Posted on Friday 27 September 2013

When I clicked on Psychiatric News, this flashed across the top banner:
by Joan Arehart-Treichel
September 27, 2013

Evidence that depression can be transmitted from a pregnant woman to her unborn child was published online August 21 in Biological Psychiatry.

Anqi Qiu, Ph.D., an associate professor of bioengineering at the National University of Singapore, and colleagues evaluated 157 women for depression when they were in the 26th week of pregnancy. The researchers used the Edinburgh Postnatal Depression Scale (EPDS), a 10-item self-report scale designed as a screening instrument for postnatal depression, but which also has been well validated for use in antenatal depression. The EPDS rates the intensity of depressive symptoms during the preceding seven days. Scores of 13 or higher indicate depression. Twenty-eight of the women scored within this range.

After the women’s infants were born, the researchers used structural MRI imaging to evaluate the size of the amygdalae in the infants. They also used a technique called diffusion tensor imaging to determine the microstructure of the infants’ amygdalae. The researchers were interested in evaluating this brain region in the infants because previous research has shown it to be associated with emotion regulation and depression. They reasoned that if maternal antenatal depression had an impact on the amygdala during gestation, it might make the fetus vulnerable to depression after birth.

After taking household income, maternal age, maternal smoking exposure, postconceptual age at brain imaging, and birth weight into consideration, the researchers could find no difference in amygdala volume between the newborns of the 28 women who had been depressed during pregnancy and those of the 129 women who had not been depressed during pregnancy. However, they did find that nerve axons in the right amygdala in the newborns of the depressed mothers were significantly different from nerve axons in the right amygdala in the newborns of the nondepressed mothers. (A similar trend was also found for the left amygdala.)

“Our findings suggest that an increased risk for depression may be transmitted from mother to child during fetal life,” Qiu said in an interview with Psychiatric News. “And together with previous studies of infant behavior, they suggest that screening for antenatal maternal depressive symptoms and intervention programs should begin during the prenatal period.”

“This study adds to the growing literature that demonstrates that untreated maternal depression has potentially negative effects on the developing fetus,” Jennifer Payne, M.D., an associate professor of psychiatry at Johns Hopkins Medical Institutions and an expert on women’s mood disorders, told Psychiatric News. “Many people mistakenly think that depression should not be treated during pregnancy. This study shows that untreated depression is an exposure for the child in the same way that taking a medication is an exposure.”
I was a bit incredulous. The pregnant mothers’ depression was from a 10 Item, self rating scale unaccompanied by a clinical interview [waiting room screening?]. 28/157 scored >= 13 which was designated as depression. The babies had MRIs and several parameters in the right amygdala were different for the children whose mothers had an elevated score. The amygdala has something to do with depressioon – ergo the maternal depression had been passed on – ergo, we should treat prenatal depression in mothers early. The leaps of logic made my head swim a bit. So I looked at the abstract and the paper itself. They said the same thing:
by Rifkin-Graboi A, Bai J, Chen H, Hameed WB, Sim LW, Tint MT, Leutscher-Broekman B, Chong YS, Gluckman PD, Fortier MV, Meaney MJ, and Qiu A.
Biological Psychiatry. 2013 Aug 19. [Epub ahead of print]

BACKGROUND: Antenatal maternal cortisol levels associate with alterations in the amygdala, a structure associated with emotion regulation, in the offspring. However, because offspring brain and behavior are commonly assessed years after birth, the timing of such maternal influences is unclear. This study aimed to examine the association between antenatal maternal depressive symptomatology and neonatal amygdala volume and microstructure and thus establish evidence for the transgenerational transmission of vulnerability for affective disorders during prenatal development.
METHODS: Our study recruited Asian mothers at 10 to 13 weeks pregnancy and assessed maternal depression at 26 weeks gestation using the Edinburgh Postnatal Depression Scale. Structural magnetic resonance imaging and diffusion tensor imaging were performed with 157 nonsedated, 6- to 14-day-old newborns and then analyzed to extract the volume, fractional anisotropy, and axial diffusivity values of the amygdala.
RESULTS: Adjusting for household income, maternal age, and smoking exposure, postconceptual age at magnetic resonance imaging, and birth weight, we found significantly lower fractional anisotropy [p = .009] and axial diffusivity [p = .028], but not volume [p = .993], in the right amygdala in the infants of mothers with high compared with those with low-normal Edinburgh Postnatal Depression Scale scores.
CONCLUSIONS: The results reveal a significant relation between antenatal maternal depression and the neonatal microstructure of the right amygdala, a brain region closely associated with stress reactivity and vulnerability for mood anxiety disorders. These findings suggest the prenatal transmission of vulnerability for depression from mother to child and that interventions targeting maternal depression should begin early in pregnancy.
The abstract mentioned antenatal cortisol levels being associated with changes in the baby’s amygdala, but they not only didn’t interview the mothers, they didn’t measure cortisol either. And you have to trust me here, the full paper made even less sense than the article or the abstract. I put it here as an extreme example of logic run amok. This screening instrument in a routine ultrasound clinic was compared to the newborn’s Amyglylas. Based on the result, they’re suggesting we treat depressed pregnant women early in pregnancy, I presume with anti-depressants? I’m just speechless. How did a paper with a logic train like that make it into Biological Psychiatry? Why was it picked up by Psychiatric News? I can only quote what Ben Goldacre famously said in his Ted Talk slide.

My advice: Avoid waiting room screening questionnaires…
    September 27, 2013 | 11:02 PM
    September 27, 2013 | 11:05 PM

    It was only a matter of time before biopsychiatry/Big Pharma went after babies in the womb:

    September 27, 2013 | 11:11 PM
    September 27, 2013 | 11:24 PM

    The Mother’s Act – Mandatory Screening of Moms for Depression is Like a Bad Movie Rerun

    Monday, April 20, 2009 by: Evelyn Pringle, health freedom writer

    Bernard Carroll
    September 28, 2013 | 12:36 AM

    “My advice: Avoid waiting room screening questionnaires.”
    To your closing comment I can only say Amen!

    The mindless push to screen for psychiatric illness has now gone to absurd lengths. And you don’t even need to be in a doctor’s waiting room any more…

    There is a consortium of researchers at U Chicago (Robert Gibbons) and U Pittsburgh (Paul Pilkonis, Ellen Frank, and the man in charge of DSM-5, David Kupfer), now pushing computerized tests for anxiety and depression. They claim that these can be completed on a mobile app, with the results going directly into your electronic medical record. Think of it! In between checking the stock market and the baseball scores and your Twitter feeds you can complete a psychiatric screening questionnaire.

    On closer examination, these screening tests deliver less than advertised and there will be a guaranteed majority of false positive screening results. Whether those false positive results will ever be purged from the EMR was not addressed.

    Plus, I should mention that this stupid work has soaked up millions of dollars of NIMH funding. Plus, I should mention that this consortium has formed a corporation that aims to commercialize the new computerized scales. You can read about it here: Caveat emptor.

    September 28, 2013 | 1:10 AM

    Reverse inference or just a mad determination to see what they wanted to see no matter how convoluted their thinking had to be in order to reach this conclusion? Who funded this mess? And who is going to stop the monkeys from using the MRIs?

    September 28, 2013 | 2:40 AM

    (got this from the paper’s pubmed linkout to

    Author: Publication Count:

    Anne Rifkin-Graboi 2
    Jordan Bai 432
    Helen Chen 3,877
    Waseem Bak’r Hameed 1
    Lit Wee Sim 1
    Mya Thway Tint 1
    Birit Leutscher-Broekman 1
    Yap-Seng Chong 171
    Peter D. Gluckman 378
    Marielle V. Fortier 3
    Michael J. Meaney 195
    Anqi Qiuemail address 16

    The winner is Helen Chen, with 3,877 publications @ 5.6 publications per month for 57 years!

    4 of 63 citations had the names of authors from of this paper ascribed.
    #35, 21, 42, 38

    4 authors are well on their way to becoming a professional Ghost Writers, Helen Chen is master of Ghost Writers.

    September 28, 2013 | 7:42 AM

    To play devils advocate, I am actually surprised that this with type of screening, they find any correlations.
    However, what I find even more troubling is this statement,”Many people think that depression should not be treated during pregnancy”
    I do not think ANYONE would think that. Many people think drug treatment should be avoided. The conflation of treatment with drugs is where we have a problem.

    September 28, 2013 | 8:24 AM


    Thanks for adding that! I don’t say those things anymore because I hear – “oh, you’re just saying that because you’re a …” [the blank varies].


    Great sleuthing!

    Steve Lucas
    September 28, 2013 | 8:37 AM

    The Sept. 25, 2013 print edition of the WSJ page A4 has this article Mental-Health Care at the Doctor’s Office by Melinda Black touches on many of the subjects being touched on in this discussion.

    The article opens with featuring psychiatrist Anna Ratzliff overseeing the treatment of nearly 500 patients via feedback from four primary care practices.

    “I get to touch so many more lives than I would if I were seeing these patients in person”

    The article then highlights the new services mandated by Obamacare and how now everyone will be able to secure mental health services.

    “In some practices, psychiatrist and psychologist work alongside primary-care doctors on cases. In others, primary-care doctors prescribe antidepressants or other medications and care managers-typically licensed clinical social workers-confer weekly with patients to monitor progress, often using a standardized nine-question depression quiz.”

    The article ties together a lot of loose concepts that those suffering psychological issues also have physical issues.

    “Magall King, 54 years old gets treatment for schizophrenia, bipolar disorder and diabetes….”

    Given this logic stream all diabetics suffer from multiple psychological disorders and need to see their primary care doctors for immediate prescriptions of multiple medications.

    Then we have this piece:

    outlining, as Mickey has noted, how some patients use their medical conditions as justification for their life choices and current situation. The result is that with unlimited care we will bankrupt our medical system and reinforcing that graph showing a never ending increase in medical spending.

    Pharma is driving this and go into almost any doctor’s office today and you will hear the doctor talk about expanding their practice into psychiatry based on the articles the drug reps have given them and the need for additional income.

    Steve Lucas

    September 28, 2013 | 12:10 PM

    This type of study is why psychiatry is called a pseudo-science.

    September 28, 2013 | 1:02 PM

    The real purpose of this vile article is probably to promote antidepressants for newborns. These could be placed in their formula or injected.

    Nick Stuart
    September 28, 2013 | 1:09 PM

    I think I will have to write to psychiatric news to try expose this sort of criminal scam.

    September 28, 2013 | 3:27 PM


    Please do. I will too now that you mention it.

    September 28, 2013 | 8:53 PM

    I’ve been absorbed with PPACA this past week, but came here tonight for a change of pace. WTF? No, the reply is WHO the F is even thinking this garbage up?! Oh, and check out Shrink Rap’s last post about a WSJ article that is suggesting psychiatry be consultants without actually seeing the patients.

    WTF indeed. Here’s a suggestion when someone is being considered for positions of power or influence in organized systems: mandatory MMPI’s to define risk for characterological disorders. At least if the people in position to somewhat control who can access such power are willing to let such personality psychopathology be considered.

    Yeah, it’s a stretch to ask, much less consider.

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