Adolescents should be screened for clinical depression, but only when appropriate systems are in place to ensure accurate diagnosis, treatment and follow-up care. Clinical depression is an important cause of poor health and lower quality of life among children and adolescents. Depression can cause difficulties in school and disruptions of family and social relationships
"Depression in adolescents has a significant impact on both mental and physical health, and adolescents with depression have more hospitalizations for psychiatric and medical issues than adolescents who are not depressed," said Task Force Chair Ned Calonge, M.D., who is also chief medical officer for the Colorado Department of Public Health and Environment.
Depressed children and adolescents are at an increased risk of suicide, which is the third-leading cause of death among people age 15 to 24 and the sixth-leading cause of death among those age 5 to 14. Adolescents suffering from clinical depression are also more likely to suffer from depression in early adulthood.
From the article:
The U.S. Preventive Services Task Force now recommends screening adolescents for clinical depression only when appropriate systems are in place to ensure accurate diagnosis, treatment and follow-up care. This applies to all adolescents 12 to 18 years of age. In a separate recommendation, the Task Force found insufficient evidence to assess the balance of benefits and harms of screening children 7 to 11 years of age for clinical depression. The recommendations and the accompanying summary of evidence appear in the April issue of Pediatrics.
The Task Force reviewed new evidence on the benefits and harms of screening children and adolescents for clinical depression, the accuracy of screening tests administered in the primary care setting and the benefits and risks of treating clinical depression using psychotherapy and/or medications in patients 7 to 18 years of age. Clinical depression is an important cause of poor health and lower quality of life among children and adolescents. Depression can cause difficulties in school and disruptions of family and social relationships as well as diminished quality of life.
"Depression in adolescents has a significant impact on both mental and physical health, and adolescents with depression have more hospitalizations for psychiatric and medical issues than adolescents who are not depressed," said Task Force Chair Ned Calonge, M.D., who is also chief medical officer for the Colorado Department of Public Health and Environment. "It is important that adolescents are diagnosed and treated for clinical depression in order to improve their health and quality of life, especially if they have a family history of depression."
There is adequate evidence that treating adolescents with selective serotonin reuptake inhibitors (SSRIs), psychotherapy or combined therapy (SSRIs and psychotherapy) result in decreased clinical depression symptoms. Treating clinically depressed youths with SSRIs is associated with an increased risk of suicidality (suicidal thoughts, preparation and attempts of suicide) and, therefore, should only be considered if careful clinical supervision is possible.
Depressed children and adolescents are at an increased risk of suicide, which is the third-leading cause of death among people age 15 to 24 and the sixth-leading cause of death among those age 5 to 14. Adolescents suffering from clinical depression are also more likely to suffer from depression in early adulthood. Nearly 6 percent of adolescents 13 to 18 years of age are clinically depressed, and it is more common among girls than boys.
Monday, April 6, 2009
Most Popular: Task Force Recommends Screening Adolescents for Clinical Depression
Tuesday, March 31, 2009
Most Popular: Octo-Moms at Risk for Postpartum Depression
The tabloid media has kept a close eye on the slow-motion train wreck of Octo-Mom Nadia Sulaiman, a California woman who recently gave birth to octuplets, bringing her grand total of children to 14. TV interviews, absurd calls to 911, and scuffles with paparazzi have shown that this woman may not be entirely stable. New research reveals that one more complication for the Octo-Mom could be a severe case of postpartum depression.
Researchers at the Johns Hopkins Bloomberg School of Public Health recently examined the relationship between multiple births and maternal depressive symptoms. They found that multiple births increased the odds of maternal depression. Mothers ofmultiples had a 43 percent increased risk of moderate to severe depression compared to mothers of single-born children.
Complicating the issue further is evidence that few mothers with depressive symptoms, regardless of the multiple births status, reported talking to a mental health specialist or a general medical provider.
"The low numbers of women receiving mental health counseling despite symptoms reinforces the need for facilitating better referral of patients with depressive symptoms," said Cynthia Minkovitz, MD, MPP, senior author of the study
From the article:Mothers of multiples have 43 percent increased odds of having moderate to severe depressive symptoms nine months after giving birth compared to mothers of single-born children, according to researchers at the Johns Hopkins Bloomberg School of Public Health. Researchers examined the relationship between multiple births and maternal depressive symptoms and found that multiple births increased the odds of maternal depression, and that few mothers with depressive symptoms, regardless of the multiple births status, reported talking to a mental health specialist or a general medical provider. The results are published in the April 1, 2009, issue of Pediatrics.
"Our findings suggest that 19 percent of mothers of multiples had moderate to severe depressive symptoms nine months after delivery, compared to 16 percent among mothers of singletons," said Yoonjoung Choi, DrPH, lead author of the study and a research associate with the Bloomberg School's Department of International Health. "Mothers with a history of hospitalization due to mental health problems or a history of alcohol or drug abuse also had significantly increased odds. Non-Hispanic black mothers had higher odds compared to non-Hispanic white mothers. Mothers who were currently married, Hispanic, or with a high household socioeconomic status were less likely to have depressive symptoms." Choi, along with colleagues, used data from the Early Childhood Longitudinal Study--Birth Cohort, a nationally representative sample of children born in 2001. They measured depressive symptoms in mothers using an abbreviated version of the Center for Epidemiologic Studies Depression (CES-D) scale. Researchers examined the association between multiple births and maternal mental health, given the rapidly increasing multiple births rate in the U.S. over the last two decades. They also found that, among the mothers of both singleton and multiples, only 27 percent reported talking to a mental health specialist or a general medical provider when experiencing depressive symptoms. Researchers believe greater attention is needed in pediatric settings to address maternal depression in families with multiple births.
"The low numbers of women receiving mental health counseling despite symptoms reinforces the need for facilitating better referral of patients with depressive symptoms," said Cynthia Minkovitz, MD, MPP, senior author of the study and an associate professor with the Bloomberg School's Department of Population, Family and Reproductive Health. "Pediatric practices should make an additional effort to educate new and expecting parents of multiples regarding their increased risk for maternal postpartum depression. Furthermore, well-child visits are potentially valuable opportunities to provide education, screening and referrals for postpartum depression among mothers of multiples; such efforts require linkages between pediatric and adult systems of care and adequate community mental health resources."
"Multiple Births Are a Risk Factor for Postpartum Maternal Depressive Symptoms" was written by Yoonjoung Choi, David Bishai and Cynthia Minkovitz.
Wednesday, January 21, 2009
Vets and Depression: Return from War to Fight New Battle
Newswise — When Lamont Christian returned from war, he often felt angry, afraid and unworthy. Years later, Christian found himself living in a homeless shelter, a sign that time had not healed his emotional wounds.
He went to the VA Ann Arbor Healthcare System for help, and there, he learned the root of his problems: he was suffering from depression, post-traumatic stress disorder and anger management problems. Now, he wants others to learn from his experience.
"If I had a message to give to veterans who are coming out of the military now or even veterans who have been out for a long period of time, it's that nothing is going to happen in your life unless you go and get the help you need," he says.
Christian is a veteran of Vietnam, but his experience holds true for soldiers returning from current battlegrounds as well.Nearly a third of veterans who are treated at Veterans Affairs health care centers have significant depressive symptoms, and about 13 percent have clinically diagnosed depression, says Marcia Valenstein, M.D., clinical psychiatrist with the VA Ann Arbor Healthcare System and associate professor of psychiatry with the University of Michigan Health System.
Depression is a "very potent" risk factor for suicide among people receiving treatment for depression at the VA, she notes, with a suicide rate that is three times higher than that of the overall VA patient population.
Such high rates led Valenstein and her colleagues to study the best time to provide intensive interventions to veterans with depression to prevent suicide. In a study just published by the Journal of Affective Disorders, the researchers found that veterans with depression were at highest risk for suicide in the 12 weeks after they were hospitalized for psychiatric conditions.
"This finding highlights the need for very close follow-up for patients who are discharged from our inpatient services because this is a particularly vulnerable time for them," says Valenstein, a core investigator with the Serious Mental Illness Treatment Research and Evaluation Center at the VA Ann Arbor Healthcare System.
Current government recommendations have focused on providing intensive follow up for patients following all new antidepressant starts. More attention needs to be paid to the highest-risk periods that follow psychiatric hospitalization, Valenstein says. "Health systems with limited resources should focus their efforts on this time period to have the greatest impact on suicide prevention."
The Department of Veterans Affairs has made mental health issues a priority, Valenstein notes. VA health centers have received more than $300 million for expansion of suicide prevention and other mental health services from the Veterans Health Administration.
Note: The views expressed in the study are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs. read the full article...
Tuesday, November 11, 2008
Depression Can Hamper Glucose Control in People With Diabetes
“Our study shows that depression is a major and important comorbidity in people with type 2 diabetes,” said study co-author Leonard Egede, M.D., from the Center for Health Disparities Research at the Medical University of South Carolina.
Through a combination of diet, exercise and medication, people with type 2 diabetes work to keep their blood glucose levels within a certain range. Past research has shown that those who are also depressed have a tougher time doing so. About 30 percent of adults with diabetes have depression and the combination is linked to poor glucose control, higher complication rates, decreased quality of life and increased risk of death.
The current study appears in the November/December issue of the journal General Hospital Psychiatry.
Egede and his colleagues analyzed data from 11,525 veterans (98 percent men) with type 2 diabetes who received medical care at a Veterans Administration facility in the Southeast. The participants’ average age was 66 years and 48 percent were white, 27 percent were African-American and 25 percent were of other races.
Researchers evaluated each participant at three-month intervals from 1997 to 2006, with 36 intervals. At each 3-month interval, clinicians checked their HbA1c level, a blood test that measures long-term glucose control. Experts recommend a target level of less than 7 percent.
Six percent of the participants had depression, researchers determined.
They found that over the four-year period, the HbA1c values in the veterans who were depressed averaged 0.13 percent higher than the veterans who were not depressed. Egede said the difference is quite significant — enough to raise people with diabetes above the desirable range for glucose control, putting them at higher risk.
“The fact that the difference persisted over time and that the depressed group had higher mean HbA1c at all 36 time points was surprising,” Egede said.
The researchers also found that the change in HbA1c among the depressed participants did not differ based on race or age.
Evette Joy Ludman, Ph.D., senior research associate at the Group Health Center for Health Studies in Seattle, said that although the link between depression and diabetes complications might seem daunting, it is possible for adults to follow treatment orders for their depression while also managing their diabetes.
“I think it is a reasonable expectation that health care teams can help patients who have both depression and diabetes manage both conditions,” she said. “I don’t think patients see themselves as a collection of different illnesses and if we take a more proactive, integrated approach to caring for them, it is likely they can benefit. Research currently in the field is addressing that exact question.”
General Hospital Psychiatry is a peer-reviewed research journal published bimonthly by Elsevier Science. For information about the journal, contact Wayne Katon, M.D., at (206) 543-7177.
Richardson LK, et al. Longitudinal effects of depression on glycemic control in veterans with type 2 diabetes. General Hosp Psychiatry, 30(6), 2008.
Tuesday, September 2, 2008
Children of Older Fathers More Likely to Have Bipolar Disorder
Newswise — Older age among fathers may be associated with an increased risk for bipolar disorder in their offspring, according to a report in the September issue of Archives of General Psychiatry, one of the JAMA/Archives journals.
Bipolar disorder is a common, severe mood disorder involving episodes of mania and depression, according to background information in the article. Other than a family history of psychotic disorders, few risk factors for the condition have been identified. Older paternal age has previously been associated with a higher risk of complex neurodevelopmental disorders, including schizophrenia and autism.
Emma M. Frans, M.Med.Sc., of the Karolinska Institutet, Stockholm, Sweden, and colleagues identified 13,428 patients in Swedish registers with a diagnosis of bipolar disorder. For each one, they randomly selected from the registers five controls who were the same sex and born the same year but did not have bipolar disorder.
When comparing the two groups, the older an individual’s father, the more likely he or she was to have bipolar disorder. After adjusting for the age of the mother, participants with fathers older than 29 years had an increased risk. “After controlling for parity [number of children], maternal age, socioeconomic status and family history of psychotic disorders, the offspring of men 55 years and older were 1.37 times more likely to be diagnosed as having bipolar disorder than the offspring of men aged 20 to 24 years,” the authors write.
The offspring of older mothers also had an increased risk, but it was less pronounced than the paternal effect, the authors note. For early-onset bipolar disorder (diagnosed before age 20), the effect of the father’s age was much stronger and there was no association with the mother’s age.
“Personality of older fathers has been suggested to explain the association between mental disorders and advancing paternal age,” the authors write. “However, the mental disorders associated with increasing paternal age are under considerable genetic influence.” Therefore, there may be a genetic link between advancing age of the father and bipolar and other disorders in offspring.
“As men age, successive germ cell replications occur, and de novo [new, not passed from parent to offspring] mutations accumulate monotonously as a result of DNA copy errors,” the authors continue. “Women are born with their full supply of eggs that have gone through only 23 replications, a number that does not change as they age. Therefore, DNA copy errors should not increase in number with maternal age. Consistent with this notion, we found smaller effects of increased maternal age on the risk of bipolar disorder in the offspring.”
(Arch Gen Psychiatry. 2008;65[9]:1034-1040. Available pre-embargo to the media at http://www.jamamedia.org.)
Editor’s Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
PET Scans Help Identify Mechanism Underlying Seasonal Mood Changes
Newswise — Brain scans taken at different times of year suggest that the actions of the serotonin transporter—involved in regulating the mood-altering neurotransmitter serotonin—vary by season, according to a report in the September issue of Archives of General Psychiatry, one of the JAMA/Archives journals. These fluctuations may potentially explain seasonal affective disorder and related mood changes.
“It is a common experience in temperate zones that individuals feel happier and more energetic on bright and sunny days and many experience a decline in mood and energy during the dark winter season,” the authors write as background information in the article. This is thought to be related to variations in brain levels of serotonin, which is involved in the regulation of functions such as mating, feeding, energy balance and sleep. The serotonin transporter, a protein that binds to serotonin and clears it from the spaces between brain cells, “is a key element in regulating intensity and spread of the serotonin signal.”
Nicole Praschak-Rieder, M.D., and Matthaeus Willeit, M.D., of the Centre for Addiction and Mental Health and the University of Toronto, Ontario, Canada, and colleagues studied 88 healthy individuals (average age 33) between 1999 and 2003. Participants underwent one positron emission tomography (PET) scan to assess serotonin transporter binding potential value, an index of serotonin transporter density. The higher the binding potential value, the less serotonin circulates in the brain. For the analysis, individual scans were grouped according to the season of the scan—fall and winter or spring and summer.
“Serotonin transporter binding potential values were significantly higher in all investigated brain regions in individuals investigated in the fall and winter compared with those investigated in the spring and summer,” the authors write. When they matched binding potential values to meteorological data, the researchers found that higher values occurred during times when there were fewer hours of sunlight per day.
“An implication of greater serotonin transporter binding in winter is that this may facilitate extracellular serotonin loss during winter, leading to lower mood,” the authors write. “Higher regional serotonin transporter binding potential values in fall and winter may explain hyposerotonergic [related to low serotonin levels] symptoms, such as lack of energy, fatigue, overeating and increased duration of sleep during the dark season.”
“These findings have important implications for understanding seasonal mood change in healthy individuals, vulnerability to seasonal affective disorder and the relationship of light exposure to mood,” they conclude. “This offers a possible explanation for the regular reoccurrence of depressive episodes in fall and winter in some vulnerable individuals.”
(Arch Gen Psychiatry. 2008;65[9]:1072-1078. Available pre-embargo to the media at http://www.jamamedia.org.)
Editor’s Note: This study was supported by grants from the National Alliance for Research on Schizophrenia and Depression, the Austrian Science Foundation, the Canadian Institute for Health Research, the Ontario Mental Health Foundation, the Canada Foundation for Innovation and the Ontario Innovation Trust. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
Family Therapy Helps Relieve Depression Symptoms in Bipolar Teens
Newswise — Family-focused therapy, when combined with medication, appears effective in stabilizing symptoms of depression among teens with bipolar disorder, according to a report in the September issue of Archives of General Psychiatry, one of the JAMA/Archives journals.
Between one-half and two-thirds of patients with bipolar disorder develop the condition before age 18, according to background information in the article. “Early onset of illness is associated with an unremitting course of illness, frequent switches of polarity, mixed episodes, psychosis, a high risk of suicide and poor functioning or quality of life,” the authors write. “The past decade has witnessed a remarkable increase in diagnoses of bipolar disorder in children and adolescents and, correspondingly, drug trials for patients with early-onset disorder. There has been comparatively little controlled examination of psychotherapy for pediatric patients.”
David J. Miklowitz, Ph.D., of the University of Colorado, Boulder, and colleagues conducted an outpatient randomized controlled trial among 58 adolescents (average age 14.5) with bipolar disorder who had experienced a mood episode in the prior three months. Between 2002 and 2005, 30 teens were randomly assigned to receive pharmacotherapy plus family-focused treatment for adolescents. Over nine months, they participated in 21 50-minute sessions. Therapy included the patient, parents and siblings and consisted of education about their disease, communication training and problem-solving skills training.
The other 28 teens were assigned to pharmacotherapy plus enhanced care, which involved three 50-minute family sessions that focused on preventing relapse. Independent evaluators, who did not know patient group assignments, assessed the teens every three to six months for two years.
A total of 60 percent of the family-focused therapy group and 64.3 percent of the enhanced care group completed the two-year follow-up; of those, 53 (91.4 percent) experienced a full recovery from their original mood episode. There were no differences between the two groups in rates of recovery or in the amount of time that elapsed before a subsequent mood episode. However, patients in the family-focused therapy group recovered from depressive symptoms more quickly, spent fewer weeks in depressive episodes over the two-year period and had an overall more favorable trajectory of depressive symptoms than those in the enhanced care group.
“To enhance full symptomatic and functional recovery among adolescents, family-focused treatment for adolescents may need to be supplemented with collaborative care interventions found effective in mania stabilization,” the authors conclude. The program’s emphasis on “reducing conflict in family relationships, enhancing social supports and teaching interpersonal skills may underlie its stronger effects on bipolar depression.”
(Arch Gen Psychiatry. 2008;65[9]:1053-1061. Available pre-embargo to the media at http://www.jamamedia.org.)
Editor’s Note: This study was supported by National Institute of Mental Health grants, a Distinguished Investigator Award from the National Alliance for Research on Schizophrenia and Depression and a Faculty Fellowship from the University of Colorado Council on Research and Creative Work (Dr. Miklowitz). Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
