Depression among preschoolers, part 2

This New York Times Magazine article asks in the headline, "Can Preschoolers Be Depressed?" Well, yes. Is this even still a question? We've known that for some time. Some say 1 in 5 kids entering kindergarten have "a psychiatric disorder with impairment." Depression is a brain thing, not a mind thing, and there's no particular reason to think this brain thing isn't present at birth. Still, the NYT Magazine article is a good look at childhood depression and the history of how we have thought about it.  Be sure to have food and water handy, because it's a son-of-a-gun long article.

Liking one best hurts them all

It seems that if mom likes one kid better than the others, all of the kids are more likely to be depressed in middle age.

Favoritism may be difficult for mothers to avoid, however, as the researchers found that 70 percent of moms surveyed named a child to whom they felt closest and only 15 percent of children saw equal treatment by their mothers. Similarly, 92 percent of children and 73 percent of mothers specified a child with whom the mother battled most frequently.

This means 85% to 92% of middle-aged adults are depressed. Works for me.

Depression among preschoolers

This study found that there are preschoolers who have depression. The  anhedonia (inability to feel pleasure) that shows up in adults as decreased libido shows up in preschoolers as not enjoying playing. Depression may not get noticed, because it's not disruptive behavior, and kids may not show the symptoms all the time, but they do still have the "symptoms of depression, including appearing less joyful, being prone to guilt, and changes in sleep patterns."

The problem is when it's not a phase but an early expression of a life-long problem. But kids brains are so plastic that you would expect early intervention to help. The miracle of compound interest works with brains, too, so the earlier it can start, the better chance a kid has to be not depressed as an adult.

I guess the lesson for providers is to notice and refer when you see a kid who just doesn't have a good time.

More bad things you can do to kids: nicotine, TV, and cortisol, oh, my!

This month's Archives of Pediatrics & Adolescent Medicine (a JAMA journal) is devoted to early experience and it's effects later in life, all nicely summarized on Science Daily.

One study looked at prenatal maternal use of cocaine, an opiate, marijuana, alcohol, and nicotine and sleep problems in the kids. Of these, only nicotine caused sleep problems. It's not so much that other drugs are turning out to be less damaging to fetuses than we thought (although there is some of that) as that tobacco is turning out to be worse than we thought.

In another study, mothers with bad enough anxiety to make them be taking selective serotonin uptake inhibitors during pregnancy had 3 year olds with increased withdrawal, anxiety, and depression. Some of it is due to a gene variant.

In another study, too much TV at 29 months of age is associated with all sorts of bad stuff in fourth grade:

"Each additional hour (per day) of television in early childhood corresponded to a

• 7 percent unit decrease in classroom engagement, 
• 6 percent unit decrease in math achievement, 
• 10 percent unit increase in victimization by classmates, 
• 13 percent unit decrease in time spent doing weekend physical activity, 
• 9 percent unit decreases in activities involving physical effort, 
• 9 percent higher scores for consumption of soft drinks and 
• 10 percent higher scores for consumption of snacks, as well as a 
• 5 percent unit increase in BMI."

Another study compared kids who stayed with their parents after CPS became involved with kids who went into foster care. "Children who still lived with their parents had different patterns of cortisol production than those in foster care, with flatter slopes in waking to bedtime values," which has god knows what effects on an adult, but you can't imagine them to be good. On the other hand, it shows foster care works, in this respect.

Another study looked at twin pairs where one weighed 20% more than the other at birth. The bigger twin was more likely to have conduct problems at age 3 or 4. The association was stronger with dizygotic twins than between monozygotic twins. So which thing causes which? Or more likely, what initial condition cascades to produce both of them.

Brain differences in symptomless depressive girls

Some researchers looked at girls 10 to 14 who did not have any symptoms of depression but whose mothers had recurrent depression.

All 26 participants underwent functional magnetic resonance imaging (fMRI) while completing a task involving the possibility of reward and punishment. They were first shown a target and told that if a circle appeared, they could gain points by being fast enough to hit the target. If a square appeared, they could avoid losing points by hitting the target quickly. If a triangle appeared, they could neither win nor lose points and should avoid responding. The task consisted of 100 six-second trials, each of which contained an anticipation phase and a feedback phase, during which the girls were told whether they gained or lost points. The points could be redeemed for prizes at the end of the task

The high-risk group displayed diminished neural responses during both anticipation and receipt of the reward when compared with the low-risk group. Specifically, they did not show any activation in a brain area known as the dorsal anterior cingulate cortex, which appears to be involved in reinforcing past experiences to facilitate learning. However, compared with low-risk girls, high-risk girls showed an increased activation in this area when receiving punishment. This suggests they may more easily integrate information about loss and punishment than reward and pleasure over time.

It's all in the brain. You have to wonder if all these girls will suffer real depression later, if they are biologically fated for it, or if it takes some environmental trigger, such as loss of a loved one, to bring it on.

If it were ever the case that fMRIs machines were cheap and everywhere, one could routinely screen kids at birth. It could become part of the APGAR score, and then at intervals we could check for signals that an intervention might be needed, before symptoms arise, and not just for depression. fMRI indicators are likely to be found for all sorts of mental problems.

I just hope that, in the midst of all the medical promise, the government doesn't get some idea of how to use it in interrogations, or corporations don't start using it as a personnel screening device. Actually, "hope" is a little strong. It should be "wish," because any technology that is useful to corporations or law enforcement  if abused, will be abused.

Mood and cognition

This is a blog post by the guy who wrote Proust was a Neuroscientist about the relationship between mood and cognition, specifically the idea that being depressed (not clinically depressed) makes you more analytic and focused. In a way it's like sickle-cell anemia: Being a little depressed makes you focused; being a lot depressed makes you useless.

This might be why bi-polar stays around. (Warning: Just so story ahead.) Maybe it's not an occasional mutation that is immediately selected against. Maybe the mild form of it it has an evolutionary advantage to the species.  Maybe the analytic abilities of mild depression and the creative abilities of mild mania attract enough mates to keep them going.

It's an interesting post, and it has links to other related interesting pieces and book recommendations.

Poor women and post-partum depression

More than half of low-income urban mothers met the criteria for a diagnosis of depression at some point between two weeks and 14 months after giving birth, according to a study led by University of Rochester Medical Center researchers and published online by the journal.

It really sucks to be poor. The adage says money can't buy happiness, but studies say that is true only after you make enough for food and shelter and basics. The study I read some time ago and don't have a cite for said happiness increased with income up to about $50,000 a year.

Lots of bad stuff happens to poor people. Bad stuff happens to all of us, but more of it happens to poor people, and money really does ameliorate a lot of it for those who have it. Car break down? Call a AAA and a cab. Or walk home. Higher risk of post-partum depression is just another blow to the poor.

I guess I should say here that the answer is to monitor poor women after they give birth to see if they develop depression, and then treat it appropriately. But we all know that's not going to happen. This study identified a problem, but there is no solution our country is willing to undertake, because it would involve spending too much money on poor people. Does that make me a commie? No, I believe in a Scandinavian-style mixed capitalist-socialist economy.

Depressed moms raise antisocial teens who become depressed moms

Here's an unpleasant cycle: Depressed moms raise antisocial teens who become depressed moms.

Children from urban areas whose mothers suffer from depression during pregnancy are more likely than others to show antisocial behavior, including violent behavior, later in life. Furthermore, women who are aggressive and disruptive in their own teen years are more likely to become depressed in pregnancy, so that the moms' history predicts their own children's antisocial behavior. ...

The study found that mothers who became depressed when pregnant were four times as likely to have children who were violent at 16. This was true for both boys and girls. The mothers' depression, in turn, was predicted by their own aggressive and disruptive behavior as teens.

So what do we do about it? Undepress moms? I'd hate to start routinely giving anti-depressants to pregnant women. Some sort of antidepressive psychological therapy? Does anything like that work on depression?

Given my predilection for believing in biological causes for behavior, it is not surprising that I suspect that hormones circulating in the mom's blood cross the placental barrier and affect the fetus's brain development in some way, so I assume people will be looking at ways of reducing the effect either during pregnancy or in the infant.

I am in general hopeful that all manner of brain dysfunction will prove amenable to medication or gene therapy. I am in general fearful that the line between a dysfunction that needs to be treated and just being different will be drawn by people I don't trust. How autistic does a person have to be before we figure they're broken and not just on an engineering career track? How destructively bipolar does a writer have to be to be forced onto meds? How strange does a religious prophet have to be before we give him meds to stop the voice of God in his head?

But that's depressing. On Friday morning, I'd rather think about the non-brain things that are clearly dysfunctional and will likely be fixable in the coming decades. Ommmmmmmmmmm.

Antidepressants may inhibit lactation

This is a depressing story. It seems some common antidepressant drugs can cause "delayed secretory activation," or a delay in starting milk production, because of their effects on seratonin production.

Oh, great. Mom has post-partum depression, her boobs hurt, her nether parts hurt, and now she's a bad mom because she can't give milk. In that condition, she has to decide whether to take her meds or feed her baby.

The abstract conclusion says "Mothers taking serotonergic drugs may need additional support to achieve their breastfeeding goals." I'd be all in favor of that, but I don't know what that support would be.