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This Month in Archives of General Psychiatry
March 2002

This Month in Archives of General Psychiatry

Arch Gen Psychiatry. 2002;59(3):211. doi:10.1001/archpsyc.59.3.211

Family and twin studies suggest that early-onset and later-onset major depressive disorder (MDD) may have distinct etiologies and correlates. In a prospective study of a birth cohort followed until age 26 years, Jaffee et al Article found that those whose MDD onset was in childhood (before age 15 years) experienced higher levels of early childhood psychosocial risks compared with those whose MDD onset was in adulthood(ages 18-26 years), including perinatal insults and motor skills deficits, caretaker instability, and psychopathology in their family of origin, and behavioral and socioemotional problems. Those with adult-onset MDD experienced similarly low levels of risk as the never-depressed group (with the exception of elevated childhood sexual abuse).

A commentary by Myrna M. Weissman Article is included.

Fergusson and Woodward Article used data gathered over the course of a 21-year longitudinal study to examine the continuities and consequences of adolescent (ages 14-16 years) depression. Results suggested the presence of 2 major pathways linking early depression to later outcomes. First, there was a direct linkage between early depression and increased risks of later depression or anxiety disorders. Second, the associations between early depression and other outcomes (substance dependence, educational underachievement, suicide attempts, unemployment, and early parenthood) were explained by confounding social, family, and individual factors.

Thase et al Article studied the utility of a switch across antidepressant classes in 168 chronically depressed patients who had not responded to 12 weeks of double-blind therapy with imipramine hydrochloride or sertraline hydrochloride. Results indicated a significant tolerability advantage for the selective serotonin reuptake inhibitor, but the drugs had comparable efficacy after taking attrition rates into account.

The stress-diathesis model predicts that the magnitude of stress at illness onset should be inversely proportional to the level of underlying diathesis. Kendler et al Article were unable to confirm 3 predictions of the stress-diathesis model for phobias in more than 7500 epidemiologically sampled twins. No relationship was found between the severity of trauma at onset of phobias (a measure of stress) and2 indices of the diathesis: risk of phobias in co-twin or level of the personality trait of neuroticism. These results are more consistent with nonassociative models of phobia acquisition than with traditional etiologic theories involving conditioning or social transmission.

Serotonin reuptake inhibitor (SRI) medications are effective for both major depressive disorder (MDD) and obsessive-compulsive disorder (OCD), but there has been scant evidence as to whether they had the same or different effects on brain function in these 2 disorders. Saxena et al Article found that pretreatment to posttreatment changes in brain glucose metabolism differed significantly between 3 groups of subjects (OCD alone, MDD alone, and concurrent OCD + MDD) that were treated with the same dose of the SRI, paroxetine, and between responders and nonresponders. These findings suggest that the effects of SRIs on brain activity are both disorder specific and response specific.

Improving the discovery and evaluation of psychotropic drugs would have enormous scientific, economic, and public health implications. Klein et al Article present many technical recommendations that could be currently effected by institutional leaders. However, some substantive suggestions require increased resources, both scientific and clinical, as well as federal initiatives to establish a proactive, pharmacological development agency.

Commentaries by Paul Leber Article and Alan J. Gelenberg Article are included.

Carpenter Article describes the growing concern with commercialism in the creation and dissemination of therapeutic knowledge. He specifies sources of relatively unbiased appraisal of clinical trials and notes a discordance in this information and industry-sponsored education regarding pharmacotherapy of schizophrenia. Carpenter provides specific suggestions for addressing potential commercial bias in psychopharmacology research and education.