The Noonday Demon (86 page)

181
The comparison of children with a depressed mother and children with a schizophrenic
mother is in Anne Riley’s NIMH grant proposal entitled “Effects on children of treating maternal depression,” page 32.

181
The problems of attention deficit disorder, separation anxiety, conduct disorder, and increased somatic complaints are described in Leonard Milling and Barbara Martin’s essay “Depression and Suicidal Behavior in Preadolescent Children” in Walker and Roberts’s
Handbook of Clinical Child Psychology,
pages 319–39. Also see Dr. David Fassler and Lynne Dumas’s monograph on childhood depression entitled
Help Me, I’m Sad: Recognizing, Treating, and Preventing Childhood Depression.

182
Sameroff’s work on two-to-four-year-old children of depressed mothers is in Sameroff et al., “Early development of children at risk for emotional disorder,”
Monographs of the Society for Research in Child Development
47, no. 7 (1982).

182
The study on high blood pressure is in A. C. Guyton et al., “Circulation: Overall regulation,”
Annual Review of Physiology
34 (1972), edited by J. M. Luck and V. E. Hall. The information cited here is in the table on page 12.

183
Anaclitic depression is outlined by René Spitz, “Anaclitic Depression,”
Psychoanalytic Study of the Child
2 (1946). For a case example, see René Spitz et al., “Anaclitic Depression in an Infant Raised in an Institution,”
Journal of the American Academy of Child Psychiatry
4, no. 4 (1965).

183
My description of “failure to thrive” is taken from oral interviews with Paramjit T. Joshi at Johns Hopkins and Deborah Christie at the Adolescent Medical Unit at University College London and Middlesex Hospital.

184
The study that came up with the 1 percent statistic is E. Poznanski et al.’s “Childhood depression: Clinical characteristics of overtly depressed children,”
Archives of General Psychiatry
23 (1970). The study that came up with the 60 percent statistic is T. A. Petti’s “Depression in hospitalized child psychiatry patients: Approaches to measuring depression,”
Journal of the American Academy of Child Psychiatry
22 (1978).

184
The figures on child suicide are taken from Leonard Milling and Barbara Martin’s essay “Depression and Suicidal Behavior in Preadolescent Children” in Walker and Roberts’s
Handbook of Clinical Child Psychology,
page 328. According to statistics for 1997, from the NIMH’s Web site, suicide was the third leading cause of death for children aged ten to fourteen.

185
That tricyclics are not effective in children and adolescents is reported in N. D. Ryan et al., “Imipramine in adolescent major depression: Plasma level and clinical response,”
Acta Psychiatrica Scandinavica
73 (1986). There are fewer studies concerning MAOIs and child and adolescent depression, largely because, as Christopher Kye and Neal Ryan write in “Pharmacologic Treatment of Child and Adolescent Depression,”
Child and Adolescent Psychiatric Clinics of North America
4, no. 2 (1995), these drugs “require an especially high sensitivity for the impulsivity, compliance, and maturity of the depressed adolescent,” page 276. The general idea held by most clinicians today is nicely summed up in Paul Ambrosini, “A review of the pharmacotherapy of major depression in children and adolescents,”
Psychiatric Services
51, no. 5 (2000). He writes that the studies to date “could suggest that affective disorders among children and adolescents represent a distinct biological entity that has a differing response pattern to pharmacotherapy,” page 632.

187
The course of life depression for those who have been depressed as children is described in Myrna Weissman et al., “Depressed Adolescents Grown Up,”
Journal of the American Medical Association
281, no. 18 (1999), pages 1707–13.

187
Only in the post-Freudian world have many of the questions surrounding childhood
depression finally been asked. While childhood depression is now well documented as a clinical reality, the numbers seem to surge during adolescence. Myrna Weissman et al. write in their article “Depressed Adolescents Grown Up,”
Journal of the American Medical Association
281, no. 18 (1999), “It is now clear that major depressive disorder often has an onset in adolescence.” That approximately 5 percent of teens suffer from depression is an oft-cited statistic; I have taken it from Patricia Meisol’s “The Dark Cloud,” published in the May 1, 1999, edition of
The Sun.

187
I recommend strongly the video
Day for Night: Recognizing Teenage Depression,
produced by the Depression and Related Affective Disorders Association (DRADA) working in cooperation with the Johns Hopkins University School of Medicine. It is an eloquent and inspiring record of the kinds of depression that afflict young people today.

187
That parents underestimate the depression of their children can be adduced from a number of studies and statistics. One such statistic, from Howard Chua-Eoan, “How to Spot a Troubled Kid,”
Time
153, no. 21 (1999), is that “57% of teens who had attempted suicide were found to be suffering from major depression. But only 13% of the parents of suicides believed their child was depressed.” Pages 46–47.

187
The statistic for suicidal thoughts among high school students is from George Colt’s
The Enigma of Suicide,
page 39.

187
Pioneering work done by Myrna Weissman and others has begun to shed light on the clinical reality of childhood and adolescent depression. Many researchers are beginning to look at the long-term effects of early diagnosis. The article “Depressed Adolescents Grown Up,” coauthored by Weissman and published in
The Journal of the American Medical Association
281, no. 18 (1999), notes: “The major findings are a poor outcome of adolescent-onset Major Depressive Disorder and the continuity and specificity of MDD arising in and continuing into adulthood.” Page 1171.

188
The multiplicand for the correlation between early depression and adult depression is in Eric Fombonne’s essay “Depressive Disorders: Time Trends and Possible Explanatory Mechanisms,” in Michael Rutter and David J. Smith’s
Psychosocial Disorders in Young People,
page 573.

188
The figure of 70 percent is from Leonard Milling and Barbara Martin’s essay “Depression and Suicidal Behavior in Preadolescent Children,” in Walker and Roberts’s
Handbook of Clinical Child Psychology,
page 325.

188
The idea that sexual abuse causes depression is discussed in Jill Astbury’s
Crazy for You,
pages 159–91. Gemma Gladstone et al., “Characteristics of depressed patients who report childhood sexual abuse,”
American Journal of Psychiatry
156, no. 3 (1999), discusses sexual abuse as an indirect cause of depression, pages 431–37.

188
The Russian orphanage adoption story was recounted in Margaret Talbot, “Attachment Theory: The Ultimate Experiment,”
New York Times Magazine,
May 24, 1998.

189
That the elderly depressed are undertreated is indicated by a number of articles and studies, both academic and popular. Sara Rimer explores the various causes and consequences in “Gaps Seen in Treatment of Depression in Elderly,”
New York Times,
September 5, 1999. In the article, Dr. Ira Katz, director of geriatric psychiatry at the University of Pennsylvania School of Medicine, is quoted as saying, “More than one in six older patients who go to a primary-care doctor’s office have a clinically significant degree of depression, but only one in six of those get adequate
treatment.” George Zubenko et al.’s “Impact of Acute Psychiatric Inpatient Treatment on Major Depression in Late Life and Prediction of Response,”
American Journal of Psychiatry
151, no. 7 (1994), explains, “It has been observed that recognition of major depression in the elderly is hampered because depressed mood seems less prominent in older patients than among younger adults. Moreover, the increasing burden of physical disorders with increasing age complicates the differential diagnosis of major depression in the elderly, especially when a cross-sectional assessment is made.”

189
Emil Kraepelin’s comments on the elderly depressed are in C. G. Gottfries et al., “Treatment of Depression in Elderly Patients with and without Dementia Disorders,”
International Clinical Psychopharmacology,
suppl. 6, no. 5 (1992).

189
On the idea that older people in nursing homes are twice as likely to be depressed as those living in their own communities, see
Ibid.

189
On the suggestion that one-third of nursing-home residents are depressed, see
Ibid.

189
On the social dimensions of elderly depression and the importance of having a good friend, see Judith Hays et al., “Social Correlates of the Dimensions of Depression in the Elderly,”
Journal of Gerontology
53B, no. 1 (1998).

189
That levels of neurotransmitters are low in the elderly is confirmed in C. G. Gottfries et al., “Treatment of Depression in Elderly Patients with and without Dementia Disorders,”
International Clinical Psychopharmacology,
suppl. 6, no. 5 (1992).

189
On the comparative levels of serotonin in the very elderly, see
Ibid.

189
That the diminution of serotonin through natural aging does not necessarily have immediate dire consequences is proposed by a number of studies. B. A. Lawlor et al.’s “Evidence for a decline with age in behavioral responsivity to the serotonin agonist, m-chlorophenylpiperazine, in healthy human subjects,”
Psychiatry Research
29, no. 1 (1989), eloquently states: “The functional significance of alterations in brain serotonin (5HT) associated with normal aging in both animals and humans is largely unknown.”

189
The information on the delayed response to antidepressants among the elderly is in George Zubenko et al., “Impact of Acute Psychiatric Inpatient Treatment on Major Depression in Late Life and Prediction of Response,”
American Journal of Psychiatry
151, no. 7 (1994).

190
On the success rate for treatment of depression among the elderly, see
Ibid.

190
On prescription of short-term hospitalization for the elderly depressed, see
Ibid.

190
The symptoms of depression among the elderly are described in Diego de Leo and René F. W. Diekstra’s
Depression and Suicide in Late Life,
pages 21–38.

190
The term “emotional incontinence” is used in Nathan Herrmann et al., “Behavioral Disorders in Demented Elderly Patients,”
CNS Drugs
6, no. 4 (1996).

192
The role of depression in predicting Alzheimer’s and senility is discussed in Myron Weiner et al., “Prevalence and Incidence of Major Depression in Alzheimer’s Disease,”
American Journal of Psychiatry
151, no. 7 (1994).

192
On serotonin levels in Alzheimer’s patients, see
Ibid.

193
Work on whether lowered levels of serotonin may cause dementia is to be found in Alan Cross et al., “Serotonin Receptor Changes in Dementia of the Alzheimer Type,”
Journal of Neurochemistry
43 (1984), and Alan Cross, “Serotonin in Alzheimer-Type Dementia and Other Dementing Illnesses,”
Annals of the New York Academy of Sciences
600 (1990).

193
On the effect of SSRIs on intellectual and motor skills, see C. G. Gottfries et al., “Treatment of Depression in Elderly Patients with and without Dementia Disorders,”
International Clinical Psychopharmacology,
suppl. 6, no. 5 (1992).

193
M. Jackuelyn Harris et al.’s “Recognition and treatment of depression in Alzheimer’s disease,”
Geriatrics
44, no. 12 (1989), is my source on long-term use of low dosages of SSRIs. They write, “Generally, Alzheimer’s patients require lower dosages of medication and longer drug treatment trials than younger patients treated for depression.” Page 26.

193
Use of trazodone and benzodiazepines for depression in the elderly is described in Nathan Herrmann et al., “Behavioral Disorders in Demented Elderly Patients,”
CNS Drugs
6, no. 4 (1996).

193
On proposal of hormone therapies for sexual aggressivity in Alzheimer’s, see
Ibid.