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August 1982, Vol 39, No. 8 >
Article | August 1982

Sleep Architecture and REM Sleep Measures in Prepubertal Children With Major Depression: Title and subTitle BreakA Controlled Study

Joaquim Puig-Antich, MD; Raymond Goetz, MA; Cleo Hanlon, MS; Mark Davies, MPH; John Thompson; William J. Chambers, MD; Mary Ann Tabrizi, RN; Elliot D. Weitzman, MD
[+] Author Affiliations

Accepted for publication March 30, 1982.

Reprints not available.


Arch Gen Psychiatry. 1982;39(8):932-939. doi:10.1001/archpsyc.1982.04290080046007
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• We performed a three-night polysomnographic study of 54 rigorously assessed, drug free, prepubertal children who fit unmodified Research Diagnostic Criteria for major depressive disorder, and two groups of nondepressed controls (25 with emotional disorders and 11 who were normal). The groups did not differ polysomnographically, even though a high proportion of depressives and neurotics reported sleep disturbance in structured interviews. Sleep stage data do not appear to differentiate children with prepubertal major depressive disorders from nondepressed neurotic or normal children. Other psychobiologic findings in prepubertal depressives together with marked age effects on polysomnographic correlates of adult major depressive disorders suggest the hypothesis that polysomnographic abnormalities in adult major depressives are secondary to an interaction between depression and age.

REFERENCES

1 +
Gillin JC, Duncan W, Pettigrew KD, et al:  Successful separation of depressed, normal, and insomniac subjects by EEG sleep data . Arch Gen Psychiatry 1979;;36:85-90.
2 +
Kupfer D: REM latency:  A psychobiological marker for primary depressive disease . Biol Psychiatry 1976;;11:159-174.
3 +
Vogel GW, Vogel F, McAbee RS, et al:  Improvement of depression by REM sleep deprivation: New findings and a theory . Arch Gen Psychiatry 1980;;37:247-253.
4 +
Coble P, Kupfer DJ, Spiker DG, et al:  EEG sleep and clinical characteristics in young primary depressives . Sleep Res 1980;;9:165.
5 +
Kupfer D, Foster FG:  EEG sleep and depression , in Williams RL, Karacan I (eds): Sleep Disorders: Diagnosis and Treatment . New York, John Wiley & Sons Inc, 1979;, pp 163-203.
6 +
Campbell JC:  Manic-depressive disease in children . JAMA 1955;;158:154-157.
7 +
Campbell JC:  Manic-depressive psychoses in children: Report of 18 cases . J Nerv Ment Dis 1952;;116:424-439.
8 +
Cytryn L, McKnew DJ:  Proposed classification of childhood depressions . Am J Psychiatry 1972;;129:149-155.
9 +
Frommer E:  Depressive disorders of childhood . Br J Psychiatry ( (special issue) ), 1968;, pp 117-136.
10 +
Ling W, Oftedal G, Weinberg WA:  Depressive illness in children presenting a severe headache . Am J Dis Child 1970;;120:122-124.
11 +
Weinberg WA, Rutman J, Sullivan L, et al:  Depression in children referred to an educational diagnostic center: Diagnosis and treatment . J Pediatr 1973;;83:1065-1072.
12 +
Welner Z, Welner A, McCray MD, et al:  Psychopathology in children of inpatients with depression: A controlled study . J Nerv Ment Dis 1977;;164:408-413.
13 +
Kupferman S, Stewart MA:  The diagnosis of depression in children . J Affect Dis 1979;;1:213-217.
14 +
Carlson GA, Cantwell DP:  A survey of depressive symptoms in a child and adolescent psychiatric population . J Am Acad Child Psychiatry 1979;;18:587-599.
15 +
Carlson GA, Cantwell DP: Diagnosis of childhood depression: A comparison of Weinberg and DSM-III criteria. J Am Acad Child Psychiatry, in press. Read before the American Psychiatric Association Annual Meeting, San Francisco, 1980.
16 +
Carlson GA, Cantwell DP:  Unmasking masked depression in children and adolescents . Am J Psychiatry 1980;;137:445-449.
17 +
Rutter M, Tizard J, Whitmore K: Education, Health and Behavior . New York, Longman Inc, 1970;.
18 +
Pearce JB:  Childhood depression , in Rutter M, Hersov L (eds): Child Psychiatry . Oxford, Blackwell Scientific Publications, 1977;, pp 447-448.
19 +
Kovacs M, Beck AT:  An empirical-clinical approach toward a definition of childhood depression , in Schulterbrandt JG, Raskin A (eds): Depression in Childhood . New York, Raven Press, 1977;, pp 1-25.
20 +
Puig-Antich J, Blau S, Marx N, et al:  Prepubertal major depressive disorder: Pilot study . J Am Acad Child Psychiatry 1978;;17:695-707.
21 +
Spitzer RL, Endicott J, Robins E:  Research Diagnostic Criteria: Rationale and reliability . Arch Gen Psychiatry 1978;;35:773-782.
22 +
Cytryn L, McKnew D, Bunney W:  Diagnosis of depression in children: Reassessment . Am J Psychiatry 1980;;137:22-25.
23 +
American Psychiatric Association, Committee on Nomenclature and Statistics: Diagnostic and Statistical Manual of Mental Disorders . Washington, DC, American Psychiatric Association, 1980;.
24 +
Kane J, Coble P, Conners CK, et al:  EEG sleep in a child with severe depression . Am J Psychiatry 1970;;134:813-814.
25 +
Williams RL, Karacan I, Hursch C: EEG of Human Sleep: Clinical Applications . New York, John Wiley & Sons Inc, 1974;, pp 37-47.
26 +
Kupfer DJ, Coble P, Kane J, et al:  Imipramine and EEG sleep in children with depressive symptoms . Psychopharmacology 1979;;60:117-123.
27 +
Hirsch M, Paez P, Chambers W, et al: A test-retest reliability study of the K-SADS-P. Read before the Annual Meeting of the American Academy of Child Psychiatry, Chicago, Oct 19, 1980.
28 +
Lukens E, Puig-Antich J, Behn J, et al: Reliability of the psychosocial schedule for school age children. J Am Acad Child Psychiatry, in press.
29 +
Puig-Antich J, Chambers WJ, Tabrizi MA: The clinical assessment of current depressive episodes in children and adolescents: Interviews with parents and children, in Cantwell D, Carlson G (eds): Childhood Depression. Jamaica, New York, Spectrum Publications, in press.
30 +
Marshall WA, Tanner JM:  Variations in pattern of pubertal changes in girls . Arch Dis Child 1969;;44:291-303.
31 +
Marshall WA, Tanner JM:  Variations in pattern of pubertal changes in boys . Arch Dis Child 1970;;45:13-23.
32 +
Rechtschaffen A, Kales A (eds): A Manual of Standardized Terminology, Techniques and Scoring System for Sleep Stages of Human Subjects . Los Angeles, Brain Information Service/Brain Research Institute, University of California, 1968;.
33 +
Puig-Antich J:  Affective disorders in childhood: review and perspective . Psychiatr Clin North Am 1980;;3:403-424.
34 +
Strober M, Burroughs J, Salkin B, et al: Ancestral secondary cases of psychiatric illness in adolescents with mania, depression, schizophrenia and conduct disorder. Biol Psychiatry, in press.
35 +
Puig-Antich J, Tabrizi MA, Davies M, et al:  Prepubertal endogenous major depressives hyposecrete growth hormone in response to insulin induced hypoglycemia . J Biol Psychiatry 1981;;16:801-818.
36 +
Gruen PH, Sachar EJ, Altman N, et al:  Growth hormone responses to hypoglycemia in postmenopausal depressed women . Arch Gen Psychiatry 1975;;32:31-33.
37 +
Grégoire F, Branman G, DeBuck R, et al:  Hormone release in depressed patients before and after recovery . Psychoneuroendocrinology 1977;;2:303-312.
38 +
Puig-Antich J, Perel JM, Lupatkin W, et al:  Plasma levels of imipramine and desmethylimipramine and clinical response in prepubertal major depressive disorder: A preliminary report . J Am Acad Child Psychiatry 1979;;18:1616-1627.
39 +
Poznanski EO, Carroll BJ, Bauagsa ME, et al:  The dexamethasone suppression test in prepubertal depressed children Am J Psychiatry 1982;;139:321-324.
40 +
Puig-Antich J, Chambers W, Halpern F, et al:  Cortisol hypersécrétion in prepubertal depressive illness . Psychoneuroendocrinology 1979;;4:191-197.
41 +
Ulrich R, Shaw DH, Kupfer DJ:  The effects of aging on sleep . Sleep 1980;;3:31-40.
42 +
Gillin JC, Duncan WC, Murphy DL, et al:  Age related changes in sleep in depressed and normal subjects . Psychiatry Res 1981;;4:73-78.
43 +
Coble P, McPartland RJ, Silva WJ, et al:  Is there a first night effect?  (A revisit). Biol Psychiatry 1974;;9:215-219.
44 +
Orvaschel H, Puig-Antich J, Chambers WJ, et al: Retrospective assessment of child psychopathology with the K-SADS-E. J Am Acad Child Psychiatry, in press.
45 +
Borkovec TD:  Pseudo (experiential)-insomnia and idiopathic (objective) insomnia: Theoretical and therapeutic issues . Behav Res Ther 1979;;2:27-55.

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1 +
Gillin JC, Duncan W, Pettigrew KD, et al:  Successful separation of depressed, normal, and insomniac subjects by EEG sleep data . Arch Gen Psychiatry 1979;;36:85-90.
2 +
Kupfer D: REM latency:  A psychobiological marker for primary depressive disease . Biol Psychiatry 1976;;11:159-174.
3 +
Vogel GW, Vogel F, McAbee RS, et al:  Improvement of depression by REM sleep deprivation: New findings and a theory . Arch Gen Psychiatry 1980;;37:247-253.
4 +
Coble P, Kupfer DJ, Spiker DG, et al:  EEG sleep and clinical characteristics in young primary depressives . Sleep Res 1980;;9:165.
5 +
Kupfer D, Foster FG:  EEG sleep and depression , in Williams RL, Karacan I (eds): Sleep Disorders: Diagnosis and Treatment . New York, John Wiley & Sons Inc, 1979;, pp 163-203.
6 +
Campbell JC:  Manic-depressive disease in children . JAMA 1955;;158:154-157.
7 +
Campbell JC:  Manic-depressive psychoses in children: Report of 18 cases . J Nerv Ment Dis 1952;;116:424-439.
8 +
Cytryn L, McKnew DJ:  Proposed classification of childhood depressions . Am J Psychiatry 1972;;129:149-155.
9 +
Frommer E:  Depressive disorders of childhood . Br J Psychiatry ( (special issue) ), 1968;, pp 117-136.
10 +
Ling W, Oftedal G, Weinberg WA:  Depressive illness in children presenting a severe headache . Am J Dis Child 1970;;120:122-124.
11 +
Weinberg WA, Rutman J, Sullivan L, et al:  Depression in children referred to an educational diagnostic center: Diagnosis and treatment . J Pediatr 1973;;83:1065-1072.
12 +
Welner Z, Welner A, McCray MD, et al:  Psychopathology in children of inpatients with depression: A controlled study . J Nerv Ment Dis 1977;;164:408-413.
13 +
Kupferman S, Stewart MA:  The diagnosis of depression in children . J Affect Dis 1979;;1:213-217.
14 +
Carlson GA, Cantwell DP:  A survey of depressive symptoms in a child and adolescent psychiatric population . J Am Acad Child Psychiatry 1979;;18:587-599.
15 +
Carlson GA, Cantwell DP: Diagnosis of childhood depression: A comparison of Weinberg and DSM-III criteria. J Am Acad Child Psychiatry, in press. Read before the American Psychiatric Association Annual Meeting, San Francisco, 1980.
16 +
Carlson GA, Cantwell DP:  Unmasking masked depression in children and adolescents . Am J Psychiatry 1980;;137:445-449.
17 +
Rutter M, Tizard J, Whitmore K: Education, Health and Behavior . New York, Longman Inc, 1970;.
18 +
Pearce JB:  Childhood depression , in Rutter M, Hersov L (eds): Child Psychiatry . Oxford, Blackwell Scientific Publications, 1977;, pp 447-448.
19 +
Kovacs M, Beck AT:  An empirical-clinical approach toward a definition of childhood depression , in Schulterbrandt JG, Raskin A (eds): Depression in Childhood . New York, Raven Press, 1977;, pp 1-25.
20 +
Puig-Antich J, Blau S, Marx N, et al:  Prepubertal major depressive disorder: Pilot study . J Am Acad Child Psychiatry 1978;;17:695-707.
21 +
Spitzer RL, Endicott J, Robins E:  Research Diagnostic Criteria: Rationale and reliability . Arch Gen Psychiatry 1978;;35:773-782.
22 +
Cytryn L, McKnew D, Bunney W:  Diagnosis of depression in children: Reassessment . Am J Psychiatry 1980;;137:22-25.
23 +
American Psychiatric Association, Committee on Nomenclature and Statistics: Diagnostic and Statistical Manual of Mental Disorders . Washington, DC, American Psychiatric Association, 1980;.
24 +
Kane J, Coble P, Conners CK, et al:  EEG sleep in a child with severe depression . Am J Psychiatry 1970;;134:813-814.
25 +
Williams RL, Karacan I, Hursch C: EEG of Human Sleep: Clinical Applications . New York, John Wiley & Sons Inc, 1974;, pp 37-47.
26 +
Kupfer DJ, Coble P, Kane J, et al:  Imipramine and EEG sleep in children with depressive symptoms . Psychopharmacology 1979;;60:117-123.
27 +
Hirsch M, Paez P, Chambers W, et al: A test-retest reliability study of the K-SADS-P. Read before the Annual Meeting of the American Academy of Child Psychiatry, Chicago, Oct 19, 1980.
28 +
Lukens E, Puig-Antich J, Behn J, et al: Reliability of the psychosocial schedule for school age children. J Am Acad Child Psychiatry, in press.
29 +
Puig-Antich J, Chambers WJ, Tabrizi MA: The clinical assessment of current depressive episodes in children and adolescents: Interviews with parents and children, in Cantwell D, Carlson G (eds): Childhood Depression. Jamaica, New York, Spectrum Publications, in press.
30 +
Marshall WA, Tanner JM:  Variations in pattern of pubertal changes in girls . Arch Dis Child 1969;;44:291-303.
31 +
Marshall WA, Tanner JM:  Variations in pattern of pubertal changes in boys . Arch Dis Child 1970;;45:13-23.
32 +
Rechtschaffen A, Kales A (eds): A Manual of Standardized Terminology, Techniques and Scoring System for Sleep Stages of Human Subjects . Los Angeles, Brain Information Service/Brain Research Institute, University of California, 1968;.
33 +
Puig-Antich J:  Affective disorders in childhood: review and perspective . Psychiatr Clin North Am 1980;;3:403-424.
34 +
Strober M, Burroughs J, Salkin B, et al: Ancestral secondary cases of psychiatric illness in adolescents with mania, depression, schizophrenia and conduct disorder. Biol Psychiatry, in press.
35 +
Puig-Antich J, Tabrizi MA, Davies M, et al:  Prepubertal endogenous major depressives hyposecrete growth hormone in response to insulin induced hypoglycemia . J Biol Psychiatry 1981;;16:801-818.
36 +
Gruen PH, Sachar EJ, Altman N, et al:  Growth hormone responses to hypoglycemia in postmenopausal depressed women . Arch Gen Psychiatry 1975;;32:31-33.
37 +
Grégoire F, Branman G, DeBuck R, et al:  Hormone release in depressed patients before and after recovery . Psychoneuroendocrinology 1977;;2:303-312.
38 +
Puig-Antich J, Perel JM, Lupatkin W, et al:  Plasma levels of imipramine and desmethylimipramine and clinical response in prepubertal major depressive disorder: A preliminary report . J Am Acad Child Psychiatry 1979;;18:1616-1627.
39 +
Poznanski EO, Carroll BJ, Bauagsa ME, et al:  The dexamethasone suppression test in prepubertal depressed children Am J Psychiatry 1982;;139:321-324.
40 +
Puig-Antich J, Chambers W, Halpern F, et al:  Cortisol hypersécrétion in prepubertal depressive illness . Psychoneuroendocrinology 1979;;4:191-197.
41 +
Ulrich R, Shaw DH, Kupfer DJ:  The effects of aging on sleep . Sleep 1980;;3:31-40.
42 +
Gillin JC, Duncan WC, Murphy DL, et al:  Age related changes in sleep in depressed and normal subjects . Psychiatry Res 1981;;4:73-78.
43 +
Coble P, McPartland RJ, Silva WJ, et al:  Is there a first night effect?  (A revisit). Biol Psychiatry 1974;;9:215-219.
44 +
Orvaschel H, Puig-Antich J, Chambers WJ, et al: Retrospective assessment of child psychopathology with the K-SADS-E. J Am Acad Child Psychiatry, in press.
45 +
Borkovec TD:  Pseudo (experiential)-insomnia and idiopathic (objective) insomnia: Theoretical and therapeutic issues . Behav Res Ther 1979;;2:27-55.

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