Low growth hormone response to growth hormone-releasing hormone in child depression

Need for Multidimensional and Multidisciplinary Management of Depressed Preadolescents and Adolescents: A Review of Randomized Controlled Trials on Oral Supplementations (Omega-3, Fish Oil, Vitamin D3)

(1) Background: Depression is a serious health problem with a high cost for public administration. Epidemiological studies report that one in five children have a mental disorder and about 50% of mental health problems exacerbate in childhood and adolescence. Moreover, the antidepressant efficacy in children and adolescents is poorly demonstrated and can cause severe behavioral adverse events such as suicidal ideation. (2) Methods: This systematic literature review examined oral supplementations (Omega-3, fish oil, Vitamin D₃) to treat depressed children, preadolescents, and adolescents. MEDLINE, Scopus, Embase, and PsycInfo were searched for articles published in the last five years. Six studies met the eligibility criteria. The inclusion criteria encompassed children, preadolescents, and adolescents, a diagnosis of depression, and an intervention of oral supplementations such as Omega-3, fish oil, and Vitamin D₃. (3) Results: Most of the studies demonstrated that dietary intervention provides positive outcomes in terms of depression symptoms. (4) Conclusions: Overall, the results demonstrate a positive effect for oral supplementation suggesting an increase intake of Omega-3, fish oil, and Vitamin D₃. However, only a few studies assess the effectiveness of diet recommendations, as a monotherapy or combined treatment, for the management of depression at developmental ages. Thus, there is still a need to further investigate these aspects and to look more specifically at adolescents and preadolescents.

Association of growth hormone deficiency (GHD) with anxiety and depression: experimental data and evidence from GHD children and adolescents

Anxiety and depression are among the commonest emotional problems in children and young adolescents. They are encountered with even higher prevalence in children and adults with growth hormone deficiency (GHD). Alterations in the somatotropic axis, as observed in both GH/IGF1 deficiency and excess, can produce permanent changes in brain tissue structure. The growth hormone/insulin-like growth factor 1 (GH/IGF1) axis seems to exert a regulatory effect on brain function and neurogenesis, especially in the hippocampus, a brain region associated with mental and emotional disorders, such as depression and anxiety. There is evidence from animal models of the possible interrelationship of the endocrine system with the pathogenesis of emotional disorders. Moreover, clinical data support the association of GHD and mood disorders, which are often reversed by GH replacement therapy. However, the causal relationship and the mechanism underlying this association are to date obscure and remain to be clarified. The present review reports experimental data from animal models regarding the role of GH/IGF1 in emotional disorders and focuses on clinical data on the presence of these disorders in children with GHD and their response to GH therapy.

Child and Adolescent Depression: A Review of Theories, Evaluation Instruments, Prevention Programs, and Treatments

Depression is the principal cause of illness and disability in the world. Studies charting the prevalence of depression among children and adolescents report high percentages of youngsters in both groups with depressive symptoms. This review analyzes the construct and explanatory theories of depression and offers a succinct overview of the main evaluation instruments used to measure this disorder in children and adolescents, as well as the prevention programs developed for the school environment and the different types of clinical treatment provided. The analysis reveals that in mental classifications, the child depression construct is no different from the adult one, and that multiple explanatory theories must be taken into account in order to arrive at a full understanding of depression. Consequently, both treatment and prevention should also be multifactorial in nature. Although universal programs may be more appropriate due to their broad scope of application, the results are inconclusive and fail to demonstrate any solid long-term efficacy. In conclusion, we can state that: (1) There are biological factors (such as tryptophan-a building block for serotonin-depletion, for example) which strongly influence the appearance of depressive disorders; (2) Currently, negative interpersonal relations and relations with one's environment, coupled with social-cultural changes, may explain the increase observed in the prevalence of depression; (3) Many instruments can be used to evaluate depression, but it is necessary to continue to adapt tests for diagnosing the condition at an early age; (4) Prevention programs should be developed for and implemented at an early age; and (5) The majority of treatments are becoming increasingly rigorous and effective. Given that initial manifestations of depression may occur from a very early age, further and more in-depth research is required into the biological, psychological and social factors that, in an interrelated manner, may explain the appearance, development, and treatment of depression.

Assessing anxiety in nonhuman primates

Anxiety can be broadly described as a psychological state in which normally innocuous environmental stimuli trigger negative emotional expectations. Human anxiety disorders are multidimensional and may be organic or acquired, situational or pervasive. The broad ranging nature of the anxiety phenotype speaks to the need for models that identify its various components and root causes to develop effective clinical treatments. The cross-species comparative approach to modeling anxiety disorders in animals aims to understand mechanisms that both contribute to and modulate anxiety. Nonhuman primate models provide an important bridge from nonprimate model systems because of the complexity of nonhuman primates' biobehavioral capacities and their commonalities with human emotion. The broad goal of this review is to provide an overview of various procedures available to study anxiety in the nonhuman primate, with a focus on the behavioral aspects of anxiety. Commonly used methods covered in this review include assessing animals in their home environment or in response to an ethologically relevant threat, associative conditioning and startle response tests, and cognitive bias tests. We also discuss how these procedures can help veterinarians and researchers care for captive nonhuman primates.

The trajectories of adolescent anxiety and depressive symptoms over the course of a transdiagnostic treatment

Anxiety and depressive disorders commonly co-occur during adolescence, share multiple vulnerability factors, and respond to similar psychosocial and pharmacological interventions. However, anxiety and depression may also be considered distinct constructs and differ on some underlying properties. Prior research efforts on evidence-based treatments for youth have been unable to examine the concurrent trajectories of primary anxiety and depressive concerns across the course of treatment. The advent of transdiagnostic approaches for these emotional disorders in youth allows for such examination. The present study examined the separate trajectories of adolescent anxiety and depressive symptoms over the course of a transdiagnostic intervention, the Unified Protocol for the Treatment of Emotional Disorders in Adolescence (UP-A; Ehrenreich et al., 2008), as well as up to six months following treatment. The sample included 59 adolescents ages 12-17 years old (M=15.42, SD=1.71) who completed at least eight sessions of the UP-A as part of an open trial or randomized, controlled trial across two treatment sites. Piecewise latent growth curve analyses found adolescent self-rated anxiety and depressive symptoms showed similar rates of improvement during treatment, but while anxiety symptoms continued to improve during follow-up, depressive symptoms showed non-significant improvement after treatment. Parent-rated symptoms also showed similar rates of improvement for anxiety and depression during the UP-A to those observed for adolescent self-report, but little improvement after treatment across either anxiety or depressive symptoms. To a certain degree, the results mirror those observed among other evidence-based treatments for youth with anxiety and depression, though results hold implications for future iterations of transdiagnostic treatments regarding optimization of outcomes for adolescents with depressive symptoms.

Increased Gsα within blood cell membrane lipid microdomains in some depressive disorders: an exploratory study

The stimulatory guanine nucleotide binding protein Gs couples many cellular receptors to adenylate cyclase, and the Gsα subunit activates all 9 isoforms of the adenylate cyclase catalytic unit to produce the enzyme product cyclicAMP or cAMP. In prefrontal cortex and cerebellum of unipolar depressive suicides, Rasenick and colleagues have found increased concentrations of Gsα in membrane lipid microdomains (Donati et al., 2008), where the ensconced Gsα is less likely to activate adenylate cyclase by receptor and postreceptor pathways (Allen et al., 2005, 2009). We report that a group of 7 depressed patients (DP-1) had (1) reduced activation of platelet receptor-stimulated adenylate cyclase by both prostaglandins E2 and D2 compared to controls, and (2) reduced postreceptor stimulation of adenylate cyclase by aluminum fluoride ion in both platelets and mononuclear leukocytes when compared to both another group of depressed patients (DP-2, n = 17) and to controls (n = 21). Our observations in the blood cells of the group DP-1 support the findings of Donati et al. (2008), and they reflect the importance of this interaction between the activated Gsα subunit and membrane lipid microdomains in the pathophysiology and treatment of some major depressive disorders.

Risk and Protective Factors for Depression in Youth

Risk and protective processes and mechanisms associated with depression in youth are discussed within a developmental–ecological framework. Risk factors at the individual (genetics, biology, affect, cognition, behaviour) and broader contextual levels (e.g., family, school, community) are proposed to interact, leading to the development of depression in youth. Transactions between these individual and contextual factors are suggested to be dynamic and reciprocal, and these transactions are expected to change over time and developmental course. The ‘best bet’ for the prevention of depression may be multicomponent and multilevel interventions that address the multiple risk and protective factors associated with depression. Preventive interventions need to focus on building protective factors within young people themselves, as well as creating health-promoting environments at home and at school. These interventions likely need to be long term and geared towards assisting youth across successive periods of development.

Altered error-related brain activity in youth with major depression

Depression is associated with impairments in cognitive control including action monitoring processes, which involve the detection and processing of erroneous responses in order to adjust behavior. Although numerous studies have reported altered error-related brain activity in depressed adults, relatively little is known about age-related changes in error-related brain activity in depressed youth. This study focuses on the error-related negativity (ERN), a negative deflection in the event-related potential (ERP) that is maximal approximately 50ms following errors. High-density ERPs were examined following responses on a flanker task in 24 youth diagnosed with MDD and 14 low-risk healthy controls (HC). Results indicate that compared to HC, MDD youth had significantly smaller ERN amplitudes and did not exhibit the normative increases in ERN amplitudes as a function of age. Also, ERN amplitudes were similar in depressed youth with and without comorbid anxiety. These results suggest that depressed youth exhibit different age-related changes in brain activity associated with action monitoring processes. Findings are discussed in terms of existing work on the neural correlates of action monitoring and depression and the need for longitudinal research studies investigating the development of neural systems underlying action monitoring in youth diagnosed with and at risk for depression.

AAS, growth hormone, and insulin abuse: psychological and neuroendocrine effects

The nontherapeutic use of prescription medicines by individuals involved in sport is increasing. Anabolic-androgenic steroids (AAS) are the most widely abused drug. Much of our knowledge of the psychological and physiological effects of human growth hormone (hGH) and insulin has been learned from deficiency states. As a consequence of the Internet revolution, previously unobtainable and expensive designer drugs, particularly recombinant human growth hormone (rhGH) and insulin, have become freely available at ridiculously discounted prices from countries such as China and are being abused. These drugs have various physiological and psychological effects and medical personnel must become aware that such prescription medicine abuse appears to be used not only for performance and cosmetic reasons, but as a consequence of psychological pre-morbidity.

Relationships of DEX/CRH and GHRH test results to the outcome of depression--preliminary results suggest the GHRH test may predict relapse after discharge

To explore and compare hypothalamic-pituitary-somatotropic (HPS) axis function and hypothalamic-pituitary-adrenocortical (HPA) axis function in depression, the dexamethasone (DEX)/CRH test and growth hormone releasing hormone (GHRH) test were prospectively performed on patients with depression at the time of admission and discharge. The patients who relapsed within six months after discharge exhibited significantly lower growth hormone (GH) responses to GHRH at the time of discharge than those who did not relapse. There were no significant correlations between GH response to GHRH and the results of DEX/CRH tests after controlling for age, sex, and body mass index. The findings of this study suggest that results of the GHRH test may be a predictor of future relapse in patients with depression.

Longitudinal neuroendocrine changes assessed by dexamethasone/CRH and growth hormone releasing hormone tests in psychotic depression

Although psychotic depression has been reported to exhibit a greater degree of dysregulation of hypothalamic-pituitary-adrenocortical (HPA) function than non-psychotic depression, little is known concerning hypothalamic-pituitary-somatotropic (HPS) function in psychotic depression and how neuroendocrine function changes after treatment. To investigate the longitudinal changes in HPA and HPS system function in psychotic depression, we performed repeated dexamethasone/corticotropin releasing hormone (DEX/CRH) tests and growth hormone (GH) releasing hormone (GHRH) tests in inpatients with major depressive disorder. The psychotic depression group exhibited greater elevation of ACTH responses to the DEX/CRH test and stronger decreases in GH responses to the GHRH test than the non-psychotic depression group at admission. At discharge, the neuroendocrine responses to the DEX/CRH test of the psychotic depression group were still stronger than those of the non-psychotic depression group, though there were no significant differences in severity of depression between the groups. There were significant longitudinal changes in neuroendocrine responses to the DEX/CRH test between admission and discharge. The psychotic depression group exhibited increased GH responses to GHRH at discharge compared with those at admission, whereas no significant longitudinal change in GH response was found in the non-psychotic depression group. Consequently, there were no significant differences in GH responses to GHRH between the psychotic and non-psychotic depression groups at discharge. The results of GHRH test showed no significant relationships with severity of depression except psychotic features and the results of the DEX/CRH test. Our findings suggest that the HPS axis may be associated with psychotic features rather than general severity of depression. Further longitudinal studies are needed to clarify the role of HPS function in psychotic depression and whether sustained dysregulation of HPA function in psychotic depression is associated with a poor outcome after discharge.

Depressive Störungen im Kindes- und Jugendalter - Eine Übersicht

Zusammenfassung: Depressive Störungen im Kindes- und Jugendalter sind ein ernstzunehmendes Gesundheitsrisiko, das eine große Anzahl von Komplikationen und Spätfolgen haben kann. Eine Literaturrecherche in PubMed, Psycontent und Psyndex gibt die gegenwärtige Datenlage wieder und die Ergebnisse werden kritisch diskutiert. Auffällig war die geringe Anzahl an Studien für Kinder und die wenige Beachtung möglicher geschlechterbezogener Unterschiede. Nicht nur im Bezug auf die Epidemiologie, Erkrankungsdauer, Symptomatik, Komorbidität, Entwicklungspsychopathologie werden weitere Untersuchungen notwendig sein, sondern gerade bezüglich einer adäquaten Pharmako- und Psychotherapie sind unumgänglich, um auf die Prognose, Progredienz und Persistenz der Erkrankung erfolgreich Einfluß nehmen zu können.

Social neuroscience of child and adolescent depression

The social neuroscience of child and adolescent depression is inherently multidisciplinary. Depressive disorders beginning early in life can have serious developmental and functional consequences. Psychopathology research has described depression's defining clinical and contextual features, and intervention research has characterized its response to treatment and prevention programs. Neuroendocrine, electrophysiological, and neuroimaging studies have identified core neurobiological aspects of early-onset mood disorders. These areas are reviewed using a developmental social neuroscience perspective for integrating disparate observations. The paper introduces a dynamic adaptive systems framework, and it discusses hedonic capacity, stress sensitivity, ruminative self-focus, and attentional impairments as fundamental components of mood disorders.

Impact of depression and its treatment on the bones of growing children

Depression in adults has been linked to reduced bone mineral density (BMD), osteoporosis, and increased incidence of fractures. Physiologic factors, such as hypothalamic-pituitary-adrenal axis dysfunction and increased circulation of inflammatory cytokines, may adversely impact bone metabolism. In addition, behavioral factors, such as reduced physical activity and altered dietary intake (especially of bone-related nutrients such as calcium and vitamin D), may be implicated. Antidepressant medications also may have an impact on BMD. Childhood and adolescence may be times of particular vulnerability to the adverse effects of depression due to the rapid bone mineral accrual that occurs during periods of growth. This article will review potential contributing factors and resulting consequences of depression on BMD in these populations and also explore areas of needed research.

Depression in children and adolescents: linking risk research and prevention

The National Institute of Mental Health has called for translational research linking basic knowledge about vulnerabilities that underlie mood disorders to the development of effective preventive interventions. This paper highlights research about risk factors for depression in children and adolescents and links it to current knowledge about interventions aimed at preventing depression in youth. Basic epidemiologic and clinical research indicates that increased risk for depression is associated with being female; a family history of depression, particularly in a parent; subclinical depressive symptoms; anxiety; stressful life events; neurobiological dysregulation; temperament/personality (e.g., neuroticism); negative cognitions; problems in self-regulation and coping; and interpersonal dysfunction. These vulnerabilities both increase individuals' chances of encountering stress and decrease their ability to deal with the stress once it occurs. Although several existing depression-prevention studies have targeted one or more of these risk factors, the efficacy of these various prevention programs for youth with different combinations of these risk factors needs to be investigated further. Most existing depression-prevention programs in youth have used cognitive-behavioral techniques, with some success. Other depression-prevention strategies have included training in coping, social problem solving, social skills, communication skills, and parenting. A comprehensive prevention program is recommended that includes multiple intervention components, each of which addresses risk and protective factors across different domains and levels of analysis.

Processing emotional facial expressions influences performance on a Go/NoGo task in pediatric anxiety and depression

BACKGROUND

This study investigated whether processing emotionally salient information such as emotional facial expressions influences the performance on a cognitive control task in pediatric anxiety and depression.

METHODS

The sample included 68 participants between 8 and 16 years of age selected into three diagnostic groups: Anxiety Disorder (ANX, n = 23), Major Depressive Disorder (MDD, n = 19), and Low-Risk Normal Control (LRNC, n = 26). Participants completed an Emotional Go/NoGo task in which participants must either respond to (Go trials) or not respond to (NoGo trials) specific facial expressions (angry, fearful, sad, happy, neutral). In order to manipulate the level of cognitive control needed to perform the task, the probability of occurrence of the Go trials was varied across 3 probability conditions (low, moderate, high).

RESULTS

Analyses showed that the MDD group had significantly faster reaction times to sad face Go trials embedded in neutral face NoGo trials in the moderate probability condition and that the ANX group had significantly slower reaction times to neutral face Go trials embedded in angry face NoGo trials in the low probability condition.

CONCLUSIONS

These data demonstrate that processing emotional facial expressions influences the performance on a cognitive control task in children and adolescents diagnosed with an anxiety disorder and major depression.

Neurobiology of depression in children and adolescents

This article reviews classical and updated studies of the neurobiology of depressive disorders in children and adolescents. Most studies of childhood and adolescent depression and suicide have followed up the observations and methods used in studies in adults. These studies include neuroendocrine studies, which particularly look at the hypothalamic-pituitary-adrenal axis, the serotonergic system, peripheral blood and cerebrospinal fluid biologic markers, genetics, gene-environment interactions and sleep studies, and neuroimaging and postmortem studies, although in these areas the number of studies is limited.

Altered emotional processing in pediatric anxiety, depression, and comorbid anxiety-depression

The goal of this study was to examine some of the mechanisms underlying emotion regulation in childhood affective disorders by examining the impact of distracting emotional information during performance on a working memory task ("Emotional n-back" or E-n-back). The sample included 75 children (38 girls and 37 boys) between 8 and 16 years of age meeting criteria for: Anxiety disorder (ANX, n = 17), Major depressive disorder (MDD, n = 16), Comorbid anxiety and depression (CAD, n = 24), or Low-risk normal control (LRNC, n = 18). Results showed that the MDD and CAD groups had significantly longer reaction times on negative emotional backgrounds compared to neutral backgrounds, whereas the LRNC group had significantly longer reaction times on positive backgrounds. These results suggest altered processing of emotional information particularly associated with depression. Because the E-n-back task engages higher-order cognitive processes, these results suggest that these alterations in processing emotional information also interfere with the cognitive processes that govern how attentional resources are allocated. Further, research is needed to replicate this study and delineate underlying neural mechanisms.

Endocrine disturbances in depression

Depression is one of the most common psychiatric disorders. For a long time, clinicians suspected a causal link between depression and the endocrine system. The most frequently occurring endocrine abnormality in depressed subjects is hyperactivity of the hypothalamic-pituitary-adrenal (HPA) axis. CRH and AVP are likely to play a substantial role in the pathophysiology of this disorder, and their receptors appear to be a specific target for future antidepressant drugs. Depression also affects the hypothalamic-pituitary-GH (HPGH) and -thyroid (HPT) axes. Alterations in the reproductive system may also play a role in the pathology of depression. In addition, there is increasing evidence that leptin and neurosteroids, such as DHEA, are implicated in mood disorders.

Twenty-four hour growth hormone secretion in patients with panic disorder

BACKGROUND

Patients with panic disorder have blunted growth hormone (GH) responses to clonidine, suggesting subsensitivity of post-synaptic alpha(2)-adrenoreceptors, presumably in response to excessive central noradrenergic outflow. However, basal levels of GH release over a full circadian cycle have not been examined in panic. Reduced basal GH release would suggest an overall hypo-active GH system rather than a specific alpha-adrenergic abnormality.

METHODS

To determine whether panic patients show reduced basal GH secretion, 20 patients and 12 healthy controls were studied. Blood samples were drawn every 15 min for 24 h and plasma was assayed for GH. Patients were restudied during successful treatment with alprazolam. Groups were compared on overnight and daytime GH secretion and circadian patterns of release.

RESULTS

Patients showed normal levels on all measures of GH release. Treatment may have reduced nocturnal GH release slightly, but treated patients still did not differ from controls. The normal predominance of sleep over waking GH secretion was seen in both groups.

CONCLUSIONS

Panic patients, in contrast to depressed patients, have normal somatotrophic axis activity when measured in a resting state over a full circadian cycle. GH dysregulation may only be evident in these patients in activation paradigms and has been most consistently demonstrated by challenges with the alpha(2)-noradrenergic agonist, clonidine.

Growth hormone, cortisol and prolactin responses to physical exercise: higher prolactin response in depressed patients

This study was designed to compare growth hormone, cortisol and prolactin responses to physical exercise in depressed patients and healthy comparison subjects. Patients fulfilled the DSM-IV diagnostic criteria for current major depressive disorder; subjective depressive symptoms were rated with Montgomery-Asberg Depression Rating Scale (MADRS) immediately before the experiment. Growth hormone, cortisol and prolactin were measured before and immediately after physiologically stressful bicycle cardiopulmonary exercise test. After exercise, there were three additional hormone measurements, with 30-min intervals. No significant difference was found in baseline growth hormone, cortisol or prolactin levels between patients and the control group. Plasma growth hormone and cortisol levels increased significantly during physical exercise in both patients and controls and returned to baseline in 90 min. There was no significant difference in growth hormone or cortisol responses to physical exercise between the two groups. However, prolactin levels increased only in the depressed patients group during the exercise. We hypothesize that acute exercise may have a stronger effect on serotonin (5-HT) release in depressed patients, which is reflected in increased plasma prolactin concentration.

Positive and negative affect in depression: influence of sex and puberty

To examine adolescent depression as a model for unusual emotion regulation, the current study considered the influence of gender, pubertal development, and cortisol on self-reported mood. Children and adolescents with major depressive disorder (n = 35, mean age 12.5 years) were compared with psychiatrically healthy children and adolescents (n = 36, mean age 10.5 years). During a three-day assessment, participants rated their mood at three time points, pubertal development was determined through physical examination, and plasma cortisol was sampled during the second night. Depressed participants experienced less positive affect and more negative affect than did controls. Diagnostic group, gender, and pubertal status interacted to predict negative affect, with depressed adolescent girls experiencing especially high levels of negative affect. Cortisol was generally unrelated to depression and mood. Findings are consistent with emotion-based models of depression and with the literature on depression and emotion regulation during adolescence.

Generalized anxiety disorder and major depressive disorder comorbidity: an example of genetic pleiotropy?

Generalized anxiety disorder (GAD) and major depressive disorder (MDD) are the most common type of anxiety-mood comorbidity. Up to 80% of subjects with lifetime GAD also have a comorbid mood disorder during their lifetime. Many hypotheses have been raised to explain such high comorbidity. Pleiotropy, i.e. a single genetic mutation explains (apparently) different disorders, is one of them and is hereby reviewed. Importance and reliability of GAD and MDD comorbidity (1); Evidence in favour of co-aggregation of GAD and MDD within families (the risk of one disorder in a proband increasing the risk for the other in relatives) (2); substantial heredity for both disorders according to twin studies with evidence for genetic correlation of unity between the two disorders (3); existence of numerous mechanisms (4) potentially linking the two disorders to common vulnerability genes, are all in accordance with such a hypothesis. Some examples of potentially shared mechanisms (such as CRF dysregulation or abnormal transcription factors) and possible common vulnerability genes (for example, the serotonin transporter gene) are given to highlight the pleiotropy hypothesis.

First episode of depression in children at low and high familial risk for depression

OBJECTIVE

To examine the development of first-onset major depressive disorder (MDD) in children at high and low familial risk for depression in a prospective study.

METHOD

High-risk children (n = 76) who were free of any lifetime affective disorder and had at least one first-degree and one second-degree relative with a lifetime history of childhood-onset, recurrent, bipolar, or psychotic depression were included. Low-risk children (n = 63) were included if they were free of any lifetime psychiatric disorder and had no first-degree relatives and fewer than 20% of their second-degree relatives with a lifetime affective disorder. Children and their parents were assessed in a prospective design using the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Epidemiologic version (K-SADS-E). The average interval between follow-up interviews was 18 months, and the average follow-up period was 6 years.

RESULTS

High-risk children had approximately a threefold increased risk of developing first-onset MDD compared with low-risk children (odds ratio = 3.21). The average age of new-onset MDD was 14.0 +/- 2.9 years (range 9.5-19.5 years). Above and beyond the familial loading for MDD, mother's lifetime anxiety disorder (odds ratio = 2.84) and lifetime behavioral disorder (odds ratio = 3.25) in the child significantly added to the risk of developing a first-onset MDD.

CONCLUSIONS

Having high familial loading for affective disorders, a mother with and anxiety disorder, and a behavioral disorder in the child all significantly contributed to the risk of developing depression.

Clinical presentation and course of depression in youth: does onset in childhood differ from onset in adolescence?

OBJECTIVE

To simultaneously and prospectively compare the clinical presentation, course, and parental psychiatric history between children and adolescents with major depressive disorder.

METHOD

A group of prepubertal children (n = 46) and postpubertal adolescents (n = 22) were assessed with structured interviews for psychopathology and parental psychiatric history and followed once every 2 years for approximately 5 years.

RESULTS

With the exception of more depressive melancholic symptoms in the adolescents, both groups had similar depressive symptomatology, duration (average 17 months), severity of the index episode, rates of recovery (85%) and recurrence (40%), comorbid disorders, and parental psychiatric history. Female sex, increased guilt, prior episodes of depression, and parental psychopathology were associated with worse longitudinal course.

CONCLUSIONS

In general, major depressive disorder is manifested similarly in children and adolescents, and both groups have a protracted clinical course and high family loading for psychiatric disorders.

Growth hormone response to growth hormone-releasing hormone and clonidine in young monkeys: correlation with behavioral characteristics

Blunted growth hormone (GH) release in response to stimulation by a secretagogue has been widely reported in both children and adults with anxiety and depressive disorders. Blunted GH responsiveness appears to be a stable characteristic of an individual, suggesting that it may be useful as a biological marker that would allow early recognition of these disease processes. Another potential biological marker for anxiety disorders is the temperamental construct of behavioral inhibition. Children identified as being behaviorally inhibited early in life are more likely than less inhibited children to suffer from anxiety disorders later in life (Biederman et al. 1993; Hirshfeld et al. 1992). If blunted GH responsiveness to pharmacological challenge and behavioral inhibition are markers of anxiety and depressive disorders, then it would follow that they would coexist in a subset of individuals. However, such prospective studies in clinically normal young children are difficult to perform. Therefore, in this study, we examined GH responsiveness and temperament in a group of 38 young rhesus monkeys (ages 3-6 months). Monkeys received an intravenous dose of 10 microg/kg of growth hormone-releasing hormone (GHRH) and 5 microg/kg of clonidine, combined, to assess GH response to stimulation. Behavioral reactivity in a fearful situation was assessed using the Human Intruder Test developed by Kalin et al. (1991). This test measures response to a potentially threatening stimulus (a human stranger making direct eye contact). Results showed a population distribution of GH response to GHRH and clonidine ranging from 120 ng/mL/90 minutes to 3,000 ng/mL/90 minutes. There was no difference in GH response in males versus females or any significant effect of age on GH response. There was a significant correlation between GH responsiveness and the time spent reacting to the intruder in the Human Intruder Test. Monkeys with lower GH responsiveness reacted less to the intruder (p < 0.01). Additionally, when monkeys were classified based on their reactivity in the Human Intruder Test, behaviorally nonreactive monkeys had significantly lower GH responsiveness than behaviorally reactive monkeys (p < 0.005). These data provide evidence that there are inherent differences in GH responsiveness to stimulation in young rhesus monkeys and that low GH responsiveness is linked to low behavioral reactivity, which may be a form of behavioral inhibition. Further studies will be necessary to determine if the characteristics of low GH responsiveness and low behavioral reactivity predict an increased propensity to develop anxious or depressive behaviors over the course of the life span.

Spectral analyses of sleep EEG in depressed offspring of fathers with or without a positive history of alcohol abuse or dependence: a pilot study

The current study was designed to examine the effects of family history of alcohol use disorders on spectral electroencephalographic (EEG) sleep measures obtained in a sample of youth with depression. We evaluated sleep in 32 depressed youth (8-16 years of age) with and without a family history of alcohol use disorders. Eighteen of the participants (10 males and 8 females) reported a positive paternal history of alcohol use disorders and made up the family history positive (FHP) group. Power-spectral analyses revealed that increased power in the 7.50-11.00 Hz band (slow alpha) was associated with boys in the FHP group for the first and second non-rapid eye movement (REM) periods, second REM period, awake during the night, and entire night period. Results also showed increased power in the higher alpha frequencies (11.00-12.25 Hz) for non-REM, REM, and awake periods. A significant increase in spectral power was also observed in boys in the FHP group in the delta frequencies (0.75-4.50 Hz) during the second REM period. These findings are consistent with results from previous studies, demonstrating that EEG alpha power is positively associated with a family history of alcohol use disorders.

Heritability of fearful-anxious endophenotypes in infant rhesus macaques: a preliminary report

BACKGROUND

Research efforts to discover the genetic underpinnings of anxiety and depression is challenging because of the etiologic heterogeneity inherent to these disorders. These efforts might be aided by the study of related behavioral phenotypes in model organisms, such as monkeys.

METHODS

Eighty-five rhesus monkeys (Macaca mulatta) from the Oregon National Primate Research Center were drawn from a standard matriarchal colony and tested for behavioral response in four testing paradigms designed to elicit fearful-anxious reactions. Heritabilities were estimated using variance component-based quantitative genetic analyses with much of the genetic information arising from paternal half-sibs.

RESULTS

Individual behaviors reflecting increased distress responses (e.g., vocalizations and teeth grinding) and behavioral inhibition (e.g., latency to leave mother, latency to inspect novel fruit) showed significant heritability, even though a small number of monkeys were assessed. Exploratory factor analyses identified seven clusters of behaviors across tests, some of which were found to be heritable.

CONCLUSIONS

These results indicate that several specific fearful-anxious behaviors in infant rhesus monkeys are heritable within this colony. Accordingly, these phenotypes, which are believed to represent the genetic liability for anxiety and depression, are good candidates for further genetic investigation in this population.

The roots of depression in adolescent girls: is menarche the key?

Before adolescence, the rates of depression are similar in girls and boys (or are slightly higher in boys). Yet with the onset of puberty, the gender proportion of depression dramatically shifts to a two girls to one boy ratio. What, then, is the relationship between menarche and the onset of major depression in early adolescence? Recent literature intimates that vulnerability to depression may be rooted in an intricate meld of genetic traits, normal female hormonal maturational processes, and gender socialization. Information regarding gender differences in the presentation of depressive symptoms is provided along with biologic, psychologic, and sociologic factors contributing to depression in adolescent girls. The burden of illness associated with onset of depression after menarche reinforces the importance of prevention or else expeditious recognition and intervention.

Are child-, adolescent-, and adult-onset depression one and the same disorder?

This paper reviews prior research studies examining neurobiological correlates and treatment response of depression in children, adolescents, and adults. Although there are some similarities in research findings observed across the life cycle, both children and adolescents have been found to differ from depressed adults on measures of basal cortisol secretion, corticotropin stimulation post-corticotropin releasing hormone (CRH) infusion, response to several serotonergic probes, immunity indices, and efficacy of tricyclic medications. These differences are proposed to be due to 1) developmental factors, 2) stage of illness factors (e.g., number of episodes, total duration of illness), or 3) heterogeneity in clinical outcome (e.g., recurrent unipolar course vs. new-onset bipolar disorder). Relevant clinical and preclinical studies that provide support for these alternate explanations of the discrepant findings are reviewed, and directions for future research are discussed. To determine whether child-, adolescent-, and adult-onset depression represent the same condition, it is recommended that researchers 1) use the same neuroimaging paradigms in child, adolescent, and adult depressed cohorts; 2) carefully characterize subjects' stage of illness; and 3) conduct longitudinal clinical and repeat neurobiological assessments of patients of different ages at various stages of illness. In addition, careful attention to familial subtypes (e.g., depressive spectrum disorders vs. familial pure depressive disorders) and environmental factors (e.g., trauma history) are suggested for future investigations.