in families Mothers remission helps her children Personalized treatment for depression to predict early remission based onpatients individual characteristics 3 4. High Risk Families Low Risk FamiliesProbandProband 4 5. Major Depression in 2 nd Generation (G2) Offspring ofDepressed and Non-depressed Probands(G1) 5 6. Mood Disorder in Grandchildren (G3),by MDD Status of Grandparents (G1)and Parents (G2)Depression Status Low RiskHigh RiskGrandparent+ +ParentRate Per 100 + +Grandchild 7. Consistent Across 3 Generations 2- to 6-fold increased risk of depression Anxiety is the first presentation in childhood Substance abuse increased in adulthood 40% of grandchildren with a depressedparent and grandparent have a depression byadolescence Parents, now in their 50s, have increased riskof cardiovascular problems 7 8. While numerous studies show that children ofdepressed mothers have more psychiatricdisorders than children of non-depressedmothers We dont know what happens to thesechildren when their mothers depressionremits Do children benefit from a remission oftheir mothers remission? 8 9. Rationale for Intervention Depression is a complex genetic disorder.Onset and recurrence is precipitated by stress invulnerable persons. A depressed parent is a stressful event in avulnerable child. Do children benefit from a remission in theirparents depression? (a modifiable risk) We designed a study to treat the depressedparent and follow their children. 10. Study DesignSTAR*DSTAR*D-CHILD Their MothersChildrenTreated for FollowedDepression over TimeMothersChildOutcomesOutcomes**Assessed by clinicians not(7 sites) providing mothers treatment andblind to mothers clinical outcome 11. Maternal Treatment Mothers received treatment as part ofSTAR*D (Sequenced TreatmentAlternatives for the Relief of Depression),conducted in 14 sites across the U.S. Purpose: To understand what to do next ifthe first treatment does not produce aremission11 12. STAR*D Child Goal Study the impact of improvement in mothersdepression on childrens psychiatric diagnoses,symptoms, and functioning Study design Recruit mothers with current MDD Treat maternal MDD Assess children before mothers are treated andfollow them up for a year after maternaldepression remission12 13. At Study Entrance 1/3 of the children were currently ill with apsychiatric disorder 1/2 had a lifetime history of a psychiatricdisorder13 14. Three Months After Initiation ofMothers Treatment 14 15. Mothers Remission andResponse at 3 Months60 49 %50Number of Mothers (%)40 34 %302010 0 Remitters Responders15 16. Change in Child Diagnoses byMothers Remission If mother remitted: 11% overall decrease in childrens diagnoses If mother did not remit: 8% overall increase in childrens diagnoses 16 17. Change in Child Diagnoses byMothers RemissionBaseline3 Months 50 45 % Children With Diagnosis 40 35 30 25 20 15 10 5 0Mother RemittedMother Unremitted Any DSM-IV Diagnosis in Child 17 18. Of children with a diagnosis at baseline: If mother remitted, 33% of children got better If mother did not remit, 12% of children got better Of children without a diagnosis at baseline: If mother remitted, ALL children remained well If mother did not remit, 17% of children developeda diagnosis18 19. 19 20. One-Year Follow-up 20 21. Change in Child Symptomsby Maternal Remission StatusChild Assessment Period Maternal RemissionBaseline3 mos.6 mos. 9 mos. 12 mos. P* EARLY REMISSION6.34.7 3.83.6 3.3 < .0001 LATE REMISSION7.67.0 7.05.1 5.4 .0497 NON-REMITTED6.65.9 5.95.9 7.0 .64 (REMISSION STATUS X TIME) INTERACTION: .01 P-levelforlineartimetrendafteradjustingforchildsage,genderandannualhouseholdincome. * Children of early remitters: Significant in DSM-IV symptoms Children of non-remitters: No significant change in DSM-IV symptoms Children of late remitters: Intermediate outcomes 21 22. Summary Overall decrease in child symptoms over thecourse of the 12-month follow-up Childs improvement significantly associated withmothers remission status Children of mothers who remitted had a greaterreduction in their own psychiatric symptoms Children of mothers who remitted in the first 3 or 6months (early remitters) had the most positiveoutcomes 22 23. Antidepressants or psychotherapy are, onaverage, more effective than placebos or notreatment BUT individual response to specifictreatment varies widely STAR*D found that only of patients went intoremission after 3 months of treatment, and only50-60% were in remission after a year of varyingthe treatments Clinicians cannot easily predict which evidence-based treatment will work for a given individual 23 24. Personalized treatment is the delivery ofhealth care tailored to a unique individualbased on his/her characteristics rather thaninformation about what works for groups ofindividuals Develop a panel of tests that together createa unique biosignature that can predictresponse Reduce hit or miss choice of evidence-based treatment24 25. 25 26. New York: Columbia University, 212-543-5734 Boston: Mass General Hospital, 617-726-0517 Dallas: Southwestern University, 214-648- HELP Detroit: University of Michigan, 877-864-3637 26 27. 27 28. This research has been supportedover the years by NIMH, NIDA,Brain & Behavior Research Foundation(NARSAD), and the Sackler Institute for Developmental Psychobiology28