Seasonality in a community sample of bipolar, unipolar and control subjects

Seasonality of symptoms in women with postpartum depression

It is important to consider the potential contribution of seasonality to postpartum depression (PPD; Hiltunen et al, 2004). A possible link between seasonality and PPD may have implications for not only choice of treatment, but also in considering pregnancy planning. The objectives of this pilot study were to examine whether women with seasonal mood changes demonstrated greater incidence of PPD, and to determine if seasonality scores were predictive of PPD. The Seasonal Pattern Assessment Questionnaire (SPAQ; Rosenthal et al, 1987) was used to assess seasonality of mood. A logistic regression analysis was conducted to determine the association between clinical factors, SAD diagnosis, SPAQ global seasonality score (GSS) and season of SPAQ administration and PPD. In our sample, twice as many women in the PPD group were found to have SAD compared to the control group. The PPD group also had a higher group GSS mean (10.44) than did the control group (8.84). However, logistic regression analysis showed that higher seasonality scores in women with PPD were not necessarily predictive of PPD. While more women in the PPD group reported increased seasonal weight fluctuation and less sleep in the spring and summer, these items alone did not predict depression after childbirth.

Relationship of movements and behaviors to Group A Streptococcus infections in elementary school children

BACKGROUND

Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcus (PANDAS) research is based on the hypothesis that infections trigger changes in behavior and movement in children.

METHODS

We enrolled 693 children (ages 3 to 12 years) into a systematic, longitudinal study. Data were collected monthly for 8 months (October-May) to determine point prevalence of Group A Streptococcal (GAS) infections, tics, behavior, and choreiform movements. Simultaneous throat cultures were obtained, and relational analyses were made between GAS and movement/observation ratings.

RESULTS

Combined behavior/GAS associations (concurrent with or 3 subsequent months to GAS) revealed a strong relationship, relative risk (RR) of 1.71 (p < .0001). Detailed analysis revealed that balance/swaying and non-tic grimacing were responsible for a significant proportion of this association (RR = 2.92, p < .0001). A strong seasonal pattern was found, with fall being more significant for GAS infections and observation ratings (p < .0001) compared with winter/spring. Children with repeated streptococcus (n = 64) showed higher rates of behavior and distal choreiform observations (p = .005).

CONCLUSIONS

Motor/behavior changes were noted to occur in relationship to positive GAS culture with support that repeated GAS increases risk.

Second-generation antidepressant discontinuation and depressive relapse in adult patients with bipolar depression: Results of a retrospective database analysis

BACKGROUND

To date, few postmarketing studies have addressed whether long-term prophylactic treatment with second-generation antidepressants (ADs) delays depressive episodes in patients with bipolar disorder.

OBJECTIVE

The aim of this study was to compare the risk of depressive relapse between patients with bipolar disorder who took second-generation ADs>-6 months after depressive remission with those who discontinued AD use early.

METHODS

Using a large US managed-care claims database, continuously enrolled bipolar subjects who took second-generation ADs after a depressive remission were identified between January 1, 1998, and December 31, 2002. Duration of AD and concurrent mood stabilizer use were based on coded diagnoses and pharmacy records. A Cox proportional hazards model was developed to predict time from depressive remission to next depressive relapse with continuous AD use, categorized as either >or=6 months or <6 months. Propensity scoring with greedy matching was used to help balance the observed background covariates and baseline disease severity between groups.

RESULTS

Five hundred eighty-nine subjects met the inclusion criteria. A Kaplan-Meer estimate found that the median depressive relapse times for the continuous (ie, >or=6 months) and early discontinuation (ie, <6 months) AD treatment groups were 16.5 and 6.8 months, respectively (P<0.05). The Cox proportional hazards model with propensity score matching identified a significantly lower risk of depressive relapse over a 2-year period among those who continued AD treatment>or=6 months after remission, compared with those who discontinued treatment within 6 months (hazard ratio, 0.61 [95% CI, 0.42-0.88]; continuous vs early discontinuation, P<0.01).

CONCLUSIONS

Continuous second-generation AD therapy for >or=6 months after depressive remission was associated with a lower risk of depressive relapse over a 2-year period in patients with bipolar depression. Given concerns regarding the risk of AD users with bipolar disorder switching to mania, an optimal prophylactic treatment after depressive remission should balance the risks between manic switching and depressive relapse.

Bipolar II and the bipolar spectrum

In studies made in the last decade, patients consulting doctors because of depression and anxiety have very often turned out to suffer from bipolar type II and similar conditions with alternating depression and hypomania/mania (the bipolar spectrum disorders - BP). Specifically, about every second patient seeking consultation because of depression has been shown to suffer from BP, mainly bipolar type II. BP is often concealed by other psychiatric conditions, e.g. recurrent depression, psychosis, anxiety, addiction, personality disorder, attention-deficit hyperactivity disorder and eating disorder. BP shows strong heredity. Relatives of patients with BP also have a high frequency of the psychiatric conditions just mentioned. Conversion ("switching") from recurrent unipolar depressions (recurrent UP) to BP is common in very long longitudinal studies (over decades). Mood-stabilizing medicines are recommended to a great extent in the treatment of BP, since anti-depressive medicines are often not effective and involve a substantial risk of inducing mood swings. Particularly in the long-term pharmacological treatment of depression in BP anti-depressive medicines may worsen the condition, e.g. inducing a symptom triad of dysphoria, irritability and insomnia: ACID (antidepressant-associated chronic irritable dysphoria).