Mood and Anxiety Disorders
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Childhood Depression and Postpartum Psychiatric
In the United States, more than 2 million adults suffer from bipolar
manic depressive disorder, an illness of extreme moods. It is characterized
by deep depression followed by periods of hyperactivity and elation,
referred to as mania, with periods of normal mood in between.
Bipolar disorder often leads to substance abuse and one in four people
with the condition attempt suicide.
In a recent study published in the American Journal of Psychiatry,
researchers set out to determine how often major childhood depression
turns into bipolar disorder. The researchers followed up on 72 subjects
who, at an average age of 10.3 years, had been treated for major depressive
disorder with the tricyclic antidepressant drug nortriptyline. They also
studied 28 normal subjects.
At the time of follow-up, the average age of the subjects who had had
prepubertal major depressive disorder was 20.7 years. Of these subjects,
33.3% now had bipolar disorder, compared to none of the normal comparison
These results may, in part, be due to heredity. A large portion of the
prepubertal children who had been diagnosed with a major depressive disorder
had family histories of bipolar disorder. Because bipolar disorder tends
to run in families, these children may have been more vulnerable to developing
the condition. Another possibility is that the children who were originally
treated with nortriptyline already had bipolar disorder, but had not
yet experienced their first manic episode.
Clinicians treating children with antidepressants should be aware of
the risk that children with major depressive disorder may develop adult
bipolar manic depressive disease.
Another study, published in Psychology and Medicine, sought to
determine the long-term prognosis of women with postpartum psychiatric
disorders. 50-80% of women experience some degree of postpartum depression
within one month of delivering a child. Postpartum psychiatric disorders
are more extreme.
The study authors used standardized questionnaires to determine the long-term
outcome of 64 women who had been hospitalized with postpartum psychiatric
disorders 23 years earlier, and who had been interviewed for a 1982
study of women with diagnoses of schizophrenia, schizo-affective, bipolar,
or unipolar affective disorders.
The researchers found that 75% of the women had recurrent psychiatric
illness, and 37% of the women had at least three subsequent episodes.
However, only 29% of the 34 women who gave birth after the initial postpartum
psychiatric disorder had additional episodes of maternal psychiatric
illness. In addition, a majority of the 64 women were functioning well
in society; 71-73% were employed and in stable relationships.
The women with the best outcomes were those who had an initial diagnosis
of unipolar disorder, those who experienced psychiatric illness after
a first pregnancy, and those whose psychiatric illness started within
one month of delivery.
July 2001 Update
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St. John's Wort as Effective as Low-Dose
Hypericum extract, the active ingredient in St. John's
wort, is as effective as a low dosage of a tricyclic antidepressant,
according to a study in the Dec. 11, 1999, British Medical Journal. Researchers
gave 263 patients with moderate depression hypericum extract, imipramine
(a popular tricyclic antidepressant), or a placebo. After eight weeks,
the researchers compared the participants' depression rating scores and
quality of life scores. They found hypericum extract was just as effective
in treating depression as imipramine, and more effective than placebo.
In addition, participants taking hypericum extract suffered fewer adverse
side effects. St. John's wort products vary considerably in composition,
the researchers note, so these results cannot be generalized. They also
point out that the dosage of hypericum extract that they tested was higher
In 1998, the National Institutes of Health began a three-year
study to compare the effectiveness of hypericum extract versus a selective
serotonin reuptake inhibitor, another commonly prescribed drug to treat
depression. Results from this trial will be reported when they are released.
About 19 million American adults suffer from depression
in any given year. Unfortunately, many of them do not seek professional
help and may turn instead to over-the-counter remedies. It is essential
that you tell your doctor if you take St. John's wort. The herb has been
found to interact adversely with many prescription drugs, including oral
contraceptives, antivirals (in particular, a drug prescribed to treat
HIV infection), and antidepressants. A research team in Switzerland also
found the herb can interfere with cyclosporine, a drug used to prevent
patients from rejecting organ transplants. Two heart transplant patients
were hospitalized after taking St. John's wort because they suffered
acute rejection of their hearts.
Depression is a treatable disorder. If you or someone you
love shows signs of depression, such as decreased appetite, insomnia,
loss of energy, and feelings of hopelessness and guilt, contact your
physician immediately. For more information about depression, including
a depression questionnaire, see page 395 of the Family Health Guide.
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