DEPRESSION is a family affair, in more ways than one. Not only does depression in one family member affect everyone else, depression in one or both parents greatly ncreases the risk that their children will also become depressed or develop other emotional disorders. This familial vuilnerability may result from the inappropriate actions of a depressed parent or from an inherited abnormality in brain chemistry, or both. Regardless of the cause, physicians and families need to be alert to the possibility that depression and related mental illnesses will persist across generations and that failure to recognize and treat them can result in serious school, social and vocational problems.
Depression Runs in Families
About 2 percent of children and 5 percent of adolescents are affected by a serious depressive disorder. Although it has long been kriown that the children of depressed parents are at greater than average risk of becoming depressed, the extent of this risk had not been documented in a large, long-term study until Dr. Myrna M. Weissman and her colleagues at the College of Physicians and Surgeons of Columbia University published the results of a ground-breaking 10-year study last fall.
In 65 of the 91 families studied, one or both parents had been treated for depression at the Yale University Depression Research Unit in New Haven. The other 26 were part of a long-term community study; no parents in this comparison group had a history of psychiatric illness.
The children, then aged 6 through 23, in both sets of families were interviewed initially, then 2 years later and again after 10 years by psychiatric professionals who did not know the mental health of the parents or their offspring. What they found was a frighteningly higher risk of depression and other problems in the children of depressed parents.
"The offspring of depressed parents are at high risk for depression, anxiety disorders and substance abuse," Dr. Weissrnan and her colleagues concluded in their report in The Archives of General Psychiatry. In an interview she added, "While obviously there are some children who escape, having a depressed parent is a risk factor for a child, and if both parents are depressed the risk is even higher." Also, the children of depressed parents are likely to develop depression and anxiety disorders sooner than the children of nondepressed parents.
Compared with the children of parents who were not depressed, 10-years down the line the children of depressed parents were three times as likely to have developed major depression; had three times the risk of phobias, and five times the risk of panic disorders and alcohol or drug abuse. These children were more likely to function poorly in school, at work and in marriage.
In addition, the children of depressed parents recovered more slowly from depressed episodes and their depressions were more likely to recur. For reasons that the researchers can only guess at, the depressed children of depressed parents also were less likely than the depressed children of nondepressed parents to seek treatment for their problems.
Who Needs Treatment?
The symptoms of depression in school-age children are not much different from those in adults They may include a change in appetite or weight or sleep habits (insomnia, excessive sleeping or difficulty getting up in the morning); a loss or interest in or pleasure from activities that used to be enjoyable; a loss of energy or chronic fatigue; abnormally agitated or slowed behavior; feelings of worthlessness or inappropriate guilt; indecision or difficulty concentrating, and recurrent thoughts of death or suicidal thoughts or gestunes. In addition, a previously normal youngster might develop antisocial behavior, violent outbursts, extreme irritability or loss of self-control. Or the child may skip school, drop out of clubs or sports or lose interest in friends or hobbies. In some youngsters, depression is expressed in physical symptoms like stomachaches and headaches.
"If such symptoms are not just a passing thing - the result, perhaps, of disliking a particular teacher or breaking up with a boyfriend - if they go on for several weeks, it's time to pay attention to them," Dr. Weissman said. "They might be an indication of depression."
Phobias and separation anxiety were also a serious and often disabling problem among the offspring, of depressed parents, and they tended to develop at an earlier age in these children, especially in girls. Often these anxiety disorders are a prelude to depression. Dr. Weissman noted that a lot of children have phobias as a normal part of growing up. But she said if the phobias persist, and interfere with life, they should be considered a disorder that warrants treatment.
"We don't want to jump on eveything and make the kid into an invalid, but we don't want to ignore problems either," she said.
In their report, Dr. Weissman and her colleagues urged pediatricians and family physicians to be alert to familial emotional problems. "When an adolescent presents with depressive symptoms, it's important to ask about the psychological status of the parents," they wrote. "Likewise, physicians should ask depressed parents about their children."
Although it has not been established that treating depressed parents has a positive effect on their children, it is reasonable to assume that a nondepressed person is likely to be better able to cope with a child's problems.
If you or someone you know is having trouble coping with depression, please contact us at the JFS of MetroWest.Click here If you would like to contact Jewish Family Service with a question or to make an appointment.