In This Issue

About half of 127 children meeting criteria for psychiatric diagnoses at age 3 received diagnoses again at age 6, and half of those with psychiatric diagnoses at age 6 also had disorders at age 3. Bufferd et al. (CME, p. 1157) recorded increases in depression and attention deficit hyperactivity disorder (ADHD) and a decrease in generalized anxiety disorder between ages 3 and 6. Disorders most likely to remain constant were ADHD, oppositional defiant disorder, and anxiety disorders. The six cases of depression at age 3 were gone at age 6, but several of these children developed anxiety disorders or oppositional defiant disorder. Switches also occurred from anxiety or ADHD to oppositional defiant disorder and from oppositional defiant disorder to ADHD. This continuity of mental disorders in young children, states Luby in an editorial (p. 1127), presents a valuable public health opportunity.

Brain-derived neurotrophic factor (BDNF), which regulates nerve cell growth and function, may provide keys to depression pathology and new antidepressants. Tripp et al. (p. 1194) detected low levels of the primary BDNF receptor in the subgenual anterior cingulate cortex of depressed individuals. The region also had low expression of genes with high and intermediate degrees of BDNF dependency, including several genes affecting γ-aminobutyric acid (GABA), a neurotransmission inhibitor. The review by Kavalali and Monteggia (CME, p. 1150) describes ketamine’s downstream effects on BDNF that account for its rapid antidepressant effect. Antidepressants without ketamine’s side effects might be found in compounds that selectively suppress spontaneous synaptic glutamate release, not release evoked by neuronal activity. Such medications may need to be sex-specific, notes Kerman in an editorial (p. 1137), given the sex-related differences in BDNF abnormalities in brain limbic circuitry.