Babies with Low Birth Weight More Prone to Future Depression and Anxiety

An important chapter reopened in the controversial “nature versus nurture” debate, as a study by Ian Colman, PhD, at the University of Cambridge, and colleagues, suggests atypical neurodevelopment may lead to future profiles of depression and anxiety.

The study involved data collected from a nationally representative sample of 4,627 members of the Medical Research Council National Survey of Health and Development from the British 1946 birth group. Measures of the depression and anxiety levels of the members at 13, 15, 36, 43, and 53 years of age were examined through a longitudinal latent variable analysis. Results revealed heavier babies show less depressive and anxious symptoms as adults. Even within the range of normal birth weight, babies slightly smaller than others had a slightly increased risk of depression and anxiety. This suggests that fetal programming may induce future depression and anxiety.

“The fetal programming hypothesis postulates that when pregnant mothers encounter stressful environments, they pass on information to the developing fetus in order for it to be prepared for a hostile environment,” Dr. Colman said. “If, however, the adverse environment that existed during pregnancy does not persist, the permanent alterations in the development of the fetus may become maladaptive.”

In addition, the study found that people who exhibited worse mental health throughout their lives reached “motor developmental milestones,” such as standing or walking for the first time, later in life compared to people with better mental health, implying possible stressful social factors and life events during childhood.

The study’s biggest limitation to this study was the lack of data on the gestational age of the babies when they were born. As the study was initiated in 1946, data was limited to what was collected at that time. Birth weight adjusted for gestational age would have been ideal; however, that the researchers found significant relationships using crude birth weight strengthens the study’s conclusions.

“Prenatal conditions have a significant impact on the long-term health of the developing fetus, and we need to do our best to take care of pregnant mothers,” Dr. Colman said.

Funding for this research was provided by the Institute for Social Studies in Medical Care, the United Kingdom Medical Research Council, the Stanley Medical Research Institute, the Leverhulme Foundation, and the Isaac Newton Trust. (Biol Psychiatry. 2007;62(11):1265-1271.) –ML


Increased Risk of Depressive and Anxiety Disorders for Relatives of Parkinson’s Disease Patients

Parkinson’s disease affects approximately 1.5% to 2% of the population >60 years of age. Recent evidence suggests that family members of Parkinson’s disease patients are at increased risk for dementia or essential tremor. A new study conducted by investigators at the Mayo Clinic revealed that first-degree relatives of Parkinson’s disease patients are also at increased risk for mood and anxiety disorders, especially when the family member with Parkinson’s disease develops the condition before 75 years of age.

Walter Rocca, MD, of the Mayo Clinic, and colleagues, led a population-based study that included 1,000 first-degree relatives of 162 patients with Parkinson’s disease. The control population included 850 first-degree relatives of 147 age-matched, healthy controls. All subjects were from Olmsted County, Minnesota, where the Mayo Clinic’s Rochester campus is located. Psychiatric disorders were documented for all relatives—in both control and Parkinson’s disease groups—by conducting individual assessments including separate telephone interviews and review of existing medical records. Other interviews were conducted with a proxy, in the case of a death of a subject or incapacitation.

The overall risk of psychiatric disorder for first-degree relatives of Parkinson’s disease patients was greater than that of first-degree relatives of healthy controls (hazard ratio, 1.54; 95% CI, 1.21–1.95; P<.001). More specifically, there was an increased risk of depressive disorders (hazard ratio, 1.45; 95% CI, 1.11–1.89; P=.006) and anxiety disorders (hazard ratio, 1.55; 95% CI, 1.05–2.28; P=.03).

The investigators controlled for type of interview, and excluded relatives who developed Parkinson’s disease or those who developed both an anxiety and depressive disorder. (Arch Gen Psychiatry. 2007;64(12):1385-1392.) –LS


Live, Online CBT Helps Service Members with PTSD

Posttraumatic stress disorder (PTSD) develops after a severely distressing, psychologically taxing occurrence. According to a study by Brett Litz, PhD, of Boston Veterans Affairs Healthcare, Boston University School of Medicine, and the National Center for PTSD, and colleagues, self-managed cognitive-behavioral therapy (CBT) live over the Internet may broaden treatment options for military personnel suffering from PTSD.

The controlled proof-of-concept trial involved Department of Defense service members who developed PTSD after the September 11, 2001 Pentagon attack or combat in the Middle East. From the pool of 141 volunteers, the researchers recruited 45 patients after an initial face-to-face assessment by therapists using the PTSD Symptom Scale-Interview Version, the Beck Depression Inventory-II, and the Beck Anxiety Inventory.

These patients were then randomly assigned to one of two arms in the DElivery of Self-Training and Education for Stressful Situations (DESTRESS) program, ie, the Internet-based self-management CBT arm or the Internet-based supportive counseling arm. Patients in the CBT arm acquired coping skills for everyday life through homework assignments, applied them during exposure to trauma-inducing triggers, and discussed their traumas during seven online sessions. The supportive counseling arm included a control group of 21 patients who wrote about non-trauma–related, present-day concerns. Both groups were able to access the Internet, allowing for independent research on PTSD, stress, anger management, and depression.

Patients were evaluated after 8 weeks of treatment (≤56 sessions), and at 3 and 6 months after baseline. Patients showed an overall similar reduction in PTSD, depression, and anxiety scores at 3 months. However, those who completed the self management in the CBT arm (N=33) achieved high-end state functioning at 6 months.

The results suggest online CBT is an effective treatment. People with PTSD learn how to independently manage challenges and DESTRESS made good use of the therapists’ time. Patients met with therapists for approximately 15 minutes per week, making the treatment convenient for large numbers that do not have conventional access to care. (Am J Psychiatry. 2007;164(11):1628-1630.) –ML


Treatment Discontinuation Increases Risk of Symptom Recurrence for Pregnant Women with Bipolar Disorder

For the approximately 5.7 million American adults with bipolar disorder, dramatic shifts in mood and other symptoms related to the disorder can be alleviated and/or stabilized with proper treatment, which typically includes the use of anticonvulsants and antidepressants as well as anti-epilepsy medications, according to the National Institute of Mental Health. Despite the benefit patients often find in the use of these medications, women with bipolar disorder who become pregnant commonly discontinue medication use in order to avoid uncertain medication side effects or risks, such as abnormal fetal development. This discontinuation leads to a lack of knowledge among researchers concerning the course of bipolar disorder and the effects and safety of mood stabilizers during pregnancy.

Adele Viguera, MD, MPH, at the Department of Psychiatry and Psychology at the Cleveland Clinic Neurological Institute in Ohio, and colleagues, studied pregnant women with bipolar disorder to determine the risk of mood episode recurrence for those who continued or discontinued treatment during pregnancy. According to the authors, such knowledge could affect clinicians’ care decisions for a patient who is or is not taking typically used medication during pregnancy.

Eighty-nine pregnant women with bipolar disorder as defined by the Diagnostic and Statistical Manual of Mental Disorder, Fourth Edition, Text Revision, participated in the study. Among the participants, 62 women discontinued treatment with mood stabilizers after becoming pregnant. Researchers examined time to first symptom recurrence and overall recurrence risk to assess affect of treatment continuation or discontinuation. 

All patients in the study were euthymic at conception and continued or discontinued treatment with mood stabilizers following an approximate date of conception. The most commonly used medication was lithium, which was taken by 61.8% of all patients in the study. Among all patients, 51.6% of those who discontinued treatment and 85.2% of those who continued treatment were taking lithium. In addition, 70.8% of patients were taking ≥2 psychotropics for bipolar disorder. The mean age of patients in the study was 32.7 years.

Viguera and colleagues found that the risk of symptom recurrence (defined as a patient experiencing ≥1 mood episode) during pregnancy was 71%. For women who discontinued treatment during pregnancy, 85% experienced symptom recurrence as compared to the 37% of patients who continued treatment. Most recurrences were depressive or mixed (74%). Predictors of recurrence included diagnosis of bipolar disorder type II, earlier first-episode onset, recent illness, and experiencing more recurrences per year. Antidepressant use and use of anticonvulsants instead of lithium were also predictors of symptom recurrence.

When comparing patients who continued or discontinued treatment, median time to first recurrence was four times shorter (40 weeks for the continuation group; 9 weeks for the discontinuation group) and the proportion of weeks patients experienced symptoms was five times greater for those who discontinued treatment. Women who discontinued treatment experienced symptoms for 40% of the duration of pregnancy as compared to the 8.8% for women who continued treatment.

Viguera and colleagues found that, for all recurrences, 47% occurred during the first trimester of pregnancy. Median time to recurrence was 11 times greater for patients who discontinued abruptly compared to patients who discontinued gradually. Patients who discontinued treatment within 14 days of approximate conception had a 50% risk of recurrence within 2 weeks. However, women who discontinued treatment at ≥15 days after conception did not reach a 50% risk of recurrence until 22 weeks. The authors concluded that abrupt discontinuation of bipolar disorder treatment for pregnant women created a high risk for new morbidity, particularly for early depressive and dysphoric states. Based on these findings, the authors recommend that clinicians practice a more balanced consideration of all risks and benefits associated with the illness management for patients during pregnancy. (Am J Psychiatry. 2007;164(12):1817-1824.) –CP

Dispatches is written by Michelisa Lanche, Carlos Perkins, Jr., and Lonnie Stoltzfoos.