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Biomedical subjects

D E Williamson

Publications and source records attributed to D E Williamson.

At least 37 records · Page 2Linked to original sources
PubMed1996

Corticotropin-releasing hormone challenge in prepubertal major depression.

This study investigates cortisol and ACTH (corticotropin) responses to an infusion of human CRH (corticotropin-releasing hormone) in prepubertal children with major depressive disorder (MDD). Following a period of 24 hours of adaptation to the laboratory environment with an intravenous catheter in place, 34 children with MDD and 22 healthy controls received 1 microgram/kg of human CRH at 5:00 PM. Blood samples for cortisol and ACTH were measured at baseline and post-CRH. Overall, there were no significant differences between the MDD and the normal controls in baseline or post CRH stimulation values of either cortisol or ACTH. Melancholic (n = 4) patients had significantly higher baseline cortisol levels than nonmelancholic (n = 24) patients. Compared with the outpatients and the nonmelancholics, the inpatients (n = 10) and the melancholics showed significantly lower total ACTH secretion (effect size: 0.9 and 1.4, respectively) after CRH infusion. These results are consistent with a broad literature suggesting that the HPA axis abnormalities occur less frequently in early-onset depression than reported in adult studies. The pattern of results in the subgroups of inpatients and in melancholic children, however, raise questions about possible continuities with adult studies.

Adolescent↗
PubMed1996

Nocturnal ACTH, cortisol, growth hormone, and prolactin secretion in prepubertal depression.

OBJECTIVE: To examine nocturnal secretion of adrenocorticotropin, cortisol, growth hormone, and prolactin in 38 medically healthy children with prepubertal major depression compared with 28 medically and psychiatrically healthy control children. METHOD: Prior to sampling, subjects underwent an "adaptation night" with the intravenous catheter in place and electroencephalographic (EEG) electrodes for standard all-night polysomnogram. On the following night, plasma samples were obtained every 20 minutes through an indwelling catheter. Hormonal concentrations were measured by specific radioimmunoassay and aligned by EEG-confirmed sleep onset. Areas under the curve were calculated for total secretion and compared using analysis of variance. RESULTS: Prepubertal depressed children had lower cortisol secretion during the first 4 hours after sleep onset compared with controls. Adrenocorticotropin, prolactin, and growth hormone secretion did not differ between groups. Examination of clinical characteristics in depressed children revealed lower nocturnal adrenocorticotropin concentrations in depressed inpatients versus depressed outpatients and in depressed sexually abused versus depressed nonabused children. A significant sex by diagnosis effect revealed lower growth hormone secretion in depressed females compared with depressed males. CONCLUSIONS: In contrast to neuroendocrine challenge studies in these same subjects, nocturnal neuroendocrine measures did not reveal any of the expected group differences. These results emphasize the contrasts between unstimulated and challenge studies of neuroendocrine secretion and of the importance of considering clinical characteristics and maturation influences in biological studies of prepubertal depression.

Adolescent↗
PubMed1996

A randomized, controlled trial of amitriptyline in the acute treatment of adolescent major depression.

OBJECTIVE: To determine amitriptyline's (AMI) efficacy in the acute treatment of adolescent major depressive disorder (MDD). METHOD: Subjects aged 12 through 17 years meeting Research Diagnostic Criteria for MDD, diagnosed with the Schedule for Affective Disorders and Schizophrenia for School-Age Children (K-SADS), participated in a 2-week placebo-washout followed by an 8-week, randomized, double-blind, parallel-design, placebo-controlled trial of AMI, 5 mg/kg per day. The K-SADS nine-item scale, the Hamilton Depression Rating Scale, and the Clinical Global Impressions rating scale were used as outcome measures. RESULTS: Thirty-one subjects were randomized (18 AMI, 13 placebo). Twenty-two subjects were study completers (12 AMI, 10 placebo). AMI's efficacy was suggested by the Clinical Global Impressions but not the K-SADS-derived data. Perhaps the primary limitation of the current study is its small sample size. CONCLUSION: No definitive recommendation can be made regarding the efficacy of tricyclic antidepressants in the treatment of adolescent MDD.

Adolescent↗
PubMed1996

Childhood and adolescent depression: a review of the past 10 years. Part I.

OBJECTIVE: To qualitatively review the literature of the past decade covering the epidemiology, clinical characteristics, natural course, biology, and other correlates of early-onset major depressive disorder (MDD) and dysthymic disorder (DD). METHOD: A computerized search for articles published during the past 10 years was made and selected studies are presented. RESULTS: Early-onset MDD and DD are frequent, recurrent, and familial disorders that tend to continue into adulthood, and they are frequently accompanied by other psychiatric disorders. These disorders are usually associated with poor psychosocial and academic outcome and increased risk for substance abuse, bipolar disorder, and suicide. In addition, DD increases the risk for MDD. There is a secular increase in the prevalence of MDD, and it appears that MDD is occurring at an earlier age in successive cohorts. Several genetic, familial, demographic, psychosocial, cognitive, and biological correlates of onset and course of early-onset depression have been identified. Few studies, however, have examined the combined effects of these correlates. CONCLUSIONS: Considerable advances have been made in our knowledge of early-onset depression. Nevertheless, further research is needed in understanding the pathogenesis of childhood mood disorders. Toward this end, studies aimed at elucidating mechanisms and interrelationships among the different domains of risk factors are needed.

Adolescent↗
PubMed1996

Childhood and adolescent depression: a review of the past 10 years. Part II.

OBJECTIVE: To review the literature of the past decade covering the assessment, treatment, and prevention of early-onset major depressive disorder (MDD) and dysthymic disorder (DD). METHOD: A computerized search for articles published during the past decade was made, and selected studies are presented. RESULTS: Diagnostic systems and standardized interviews have been developed to reliably assess and diagnose early-onset MDD and DD. To data, few controlled psychotherapeutic trials, in particular cognitive-behavioral therapy (CBT), and one study using fluoxetine have been shown to be efficacious in the acute management of early-onset MDD. While studies of tricyclic antidepressants have shown no difference between medication and placebo, these studies are inconclusive because of the inclusion of small samples and other methodological issues. CBT may also be useful for the prevention of MDD. No studies have been published on maintenance treatment of MDD or the treatment of early-onset DD. CONCLUSIONS: It appears that both pharmacological and psychotherapeutic interventions have a role in the acute treatment of MDD. However, further research on the separate and combined efficacy of these treatments for the acute treatment, maintenance, and prevention of early-onset MDD and DD is needed. The impact of comorbidity and psychosocial consequences of early-onset depression also emphasize the importance of utilizing a multimodal approach to treatment.

Adolescent↗
PubMed1995

Stressful life events and EEG sleep in depressed and normal control adolescents.

EEG sleep measures in 35 depressed and 33 normal control adolescents were examined in relation to stressful life events occurring in the year before sleep studies. There was a significant interaction between stressful life events and diagnostic status for REM latency and total REM time. In the normal controls, the presence of stressful life events was significantly associated with reduced REM latency and increased total REM time. Among the depressed adolescents, there were no significant effects of stressful life events on REM latency or total REM time. The depressed adolescents with no stressful life events (n = 9) had significantly lower REM latency values compared to normal control adolescents with no stressful life events (n = 13)(61.7 +/- 50.0 vs. 132.1 +/- 79.0, p < or = .01). It appears that stressful life events influence at least some measures of adolescent sleep and should be considered in future controlled studies aimed at understanding sleep changes in adolescent depression.

Adolescent↗
PubMed1995

A longitudinal study of prenatal marijuana use. Effects on sleep and arousal at age 3 years.

OBJECTIVE: To test the hypothesis that sleep disruptions would be evident in 3-year-old children with a history of prenatal marijuana exposure. DESIGN: A prospective study using stratified random sampling beginning in the fourth month of pregnancy. Marijuana and other substance use were assessed by interviews at multiple time points. Offspring were followed up through age 3 years with multidomain assessments at fixed time points, including electroencephalographic sleep studies in the newborn period and at age 3 years. SETTING: Primary care, prenatal clinic at a university hospital. SUBJECTS: The sample included 18 children with prenatal marijuana exposure (mean [+/- SD] age, 39.0 +/- 4.4 months) and 20 control children (mean [+/- SD] age, 39.7 +/- 4.4 months). The two groups were similar in relationship to maternal age, race, income, education, or maternal use of alcohol, nicotine, and other substances in the first trimester. MAIN OUTCOME MEASURE: Sleep variables from polysomnographic recordings at age 3 years. RESULTS: Children with prenatal marijuana exposure showed more nocturnal arousals (mean [+/- SD], 8.2 +/- 5.3 vs 3.2 +/- 4.6; P < .003), more awake time after sleep onset (mean [+/- SD], 27.4 +/- 20.0 vs 13.7 +/- 12.4 min; P < .03), and lower sleep efficiency (mean [+/- SD], 91.0 +/- 3.8 vs 94.4 +/- 2.1; P < .03) than did control children. CONCLUSION: Prenatal marijuana exposure was associated with disturbed nocturnal sleep at age 3 years.

Adolescent↗
PubMed1995

Unipolar depression in adolescents: clinical outcome in adulthood.

OBJECTIVE: This study examined the longitudinal clinical course and adult sequelae of adolescent unipolar major depressive disorder (MDD) using a controlled longitudinal design. METHOD: Subjects were 28 adolescents (15.4 +/- 1.3 years) with systematically diagnosed unipolar MDD and 35 group-matched control subjects who participated in a cross-sectional electroencephalogram sleep and neuroendocrine study. Using standardized instruments, interviewers who were blind to subjects' initial diagnoses conducted follow-up clinical assessments 7.0 +/- 0.5 years later in 94% of the original cohort. RESULTS: The depressed group showed high rates of recurrence of MDD episodes during the interval period (69%). They also had elevated rates of new-onset bipolar disorder (19%). Twenty-three percent of subjects with an initial diagnosis of MDD had no additional depressive episodes after the index assessment. The rate of new onset of depression in the controls was 21%. Low socioeconomic status predicted recurrence of depressive episodes in the MDD group. MDD subjects with recurrence(s) and controls with new onset of depression during the follow-up period had significant psychosocial morbidity, as evidenced by disruption in interpersonal relationships and dissatisfaction with life and decrease in global functioning, compared with both MDD subjects with no further episodes and control subjects who had never been psychiatrically ill. These psychosocial deficits persisted remission from depressive episode(s). CONCLUSIONS: Adolescent unipolar MDD predicts continued risk for recurrences with persistence of depressive episodes and psychosocial morbidity into adulthood. A sizable minority, however, have sustained periods of remission associated with good social adjustment.

Adolescent↗
PubMed1995

Stressful life events in depressed adolescents: the role of dependent events during the depressive episode.

OBJECTIVE: To examine the relationship between stressful life events and major depressive disorder (MDD) in adolescents. METHOD: Adolescents (aged 12 to 18 years) with a current episode of MDD based on Research Diagnostic Criteria (n = 39) and normal controls free of any Axis I lifetime psychiatric disorder (n = 35) were assessed using the Life Events Record. RESULTS: MDD and normal control adolescents had similar rates of total stressful life events in the year before being interviewed. Stressful life events were dichotomized into those that were most likely either independent of or dependent on the adolescent's influence/behavior. Depressed adolescents had significantly more dependent stressful life events during the previous year than did the normal controls. Further analyses showed that depressed adolescents with dependent stressful life events scored lower on symptom clusters and accordingly were less severely depressed than depressed adolescents without dependent life events. CONCLUSIONS: The results of this study indicate that depressed adolescents have an increased risk for experiencing dependent life events. Furthermore, these data suggest that dependent life events in depressed adolescents are differentially associated with the type and severity of symptom presentation. The temporal occurrence, severity, and type of stressful life events as they relate to the onset, phenotypic expression, and maintenance of depression in adolescents need to be more fully understood.

Adolescent↗
PubMed1995

A case-control family history study of depression in adolescents.

OBJECTIVE: To examine whether depression aggregates in the families of depressed adolescents and to determine whether clinical features and/or comorbid syndromes in the depressed adolescents change the risk of psychopathology in relatives. METHOD: Lifetime prevalence rates of psychopathology in the first-degree (n = 228) and second-degree (n = 736) relatives of 76 adolescents with major depressive disorder (MDD) and the first-degree (n = 107) and second-degree (n = 323) relatives of 34 normal control adolescents were assessed by the Family History-Research Diagnostic Criteria (FH-RDC) method using the parent/guardian as the family informant. RESULTS: Compared with the first-degree relatives of normal controls, the relatives of depressed adolescents had significantly higher lifetime rates of MDD (25% versus 13%) and "any" of the FH-RDC psychiatric disorders (53% versus 36%). The second-degree relatives of adolescents with MDD had significantly higher lifetime rates of FH-RDC "other" psychiatric disorder (12% versus 7%) and "any" of the FH-RDC psychiatric disorders (22% versus 15%) but not MDD (5% versus 6%) compared with the relatives of normal controls. The first-degree relatives of depressed adolescents who were also suicidal had increased lifetime rates of suicidal behavior which significantly cosegregated with MDD. Comorbid conduct disorder in the depressed adolescent was associated with increased rates of antisocial personality disorder in the first-degree relatives and also tended to cosegregate with MDD. CONCLUSIONS: The current study provides further evidence for the familial aggregation of depression in adolescent-onset MDD. This study also suggests that the familial aggregation of nonaffective psychiatric disorders depends on the clinical features and comorbid syndromes present in the depressed adolescent proband.

Adolescent↗
PubMed1994

Cellular immunity in depressed, conduct disorder, and normal adolescents: role of adverse life events.

OBJECTIVE: To determine whether adolescents with major depressive disorder have disturbances in their cellular immunity and to study whether the immunological changes detected are specific to depression or are general responses to stress. METHOD: Twenty subjects with major depressive disorder, 17 nondepressed subjects with conduct disorder, and 17 normal adolescents were recruited. Subjects were assessed with a clinical interview for DSM-III-R and a modified version of the Coddington Life Events Checklist. Blood samples were drawn for total white blood cells, lymphocytes subsets, natural killer cell activity, lymphocyte proliferation response to phytohemagglutinin, and cortisol plasma levels. RESULTS: Overall, there were no significant between-group differences in any of the cellular immune measurements. Natural killer cell activity was significantly negatively correlated with past year and lifetime adverse life events across all effector-target cell ratios. Controlling for diagnoses and socioeconomic status yielded similar results. There were no significant effects of age, sex, race, sleep, nutrition, cigarette use, menstrual cycle, or cortisol on any of the immunological variables. CONCLUSIONS: In this sample of adolescents, we found that independent of the diagnoses and socioeconomic status, increases in adverse life events were associated with low natural killer cell activity.

Adolescent↗
PubMed1993

The psychosocial functioning and family environment of depressed adolescents.

OBJECTIVE: This study examined measures of functional impairment and family relations in a sample of 62 adolescents with major depressive disorder (MDD) and 38 normal controls with no history of psychiatric illness. METHOD: Ratings of the following domains were obtained: mother-child relations, father-child relations, spousal relations, sibling relations, peer relations, and school performance. Ratings of each domain for the 3-month period preceding the assessment were derived from information obtained using a semistructured interview administered independently to the adolescents and one of their parents. RESULTS: Adolescents with MDD were found to have severe difficulties in all areas. Ninety percent of the depressed adolescents had scores greater than 2 SD above the mean of the normal controls on one or more of the domain ratings. In addition, adolescents with difficulties in parent-child relations were more likely than those adolescents without problems in family relations to have difficulties in peer relations and school performance. CONCLUSIONS: The authors discuss the importance of systematically examining psychosocial variables in future studies of the etiology, course, and treatment of MDD in adolescents.

Adolescent↗
PubMed1992

Nocturnal urinary excretion of 6-hydroxymelatonin sulfate in prepubertal major depressive disorder.

Levels of the melatonin metabolite, 6-hydroxymelatonin sulfate, were measured in overnight urine from 31 prepubertal children with major depressive disorder and 15 normal control children with very low family loading for affective disorder. The two groups did not differ with regard to their nocturnal excretion of this compound, nor was any depressive subgroup identified whose 6-hydroxymelatonin sulfate excretion differed from that of the control group. Previous studies of pineal function in depression are reviewed and discussed in the context of the present investigation.

Adolescent↗
PubMed1992

Dexamethasone suppression test in children with major depressive disorder.

The authors report a study of 24-hour serial cortisol determinations, measured during baseline and after the administration of 0.25 and 0.5 mg of dexamethasone in a sample of predominantly outpatient children with major depressive disorder, nonaffective psychiatric controls, and normal controls. In this sample, 24-hour baseline cortisol and the dexamethasone suppression test (DST) do not discriminate between the three groups. In addition, the authors measured 24-hour serum dexamethasone levels. There were no significant between group differences in serum dexamethasone. These results raise questions as to the utility of this test in the diagnosis of affective disorders in children. Possible reasons for the discrepancies in the dexamethasone suppression test results between in- and outpatient studies are discussed.

Administration, Oral↗
PubMed1992

A secular increase in child and adolescent onset affective disorder.

Both longitudinal and cross-sectional studies utilizing population and family study samples have found evidence for a secular increase in major affective disorders in adults. Applying techniques used in cross-sectional studies in adults to family study data of children and adolescents, the authors demonstrate evidence of a parallel secular increase for child and adolescent onset affective disorders. Normal and depressed prepubertal probands were identified. All full siblings were directly interviewed for lifetime episodes of affective disorder. Analysis of the siblings (probands not further analyzed in this article) by the Cox proportional hazards model demonstrates that the risk for affective disorder is higher in siblings born more recently.

Bias↗
PubMed1992

Regulation of sleep and growth hormone in adolescent depression.

This article reviews findings of sleep, growth hormone (GH), and cortisol measures from a number of separate controlled studies of prepubertal and adolescent depression carried out by Puig-Antich and colleagues since 1978. New data are presented comparing 24-hour GH measures in adolescents with major depressive disorder (MDD) (N = 44; mean age = 14.8 +/- 2.0) to normal control adolescents (N = 37; mean age = 15.3 +/- 1.5). There were no significant overall group differences in summary GH measures between MDD and normal controls. Splitting the MDD group on the basis of suicidality (definite plan or attempt) (N = 20), revealed a significant blunting of sleep GH compared to the nonsuicidal group (N = 24). These results are discussed in the context of the other sleep and neuroendocrine findings in this population, with evidence for dysregulation around sleep onset. The influences of development on sleep and GH regulation are also considered.

Adolescent↗
PubMed1992

Corticotropin releasing hormone stimulation test and nocturnal cortisol levels in normal children.

This study examined hypothalamic-pituitary-adrenal axis functioning in a group (n = 25) of very carefully screened normal children with considerable attention to issues of adaptation and procedural stress. The subjects (mean age 10.3 +/- 1.6 y) were selected as "supernormal" controls as a part of a large psychobiologic study of childhood depression. After careful acclimatization over 24 h, the subjects underwent all-night sampling of plasma cortisol every 20 min, then the following evening had a corticotropin releasing hormone (CRH) stimulation test (using human CRH). Human CRH resulted in a rapid stimulation of adrenocorticotropin and cortisol. Adrenocorticotropin levels increased from 6.8 +/- 3.5 (+/- SD) pmol/L (30.7 +/- 16.1 pg/dL) to a peak of 11.6 +/- 5.5 pmol/L (52.9 +/- 24.8 pg/mL) at 15 min with return to baseline levels by 60 min. Cortisol levels increased from 131.4 +/- 59.7 nmol/L (4.8 +/- 2.2 micrograms/dL) to a peak of 427.0 +/- 113.5 nmol/L (15.5 +/- 4.1 micrograms/dL) at 30 min with return to baseline by 120 min. The cortisol peak was significantly greater (p less than 0.05) in boys [474.6 +/- 129.7 nmol/L (17.2 +/- 4.7 micrograms/dL)] than in girls [366.9 +/- 52.4 nmol/L (13.3 +/- 1.9 micrograms/dL, p less than 0.05)]. Age, body mass index, and pubertal status were not significantly related to hypothalmic-pituitary-adrenal axis measures. Nocturnal cortisol reached a nadir at 160 +/- 60 min after sleep onset (0102 h) and a peak 480 +/- 60 min after sleep onset (0612 h). Nocturnal cortisol levels were significantly (positively) correlated with human CRH-stimulated cortisol (r = 0.56, p = 0.004).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗