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Can Young Babies be Depressed?

Eight-month old Carrie stayed with me and my toddler for a week while her mother joined her sailor-husband for a much needed shore leave.  When she arrived Carrie's mother took her out of her infant carrier and put her down in a playpen that she brought along.  She handled the baby like all the other baggage.  The baby made not a sound, just laid where she was placed.

Carrie looked more like a shriveled old woman than a baby girl-her skin dry and gray-like there was hardly any life in her.  I did nothing special, just folded her into our daily routine.  The transformation was astonishing.

I saw Carrie's smile for the first time the next morning.  Her eyes got a little brighter each time I said her name.  I could almost see her gaining weight.  By the end of the week she had rosy baby cheeks and a ready giggle.

Her mother was overcome when she picked her up.  "I never knew she could be so beautiful!" she said through tears and smiles.

The question is...Can Young Babies be Depressed?

Depression: A mental state characterized by dejection, absence of cheerfulness, feelings of sadness, despair, discouragement, inactivity, and low vitality. Often accompanied by low self esteem, self reproach, and somatic symptoms such as eating, and sleep disturbances. 

Scientific studies since the 1950s suggest that babies get depressed. The term “infant depression” recognizes the infant as a person, someone who can suffer psychic pain. It suggests the baby has exhausted all solutions for keeping his psychological balance. Yet current discussion of depressed infants is limited to a small community of specialists in Infant Mental Health and we know relatively little about depression in very young children, especially before age 2.

There is now a tendency to diagnose “Major Depressive Disorder” in children as young as 3; this may be reasonable, or over-diagnosing. In the scientific literature, the focus is on mothers' depression during and after pregnancy. About 70% of women report negative moods during pregnancy; 10% to 15% are diagnosed with major depression, although most depression may go undetected. Several controlled studies report 12% to 16% of all women experience postpartum depression, up to 26% in teen mothers. Estimates of depression in low-income mothers of young children consistently run near 40% and higher. 

Effects of mothers' depression are well documented Bowlby first described a profound negative impact on the child's environmental and intellectual well-being over 55 years ago. Animal studies over many species consistently show that babies deprived of competent mothering suffer significant adverse effects through adulthood. Research done in the 1990s strongly suggests that young babies do indeed get depressed themselves and might actually be born depressed. Brain studies of neonates whose mothers are depressed show reduced activity in the area of the brain that mediates social behaviors and positive expression. Neonates with this brain activity variation may be predisposed to affective disorders later in life. At 14-15 months, babies with similar brain activity variation show less affection and touching, higher levels of negative affect,  Another meta-analysis verified that maternal depression has a significant negative effect on infants' cognitive and emotional development. In one study, 6- and 12-month-olds of depressed mothers showed reduced attention span and persistence, lower frustration tolerance, and more fear of unfamiliar people and situations. Infants' and toddlers' whose mothers are depressed have more sleep problems than other infants.

How is depression transferred from mother to baby Brain activity variations signaling depression in the first week of life suggest that depression may start in the womb. Some scientists believe that a mother communicates depression to her fetus biochemically. When she is distressed, her body produces cortisol and other hormones which cross the placenta. Cortisol – the stress hormone – has been shown to interfere with cognition in adults – it’s what makes it hard to think straight and concentrate under pressure. When a mother is distressed during pregnancy, her baby may be born with depression “in his blood”. Depression may lead mothers to smoke, drink alcohol and take recreational drugs during pregnancy. Findings also suggest that depression contributes to complications such as preterm birth and low birth weight. After birth, the baby’s acquired depression may intensify if his mother’s depression prevents her from fully meeting his needs and makes their interactions unpredictable and disorganizing. One study showed that maternal depression adversely affects preterm newborns’ health status during the initial hospitalization. Other researchers found that depression interferes with preventive care. Depressed mothers were less likely to use an infant car seat or cover electrical outlets. Infants as young as three months old can detect depression in their mothers. They respond in kind. If the mother withdraws and becomes silent or easily upset; so does the baby. Goodman and Gotlib (1999) suggest four pathways by which maternal depression might be passed on to babies:

♦  Depression or predisposition may be inherited 
♦  Dysfunctional regulation, possibly due to a neurological deficiency or mother's stress-related hormones
♦  Exposure to mother's negative thoughts, behaviors, and affect
♦  Stressful life

Factors that might moderate the effects of maternal depression on the infant are:
♦  Father's health and involvement. Dads, grandparents and other caregivers can provide the very resilient and may bounce back quickly with timely ordinary care and attention the mother is temporarily unable to offer
♦  Course and timing of mothers' depression Child characteristics. 
♦  Children are very resilient and may bounce back quickly with timely ordinary care and attention. 

Latest Research Although infant depression has been studied for decades, we still do not really know when infant depression begins or what its outcome is. Some scientists see depression in every kind of suffering in infancy. Some say it does not exist until much later. It could be an outcome of attachment disorganization in infancy, since depression and disorganization seem to share the same learned helplessness. New research from France suggests that infant depression needs a certain amount of emotional and cognitive development to unfold, and that it might not exist before 18-20 months when major cognitive and emotional abilities emerge and the child is able to think of himself as responsible for loss within a relationship, and to feel hopeless, without a safe base. This may happen if the mother is depressed or with incoherent parenting in general. Infants’ reactions follow a path delineated by Bowlby in 1951: surprise, protest, withdrawal and despair. Before 18-20 months, Guedeney suggests that the concept of “relational withdrawal” maybe more applicable and useful than “depression”. It is difficult to find a clear definition of “withdrawal”, although it is recognized as an important part of normal parent-infant interaction and regulation. Withdrawal seems to be a key symptom of infant depression, but is seen with attachment disorders, pain, autism, PTSD, and anxiety. Sustained withdrawal is seen as a warning sign of relationship problems and depression. Infant depression is difficult to differentiate from attachment disorders and non-organic failure to thrive.

Implications for Practice The literature shows that a mother's depression may be transferred biochemically to her baby in the womb or later through compromised bonding and care giving. Knowledge of the devastating effects of mothers' depression on babies presents an urgent need to incorporate into prenatal care and public health programs methods to identify women at risk for depression and intervene early. Beck's (1998) Postpartum Depression Predictors Inventory is a checklist to help maternity care providers identify women whose depression may interfere with mothering. Healthy fathers and siblings can nurture the baby and support the mother emotionally. However, if a mother's depression is lasting or severe, the entire family may need support. Experts recommend music and massage therapy for both parents and children. These stress-relieving measures may enable mothers to be more receptive   to parenting coaching and help babies respond to improved interactions. Drug therapies must consider effects on the breastfeeding infant. A trial of parent-toddler psychotherapy found that the intervention prevented an IQ decline exhibited by depressed 3 year olds who received no therapy. More research is needed to identify effective prevention, screening and treatment of depression in mothers and young babies.

For more information on infant mental health, visit www.zerotothree.org

Beginnings Parent's Guide offers practical advice for dealing with infant and toddler anxiety and stress including, baby massage, night terrors, separation anxiety and more. To view the Table of Contents for the Beginnings Parent's Guide, click here. You can preview the Beginnings Pregnancy and the Beginnings Parent's Guides online - click here to learn more.

References
Armstrong, K.L., O'Donnell, H., McCallum, R., et al. (June 1998) Childhood sleep problems: association with prenatal factors and maternal distress/depression . J Paediatric Child Health
Beck, C.T. (Jan-Feb 1998) A checklist to identify women at risk for developing postpartum depression. J Ostet Gynecol Neonatal Nurs 27(1):39-46.
Cicchetti, D., Rogosch, F.A., Toth, S.L. (April 2000). J Abnorm Child Psycho 28(2):135-48.
Dawson,G., Frey, K., Self, J., et al. (Summer 1999). Frontal brain activity in infants of depressed and nondepressed mothers: relation to variations in infant behavior. Dev Psychopathol 11(3)589-605.
Field, T. (March April 1998). Maternal depression effects on infants and early interventions Prev Med 27(2):200-3. Goodman, S.H., Gotlib, I.H. (July 1999). Risk for psychopathology in children of depressed mothers: a developmental model for understanding mechanisms of transmission. Psychol Rev 106(3): 458-90.
Guedeney, A. (2007). Withdrawal behavior and depression in infancy. Infant Mental Health Journal 28(4), 393-408. Korn, M.L. (May 14, 2000). Perspectives in Women's Mental Health, American Psychiatric Association 153rd Annual Meeting.
Knitzer, J. (2007). Putting knowledge into policy: Toward an infant-toddler policy agenda. Infant Mental Health Journal 28(2), 237-245. M.L. (May 14, 2000). Perspectives in Women's Mental Health, American Psychiatric Association 153rd Annual Meeting.
Locke, R., Baumgart, S., Locke, K., et al. (March 1997). Effect if
McLennan, J.D., Kotelchuck, M. (May 2000). Parental Prevention Practice for Young Children in the Context of Maternal Depression. Pediatrics 105(5): 1090-5.
Medscape, Inc. (2000). Mood and Anxiety Disorders during Pregnancy and the Postpartum Period. Psychiatry and Mental Health Treatment Update, Medscape.
Sugawara, M., Kitamira, T., Toda, M.A., et al. (July 1999). Longitudinal relationship between maternal depression and infant temperament in a Japanese population. J Clinc Psychol 55(7) 869-80.
Weinberg, M.K., Tronick, E.Z. (Nov 1998). Emotional characteristics of infants associated with maternal depression


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