Major depressive disorder: Symptoms and Signs

Depressive disorders to Adults, Children, and Adolescents

Depressive disorders, which include major depressive disorder (unipolar depression), dysthymic disorder (chronic, mild depression), and bipolar disorder (manic-depression), can have far reaching effects on the functioning and adjustment of young people. Among both children and adolescents, depressive disorders confer an increased risk for illness and interpersonal and psychosocial difficulties that persist long after the depressive episode is resolved; in adolescents there is also an increased risk for substance abuse and suicidal behavior. Unfortunately, these disorders often go unrecognized by families and physicians alike. Signs of depressive disorders in young people often are viewed as normal mood swings typical of a particular developmental stage. In addition, health care professionals may be reluctant to prematurely "label" a young person with a mental illness diagnosis. Yet early diagnosis and treatment of depressive disorders are critical to healthy emotional, social, and behavioral development.

A number of epidemiological studies have reported that up to 2.5 percent of children and up to 8.3 percent of adolescents in the U.S. suffer from depression. An NIMH-sponsored study of 9- to 17-year-olds estimates that the prevalence of any depression is more than 6 percent in a 6-month period, with 4.9 percent having major depression. In addition, research indicates that depression onset is occurring earlier in life today than in past decades. A recently published longitudinal prospective study found that early-onset depression often persists, recurs, and continues into adulthood, and indicates that depression in youth may also predict more severe illness in adult life. Depression in young people often co-occurs with other mental disorders, most commonly anxiety, disruptive behavior, or substance abuse disorders, and with physical illnesses, such as diabetes.

Clinical Characteristics
The diagnostic criteria and key defining features of major depressive disorder in children and adolescents are the same as they are for adults. However, recognition and diagnosis of the disorder may be more difficult in youth for several reasons. The way symptoms are expressed varies with the developmental stage of the youngster. In addition, children and young adolescents with depression may have difficulty in properly identifying and describing their internal emotional or mood states. For example, instead of communicating how bad they feel, they may act out and be irritable toward others, which may be interpreted simply as misbehavior or disobedience. Research has found that parents are even less likely to identify major depression in their adolescents than are the adolescents themselves.

Symptoms of Major Depressive Disorder Common to Adults, Children, and Adolescents:

• Persistent sad or irritable mood
• Loss of interest in activities once enjoyed
• Significant change in appetite or body weight
• Difficulty sleeping or oversleeping
• Psychomotor agitation or retardation
• Loss of energy
• Feelings of worthlessness or inappropriate guilt
• Difficulty concentrating
• Recurrent thoughts of death or suicide

Five or more of these symptoms must persist for 2 or more weeks before a diagnosis of major depression is indicated.

Signs That May Be Associated with Depression in Children and Adolescents

• Frequent vague, non-specific physical complaints such as headaches, muscle aches, stomachaches or tiredness
• Frequent absences from school or poor performance in school
• Talk of or efforts to run away from home
• Outbursts of shouting, complaining, unexplained irritability, or crying
• Being bored
• Lack of interest in playing with friends
• Alcohol or substance abuse
• Social isolation, poor communication
• Fear of death
• Extreme sensitivity to rejection or failure
• Increased irritability, anger, or hostility
• Reckless behavior
• Difficulty with relationships

While the recovery rate from a single episode of major depression in children and adolescents is quite high, episodes are likely to recur. In addition, youth with dysthymic disorder are at risk for developing major depression. Prompt identification and treatment of depression can reduce its duration and severity and associated functional impairment.

National Institute of Mental Health

Vitamin D: risk of multiple sclerosis

High levels of vitamin D in the body may decrease the risk of multiple sclerosis

The possibility that vitamin D could help protect people from developing multiple sclerosis (MS) has been posited by researchers in recent decades, but evidence to support that link has been scant. In the first large-scale, prospective study to investigate the relationship between vitamin D levels and MS, researchers at the Harvard School of Public Health (HSPH) have found an association between higher levels of vitamin D in the body and a lower risk of MS.

“If confirmed, this finding suggests that many cases of MS could be prevented by increasing vitamin D levels. Although these levels could be increased by taking supplements, before any recommendation is made it is important to establish whether we are seeing a true causal association or whether vitamin D levels are only a marker of MS risk,” said Alberto Ascherio, senior author of the study and associate professor of nutrition and epidemiology at HSPH.

MS is a chronic degenerative disease of the central nervous system. It affects some 350,000 people in the U.S. and 2 million worldwide, and occurs most commonly in young adults. Women, who are affected more than men, have a lifetime risk of about 1 in 200 in the U.S. Vitamin D is a hormone manufactured naturally in the body, and its levels can be increased with exposure to sunlight, consumption of foods rich in vitamin D, such as fatty fish, and by taking supplements.

The researchers, led by Ascherio, worked in collaboration with colleagues in the U.S. Army and Navy to determine whether vitamin D levels measured in healthy young adults predict their future risk of developing MS. The investigation relied on a study population of more than 7 million individuals, whose serum samples are stored in the Department of Defense Serum Repository. Between 1992 and 2004, 257 U.S. Army and Navy personnel with at least two serum samples stored in the repository were diagnosed with MS. A control group, consisting of participants who did not develop MS, was randomly selected from the study population. Serum samples were analyzed for levels of 25-hydroxyvitamin D, a good indicator of vitamin D availability to tissues, and individuals were divided into five groups of equal size according to their average levels. Because vitamin D levels are strongly influenced by skin color, separate analyses were conducted among whites, blacks, and Hispanics.

The results showed that, among whites, MS risk declined with increasing vitamin D levels—the risk was 62% lower among individuals in the top fifth of vitamin D concentration (corresponding approximately to levels above 100 nmol/L or 40 ng/mL) than among those in the bottom fifth (approximately below 63 nmol/L or 25 ng/mL). The association was strongest among individuals who were younger than 20 when they first entered the study. No significant association was found among blacks and Hispanics, possibly because of a smaller sample size and the lower levels of vitamin D found in those groups. The average age of onset of MS cases was 28.5 years old; there was no significant difference in the results between men and women.

“The results of this study converge with a growing body of experimental evidence supporting the importance of vitamin D in regulating the immune system and suppressing autoimmune reactions, which are thought by most experts to play a key role in the development of MS,” said Ascherio. Kassandra Munger, first author and a doctoral candidate in nutrition at HSPH, added, “The amount of vitamin D that is needed to reach levels associated with MS protection is largely considered safe, and in fact higher vitamin D levels could be beneficial to prevent osteoporosis and other chronic diseases.”

The researchers note that there could be other possible explanations for the protective role of vitamin D. For example, it’s possible that exposure to UV light from the sun—the major determinant of serum levels of 25-hydroxyvitamin D—could protect people in other ways than increased vitamin D production.

The authors suggest further studies exploring how vitamin D may protect individuals from developing MS. “Although the results of this study are quite encouraging, reasonable certainty of a protective effect of vitamin D supplements requires direct experimental evidence in a large trial. Meanwhile, we are planning to expand our study to obtain more accurate data on the importance of age and of the vitamin D levels that need to be achieved for optimal protection,” said Ascherio.

Harvard School of Public Healt

hhttp://www.brightsurf.com/news

ADHD — Common Questions

Attention-Deficit/Hyperactivity Disorder (ADHD) — Common Questions

As they learn more about Attention-Deficit/Hyperactivity Disorder (ADHD), many parents will have similar questions and concerns. Here are answers to a few of the more frequently asked questions. Also remember that your pediatrician is available to answer your questions and discuss your concerns.

Will My Child Outgrow ADHD?
ADHD continues into adulthood in most cases. However, by developing their strengths, structuring their environments, and using medication when needed, adults with ADHD can lead very productive lives. In some careers, having a high-energy behavior pattern can be an asset.

Why Do so Many Children Have ADHD?
The number of children who are being treated for ADHD has risen. It is not clear whether more children have ADHD or more children are being diagnosed with ADHD. ADHD is now one of the most common and most studied conditions of childhood. Because of more awareness and better ways of diagnosing and treating this disorder, more children are being helped.

Are Schools Putting Children on ADHD Medication?
Teachers are often the first to notice behavior signs of possible ADHD. However, only physicians can prescribe medications to treat ADHD. This follows a careful process of diagnosis.

Are Children Getting High on Stimulant Medications?
There is no evidence that children are getting high on stimulant drugs such as methylphenidate and amphetamine. These drugs also do not sedate or tranquilize children and have no addictive properties.
Stimulants are classified as Schedule II drugs by the US Drug Enforcement Administration. There are some reports of abuse of this class of medication. If your child is on medication, it is always best to supervise the use of the medication closely.

Are Stimulant Medications "Gateway" Drugs Leading to Illegal Drug or Alcohol Abuse?
People with ADHD are naturally impulsive and tend to take risks. But those patients with ADHD who are taking stimulants are actually at lower risk of using other drugs. Children and teenagers who have ADHD and also have coexisting conditions may be at high risk for drug and alcohol abuse, regardless of the medication used.

Excerpted from "Understanding ADHD" from the American Academy of Pediatrics. For more information about this brochure, click here.

http://www.aap.org/pubed/ADHDCommquestions.htm

American Academy of Pediatrics

Sleep apnea

Obstructive Sleep Apnea Syndrome

Obstructive sleep apnea syndrome may be defined as a cessation of breathing characterized by repetitive episodes of airway obstruction caused by collapse of the upper airway during sleep. Classic features of patients with obstructive sleep apnea syndrome include:

• Excessive daytime sleepiness
• Loud snoring during sleep
• Fatigue
• Obesity or being overweight
  

Research has suggested that there is a strong association between obstructive sleep apnea syndrome and cardiovascular diseases including:

• Hypertension - high blood pressure
• Congestive heart failure - accumulation of fluids in the lungs and other body tissues caused by insufficient pumping of blood by the heart muscles
• Arrhythmias - irregular heart beats
• Stroke
• Angina pectoris - chest pain that occurs in people with underlying coronary artery disease
  

Polysomnography (overnight sleep test) is considered to be the most accurate test available for establishing the diagnosis of obstructive sleep apnea syndrome in adults. During polysomnography, episodes of apnea (cessation of breathing lasting for 10 seconds or longer) and hypopnea (decreased rate and depth of breathing lasting 10 seconds or longer) are recorded. The number of apnea/hypopnea episodes per hour of sleep is calculated and is expressed as the apnea-hypopnea index (AHI). Most experts agree that an AHI score of 5 or higher in patients with excessive daytime sleepiness is sufficient to establish the diagnosis of obstructive sleep apnea syndrome.

In general, the treatment options for patients with obstructive sleep apnea syndrome include:

• Lifestyle modifications (e.g., weight loss; smoking cessation; avoiding sleeping in the supine position)
• Continuous positive airway pressure (CPAP)
• Oral appliances
• Surgery

http://www.sleepapnea-info.com

Mental imagery and autonomic reactivity in children

Effects of self-induced mental imagery on autonomic reactivity in children

Lee LH, Olness KN.

Developmental and Behavioral Pediatrics, Case Western Reserve University. Cleveland, Ohio, USA.

The purposes of this research study were: (1) to determine whether changes in cardiac rate, skin temperature, and/or electrodermal activity occur as children change mental imagery and (2) to determine whether such changes are related to age, sex, or other variables.

Children who were evaluated in this study had no previous experience with hypnosis or biofeedback training and were in good health with no learning disabilities. Thirty-eight boys and 38 girls ranging in age from 5 to 15 years were studied in a comfortable setting with a constant room temperature and biofeedback equipment. A Procomp 5DX computer software unit was used to measure autonomic reactivity during baseline and mental processing periods. After baseline monitoring indicated stabilization of autonomic measures, each child was asked to think about being in a quiet, pleasant place for 120 seconds. Pulse rate, skin temperature, and electrodermal activity were recorded. A resting period followed, and each child was then asked to think about an exciting activity, such as a preferred sports activity, for another 120 seconds. At the end of this monitoring, each child was asked to describe what had been his/her mental imagery during the two monitoring periods. Data analysis used paired t tests and repeated measures analysis of variance. For all children, the pulse rates showed significant decreases (p < .001) during quiet and relaxing imagery and significant increases (p < .001) during active imagery. Skin temperatures increased significantly (p < .001) during quiet imagery and active imagery, whereas electrodermal activity decreased (p < .001) during active imagery. Observed changes did not relate to age or sex.

The results confirm our clinical observations that deliberate changing of mental imagery by children results in immediate autonomic changes. Questions evolving from this study and similar studies done in adults are: (1) Do average-thinking processes impact on autonomic changes over long periods of time and (2) do these changes ultimately impact on health, such as cardiovascular status?

J Dev Behav Pediatr. 1996 Oct;17(5):323-7.

http://www.ncbi.nlm.nih.gov