Posted by Scott L. Schofield on March 7, 2000, at 8:48:48
In reply to Re: Childhood disorders that disappear at puberty..., posted by Janet on March 3, 2000, at 17:32:28
Janice:
I am very curious about one of my sisters. Up until puberty, she had a terrible temper, was violent, was unsuccessful socially both shy and awkward), and had no childhood friends. At about puberty, whatever it was seemed to disappear.
ChrisK:
My sister had the same type of response to puberty. In Elementary School she was what I would describe as Social Phobic. Once she got into 7th grade (about puberty time), she became very social and outgoing. It may very well be a hormonal thing as in my case, being a male, my depression only got worse after puberty.
Janice:
Are there other disorders that fizzle out just after puberty (around 15 or 16)?
Sarah:
I've done ALOT of research on ADHD. Alot of children that have it all their childhood will "grow out of it" during puberty. (wish I had been one!) It seems that girls have a higher chance of that than boys, though.Janice:
My sister was a bitch (I was just looking for a more mature way of saying this). It must have been ADHD - everyone else in the family has it (except for a sister and father). Lucky her, she grew out of it. As for me and my brother, we were very sweet children although a little hyper. My emotional problems became way worse at puberty.Puberty seems to be a real marker for mental illnesses.
Janet:
My bi-polar really showed up at puberty but I had no idea what it was. I thought I was just being the life of the party, ending up ailienating myself from a lot of people. I'd stay up late, not needing sleep, writing in my journal a lot, acting crazy enough for the school to question if I were on drugs. I questioned the suicidal thoughts, but felt this whole thing must just be part of being a teenager. The manic felt great but for some reason I was alone in it, which was lonely. At about 18 yrs everything stopped until I was 33 yrs when I went full blown manic and had to be hospitalized. I've been medicated ever since.
Scott:
Things began to turn foul for me at puberty also. At first, it seemed like dysthymia and gradually became worse episodically. However, The "Big Bang" didn't hit me until age 17. Many people who I have come across have recounted similar stories.Until recently, I don't think there has been enough attention paid to the role that hormones play, particularly sex hormones, in the causes and course of affective-spectrum disorders. These would include depression, bipolar-disorder, dysthymia, cyclothymia, social anxiety disorder (social phobia}, aggression etc. Having said that, one can find many studies in the medical literature dealing with this. It just hasn't seemed to be addressed regularly and accounted for in the vast majority of investigations, and has not trickled-down into clinical practice.
In the case of Joyce's sister, I believe that there is a strong association between her experience and the fact that many women who suffer from treatment-resistant depression find that their mood improves dramatically during pregnancy, only to relapse into severe depression postpartum. Additionally, many women without depressive disorders experience a profound postpartum depression. Relatedly, changes in mood are linked to the menstrual cycle. Depression and irritability, aggression, and even suicidality, are some of the symptoms often seen premenstrually (PMS).
The common variable here seems to be the changes in the levels of estrogen. Estrogen levels are increased during pregnancy and drop precipitously after birth. Similarly, levels of estrogen are lowest during the few days prior to the onset of bleeding during the menstrual cycle. In both scenarios, the changes in estrogen levels coincide with occurrence of depression and other affective-symptoms. It would seem that an increase in estrogen relieves depression while a decrease precipitates or worsens it.
Estrogens modify the concentration and the density of adrenergic, noradrenergic and dopaminergic receptors in limbic structures, an area thought to be involved in mood-illness. Studies have shown that serotonin systems are also affected by estrogen. It is not so surprising that SSRI (selective serotonin reuptake inhibitors) antidepressants are frequently used successfully to treat PMS.
Estrogen is often used as a treatment for depression. It has been used as monotherapy, but it is used more often as an augmentation strategy in combination with antidepressants or mood-stabilizers. Contraceptive drugs are used sometimes to treat PMS as well as depression. In this way, it might act as a prophylactic against future recurrence of depression. Perhaps it is estrogen that is responsible for the higher rate of spontaneous resolution of ADD in females as indicated by Sarah.
In females, puberty signals the point at which estrogen production increases, along with an increase in the numbers and sensitivity of estrogen receptors. This might account for the improvements in affective temperament seen in the case of Janice's sister.
As far as males are concerned, the increase in the levels of testosterone, an androgenic anabolic steroid, may be one of the factors contributing to the onset of depression or bipolar disorder at puberty. It is well know that some bodybuilders and athletes have used testosterone and synthetic androgens to increase muscle-mass along with strength. It is also well known that depression, irritability, and aggression are frequent side-effects of these steroids. One may conclude that increased levels of testosterone in males at puberty is responsible for the onset of affective illness at that time.
I'm sure that things are not so simple. Puberty in females is often associated with the onset of depression. In males, there are many cases of depression that are associated with low levels off testosterone, and in which the addition of testerone has let to improvement.
In the population, the rate of depression in females is significantly greater than that in males. This fact would seem to support the idea that increased levels of estrogen, as opposed to decreased levels, is the cause for this difference. However, there are so many other biological variables that are obviously associated with mood-disorders, that it is unlikely that any one of them by itself is fully responsible for producing them.
- Scott
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Psychol Med 1999 Sep;29(5):1043-53Pubertal changes in hormone levels and depression in girls.
Angold A, Costello EJ, Erkanli A, Worthman CM Department of
Psychiatry and Behavioral Sciences, Duke University Medical
Center, NC 27710, USA.BACKGROUND: Throughout their reproductive years, women suffer from
a higher prevalence of depression than men. Before puberty,
however, this is not the case. In an earlier study, we found that
reaching Tanner Stage III of puberty was associated with increased
levels of depression in girls. This paper examines whether the
morphological changes associated with puberty (as measured by
Tanner stage) or the hormonal changes underlying them are more
strongly associated with increased rates of depression in
adolescent girls. METHODS: Data from three annual waves of
interviews with 9 to 15-year-olds from the Great Smoky Mountains
study were analysed. RESULTS: Models including the effects of
testosterone and oestradiol eliminated the apparent effect of
Tanner stage. The effect of testosterone was non-linear. FSH and
LH had no effects on the probability of being depressed.
CONCLUSIONS: These findings argue against theories that explain
the emergence of the female excess of depression in adulthood in
terms of changes in body morphology and their resultant
psychosocial effects on social interactions and self-perception.
They suggest that causal explanations of the increase in
depression in females need to focus on factors associated with
changes in androgen and oestrogen levels rather than the
morphological changes of puberty.
poster:Scott L. Schofield
thread:25354
URL: http://www.dr-bob.org/babble/20000302/msgs/26221.html