DEPRESSION IN
Renato
COCCHI, neurologist and medical psychologist
Summary.
The clinical records of Ss, who had
specific antidepressant therapies added
to usual drug therapies, were
retrieved from a consecutive not selected
series of clinical records on 510
home reared Down's syndrome individuals.
The
records of 45 Ss (
The
M/F ratio of these 45 Ss was found inverted in comparison with the normal male prevalence among Down Ss, and an
anticipation of age of the onset of depression was observed in females.
The specific antidepressant drugs used,
were viloxazine, as the first choice drug in 38 Ss,
amitryptiline (6 Ss),
fluoxetine (2 Ss),
clomipramine (2 Ss), nortryptiline (2 Ss) and imipramine (1 S). Six cases, 5
treated by viloxazine and 1 by fluoxetine, had these
drugs substituted by another antidepressant.
Key
words: Down's syndrome; depression; epidemiology;
gender prevalence; symptoms; drug
therapy.
Drug modulation of stress reaction
Surely clinicians have paid attention to
coming out of depression and to its diagnosis in individuals with mental
retardation. If we consider the language and communication deficits in this
group, their lack of social skills and
socialisation, it becomes obvious that all the marks of loneliness are
present. So the mentally retarded, without any doubt has the risk of developing
mood troubles (Wells and Duncan 1980, Matson, 1982; Schloss 1982; Menolascino,
1990).
After study decades, we just have scarce
doubts that mentally retarded are can have and in facts suffer from affective
troubles. That so, even if we must ask
ourselves if they show all the range of mood troubles found in the general
population (Fleisher and Weiler, 1990).
According to Dosen, 1990, depression in
children with mental retardation has the same nurobiological and psychological
base of depression in normal children.
The illness can come out independently from sex, age and IQ, even if age
and IQ can influence its appearance, or these can modify it.
Since the end of the years 70 I was involved
in depression in mentally retarded people, either from a therapeutic point of
view (Cocchi and Occhialini, 1981 and 1982) and drug therapy in the Down syndrome of Down. So. On one hand I
became very sensitive to this problem, and on the other I could collect a large
own and usable casuistry for specific investigations.
Materials and methods.
I reexamined the clinical reports
belonging to 510 Down subjects raised in their families, coming from all
Italian regions and being a consecutive non selected series of patients visited from the January 1979 and March 31,
1994.
From these reports I excluded those belonging
to subjects with autism (DSM-III, R: 290.00).
Among the remaining ones I selected the
clinical reports of the subjects in whom I
prescribed a tricyclic or an atypical antidepressant drug. Even if they
own some antidepressant actions, I did not consider therapies made by glutamine, or S-adenosil-l-methionine, or
5-hydroxytriptophan, or carbamazepine or more than one of these drugs
contemporarily prescribed.
From the case reports so selected, then I
collected:
-
sex;
-
chromosomal diagnoses;
-
age at the first consultation (in months);
-
age (always in months) of the appearance of the symptoms that forced me to
prescribe of a specific antidepressant drug;
-
meaningful symptoms;
-
current therapy when the depression had its diagnosis;
-
antidepressants used with their daily doses.
Collected data had descriptive statistical
elaboration and analysed with the
Results.
Following the above defined criteria I found
out 45 records that are 8.82% of the whole series.
The
sex distribution was:
I
summarized these results in the tables no. 1-9.
Table 1: Distribution of chromosomal
diagnoses.
|
Chromosomal anomaly |
M |
% |
F |
% |
Total |
% |
|
Standard Trisomy 21 |
13 |
76.48 |
25 |
89.29 |
38 |
84.44 |
|
Translocations |
0 |
0.00 |
2 |
3.57 |
1 |
2.22 |
|
Mosaicisms |
2 |
11.76 |
1 |
3.57 |
3 |
6.67 |
|
Not known |
2 |
11.76 |
1 |
3.57 |
3 |
6.67 |
|
Totals |
17 |
100.00 |
28 |
100.00 |
45 |
100.00 |
Chi Square = 1.268 with 3 df; p = 1.00.
Table2: Average age, in months, as divided by gender.
|
Age |
M |
F |
|
Average |
138.24 |
87.50 |
|
SD |
108.58 |
55.52 |
|
minimum |
23 |
5 |
|
maximum |
474 |
231 |
The showy difference of the age at first
consultation is surely casual and due to a large extent from the presence of
range limits, mainly maximums, very different, by having a larger weight in the
average calculation.
Table 3: Average
gender age (in months) when
the
antidepressant drug was prescribed.
|
Age |
M |
F |
|
Average |
187.65 |
140.48 |
|
SD |
89.11 |
35.54 |
|
Minimum |
103 |
65 |
|
Maximum |
474 |
231 |
In spite of the bias made by a male subject nearly 40 years old, I dare
strongly suggest that Down females had reduced
ages when the depressive picture became evident.
Table 4: Depressive symptoms not controlled by
the current therapy
|
Symptom |
M |
F |
||
|
|
Ss nr. |
% |
Ss nr. |
% |
|
Sadness |
10 |
58.82 |
18 |
66.67 |
|
Poor playing and social interest |
8 |
47.06 |
13 |
48.15 |
|
Irritability |
8 |
47.06 |
8 |
29.63 |
|
Low self-esteem |
7 |
41.18 |
8 |
29.63 |
|
Aggression |
6 |
35.29 |
3 |
11.11 |
|
Reduced use of the speech |
6 |
35.29 |
8 |
29.63 |
|
Crying without any reason |
0 |
0.00 |
6 |
22.22 |
|
Crying after frustration |
4 |
23.53 |
3 |
11.11 |
|
Spitefulness |
4 |
23.53 |
0 |
0.00 |
|
React. Depres. (by his father’s death) |
1 |
5.88 |
0 |
0.00 |
|
Bedwetting |
1 |
5.88 |
4 |
14.81 |
|
Brothers’ or sisters’ jealousy |
0 |
0.00 |
3 |
11.11 |
|
Eyelash and/or hair pulling |
0 |
0.00 |
2 |
7.41 |
Chi Square (only for the 8 common symptoms): 4.898,
with 7 df, p = 0.732 N.S.
There
is not any significant difference on the presence of 8 common symptoms. Of the
five uncommon ones, two pertain only to males (spitefulness and reactive
depression) and the three others only to females (weeping without any apparent
cause, jealousy, eyelash and/or hair pulling).
Table 5: Drugs
prescribed in males before adding the antidepressant drug.
|
Prescribed drug |
Mg/die (*) |
Ss nr. |
% |
|
S-adenosil-L-methionine |
100 |
11 |
64.71 |
|
Folates |
7.5 |
11 |
64.71 |
|
Carbamazepine |
100-200 |
9 |
52.94 |
|
Diazepam |
1-2.5 |
8 |
47.06 |
|
Pyridoxina |
150 |
8 |
47.06 |
|
Pyritinol |
50-100 |
6 |
35.29 |
|
Bromazepam |
0.5-1.5 |
5 |
29.41 |
|
Vit.s B1+B6+B12 |
125+125+mcg500 |
5 |
29.41 |
|
l-glutamine + pemoline |
45+5 – 90+10 |
5 |
29.41 |
|
l-glutammne |
125-250 |
3 |
17.65 |
|
Delorazepam |
0.5 |
2 |
11.76 |
|
A polyvitaminic drug (Berocca TM) |
|
2 |
11.76 |
|
Alpha-tocopherol |