This article reviews the various literatures on the adjustment of children of depressed parents, difficulties in parenting and parent-child interaction in these families, and contextual factors that may play a role in child adjustment and parent depression. First, issues arising from the recurrent, episodic, heterogeneous nature of depression are discussed. Second, studies on the adjustment of children with a depressed parent are summarized. Early studies that used depressed parents as controls for schizophrenic parents found equivalent risk for child disturbance. Subsequent studies using better-defined samples of depressed parents found that these children were at risk for a full range of adjustment problems and at specific risk for clinical depression. Third, the parenting difficulties of depressed parents are described and explanatory models of child adjustment problems are outlined. Contextual factors, particularly marital distress, remain viable alternative explanations for both child and parenting problems. Fourth, important gaps in the literature are identified, and a consistent, if unintentional, "mother-bashing" quality in the existing literature is noted. Given the limitations in knowledge, large-scale, long-term, longitudinal studies would be premature at this time.

Children of depressed parents: an integrative review.

Objective To qualitatively review the literature of the past decade covering the epidemiology, clinical characteristics, natural course, biology, and other correlates of early-onset major depressive disorder (MDD) and dysthymic disorder (DD). Method A computerized search for articles published during the past 10 years was made and selected studies are presented. Results Early-onset MDD and DD are frequent, recurrent, and familial disorders that tend to continue into adulthood, and they are frequently accompanied by other psychiatric disorders. These disorders are usually associated with poor psychosocial and academic outcome and increased risk for substance abuse, bipolar disorder, and suicide. In addition, DD increases the risk for MDD. There is a secular increase in the prevalence of MDD, and it appears that MDD is occurring at an earlier age in successive cohorts. Several genetic, familial, demographic, psychosocial, cognitive, and biological correlates of onset and course of early-onset depression have been identified. Few studies, however, have examined the combined effects of these correlates. Conclusions Considerable advances have been made in our knowledge of early-onset depression. Nevertheless, further research is needed in understanding the pathogenesis of childhood mood disorders. Toward this end, studies aimed at elucidating mechanisms and interrelationships among the different domains of risk factors are needed.

Childhood and adolescent depression: a review of the past 10 years. Part I.

https://www.healio.com/psychiatry/journals/psycann/1976-12-6-12/{806b8887-c02e-40c8-a228-57f1cdb2bdba}/the-stress-of-life.pdf

The stress of life

Thousands of studies have been conducted of the functioning of the many neurotransmitter systems in order to explore the biologic basis of major depressive disorder. Instead of reviewing this literature exhaustively, we have attempted to propose a model that accommodates the clinical observation that chronic stress early in life in vulnerable persons predisposes them to major depression with contemporary observations of the potential consequences of repeated central nervous system exposure to effectors of the stress response. This model accords with current clinical judgment that major depression is best treated with a combination of psychopharmacologic agents and psychotherapy. Accordingly, whereas psychopharmacologic intervention may be required to resolve an active episode of major depression and to prevent recurrences, psychotherapy may be equally important to lessen the burden of stress imposed by intense inner conflict and counterproductive defenses.

Clinical and biochemical manifestations of depression. Relation to the neurobiology of stress (2)

This practice parameter describes the epidemiology, clinical picture, differential diagnosis, course, risk factors, and pharmacological and psychotherapy treatments of children and adolescents with major depressive or dysthymic disorders. Side effects of the antidepressants, particularly the risk of suicidal ideation and behaviors are discussed. Recommendations regarding the assessment and the acute, continuation, and maintenance treatment of these disorders are based on the existent scientific evidence as well as the current clinical practice. J. Am. Acad. Child Adolesc. Psychiatry, 2007; 46(11):1503Y1526. Key Words: major depressive disorder, dysthymic disorder, evaluation, treatment, antidepressants, selective serotonin reuptake inhibitors, psychotherapy, practice parameter. Depressive disorders are often familial recurrent illnesses associated with increased psychosocial morbidity and mortality. Early identification and effective treatment may reduce the impact of depression on the family, social, and academic functioning in youths and may reduce the risk of suicide, substance abuse, and persistence of depressive disorders into adulthood. Evidencesupported treatment interventions have emerged in psychotherapy and medication treatment of childhood depressive disorders that can guide clinicians to improve outcomes in this population.

https://aacap.org/app_themes/aacap/docs/practice_parameters/depressive_disorders_practice_parameter.pdf

Practice Parameter for the Assessment and Treatment of Children and Adolescents With Depressive Disorders

Depression in prepubertal children: dexamethasone nonsuppression predicts differential response to imipramine vs. placebo.

Children with pure depression or depression plus an anxiety-related disorder (n = 14) had a higher drug response rate (57%) and a lower placebo response rate (20%) when compared to children with depression plus a concomitant conduct or oppositional disorder (n = 17) (33% drug response rate and 67% placebo response rate). These findings could explain why studies of prepubertal-onset depression found no differences between drug and placebo treatment assuming that a large percentage of the studies' subjects had concomitant conduct or oppositional disorders. The children with pure depression or depression plus an anxiety-related disorder had different symptom clusters from those with depression plus a concomitant conduct or oppositional disorder. The former had more severe CDRS ratings on sleep, appetite disturbance, depressed feelings, and psychomotor retardation. In contrast, those with a concomitant conduct or oppositional disorder had shorter attention spans and were more likely to disturb other children (based on Conners scale scores).

The effect of concomitant disorders in childhood depression on predicting treatment response.

Two experiments using domestic and wild rats (Rattus norvegicus) were conducted to assess the ontogenetic as well as phylogenetic influences of early experience on domestication. Experiment 1 was a factorial, reciprocal cross-foster study. Experiment 2 was a factorial assessment of the combined effects of preweaning handling and postweaning enriched environments. These experiments on rat domesticatoin showed that preweaning handling has a strong influence on the ontogenetic development of the rat in terms of reduced emotionality. Handled wild rats became much more like domestic rats in their behavior. This finding for handling contrasted with minimal effects for cross fostering and enriched environments.

Early experience in domestication.

The effects of a purported animal model of depression (inescapable shock, IS) was tested on: (a) escape behavior, (b) regional brain levels of norepinephrine (NE), serotonin (5-HT), and dopamine, and (c), the response of the cerebromicrovasculature to metabolic demand as mimicked by manipulation of arterial CO2 content (PaCO2) Multidisciplinary research has implicated central biogenic amines in the regulation of cerebromicrocirculation IS treatment resulted in increased escape latency and lowered levels of NE and 5-HT in the locus coeruleus but not in terminal fields in distant regions This treatment also did not alter cerebral blood flow or capillary permeability in distant regions when compared with control rats Thus, the discrete changes in NE and 5-HT in locus coeruleus induced by IS treatment is not reflected in changes in cerebral blood flow and the effective permeability of the blood-brain barrier

Carroll W. Hughes

Papers

Depression in prepubertal children: dexamethasone nonsuppression predicts differential response to imipramine vs. placebo.

The effect of concomitant disorders in childhood depression on predicting treatment response.

Early experience in domestication.

Cerebral blood flow and cerebrovascular permeability in an inescapable shock (learned helplessness) animal model of depression

Depression in children: concentration-dependent CNS toxicity of tricyclic antidepressants.