Article

Juvenile-Onset Major Depression Includes Childhood- and Adolescent-Onset Depression and May Be Heterogeneous

Division of Clinical and Genetic Epidemiology, College of Physicians and Surgeons of Columbia University and the New York State Psychiatric Institute, 1051 Riverside Dr, Unit 24, New York, NY 10032, USA.
Archives of General Psychiatry (Impact Factor: 14.48). 04/2002; 59(3):223-4. DOI: 10.1001/archpsyc.59.3.223
Source: PubMed
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    ABSTRACT: Purpose of review: There has been a rapid expansion of interest into the role of childhood trauma in depression over the past 10-15 years. Most studies find associations between recalled trauma, particularly child sexual abuse, and depression. There is, however, a need to establish whether it has a causal role, and if so what are the processes linking the trauma to depression. Recent findings: Several recent studies have confirmed a high rate of recalled sexual abuse in the general population, of around 18% in women and 5% in men. Recalled sexual abuse has been associated consistently with the diagnosis of depression in both men and women. Much less attention has been paid to the role of physical abuse. These associations hold up in studies that account for genetic influences. However the specific role of child sexual abuse is not yet clear. It is associated with multiple adult psychiatric disorders, and recent studies indicate that it may contribute to some, but not all, pathways to depression. It is likely that psychological, social and neuro-endocrine processes are affected by childhood trauma, and contribute to the risk for depression. Summary: The finding of associations of childhood trauma with depression, together with other adverse childhood experiences, underlines the need for clinicians treating children and adults to take a developmental perspective. The elucidation of different pathways to depression, including childhood adversities, can help to clarify heterogeneity within the broad-brush diagnosis of depression. This should lead to a better understanding of the role of different mechanisms, with implications for early intervention and treatment.
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    ABSTRACT: As with adult major depressive disorder (MDD), child and adolescent MDD is characterized as a common, chronic and recurrent disorder. It is also associated with short- and long-term functional impairment, morbidity, and mortality. Effective treatments, both psychotherapeutic and pharmacotherapeutic, are available for the short-term treatment and management of youth with MDD. However, to date, there are no data on the long-term treatment and management of children and adolescents with MDD and how long-term treatment may affect the outcomes of either high-risk or already affected youth. Understanding the long-term consequences of MDD during youth is as important as understanding how to treat a single episode of depression. Available data on the pharmacotherapeutic and psychotherapeutic options are discussed. In general, tricyclic antidepressants (TCAs) are not as effective for the treatment of youth with MDD as adults with MDD. The selective serotonin reuptake inhibitors (SSRIs) have been shown to be effective in children and adolescents with MDD and non-obsessive compulsive anxiety disorders. The serotonin and norepinephrine reuptake inhibitor (SNRI), venlafaxine XR, has been shown to be effective for the treatment of generalized anxiety disorder in children and adolescents. Understanding the long-term clinical consequences of depressive disorders in youth may provide opportunities for better intervention across the clinical course of illness. Early recognition, diagnosis and adequate treatment of 'high-risk' youth with subsyndromal depressive symptoms, treatment of acute episodes of depression to prevent 'kindling', and aggressive prophylaxis have the potential to improve the mental health of youth throughout their lives.
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    ABSTRACT: Several sources of heterogeneity in major depression have been identified. These include age of onset, presence of co-morbid disorders, and history of childhood sexual abuse. This study examined these factors in the context of the contrast between onset of depression in young women before and after age 16. Sampling was carried out in two phases. In the first, questionnaires were sent to women aged 25-36 in five primary care practices. Second-phase subjects for interview (n = 197) were drawn from three strata defined on the basis of childhood adversities. Interviews conducted and rated independently assessed (1) recalled childhood experiences, psychopathology and parental psychiatric disorder, and (2) adult personality functioning and adult lifetime psychopathology. Frequencies of predictor and response variables, effect estimates and their confidence intervals were weighted back to the general population questionnaire sample. Compared with adult-onset depression, juvenile-onset adult depression was associated with co-morbid childhood psychopathology and peer problems, poor parental care, and childhood sexual abuse involving actual or attempted intercourse; in adult life there were higher levels of co-morbid psychiatric disorders, and personality dysfunction. The adult-onset depression group was characterized by a history of contact childhood sexual abuse without actual or attempted intercourse, and to a lesser extent, poor parental care. The juvenile- versus adult-onset distinction appears to be important to heterogeneity in adult depression, implicating different individual and environmental factors during childhood, and different mechanisms in adult life.
    No preview · Article · Dec 2004 · Psychological Medicine
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