In a study of the effect on infant health of a mother’s experience of adversity in childhood by researcher Deborah Kim and colleagues, both adversity in childhood (such as physical abuse or the loss of a parent) and stress during pregnancy were associated with low infant birth weight and lower gestational age at birth.
Among 146 women enrolled in the study, 58.2% percent scored a 0 on the Adverse Childhood Experience Questionnaire (ACE), 24% scored a 1, and 17.8% scored a 2. Those who scored higher on the ACE also scored higher on a scale measuring perceived stress. A score of 2 or higher on the ACE was associated with lower gestational age at birth, indicating infants born prematurely. Greater stress during pregnancy was associated with lower gestational age at birth and lower infant birth weight. When potential confounding demographic factors were removed from the analyses, ACE scores of 2 or higher were still associated with lower infant birth weight, while perceived stress was no longer associated with either low birth weight or gestational age.
Childhood adversity is associated with increases in inflammation and multiple adverse medical consequences in adults. The researchers called childhood adversity a “significant predictor of poor delivery outcomes” for women.
Editor’s Note: This research shows that a mother’s health and earlier life stressors could have an adverse effect on her child.
Childhood adversity leaves behind a residue of neuroendocrine and neuroclinical alterations that can persist into adulthood. Many are mediated by epigenetic changes, consisting of small chemical marks that attach to DNA and the histones around which it is wrapped.
In addition to these neurobiological alterations mediated by epigenetic effects, there is new evidence that some epigenetic marks can be passed on to the next generation via a mother’s egg or a father’s sperm. Thus, either directly or indirectly, parents’ adverse life experiences can influence the health of their offspring.
Disruptions to circadian rhythms are common in mood disorders, leading some researchers to believe that normalizing these daily rhythms may improve the illnesses. Several genes, called CLOCK genes, are implicated in circadian rhythms. In animal studies, researcher Marco Riva and colleagues are examining the expression of CLOCK genes in different brain regions as a result of chronic stress that is meant to produce behaviors resembling human depression.
Male rats were exposed to chronic mild stress for two weeks, and divided into those that were susceptible to stress (identified by their loss of interest in sucrose) and those who were not. Then the rats were randomized to receive either a placebo treatment or 3 mg/kg/day of the atypical antipsychotic lurasidone (trade name Latuda), which has been effective in bipolar depression, during five more weeks of the stress procedure.
The researchers observed the expression of clock genes Clock/Bmal1, Per1, Per2, Cry1, and Cry2. In susceptible rats, the chronic mild stress decreased the clock genes Per1, Per2, and Cry2 in the prefrontal cortex. Lurasidone reversed these CLOCK gene abnormalities and the rats’ depression-like behaviors, which may explain some of the drug’s efficacy in bipolar depression.
Editor’s Note: Lurasidone is also a potent inhibitor of 5HT7 serotonin receptors, an effect that has been linked to antidepressant efficacy. Lurasidone also increases brain-derived neurotrophic factor (BDNF), which is important for learning and memory, and prevents stress from decreasing BDNF. Now it seems that lurasidone’s normalization of CLOCK genes may be another mechanism that explains the drug’s antidepressant effects.
Telomeres sit at the end of DNA strands and shorten with each cell replication. Shorter telomeres are associated with aging and an increase in multiple medical and psychiatric disorders. New research draws connections between the production of mitochondrial DNA, telomere length, the experience of childhood adversity, and mental illness.
Researcher Audrey Tyrka and colleagues divided 290 healthy adults into four categories based on whether or not they had experienced adversity in childhood and whether they had been diagnosed with a mental illness in their lifetime, including depression, anxiety, and substance abuse. The researchers also analyzed the participants’ telomere lengths and the copy number of their mitochondrial DNA. Both stressful events in childhood (such as maltreatment or the loss of a parent) and a history of mental illnesses (depression and anxiety) were associated with shorter telomeres and higher mitochondrial DNA copy numbers, a measure of cellular aging. Substance abuse was associated with higher mitochondrial DNA copy numbers.
Editor’s Note: This research replicates earlier findings that adversity is associated with shortening telomeres. The finding that mitochondrial DNA could play a role in the long-term effects of early life adversity and mental illnesses is new.
Sensory gating is a process by which the brain filters out unimportant information, to avoid flooding higher cortical centers with irrelevant stimuli. New research from Randal Ross and colleagues shows that infants of mothers with anxiety have deficits in the way their brains inhibit response to this type of irrelevant information.
Mothers who were rated higher on the trait of anxiety had paradoxically lower levels of the inflammatory cytokine interleukin 6 at week 16 of their pregnancy, and their one-month-old infants showed more deficits in sensory gating. The reasons for these relationships requires further investigation.
Choline is a nutrient found in liver, muscle meats, fish, nuts, and eggs, and it may help. In a 2013 article in the American Journal of Psychiatry, Ross and colleagues showed that the supplement phosphatidylcholine (which converts to choline), taken during the second and third trimesters of pregnancy (at doses of 6300 mg/day, the equivalent of about three eggs) and followed up with 700 mg/day in the infant, led to improvements in sensory gating in the infants. These infants went on to have fewer behavioral problems as toddlers.
Ross and colleagues suggest that pre- and post-natal choline supplementation may be able to reverse the effects of maternal anxiety on infants. The researchers believe it could be helpful in the prevention of schizophrenia, as insufficient cerebral inhibition (decreased sensory gating) is a characteristic of that illness as well.
In a recent retrospective study, people with bipolar disorder I, bipolar disorder II, and major depressive disorder were interviewed about a 14-year period of their illness, and several differences emerged.
People with bipolar disorder I described their illnesses as including more psychomotor retardation (slowing of movements) and more psychotic features. People with bipolar disorder II had more mixed states than both people with major depression and people with bipolar I disorder. They also had less psychomotor slowing than people with bipolar I disorder.
Another purpose of this study by Andrew Frankland and colleagues in the Journal of Clinical Psychiatry, was to determine the effectiveness of the Probabalistic Approach to Bipolar Disorder, a statistical method for differentiating diagnoses. The approach was successful in differentiating both bipolar subtypes from major depression, but not in differentiating between the bipolar subtypes.
In a recent randomized, controlled clinical study comparing two types of omega-3 fatty acid supplements (one with EPA and one with DHA) with placebo in 196 adults with major depression, there were no statistically significant differences in outcomes across the three groups. The participants received the treatments for eight weeks, and response and remission rates were 40-50% in those receiving either omega-3 preparation (at doses of 1000mg/day) and 30% for placebo. The research was published by David Mischoulon and colleagues in the Journal of Clinical Psychiatry.
Depression is common following heart attacks, and it can complicate recovery. A recent study by Jae-Min Kim and colleagues investigated the safety of treating depression with escitalopram in people recovering from acute coronary syndrome. In a 2015 article in the Journal of Clinical Psychiatry, they reported that 217 people with depression and acute coronary syndrome were randomized to receive either escitalopram (in flexible doses ranging from 5–20 mg/day) or placebo for 24 weeks. Patients who received escitalopram saw more improvement in their depression on a variety of scales, and also showed improvements in social and occupational functioning. There were no adverse cardiac effects from escitalopram, though some people taking it did experience dizziness.
A STUDY ASSESSING YOUR CHILD’S MOOD AND BEHAVIOR
Parents, if your child (aged 2 – 12) has mood or behavioral difficulties, we would like to enlist your participation in a study called the Child Network. Parents who enroll in the study will complete an online rating checklist of your child’s symptoms once a week by a secure web-based system.
In addition, adults who have been diagnosed with depression or bipolar disorder and are the biological parent of a child (ages 2-12) who is currently healthy and has no troublesome mood or behavioral symptoms may also be eligible to participate in this study.
While attention-deficit hyperactivity disorder (ADHD) is fairly common among people with bipolar disorder, the genetic risks of inheriting these two illnesses run separately in families. In a recent study of 465 people and 563 of their first-degree relatives by Susan Shur-Fen Gau and colleagues, people with bipolar I disorder were likely to have relatives with bipolar I disorder, and people with ADHD were likely to have relatives with ADHD, but ADHD did not increase risk of bipolar disorder and vice versa.
The researchers hypothesize that other reasons people might develop both disorders include developmental precursors to the illnesses, neurocognitive functioning, sleep problems, and personality traits such as impulsivity and disinhibition.
Editor’s Note: At a recent scientific meeting, Gau and her colleague Kathleen Merikangas said that people with bipolar disorder in the study were five times more likely to have relatives with bipolar disorder. Bipolar disorder and ADHD were comorbid in 37.8% of those with bipolar I disorder, 16.4% in bipolar II disorder, 14% in depression, and 1.1% in normal controls.
“Society’s accumulated myths and fears about disability and disease are as handicapping as the…limitations that flow from actual impairment.”
—US Supreme Court
Attorney Katharine Gordon has provided some information on legal rights under the ADA.
When we think of the Americans with Disabilities Act (ADA), we might think of physical modifications to buildings, expensive lawyers, and complicated trials. But this law also gives people with bipolar ways to get fair treatment in the workplace. By learning a bit about your employment rights under this law, you can focus on excelling in your chosen career, rather than being sidetracked by ignorance, stereotypes, and stigma.
Here are a few things that you may not know about bipolar disorder and the ADA:
It is now clear that people with bipolar disorder are protected under the ADA in employment. Prior to 2008, there was often a battle of the experts to prove that a person with bipolar disorder had a severe enough impairment to be protected. This discouraged many from asking for their rights to be respected under this law in the first place. Unfortunately, companies would fire people for having bipolar disorder and then, in next breath, argue that bipolar wasn’t a real disability therefore it was legal to fire people for reasons related to their bipolar disorder.
This changed with the passage of the Americans with Disabilities Act Amendments Act of 2008, which made it easier to establish disability. The Equal Employment Opportunity Commission, the agency responsible for enforcing this law, has made it clear in official regulations that bipolar should generally be covered as a disability for the purposes of protection in employment: “It should easily be concluded that the following types of impairments will, at a minimum, substantially limit the major life activities indicated:…major depressive disorder, bipolar disorder, post-traumatic stress disorder, obsessive compulsive disorder, and schizophrenia substantially limit brain function.” 29 C.F.R. § 1630.2(j)(3)(ii), (iii).
Job applicants should never be asked whether they have bipolar disorder (or any other disability) until a conditional offer has been made. Read more