Certain Factors in Youth May Prolong Depression

Many young people who experience a major depression get over it a few weeks later. Others, however, do not. Why do these youngsters remain in the clutches of gloom?

A new study out of England and published in the September 1 Biological Psychiatry provides some insight. The investigation was conducted by Ian Goodyer, M.D., and his colleagues in the departments of psychiatry and anatomy at the University of Cambridge.

On the basis of their previous research, Goodyer and his coworkers had reason to suspect that being an adolescent rather than a child when major depression strikes, that experiencing emotionally traumatic life events after the major depression develops, having obsessive-compulsive disorder comorbid with the depression, or excreting excessive amounts of cortisol in the evening are some of the elements that might transform a major depression into a chronic state. The researchers decided to test their hypothesis by comparing the presence of the suspected risk factors in youngsters whose major depression didn’t remit before 72 weeks with their presence in youngsters whose major depression lifted earlier.

Of 104 8- to-16-year-olds who agreed to enter the study, 53 remained in the study for the duration of the 72-week study. All 53 were assessed at the start of the study for the presence of major depression, the presence of other psychiatric disorders, nighttime secretion levels of cortisol, and whether they were currently experiencing any emotionally upsetting life events such as failing an exam, having a romance break up, or being in an accident or a community disaster. At 36 weeks and 72 weeks into the study, the 53 subjects were again assessed for the same factors.

At the end of the 72-week period, 27 of the 53 subjects were found to have recovered from their major depression, 20 not to have recovered, and the remaining six to have recovered from depression, but to have acquired another psychiatric disorder. These six were thus dropped from the study, leaving 47 subjects.

Comparing data for the 27 recovered subjects and the 20 with persistent depression, the researchers found that the latter had been significantly older at the start of the study—that is, 13 years of age or older on average. The researchers also found that the persistently depressed subjects had been significantly more likely to have obsessive-compulsive disorder at the start of the study. Also, the chronically depressed youngsters secreted more nighttime cortisol at the start of the study, during the study, and at the end of the study than had the recovered youngsters. And finally, the unrelentingly depressed young people had experienced more emotionally upsetting life events in the months following their major depression than had the young people who got better.

Upon further statistical analysis of their data, the researchers found that the best predictors of what turns an acute major depression into a chronic major depression in childhood seem to be being a teenager and experiencing emotionally traumatic life events after the depression begins.

The Cambridge scientists also speculated on how these various risk factors might lead to a major depression’s becoming an unrelenting depression. For instance, elevated levels of cortisol are known to be capable of impairing memory. A youngster with a major depression and elevated cortisol levels, for example, might have a distorted memory that might lead to blaming himself or herself for any negative events experienced, thus amplifying or prolonging his or her depression. A youngster with both major depression and an obsessive-compulsive disorder might have a tendency to brood about any negative events he or she experiences, thus intensifying and prolonging the depression.

Psychiatric News asked Elizabeth Weller, M.D., a professor of psychiatry and pediatrics at the University of Pennsylvania and a childhood depression authority, for her opinion of the research by Goodyer and colleagues.

“This is a well-designed and well-executed study,” she said. “[However,] the high rate of subject attrition, which is not unusual in studies with youth, and thus the small sample size make it hard to generalize about the importance of the findings.”

This research was supported by a grant from the Wellcome Trust.

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