Fertility and childhood bipolar disorder

University of Louisville, Department of Psychiatry, 501 E Broadway, Suite 340, Louisville, KY 40202, United States.
Medical Hypotheses (Impact Factor: 1.07). 02/2007; 69(3):587-9. DOI: 10.1016/j.mehy.2006.12.055
Source: PubMed


The observation that the diagnosis of bipolar illness is increasingly being made in the young is fascinating and potentially quite instructive. Several potential reasons have been put forward, which may all play a role. These include increased awareness, a cohort effect, changes in the diagnostic criteria, increased use of stimulants and antidepressants unmasking the illness, and others. It is interesting to note that this increase in recognition of bipolar illness in the young comes about one generation after the introduction of lithium as a therapeutic agent in bipolar disorder. We propose that the introduction of lithium may have increased fertility (broadly defined) of bipolar patients allowing for the expression of genetic anticipation by having a second and third generation of offspring that are affected at earlier ages. A similar phenomenon was seen in schizophrenia after the introduction of phenothiazines for the treatment of psychosis. These pharmacologic and social changes may have all conspired to increase reproductive success of bipolar subjects, giving rise to a new generation of bipolar patients with earlier onset and more severe manifestation of their disorder.

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    • "For example, fragmentation of nuclear and extended families, economic or life style stressors, or even changes in dietary habits may be conspiring to increase the prevalence of depression and its resistance to somatic treatment . Additionally, the biological course of major depression itself may be changing due to a multitude of biologic and genetic factors, as may be occurring in bipolar illness [21]. Alternatively, the loss of efficacy of the antidepressant may be related to clinical issues such as inadequate dosing of antidepressants [22] or antidepressant tolerance [23]. "
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    ABSTRACT: Treatment-resistant and chronic depression appear to be increasing. The recent identification of antidepressant tachyphylaxis, the loss of antidepressant efficacy over time, is only a partial explanation. This is an emerging evidence that, in some individuals, persistent use of antidepressants may be prodepressant. A literature search of PubMed utilizing the terms: antidepressant tachyphylaxis, treatment-resistant depression, chronic depression, and antidepressant tolerance was performed, and relevant articles were used. Depressed patients who ultimately become treatment resistant frequently have had a positive initial response to antidepressants and invariably have received these agents for prolonged time periods at high doses. Parallels between this course and tardive dyskinesia are noted. It is proposed that neuroplastic processes related to dendritic arborization may underlie the treatment resistant depression that occurs in the setting of chronic antidepressant use. Since the prodepressant effect is seen after prolonged antidepressant use, the term tardive dysphoria is proposed. Tardive dysphoria, needs to be considered in studies of treatment resistant depression, and should be examined in blinded, randomized antidepressant discontinuation trials.
    Full-text · Article · Apr 2011 · Medical Hypotheses
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    ABSTRACT: Substance use disorders and birth-cohort have been associated with an earlier onset in bipolar disorder (BD). This study aimed at evaluating the inter-relations of these factors in age-at-onset in bipolar illness. Two-hundred and thirty patients with bipolar I disorder were cross-sectionally evaluated. Patients were categorized into four age groups for analysis. Lifetime comorbidity and age-at-onset were derived from the Structured Clinical Interview for DSM-IV. There was a strong linear association between age group and age-at-onset. Lifetime alcohol and drug use disorders were also associated with age-at-onset. Illicit drug and alcohol use disorders and age group remained significant in the multivariate model. No interactions appeared. Both age group and dual diagnoses had strong and independent impacts on age-at-onset in out-patients with BD. Substance abuse may be partly accountable for earlier symptom onset, but other features of BD in younger generations are still in need to be accounted for.
    Full-text · Article · Aug 2009 · Acta Psychiatrica Scandinavica
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    Full-text · Article · Sep 2009 · Social Psychiatry
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