The consistency of a mother’s signals to her infant before and after delivery may affect the offspring’s later vulnerability to mental disorders. Baram et al. (p. 907) note that mental development was greater in 1-year-old infants whose mothers were depressed both before and after delivery than in infants whose mothers were depressed during only one of these periods. Effects of fragmented care are evident in rodents when the overall quantity of maternal care remains constant but the pattern or sequence of care is disrupted.
Patients treated in dynamic psychotherapy for depressive, anxious, or personality disorders were assessed by Perry and Bond (CME, p. 916) over the course of their 5-year therapy for their use of defense mechanisms. Patients generally progressed from immature defenses, such as acting out, image distortion, and disavowal, to more neurotic defenses, such as displacement, dissociation, and intellectualization, and then to highly adaptive defenses, such as sublimation and humor. However, the majority of defenses remained below the healthy-neurotic range. Sexual abuse and witnessing violence were associated with slower improvement. Changes in defenses at 2.5 years were associated with improvement in functioning and symptoms at 5 years (figure). In an editorial, Vaillant (p. 885) recommends streamlining the hierarchy and including a control condition in testing, to achieve a clinically useful instrument.
Antidepressants often take several weeks to work, but depressed women who took the antidepressant escitalopram plus 5 g/day of creatine monohydrate, a supplement that increases cellular energy, had earlier and greater symptom decreases than women who took escitalopram plus placebo. Lyoo et al. (p. 937) found a difference by the second week of treatment, and the remission rate at 8 weeks was twice as high for the creatine group (52%) as for the placebo group (26%). Most side effects were attributed to escitalopram, not creatine, but serum creatinine was elevated in the treatment group. The editorial by Strakowski (p. 891) cites the focus on brain bioenergetics as an example of translating neuroscience advances into clinical research.