A 2015 study by Rene L. Olvera and colleagues in the Journal of Clinical Psychiatry indicated that among 1,768 Mexican-Americans living along the border from 2004–2010, 30% were currently depressed, 14% had severe depression, and 52% were obese. Women were more likely to be depressed, and more likely to have severe depression. Other factors making depression more likely included low education, obesity, low levels of “good” cholesterol, and larger waist circumference. Low education and extreme obesity were also linked to severe depression.
In a commentary on the article in the same issue, researcher Susan L. McElroy wrote that “the medical field needs to firmly accept that obesity is a risk factor for depression and, conversely, that depression is a risk factor of obesity.” She suggested that people with obesity, those who carry excess weight around their middles, and those who have related metabolic symptoms such as poor cholesterol should all be evaluated for depression. Likewise, those with depression should have their weight and body measures monitored. People with both obesity and depression should be evaluated for disordered eating.
Lithium is the treatment of choice for adults with bipolar disorder, but has rarely been studied in children or adolescents. One of the first double-blind placebo-controlled trials of lithium for the treatment of mania in children and teens aged 7–17 showed that the drug produced greater improvement in mania than did placebo. Side effects included blurred vision, abdominal pain, diarrhea, nausea, vomiting, fatigue, thirst, increased thyroid-stimulating hormone, decreased appetite, dizziness, sedation, tremor, increased urination, and rash.
In the study by researcher Adelaide S. Robb and colleagues, which was presented at the 2015 meeting of the American Academy of Child and Adolescent Psychiatry, doses began at 300mg twice a day, were based on each child’s weight, and were slowly increased.
At the same meeting, researcher Russell Scheffer presented data on 41 children who continued lithium treatment for 16 weeks with good results. The mean dose was 27.8 +/- 6.7 mg/kg per day.
Pediatric Acute-Onset Neuropsychiatric Syndrome, or PANS, describes a condition in which a child develops acute onset of psychiatric symptoms following an infection. At the 2015 meeting of the American Academy of Child and Adolescent Psychiatry, researcher Tanya K. Murphy reported on symptoms that differentiate PANS from other childhood-onset illnesses. Kids with PANS are more likely to have:
- sudden onset of symptoms
- earlier age of onset
- personality changes
- new onset of attention deficit hyperactivity disorder (ADHD) symptoms
- food refusal and weight loss
- behavioral regression
- deterioration in handwriting
- severe sleep disruption
- memory problems
- frequent urination
- dilated pupils
- an infection at the time of onset, particularly a group A streptococcal infection
A child with sudden onset of these symptoms following an infection may have PANS. It is important to differentiate PANS from traditional psychiatric diagnoses because treatment of PANS often consists of antibiotics, anti-inflammatory medications, and other treatments that target the immune system. See our case report about a boy with PANS.
At the 2015 meeting of the American Academy of Child and Adolescent Psychiatry, researcher Mary A. Fristad reported that omega-3 fatty acid supplements had a small beneficial effect on depression in children aged 7–14. The supplements did not noticeably improve bipolar disorder not otherwise specified (NOS) or mania. The supplements consisted of several types of omega-3 fatty acids, including 1400mg of EPA, 200mg of DHA, and 400mg of others per day. The children were also undergoing psychotherapy during the study.
At the 2015 meeting of the American Academy of Child and Adolescent Psychiatry, researcher Charles Popper reviewed the literature to date about broad-spectrum micro-nutrient treatments for psychiatric disorders in young people, concluding that these formulations of vitamins and minerals can reduce symptoms of aggressive and disordered conduct, attention deficit hyperactivity disorder, mood disorders, anxiety, and stress. Four randomized controlled trials showed that micronutrient formulas reduced violence and major misconduct in children.
Popper warned that while these micronutrients can be helpful in treating children who have never been prescribed psychiatric medication, they can interact dangerously with psychiatric medications in children who do take them.
At the same meeting, researcher Bonnie Kaplan reported that six randomized controlled trials of broad-spectrum micro-nutrients and B-complex vitamins in adults with and without psychiatric disorders showed that both of the formulas reduced anxiety and stress following natural disasters (which are associated with the development of post-traumatic stress disorder (PTSD)).
A statewide program to promote healthy behaviors within families has been successful in Vermont. The approach, described by researcher James J. Hudziak at the 2015 meeting of the American Academy of Child and Adolescent Psychiatry, is based on three assumptions. The first is that emotional and behavioral health is the cornerstone of all health. The second is that health behaviors are formed and sustained within families. The third is that promoting healthy behaviors, preventing illness, and intervening for better health outcomes are all important to enhancing the health of the population.
Vermont used community outreach (including town-hall public events), the media (including Twitter, blogs, radio, television, public service announcements, and a short film), and group trainings of community professionals to successfully spread health messages to families. The program targeted pediatricians’ offices, schools, community mental health centers, federally qualified health centers, and Departments of Health, Mental Health, and Child Welfare.
Hudziak has also suggested that programs of exercise, music, and mindfulness (all of which enhance brain growth and development) should be made universally available to children in school.
New research shows that bipolar disorder risk is higher in the US than in the Netherlands. At the 2015 meeting of the American Academy of Child and Adolescent Psychiatry, researchers Manon Hillegers and Esther Mesman described a study in which they compared the offspring of mothers with bipolar disorder in the US to those in the Netherlands. The offspring ranged in age from 10–18.
In the US, the mothers had, on average, an earlier age of onset, more substance abuse comorbidity, and were more likely to have been diagnosed with bipolar II disorder. Among the US offspring, 66% had been diagnosed with a psychiatric illness compared to 44% of the Dutch offspring. This included significantly higher rates of anxiety, ADHD, and disruptive behavior disorders in the US offspring. Among the offspring who had been diagnosed with a mood disorder, 80% of those in the US had other additional psychiatric disorders, but only 34% of the Dutch did. Bipolar disorder is more rare among children under the age of 12 in the Netherlands compared to the US.
Dutch children and adolescents were typically treated with lithium and with only one drug at a time. In the US, lithium is less widely used, and simultaneous treatment with several medications (usually including atypical antipsychotics) is common.
Editor’s Note: The research by Hillegers and Mesman replicates research by this editor (Robert M. Post) and colleagues that compared bipolar disorder incidence and severity in the US, Germany, and the Netherlands. Other comparisons have been made between the US and Europe. A 2014 article by Frank Bellivier and colleagues in the World Journal of Biological Psychiatry also showed that bipolar disorder onset occurs earlier in the US than in 10 different European countries, while Bruno Etain and colleagues found that bipolar disorder onset occurs earlier in the US than in France in a 2012 article in the Journal of Clinical Psychiatry.
Together this research shows that bipolar disorder is more serious in the US than in a number of European countries. Two-thirds of adults with bipolar disorder report that their illness began in childhood or adolescence. Most of these cases are not properly diagnosed or treated. A concerted effort must be made by the medical establishment and healthcare policymakers in the US to provide better and earlier treatment of bipolar illness.
Exercise isn’t just good for the body—new research suggests it can improve cognition and normalize brain activity.
At the 2015 meeting of the American Academy of Child and Adolescent Psychiatry, researcher Benjamin I. Goldstein reported that 20 minutes of vigorous exercise on a bike improved cognition and decreased hyperactivity in the medial prefrontal cortex in adolescents with and without bipolar disorder.
At the same meeting, researcher Danella M. Hafeman reported that offspring of parents with bipolar disorder who exercised more had lower levels of anxiety.
A plenary address by James J. Hudziak also suggested that exercise, practicing music, and mindfulness training all lead to improvements in brain function and should be an integral part of treatment for children at high risk for bipolar disorder and could be beneficial for all children.
Editor’s Note: Recognizing and responding to mood symptoms is key to the prevention and treatment of bipolar disorder in children and adolescents at high risk for the illness. For these young people, exercise, a nutritious diet, good sleep habits, and family psychoeducation about bipolar disorder symptoms may be a good place to start. Joining our Child Network may also be helpful.
At the 2015 meeting of the American Academy of Child and Adolescent Psychiatry, researcher Jeffrey R. Strawn reported that among children at high risk for bipolar disorder (because of a family history of the disorder) who are prescribed antidepressants for depression and anxiety, adverse reactions are common. These reactions include irritability, aggression, impulsivity, and hyperactivity, and often lead to discontinuation of the antidepressant treatment.
Younger patients at risk for bipolar disorder were more likely to have an adverse reaction to antidepressants. Risk of an adverse reaction decreased 27% with each year of age.
At the 2015 meeting of the American Academy of Child and Adolescent Psychiatry, researcher Melissa P. DelBello reported that compared to placebo, the anticonvulsant topiramate reduced marijuana craving in young people aged 12–21 who were already taking the antipsychotic quetiapine. Functional magnetic resonance imaging (fMRI) revealed that topiramate altered the activation of brain regions common to both drug craving and mood dysregulation. Topiramate could be a good treatment to reduce marijuana abuse. The antioxidant n-acetylcysteine (NAC) is another option.