Faculty Bibliography

BACKGROUND: Increased systemic cytokine levels, modulators of the immune system, have been repeatedly documented in adult and adolescent major depressive disorder (MDD). This preliminary study extends this work to test the role of cytokines in suicidal symptomatology in adolescent MDD. Hypotheses were that acutely suicidal depressed adolescents would have: (1) increased plasma levels of interferon-gamma (IFN-gamma), tumor necrosis factor-alpha (TNF-alpha), interleukin-6 (IL-6), and IL-1beta, and (2) a proinflammatory/antiinflammatory cytokine imbalance (indexed by plasma IFN-gamma/IL-4), compared to nonsuicidal depressed adolescents and healthy controls. METHODS: Twelve suicidal adolescents with MDD (7 females [58%]; 5 medication-free/naive), 18 nonsuicidal adolescents with MDD (12 females [67%]; 8 medication-free/naive), and 15 controls (8 females [53%]) were enrolled. MDD had to be of at least 6 weeks duration, with a minimum severity score of 40 on the Children's Depression Rating Scale-Revised. Plasma cytokines were examined using enzyme-linked immunosorbent assays. Nonparametric tests were used to compare subject groups. RESULTS: Unexpectedly, suicidal adolescents with MDD had significantly decreased plasma TNF-alpha concentrations compared to nonsuicidal adolescents with MDD (1.33 +/- 2.95 pg/mL versus 30.9 +/- 110.9 pg/mL; p = 0.03). IFN-gamma was increased in both suicidal and nonsuicidal adolescents with MDD compared to controls (2.14 +/- 6.22 and 4.20 +/- 14.48 versus 0.37 +/- 0.64; p < 0.02, p = 0.005). Findings remained evident when controlled for age and gender. CONCLUSIONS: Our preliminary findings suggest that immune system dysregulation may be associated with suicidal symptomatology in adolescent MDD. These findings should be replicated in larger samples with medication-free adolescents

BACKGROUND: A large body of evidence suggests that immune system dysregulation is associated with Major Depressive Disorder (MDD) in adults. This study extends this work to adolescent MDD to examine the hypotheses of immune system dysregulation in adolescents with MDD, as manifested by significantly: (i) elevated plasma levels of cytokines (interferon [IFN]-gamma, tumor necrosis factor-alpha, interleukin [IL]-6, IL-1beta, and IL-4); and (ii) Th1/Th2 cytokine imbalance shifted toward Th1 as indexed by increased IFN-gamma/IL-4. METHOD: Thirty adolescents with MDD (19 females; 13 medication-free/naive; ages 12-19) of at least 6 weeks duration and a minimum severity score of 40 on the Children's Depression Rating Scale-Revised, and 15 healthy comparisons (8 females), group-matched for age, were enrolled. Plasma cytokines were examined using enzyme-linked immunosorbent assay. Mann-Whitney test was used to compare subjects with MDD and controls. RESULTS: Adolescents with MDD had significantly elevated plasma IFN-gamma levels (3.38+/-11.8 pg/ml versus 0.37+/-0.64 pg/ml; p<0.003), and IFN-gamma/IL-4 ratio (16.6+/-56.5 versus 1.76+/-2.28; p=0.007). A trend for IL-6 to be elevated in the MDD group was also observed (1.52+/-2.88 pg/ml versus 0.49+/-0.90 pg/ml; p=0.09). Importantly, findings remained evident when medicated subjects were excluded. CONCLUSIONS: Findings suggest that immune system dysregulation may be associated with adolescent MDD, with an imbalance of Th1/Th2 shifted toward Th1, as documented in adult MDD. Larger studies with medication-free adolescents should follow

Reviews the book, The invisible man. A self-help guide for men with eating disorders, compulsive exercise, and bigorexia by John F. Morgan (see record 2007-18411-000). Dr. Morgan's The Invisible Man is a self-help guide tailored for those men struggling with eating disorders and body image disorders. Dr. Morgan, the author of multiple previous scientific publications on eating disorders and body image issues, is the head of Yorkshire Center for Eating Disorders in the United Kingdom. In this book Dr. Morgan argues that the majority of previous research, outreach, and treatment with regards to eating disorders have been focused on women. He has written The Invisible Man as a resource for the growing number of boys and men who are suffering from eating disorders and body image issues. In his book, Morgan targets a male audience. He provides easy to understand psychoeducation about these illnesses and he introduces cognitive behavioral and motivational treatments to help guide his reader toward recovery. The book follows a logical organization that accomplishes Dr. Morgan's apparent goal of providing information to the reader about the identification, diagnosis, and treatment of eating disorders and body image issues in men. Dr. Morgan has produced an important contribution to the therapeutic community by providing a book for men and their families who may have otherwise suffered alone and in silence. He covers a great deal of useful information in a relatively brief book, though there are some weaknesses to note. Overall, this is a clearly written book that could be very be helpful for men struggling with eating disorders and body image issues. As the title outlines, this book is a 'self-help' book written for a male audience.

In June 2003, the manufacturer of paroxetine (Paxil) submitted data to the British equivalent of the United States Food and Drug Administration which unexpectedly included the finding that the risk of suicidality was greater in children and adolescents treated with paroxetine than in those given placebo. This event set into motion a cascade of investigations and review of prior studies resulting in the FDA conclusion that the risk of suicidal thinking and behavior (collectively referred to as suicidality) was 4% in children and adolescents treated with antidepressants and 2% in those on placebo. In October 2004, a black-box warning was issued regarding use of all antidepressants in children and adolescents. While this may result in better selection and monitoring of depressed young people, it may also lead to undue reluctance to prescribe antidepressants, resulting in an increase in the morbidity and mortality of a very serious illness. There is a growing literature demonstrating the efficacy of selective serotonin reuptake inhibitors (SSRIs) in the treatment of children and adolescents with depression. Guidelines regarding the safe use of SSRIs and a call to action regarding research are presented. (journal abstract)