Since I left the psychiatric prescribing trenches and came south for the winter, I’ve been staying in a beach town within driving distance of a technology metropolis. I take breaks from my writing and walk to the beach. There, I meet and talk with the winners of the American dream. They are intelligent, highly educated and financially successful. They take their beach vacations here. Full Article →
In a study of 6,767 reports of antidepressant trials in juveniles treated for depressive and anxiety disorders, the risk of psychopathological behavioral or mood elevation was 3.5x greater with antidepressants than with placebo. The authors (which include Giovanni Fava of the University of Bologna and Ross Baldessarini of Harvard Medical School) urge “particular caution and monitoring for potential risk of future bipolar disorder.”
A North Carolina study of 1,420 participants finds higher rates of agoraphobia (4.6x), generalized anxiety disorder (2.7x), and panic disorder (3.1x) among victims of bullying. Among those who had been both bullies and victims, the study found higher rates of depression (4.8x), panic disorder (14.5x), agoraphobia (26.7x) and suicidality (18.5x) in both childhood and young adulthood. Results appeared in JAMA Psychiatry.
Eminent developmental psychologist Jerome Kagan, in an interview with Spiegel, accuses the mental-health establishment and pharmaceutical companies of incorrectly classifying millions as mentally ill out of self-interest and greed. “That is the history of humanity: Those in authority believe they’re doing the right thing, and they harm those who have no power,” Kagan says.
Researchers from Belgium and the Netherlands, publishing online June 20 in Neuroscience, found that prenatal fluoxetine (Prozac) differentially affected the development of glucocorticoid receptors in male (but not female) rats. This response to SSRI medications “may differentially alter the capacity of the hippocampus to respond to stress.”
A study of 566 families with 1416 bipolar-disordered members, and 675 families with 1726 depressed members by researchers from Johns Hopkins and the University of Iowa, published in Psychological Medicine‘s July issue finds that the comorbidity of these disorders with OCD, panic disorder and specific phobia is “at least partly due to familial factors, which may be of relevance to both phenotypic and genetic studies of co-morbidity.”
Researchers from the MRC Social, Genetic and Developmental Psychiatry Centre of King’s College’s Institute of Psychiatry in London, publishing in the Journal of Affective Disorders, review the literature on ADHD and bipolar disorder. The boundaries between the two are blurred, they say, and “comorbidity and family studies appear to show that the two disorders occur together and aggregate in families at higher than expected rates. Furthermore close inspection of results from population studies reveals heightened co-occurrence of ADHD and BD even in the context of high comorbidity commonly noted in psychopathology. These results point towards a meaningful association between ADHD and BD, going beyond symptomatic similarities.”
Researchers from the universities of Wisconsin, Pennsylvania, Illinois and New Orleans collected MRI scans and assessments of executive functioning and stress exposure from 61 children aged 9 to 14. Smaller volumes in the prefrontal cortex, specifically the anterior cingulate cortex, were associated with both cumulative life stress and impaired memory. Results are in the June issue of the Journal of Neuroscience.
Data drawn from the Bucharest Early Intervention Project show that children raised in institutions in Romania exhibit elevated symptoms of ADHD, anxiety, depression, and disruptive behavior compared with controls. Researchers from Harvard, the University of Maryland and Tulane also found disrupted brainwave patterns consistent with with risk for psychopathology. Exposure to early life deprivation, the authors write, may contribute to abnormal patterns of neurodevelopment generated by adverse rearing environments. The study is available online from the Archives of General Psychiatry.
Robert Whitaker, author of Anatomy of an Epidemic, discusses the disturbing effects of psychotropic drugs prescribed for children. Such medications, used for ADHD, depression, and anxiety, for example, have become commonplace over the past 30 years. This practice profoundly alters the lives of the children, and so now we, as a society, urgently need to address this question: do the medications help the children thrive and grow up into healthy adults? Or does this practice do more harm than good over the long term. Robert Whitaker emphasizes two things: first, the need for an objective, evidence-based approach to evaluating these drugs; and second, the need for better public understanding of how these medications work.
The Marine Corps Times writes of a dramatic increase in prescriptions of psychiatric medication for children of active-duty military personnell during their parents’ deployment and re-integration; a trend seen as contributing to a rise of suicides among military children. “The psychiatrist never once told me Celexa was a risk” said one parent, “I didn’t find out the seriousness until after he died.”
In response to pressure over the 40-fold increase of bipolar diagnoses in children, many of which are being reviewed and dropped in retrospect, the APA has proposed a new, potentially more transient “disruptive mood dysregulation disorder” that would apply to children with chronic irritability and recurrent temper outbursts, and would ostensibly be treated with antidepressants instead of antipsychotics. The proposal, according to the Boston Globe, has brought new scrutiny to Joseph Biederman,who argued that chronic irritability can be interpreted as juvenile mania.
“Mixed anxiety-depressive disorder,” “attenuated psychosis syndrome,” “obsessive-compulsive personality disorder,” “antisocial personality disorder,” and “nonsuicidal self-injury” were among diagnoses that met with disappointing results in field trials for the new DSM-5. Either low interrater reliability (a lack of sufficient agreement between clinicians), or a lack of sufficient examples of people with a proposed diagnosis in the real world meant that these diagnoses could not be included in this round of the APA’s official list of disorders. One architect of the trials said that a goal of the DSM-5 was to test diagnoses “with real clinicians and real patients,” a goal that may explain why even “major depressive disorder” was found to be surprisingly unreliable, possibly because the previous version of the DSM excluded patients with complicated “psychiatric comorbidities.”
Researchers from China and the Harvard Medical School studied the effects of anxious and avoidant attachment on the development of depression and anxiety in a sample of 662 Chinese university students recruited in Hunan, China. Insecure attachment styles served as a vulnerability factor in the development of depressive and anxious symptoms. The authors recommend fostering secure attachment in prevention and intervention programs as a means of preventing the onset and maintenance of depressive and anxious disorders. Results will appear in Depression and Anxiety.
Although research supports the stigma and labeling perspective, empirical evidence also indicates that a social safety net remains intact for those with mental illness, recalling the classic “sick role” concept. Here, insights from social networks theory are offered as explanation for these discrepant findings. Using data from individuals experiencing their first contact with the mental health treatment system, the effects of diagnosis and symptoms on social networks and stigma experiences are examined. The findings suggest that relative to those with less severe affective disorders, individuals with severe diagnoses and more visible symptoms of mental illness have larger, more broadly functional networks, as well as more supporters who are aware of and sympathetic toward the illness situation. However, those with more severe diagnoses are also vulnerable to rejection and discrimination by acquaintances and strangers. These findings suggest that being formally labeled with a mental illness may present a paradox, simultaneously initiating beneficial social processes within core networks and detrimental ones among peripheral ties.
Whether it’s the Nurtured Heart Approach, or any other method that’s truly up to the task, we need these effective strategies and ways of thinking to be more widespread so we can lessen the pitfalls of the medical model’s limited prospective which has no idea of how to turn intense into immensely great. Full Article →
In a rare long-term study of antipsychotics used in children and adolescent inpatients, the Institute of Living in Hartford, CT followed 3,851 consecutive admissions over a ten-year period. Results show that nearly 45% of children and adolescents were prescribed antipsychotics. “This is an important issue,” said Dr. John W. Goethe, the study’s presenter, “because these antipsychotic medications are commonly prescribed” despite being used for indications that have not been approved by the FDA. The results were presented yesterday at the 17th annual Psychopharmacology Conference in Las Vegas, NV.
Researchers in China found that among 27 young adults with early-onset major depressive disorder matched against 25 healthy controls, MRI detected elevated response in the left amygdala, thalamus, prefrontal and temporal cortex and significantly lower response in the right prefrontal cortex in response to threat-related facial expressions. This response was significantly correlated with depression. Results are published in this month’s Psychiatry Research.