Mood and Anxiety Disorders

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Childhood Depression and Postpartum Psychiatric Depressive

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 subjects.

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

A positive view of life and aging may help you live longer.

Giving life two thumbs up may help you stay healthier.
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Do you look forward to the next week? Do you feel younger than your age? Do you have a sense of purpose? If so, you may already have done something to reduce your risk of degenerative diseases and may even be adding years to your life.

It's called dysthymia, and it often goes unnoticed and thus undiagnosed and untreated.

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Everyone feels down at some time. You may lack energy, have trouble sleeping, or just feel blah. The feeling often goes away, or it comes and goes, but does not seem like a cause for concern. Yet if these blue feelings persist, they could be a red flag for a type of depression called dysthymia, or low-grade depression.

"Even though dysthymia is regarded as a lesser form of depression, it should be taken seriously," explains Dr. David Mischoulon, psychiatrist at Harvard-affiliated Massachusetts General Hospital. "Its persistent hold can interfere with your health, family, and social life."

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Antidepressants can help reduce insomnia, loss of appetite, and fatigue associated with depression.

When your doctor recommends an antidepressant to fight depression—such as selective serotonin reuptake inhibitors (SSRIs) or serotonin and norepinephrine reuptake inhibitors (SNRIs)—it’s about more than just boosting your mood. Depression has many potential physical effects. “Most people aren’t aware that depression can lead to other health problems,” says Dr. Amanda Hernandez, a geriatrician at Harvard-affiliated Massachusetts General Hospital.

Put some oomph into your intentions with simple strategies to keep you on track.

The new year brings new resolve. But if this is the year you’re finally going to start exercising and keep exercising, you’ll need strategies to back up your good intentions. “Research indicates that people have limited reserves of willpower that are taxed by many different aspects of life, such as eating a healthy diet or doing household chores. If you exhaust your will-power in one area, you’ll have less to expend in the others,” says Rachel Wilson, a physical therapist with Harvard-affiliated Brigham and Women’s Hospital.

If you are returning to exercise after a long break, or if you’ve never exercised, get your doctor’s okay first. Then use some of the following strategies to stay on the path to a healthier lifestyle.

They'll tempt you with their marketing promises, but beware the dangers hidden within.

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It's February — time to think about roses, chocolates, sweethearts, and romance. And if those sentiments bring you to a certain drugstore aisle stocked with pills and potions promising to boost your sex life, you may want to think twice before buying any. "Most are a phenomenal waste of money, in my opinion," says Dr. Michael O'Leary, a urologist at Harvard-affiliated Brigham and Women's Hospital.

Unicorn juice?

With a few exceptions, most supplements for sexual function haven't been studied scientifically. At best, says Dr. O'Leary, they have a placebo effect (a beneficial result from an inactive treatment).

Treating underlying conditions and using helpful strategies may be all it takes to get you back on track.

Reading for pleasure is one of life's great gifts. It's an escape to another world or a path to increased knowledge. Plus, reading about a subject that's new to you challenges the brain, which may help create new brain cell connections. But many aspects of health can affect our ability to read in older age.

Physical changes

Chronic disease and age-related changes can have a big effect on your ability to read. Consider these factors: