Childhood-Onset Social Anxiety Disorder Associated With Later Development of Major Depressive Disorder

According to the National Institute of Mental Health, social anxiety disorder (SAD), also called social phobia, affects approximately 15 million American adults ≥18 years of age. The disorder, which is characterized by extreme anxiety and self-consciousness in response to everyday social situations, often can lead to or occur comorbid with other mental health disorders such as major depressive disorder (MDD). Patients typically first experience SAD symptoms around 13 years of age.

Although studies have shown that patients with SAD have an increased risk of subsequently developing MDD, results from prospective longitudinal analyses on the association between MDD development and SAD in children and adolescents have been mixed. Recently, researchers at the Institute of Clinical Psychology and Psychotherapy at Dresden University of Technology in Germany sought to determine the prevalence of SAD in children and adolescents as well as rates of MDD development from childhood through young adulthood.

Katja Beesdo, PhD, and colleagues, studied 3,021 patients 14–24 years of age at baseline and 21–34 years of age at the study follow-up. Beesdo and colleagues also sought to determine distal and proximal predictors for the development of MDD in SAD patients. All patients were evaluated using the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Munich–Composite International Diagnostic Interview through in-person interviews. Incidence of dysthymia and major depressive episodes were the main outcome measures of the study.

The authors found that 11% of patients met diagnostic criteria for SAD and 27% of patients had MDD or dysthymia. For patients 10–19 years of age, SAD prevalence was highest (0.72% per person/year), while SAD incidence rates dropped for patients younger or older than that age range. Of SAD patients, 50% had MDD at the study follow-up.

The later development of MDD was significantly associated with SAD incidence, which was a result independent of the patient’s age of SAD onset. In addition, Beesdo and colleagues found that proximal factors, such as the severity and persistence of SAD symptoms, and distal factors, such as parental anxiety and depression, were each predictors of MDD development. Behavioral inhibition and occurrence of a panic attack were also MDD predictors.

Beesdo and colleagues concluded that childhood- and early adolescent-onset SAD is associated with an increased risk for the development of MDD in young adults. As prior studies have shown that SAD severity is associated with a more severe course of MDD and other depressive disorders, the authors found that targeted prevention and treatment of SAD symptoms is crucial. Future studies should also examine the role of proximal and distal predictors for MDD development. (Arch Gen Psychiatry. 2007;64(8):903-912). —CP


Use of MRIs and fMRIs Could Lead to Personalized Treatment for Major Depressive Disorder

The use of magnetic resonance imaging (MRI) and functional magnetic resonance imaging (fMRI) for the treatment of major depressive disorder (MDD) was recently studied by Edward Bullmore, MRCP, MRCPsych, PhD, and colleagues, at Addenbrooke’s Hospital in Cambridge, United Kingdom. Bullmore and colleagues believe that personalized treatment for depression via MRIs can help physicians predict which method of treatment will be the most beneficial for each individual patient.

Bullmore and colleagues evaluated structural MRIs and fMRIs as predictors of symptom change in people with depression. They conducted MRIs on 17 patients before, during, and after receiving antidepressant treatment and measured the structure and functioning of each patient’s brain. All patients were suffering from MDD and began receiving fluvoxamine 20 mg/day after the baseline MRI. fMRIs were conducted to record brain activity as the patients were presented with sad faces (each face represented a different intensity of sadness). The Hamilton Rating Scale for Depression was used to assess clinical response.

Bullmore and colleagues found that there were faster rates of MDD improvement in patients with greater grey matter volume in the anterior cingulate cortex, insula, and right temporo-parietal cortex. Some patients were found to have more than the average amount of grey matter and these patients had faster rates of improvement and lower residual symptom scores at endpoint. Patients with greater functional activation in the anterior cingulate cortex also had faster improvement.

The researchers believe that structural MRIs of the anterior cingulate cortex in patients suffering from MDD could provide useful data as to the efficacy of antidepressant use and lead to greater individualized treatment responses in each patient. (Biol Psychiatry. 2007;62(5):407-414). —CN


Overweight Teens at Risk for Disordered Eating

Obesity and eating disorders are both significant issues for adolescents. While disordered eating behaviors are commonly thought to affect thin teenagers, a new study suggests that thin teenagers are not the only ones in danger of developing eating disorders or disordered eating habits.

Dianne Neumark-Sztainer, PhD, at the University of Minnesota, and colleagues, looked at 2,516 adolescents first in 1998–1999 and then 5 years later in 2003–2004. The teenagers were questioned on eating patterns, exercise, disordered-eating behaviors, weight teasing by family and friends, exposure to weight-related messages from the media, and family meal practices. The researchers found weight-related problems in 44% of female teenagers and 29% of male teenagers. Additionally, they found that 40% of overweight females and 20% of overweight males used at least one disordered-eating behavior to control their weight. Disordered-eating behaviors ranged from taking diet pills or laxatives to vomiting after meals.

The study also found that teasing from family or friends was one of the strongest predictors for both extreme dieting as well as being overweight. Teasing from family members about weight, even if not intended to be malicious, was detrimental to the teenagers’ weight. Those who reported being teased by family members were twice as likely to be overweight at the time of the second survey. However, families could also have a positive effect on teenagers’ weight as well. Factors such as eating meals as a family and fostering a sense of connection were both found to be protective factors.

Dr. Neumark-Sztainer notes that positive reinforcement and modeling healthy behavior are the keys to decreasing unhealthy eating habits and weight-loss practices. Although this study cannot prove a causal relationship between any of the factors studied, the hope is that future research will be able to determine whether decreasing any of these factors will lead to a decrease in childhood obesity. (Am J Prev Med. 2007;33(5):359-369). —VJ

Psychiatric Dispatches is written by Virginia Jackson, Christopher Naccari, and Carlos Perkins, Jr.