Maternal Depression Leads to Brain Changes in Children

Megan Brooks

Authors and Disclosures

August 17, 2011 — Children who grow up with a depressed mother, who probably is not as attentive as a nondepressed mother, may develop an enlarged amygdala, the part of the brain linked to emotional responses, a new study suggests.

In the study, researchers observed significantly larger amygdala volume in 10-year-old children whose mothers struggled with depression throughout their young lives compared with their peers who had not been exposed to maternal depression.

Sonia Lupien, PhD, from the Mental Health Institute of University of Montreal, Quebec, Canada, and colleaguesreport their study online August 15 in Proceedings of the National Academy of Sciences.

Enlarged amygdala volumes have also been seen in adoptees initially raised in orphanages, the study team notes.

Taken together, the findings suggest that the developing amygdala may be very sensitive to the quality and quantity of maternal care.

"Maternal depressive symptomatology has been associated with reductions in overall sensitivity to the infant and with an increased rate of withdrawn, disengaged behaviors," Dr. Lupien and her colleagues write.

The message, Dr. Lupien told Medscape Medical News, is that it is "important to treat the depressed patient, but also take into account the family unit."

"Many clinicians only concentrate on the patient that they treat, but other members of the family may also suffer from the depression of an adult (spouses and/or children)," Dr. Lupien added.

"No individual is alone in depression and it might be important to take care of the children as well as the mother and/or father in order to prevent the effects of depression from spilling over other family members."

Long-Term Consequences Unknown

Dr. Lupien and colleagues measured hippocampal and amygdala volume as well as stress hormone (glucocorticoid) levels in 17 children exposed to maternal depression since birth and 21 who were not. All of the children were 10 years old at assessment.

They found larger left and right amygdala volumes (P < .01) in the children exposed to maternal depression since birth compared with children without this exposure. They also observed a significant positive correlation between mothers' mean depression score over the first 7 years of the child's life and her own child's mean amygdala volume (P < .0001).

Hippocampal volumes did not differ between children exposed or unexposed to maternal depression, which isn't all that surprising, Dr. Lupien said.

Many studies, she explained, have shown hippocampal atrophy in adults, but not children, who report exposure to childhood adversity.

"This has led to the 'incubation hypothesis' whereby the effects of stress during childhood may only be apparent during adulthood (they may take time to emerge). This would be why we see hippocampal atrophy in adults exposed to early adversity but not in children exposed to adversity," Dr. Lupien said.

The investigators also observed increased salivary glucocorticoid levels (P < .05) in the children of depressed mothers when they were presented with unfamiliar situations, suggesting increased reactivity to stress in those children.

"The long term consequences of this increased reactivity to stress are unknown at this point," Dr. Lupien said.

Sensitive to Neglect

Medscape Medical News asked Nim Tottenham, PhD, assistant professor of psychology, Department of Psychology, University of California, Los Angeles, for her thoughts on this study.

Dr. Tottenham was involved in the study, reported by Medscape Medical News, that found enlarged amygdala volumes and difficulties in emotion regulation in a group of children reared in orphanages (Dev Sci. 2010;13:46-61).

The current study, Dr. Tottenham said, "is very similar to what we had published in children adopted from orphanages (which is important), but I think what is most novel is that these children had experienced a more 'species-typical' rearing environment and yet showed the same phenotype."

"Taken together," Dr. Tottenham said, "the studies are showing that the developing human amygdala is highly sensitive to maternal neglect, whereas the hippocampus, unlike in adults, fails to show an impact during childhood."

"A strength of the paper," she said, "was that all the children were exactly 10 years old and the mother's depression was well-characterized across those 10 years."

"I sincerely think," Dr. Lupien commented, "that developing interventions to help parents and children deal with the stress associated with depression in one family member could provide very positive results for all the family members, and society at large."

The study was supported by grants from the John D. and Catherine T. MacArthur Foundation, the Canadian Institutes for Health Research, and Fonds de recherche en santé du Québec. The authors and Dr. Tottenham have disclosed no relevant financial relationships.

Proc Natl Acad Sci. Published online August 15, 2011.

Updated Influenza Vaccine Recommendations Issued

Updated Influenza Vaccine Recommendations Issued

Megan Brooks 

  

 August 18, 2011 — Updated guidance for influenza vaccination in the United States for the upcoming 2011-2012 influenza season has been released by federal health officials with the Centers for Disease Control and Prevention (CDC).

"There are relatively few changes from 2010-2011 recommendations," Carolyn Bridges, MD, associate director for adult immunization, Immunization Services Division, National Center for Immunization and Respiratory Disease, said during a telebriefing today.

As a result, the 2011-2012 recommendations from the Advisory Committee on Immunization Practices have been issued in a shortened format, Dr. Bridges noted.

The report was published online August 18 in the Morbidity and Mortality Weekly Report.

The 2010 recommendation for routine annual influenza vaccination for all persons aged 6 months or older in the United States has not changed.

"We continue to recommend that people age 6 months and older be vaccinated," Dr. Bridges emphasized.

To allow time for production of protective antibody levels, "vaccination should optimally occur before onset of influenza activity in the community, and providers should offer vaccination as soon as vaccine is available," the report reads. "Vaccination also should continue to be offered throughout the influenza season."

Vaccine Strains Identical to Last Year

This year's seasonal influenza vaccine virus strains are identical to those contained in last year's vaccine. These include A/California/7/2009 (H1N1)-like, A/Perth/16/2009 (H3N2)-like, and B/Brisbane/60/2008-like antigens. The influenza A (H1N1) vaccine virus strain is derived from a 2009 pandemic influenza A (H1N1) virus.

Dr. Bridges emphasized that the recommendation for annual vaccination remains in place, even though the strains of this year's vaccine are the same as those in 2010-2011.

"Levels of protective antibody against influenza viruses can decline over the course of a year, so even people who got a flu vaccine last year should get vaccinated again this year to ensure that they are optimally protected," she said.

The report reminds providers that children aged 6 months through 8 years need 2 doses of influenza vaccine, administered a minimum of 4 weeks apart, during their first season of vaccination to optimize immune response.

In past influenza seasons, children aged 6 months through 8 years who received only 1 dose of influenza vaccine in their first year of vaccination required 2 doses the following season. However, because the 2011-2012 vaccine strains are unchanged from the 2010-2011 vaccine strains, "children in this age group who received at least 1 dose of the 2010-2011 seasonal vaccine will require only 1 dose of the 2011-2012 vaccine," the report states.

"Children in this age group who did not receive at least 1 dose of the 2010-2011 seasonal influenza vaccine, or for whom it is not certain whether the 2010-2011 seasonal vaccine was received, should receive 2 doses of the 2011-2012 seasonal influenza vaccine." it adds.

Multiple Products to Be Available

Multiple influenza vaccines are expected to be available during the upcoming influenza season, all containing the same antigenic composition, the CDC notes.

"We are anticipating, based on reports from manufacturers, that probably 166 million or so doses of vaccine will be produced this year; that compares with 157 million doses that were distributed last year," Dr. Bridges said.

The updated recommendations make note of the new intradermally administered trivalent inactivated vaccine (TIV) preparation (Fluzone Intradermal, Sanofi Pasteur) licensed in May 2011.

This vaccine is indicated for people 18 to 64 years old and contains less antigen than intramuscular TIV preparations (9 μg vs 15 μg of each strain per dose) in a smaller volume (0.1 mL vs 0.5 mL).

This vaccine is administered in a single dose (preferably over the deltoid muscle) and comes in a prefilled microinjection syringe. The most common adverse reactions include injection-site erythema, induration, swelling, pain, and pruritus, the CDC notes. With the exception of pain, these reactions occurred more frequently than with intramuscular vaccine, but generally resolved within 3 to 7 days.

"This vaccine is an alternative to other TIV preparations for those in the indicated age range, with no preferential recommendation," the agency writes.

Recommendations for People With Egg Allergy

When considering influenza vaccination in people who have or report a history of egg allergy, several considerations must be taken into account, the Advisory Committee on Immunization Practices notes. For those who have experienced only hives after exposure to egg, it is recommended that the inactivated vaccine, rather than live attenuated vaccine, be used.

For these individuals, it is also recommended that vaccine be administered by a healthcare provider familiar with the potential manifestations of egg allergy, and that vaccine recipients be observed for at least 30 minutes after receipt of the vaccine.

"Other measures, such as dividing and administering the vaccine by a two-step approach and skin testing with vaccine, are not necessary," the report states.

The report also states that persons who have had reactions to egg involving angioedema, respiratory distress, lightheadedness, or recurrent emesis, or those who required epinephrine or other emergency medical intervention, are more likely to have a serious systemic or anaphylactic reaction on reexposure to egg proteins. "Before receipt of vaccine, such persons should be referred to a physician with expertise in the management of allergic conditions for further risk assessment," the Advisory Committee on Immunization Practices recommends.

"A previous severe allergic reaction to influenza vaccine, regardless of the component suspected to be responsible for the reaction, is a contraindication to receipt of influenza vaccine," the report states.

Vaccination Rates Still Low in Providers, Pregnant Women

During the telebriefing, Dr. Bridges reported data on vaccination rates in 2 key groups: healthcare providers and pregnant women. She said that although vaccination rates have risen in healthcare providers, they still remain "far too low."

During the 2010-2011 season, estimated coverage rates among healthcare personnel were 63.5%, which is "well below the Healthy People 2020 goal of 90%," Dr. Bridges noted. The 63.5% coverage rate for the 2010-2011 season is up from the 62% coverage rate in the prior season (2009-2010), she noted.

It is currently recommended that all healthcare personnel be vaccinated annually. This is "important for patient safety, and healthcare facilities should make influenza vaccine readily available to all healthcare personnel as part of a comprehensive infection control program," Dr. Bridges said.

Influenza vaccine coverage rates among pregnant women also remain low, according to Dr. Bridges, with only about half of pregnant women in the United States getting vaccinated during the 2009-2010 and 2010-2011 seasons.

"Pregnant women and children younger than 6 months of age are known to be at higher risk for severe illness from influenza," Dr. Bridges noted. "Vaccination during pregnancy has been shown to decrease the risk [for] illness in the mother, as well as the risk of influenza and influenza hospitalization in their infants during the first 6 months of life."

"Continued efforts are needed to encourage providers to strongly recommend and offer vaccination to their pregnant patients," Dr. Bridges said.

Morb Mortal Wkly Rep. Published online August 18, 2001. Full tex
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