药物临床试验中孕产妇抑郁症的治疗及其对儿童的影响。
Treatment of maternal depression in a medication clinical trial and its effect on children.
作者信息
Weissman Myrna M, Wickramaratne Priya, Pilowsky Daniel J, Poh Ernest, Batten Lisa A, Hernandez Mariely, Flament Martine F, Stewart Jessica A, McGrath Patrick, Blier Pierre, Stewart Jonathan W
机构信息
From the Department of Psychiatry, the Department of Child and Adolescent Psychiatry, and the Mailman School of Public Health, College of Physicians and Surgeons, Columbia University, New York; New York State Psychiatric Institute, New York; the Institute of Mental Health Research, University of Ottawa, Ottawa; the Department of Psychology, Carleton University, Ottawa; and the Department of Child and Adolescent Psychiatry, Cornell University, Ithaca, N.Y.
出版信息
Am J Psychiatry. 2015 May;172(5):450-9. doi: 10.1176/appi.ajp.2014.13121679. Epub 2015 Jan 23.
OBJECTIVE
Observational studies show that when a depressed mother's symptoms remit, her children's psychiatric symptoms decrease. Using randomized treatment assignment, the authors sought to determine the differential effects of a depressed mother's treatment on her child.
METHOD
The study was a randomized double-blind 12-week trial of escitalopram, bupropion, or the combination of the two in depressed mothers (N=76), with independent assessment of their children (N=135; ages 7-17 years).
RESULTS
There were no significant treatment differences in mothers' depressive symptoms or remission. Children's depressive symptoms and functioning improved significantly among those whose mothers were in the escitalopram group (compared with those whose mothers were in the bupropion and combination treatment groups). 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 in the escitalopram group reported significantly greater improvement, compared with the other groups, 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. Maternal baseline negative affectivity appeared to moderate the effect of maternal treatment on children, although the effect was not statistically significant. Children of mothers with low negative affectivity improved in all treatment groups. Children of mothers with high negative affectivity improved significantly only for those whose mothers were in the escitalopram group.
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.
目的
观察性研究表明，当抑郁母亲的症状缓解时，其子女的精神症状会减少。作者通过随机治疗分配，试图确定抑郁母亲接受治疗对其子女的不同影响。
方法
该研究是一项针对76名抑郁母亲进行的随机双盲12周试验，她们被随机分配接受艾司西酞普兰、安非他酮或两者联合治疗，同时对她们的135名子女（年龄7至17岁）进行独立评估。
结果
母亲的抑郁症状或缓解情况在治疗上无显著差异。母亲接受艾司西酞普兰治疗组子女的抑郁症状和功能有显著改善（与母亲接受安非他酮及联合治疗组的子女相比）。只有在艾司西酞普兰治疗组中，母亲抑郁症状的显著改善与孩子症状的改善相关。探索性分析表明，这可能是由于父母功能的变化：与其他组相比，艾司西酞普兰治疗组的母亲报告称，她们倾听和与孩子交谈的能力有显著提高，而她们的孩子也表示，在这12周里母亲更体贴。母亲的基线消极情感似乎会调节母亲治疗对孩子的影响，尽管该影响无统计学意义。消极情感低的母亲的孩子在所有治疗组中都有改善。消极情感高的母亲只有在接受艾司西酞普兰治疗时，其孩子才有显著改善。
结论
抑郁母亲病情改善对其子女的影响可能取决于她所接受的治疗类型。焦虑痛苦和易怒程度高的抑郁母亲可能需要使用能减轻这些症状的药物，以便显示其病情缓解对子女的影响。
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