TIME Mental Illness

Depression Is a Risk Factor for Dementia, New Research Says

The two have been linked before, but the new study says depression may be an independent risk factor for the disease

The link between depression and dementia is puzzling for researchers. Many studies have noticed a correlation between the two diseases and a 2013 review of 23 studies of about 50,000 older men and women reported that older adults suffering from depression were more than twice as likely to develop dementia and 65% more likely to develop Alzheimer’s. But these have often only been associations. The newest study, published Wednesday in the journal Neurology, takes it further. The researchers believe that their findings, while not definitive, show that depression is in fact an independent risk factor for dementia — and not the other way around.

Researchers looked at 1,764 people with no memory problems around age 77 and followed them for about eight years. They discovered that people with mild cognitive decline as well as people with dementia were likely to have higher levels of depression symptoms before they were diagnosed, and that having these symptoms was associated with a greater decline in memory. Depression symptoms, the researchers estimated, accounted for 4.4% of the difference in memory decline that could not be caused by brain damage.

The reasons for the link between the two diseases are more unclear. Some research suggests that people with depression may have high levels of hormones that interfere with the region of the brain responsible for learning and memory aptitude. Gary Kaplan, an osteopath who runs the Kaplan Center for Integrative Medicine, as well as a handful of other researchers, has another theory: that inflammation caused by hyperreactivity of immune cells can hinder blood flow to — and impact neural pathways in — the brain.

Kaplan, who was not involved in this research, views depression as a symptom of inflammation in the nervous system, and not a disease in itself. “Depression is manageable,” says Kaplan. “We can modify risk for depression by lowering neuroinflammation. And these findings are completely consistent with depression as an inflammatory disease.”

It’s also possible that depression adds stress to the brain, and that can play a role in its deterioration.

If it was possible that treating depression could curb dementia risk, that would be game changing, medically speaking. That hasn’t been proved yet, but it’s an active area of research. The Mayo Clinic recommends that patients opt for treatments that are safe for both issues — for instance, taking antidepressants for depression, though “these medications may not be as effective at treating depression with Alzheimer’s as they are at treating depression alone,” they write. Kaplan thinks treating depression can be done with practices like meditation and getting more sleep — activities thought to calm the brain and improve overall brain health.

If the new research is right, finding new ways to treat depression may have an impact on dementia risk — even if it’s small.

TIME Mental Illness

Schizophrenia Linked to 108 Genes

In a groundbreaking study, researchers reveal a host of new genes involved in schizophrenia, making it possible to develop desperately needed treatments

It took 80,000 genetic samples, seven years and the work of 300 scientists from around the world, but scientists now have the most complete dossier on schizophrenia ever.

In an historic paper published in the journal Nature, the Schizophrenia Working Group of the Psychiatric Genomics Consortium identified 108 new regions on the genome linked to the psychiatric disorder, which is associated with hallucinations and psychotic episodes and affects about 1% of people worldwide.

The genetic clues are the most dramatic hints that experts have gotten so far about what causes that mental illness. Schizophrenia has had a rocky history in the psychiatric community, with some doctors early on not even recognizing it as a disorder, and others debating whether its origins were biological or caused by traumatic events or other experiences. Now, by comparing the genomes of people with and without the disorder, it’s clear that at least some of the psychotic symptoms can be traced to changes in the genes.

“For the first time, we are starting to see the underlying biological basis of the disease, and that can lay the foundation for understanding the disorder, and eventually developing treatments,” said Eric Lander, founding director of the Broad Institute of MIT and Harvard, where about one third of the DNA samples were sequenced.

MORE: Older Fathers Linked to Kids’ Autism and Schizophrenia Risk

The study used genome wide association, a technique that sequences the genomes of affected and unaffected individuals, and then compares where they differ. Those DNA differences may be hints about why people develop schizophrenia in the first place, and therefore lead to new drugs or treatments.

The 108 genetic regions aren’t all located in specific genes, nor is it known yet if this is what actually causes schizophrenia. But, like evidence at a crime scene, they may point to certain molecular pathways that are responsible for the mental illness. It’s already known that some of the identified regions, for example, are involved in how adaptable or plastic the brain is, and in regulating the immune system, a connection that experts have previously not investigated before. Other genes may also reveal new ways to potentially treat the disease, a significant improvement over the existing therapies, which only address one brain system, involving dopamine. “Thorazine was approved in 1954 as the first anti-psychotic medication, and every antipsychotic since then has relied on the same fundamental mechanism of action,” Steve Hyman, director of the Broad Institute’s Stanley Center for Psychiatric Research and professor of stem cell and regenerative biology at Harvard University said. “And their efficacy has plateaued since the 1960s.”

MORE: Most Common Psychiatric Disorders Share Genetic Roots

Having a greater suite of potential areas of inquiry, the researchers hope, will attract pharmaceutical companies back to the field of mental illness. “We now have more than 100 genes pointing to distinct pathways – calcium channels, glutamate, the immune system – this is concrete stuff, and it means that the pharmaceutical companies who left [this area of drug development] because they didn’t have anything concrete to work on, are beginning to get their toes in the water, and are thinking of jumping back in the water,” says Lander.

The genetic windfall can also help scientists piece together how genetic changes may work in tandem to cause symptoms of psychoses. They warn that these advances, and new treatments, may not come in the next year, but they may be able to provide better answers to questions about which drugs may work better in which patients, and in finding ways to detect and hold off symptoms of schizophrenia earlier, before they become debilitating. All of the genetic information released in the paper will be deposited in a public database for researchers to access and advance the understanding of the disorder.

TIME PTSD

Here’s What Happens To The Mind After 5 Years of Captivity

Captured US Solider
Sgt. Bowe Bergdahl in an undated image provided by the U.S. Army. U.S. Army/AP

Sgt. Bowe Bergdahl has a lot of healing to do after five years of captivity. The physical scars may fade, but the emotional ones can sometimes be too deep to heal completely

U.S. Army Sergeant Bowe Bergdahl, the last known American POW, was finally returned home over the weekend after five years held in captivity in Afghanistan. Since Bergdahl’s return, curious details have emerged about his mental state before and after capture. And it all begs the question: What does five years in captivity do to the human mind?

Bergdahl’s repatriation is going to be a challenge, and piecing together the psychologically and physically broken veteran is a delicate process. After all, an abduction is the ultimate exchange of power, spurring the start of a complicated relationship based on both deep distrust and reliance, say experts. “He’s to some degree merged with those who held him,” says Brian Engdahl, professor of PTSD Research and Neuroscience at the University of Minnesota. “He was totally dependent on them for food, shelter, clothing. It can reduce a person to a weak state where their entire life revolves around how their captors are treating them.” A morsel of food becomes a generous gift, only to be withheld at the next feeding.

Many POWs find physical and mental strength by relying on their fellow captured soldiers, but Bergdahl was alone. Speculation about whether he suffered from Stockholm Syndrome—the phenomenon where captives identify with their captors—are not unwarranted, though so far evidence hasn’t suggested this to be true.

Studies of POWs from the Korean War show that the psychological injuries from captivity stem from two types of trauma. The first is physical and usually short-term, caused by malnutrition and injury. The more persisting trauma is, of course, psychological. At Landstuhl Regional Medical Center in Germany, which treats U.S. vets from Afghanistan and Iraq, Bergdahl is likely being tested for depression, anxiety, and PTSD, says Engdahl. “Beyond that, he could be feeling deep guilt, shame, bewilderment, and a lost sense of identity,” says Engdahl. If his English is poor, as has been reported, it’s likely from lack of speaking.

Once home, psychological challenges won’t likely abate overnight, says Barbara Rothbaum, the associate vice chair of clinical research in the department of psychiatry at Emory School of Medicine. “But even if the trauma is over, it’s not really over,” she says. POWs often experience flashbacks, and will wake up in the middle of the night thinking they are still in captivity. Many victims become avoidant and don’t want to talk about their experience because they are afraid it will trigger memories, she says. It’s one of the reasons many will forgo treatment.

“I’ve had veterans tell me they were drunk for a year,” says Rothbaum. But avoidance is one of the worst ways to deal with the harsh return, and Rothbaum’s research has shown that talking about experiences early can actually help prevent the onset of PTSD.

“People want to avoid talking about the worst parts, the most shameful, the most embarrassing,” says Rothbaum. “But it will help.”

TIME Crime

Mental-Health Lessons Emerge from Isla Vista Slayings

UCSB Victims Memorial
Jose Cardoso, 50, cries in front of a makeshift memorial for 20-year-old UCSB student Christopher Ross Michaels-Martinez outside a deli in Santa Barbara, Calif., on May 25, 2014 Lucy Nicholson—Reuters

Police missed an opportunity to thwart Elliot Rodger’s plans before he killed six people

When a mad man goes on a killing spree, a few questions immediately bubble to the surface. Who’s to blame? What should we do now? Could this have been prevented?

In the case of Elliot Rodger, who police say killed six people and himself in Isla Vista, Calif., on May 23, there are no definitive answers to any of these questions — at least not yet. But what’s clear is that a few weeks earlier, police missed an opportunity to thwart Rodger’s plans.

On April 30, deputies from the Santa Barbara County Sheriff’s Department, which has jurisdiction in Isla Vista, visited Rodgers at his home to assess his mental state. They had been indirectly summoned there by Rodger’s mother. Reportedly disturbed by videos her son had posted on YouTube, she called a therapist who had been treating him, who called a mental-health hotline, which contacted the authorities. The deputies interviewed Rodger and determined that he was shy, according to Santa Barbara County Sheriff Bill Brown — but polite and did not pose a risk to himself or others. Absent that, they had no legal right to take him into custody. They urged him to call his mother and they left.

In a departing manifesto, Rodger wrote of the April 30 encounter: “For a few horrible seconds I thought it was all over. When they left, the biggest wave of relief swept over me.”

As became painfully clear weeks later, Rodger posed a grave threat. He had recently purchased several guns, along with hundreds of rounds of ammunition. And he had been plotting for several years to exact revenge on “humanity” — particularly women — for rejecting him socially, according to a final YouTube video and a manifesto he wrote before stabbing his two roommates and another man to death and then fatally shooting three others. He wounded 13 more.

A spokeswoman for the Santa Barbara Sheriff has said the department was not aware of Rodger’s YouTube posts until after he went on his killing spree. If they had been, it’s possible the outcome might have been different. “They should have definitely been made aware of those videos in my opinion,” says Kenton Rainey, chief of police for Bay Area Rapid Transit (BART) in San Francisco and a board member at the National Alliance for Mental Illness (NAMI) in California. “It would have been impossible for them to make an informed assessment without those.”

An official from a local chapter of the National Alliance on Mental Illness said there was a program in Santa Barbara County to provide officers with so-called crisis-intervention training (CIT) that has been utilized elsewhere to help officers detect signs of mental illness, but it’s unclear whether the deputies who check on Rodger had received this training. Only about 30 law-enforcement personnel in the entire county receive such crisis intervention training annually, according to the NAMI chapter official.

“Crisis-intervention training is a national movement,” says Dr. Kenneth Duckworth, medical director for NAMI and a professor at Harvard. “But even that may not be enough to respond to this from an upstream perspective.”

If the deputies who met Rodger had been specially trained, it’s possible he could have simply fooled them into thinking he was mentally stable.

“My guess is he was on the best behavior possible for him,” says Kristine Schwarz, executive director of New Beginnings Counseling Center in Santa Barbara. Schwarz, who has no direct knowledge of Rodgers or his mental state adds, “It’s not out of the ordinary or out of the question that somebody could miss something in a wellness check like that. There are always people who are able to present perfectly functional.” Schwarz says law-enforcement officers in Santa Barbara County regularly collaborate with mental-health professionals and appear well trained. “But it depends on the individual law-enforcement officer and the individual client,” she says.

Jessica Cruz, executive director of NAMI California says programs like CIT are helpful, but that “more importantly, we should be able to call somebody other than the police for our loved ones going through a mental-health crisis.” NAMI is among the organizations that regularly lobby to train more mental-health professionals and provide more services, including prevention and treatment. Funding for the latter is often inadequate, says Cruz. California, for example, has less than half the number of hospital beds dedicated to in-patient mental-health care than recommended by a panel of psychiatric experts convened to study the issue.

There have also been efforts to reach more mentally ill people in outpatient settings, but here too, intentions sometimes fall short. Laura’s Law, passed in California in 2002, would allow counties to mandate outpatient treatment for some mentally ill adults, but the law includes no dedicated funding, most counties have not adopted it and the criteria for applying the law is very strict. (Laura’s Law would likely not have applied in Rodger’s case.) Cruz also points to a program in San Diego County that sends mobile teams, including clinicians, to the homes of severely mentally ill people who are reluctant to get treatment. Such non-law-enforcement approaches, if adequately funded, are often more effective, says Cruz.

As for Rodger’s parents, it appears they took appropriate steps to help their son and keep him from hurting others. They called police upon seeing his manifesto and final YouTube video, in which he outlined his plans to “slaughter” sorority members and kill others. They raced to Santa Barbara County in hopes of intervening directly, only to find their son and six others already dead.

“The family did everything they could have done,” says Cruz. “If a family is worried about their loved one and they call who they think they’re supposed to call, what else can you do?”

TIME Mental Illness

Higher Doses of Antidepressants Linked to Suicidal Behavior in Young Patients

A new study based on suicide risk by drug dosage, involving 162,000 patients aged 10 to 64, finds that younger patients starting off with a higher-than-recommended dose of antidepressants have an elevated risk of suicidal behavior

New research on suicide risk by drug dosage has found that doctors should avoid prescribing high quantities of antidepressants to young adults. Younger patients starting off with a higher-than-recommended dose elevated their risk of self-harm compared with those who started at lower doses, according to a study from the JAMA Internal Medicine based on 162,000 patients ages 10 to 64.

Nearly 18% of patients in the study started on doses higher than normal for drugs including Celexa, Zoloft and Prozac. Researchers checked patients’ medical records to see how many had deliberately self-harmed within a year of starting their medications.

Patients younger than 24 taking higher doses harmed themselves more than twice as frequently as those taking lower amounts — 32 incidents of self-harm per 1,000 young patients on high doses, compared with only 15 incidents within the same number on the recommended dose.

“If I were a parent, I definitely wouldn’t want my child to start on a higher dose of these drugs,” study author Dr. Matthew Miller, associate director of Harvard School of Public Health’s Injury Control Research Center in Boston, told WebMD.

TIME Mental Illness

Don’t Blame PTSD for the Fort Hood Shooting

The disorder's link to violence is the first thing we look to when vets are involved in mass shootings, but research in the area is inconsistent and weak

Shortly after America learned of another shooting Wednesday evening at Fort Hood, news outlets flashed alerts about the shooter’s deployment history and mental health. Among the first facts confirmed and reported about Spec. Ivan Lopez were his four-month deployment to Iraq in 2011, and that he was being diagnosed for post-traumatic stress disorder—though, importantly, had not yet been diagnosed. As post-9/11 conflicts wind down and veterans seek to reintegrate into civilian society, reports of violence perpetrated by veterans increasingly focus on whether a former service member has seen conflict and whether he suffers from mental illness as a result.

A 2008 RAND study estimated that 18.5% of combat veterans return with symptoms of PTSD. Most of them, though, with time and support, go on to lead stable, productive lives. For veterans enrolled in treatment programs, the likelihood of successful reintegration is even stronger. But for a slim minority, problems arise.

I am a veteran, having served in Afghanistan with the 82nd Airborne from February 2007 to April 2008. I’ve also been diagnosed with PTSD related to my time in service. (Many vets, myself included, favor the removal of “disorder” from PTSD, our symptoms being a natural human response to what we have experienced.) When mass shootings occur, much too commonly lately, my veteran friends and I always have the same initial reactions. First, a sincere hope that everyone is okay. But immediately after that we think, “Please don’t let it be a veteran.” When Kate Hoit, a 29 year-old Iraq war veteran and graduate student living in Washington, D.C., first heard of the shooting, she thought, “Here we go again with another round of onslaughts on veterans and those with PTSD.” But a strong link between violent crime and PTSD has not been firmly established.

A 2012 study found that 9% of Iraq and Afghanistan war veterans surveyed reported arrests since returning from service. But even with this incidence of arrest, most offenses were associated with nonviolent behavior. It’s also notable that the veterans studied, as well as post-9/11 veterans in general, come from demographics associated with higher rates of criminal behavior (young, male, history of family violence, etc.) that are not related to service. That study concluded that veterans suffering from PTSD are at increased risk for criminal arrests, but those arrests are more strongly linked to substance abuse than a predilection towards violence.

The rush to erroneously blame PTSD for violent veterans has been noted. But available research and increased awareness hasn’t stopped the speculation.

In January of 2012, Iraq war veteran Benjamin Barnes killed a park ranger in Mount Rainier National Park in Washington State and was later found dead in an icy creek. The media was quick to report on his wartime service and speculate that his time there was partially responsible for his crime. Further investigation revealed that Barnes had suffered from mental illness prior to enlisting, and his time in Iraq consisted of service with a headquarters element and no record of direct combat. When Maj. Nadal Hassan opened fire at Fort Hood in 2009, the early reaction was much the same, until it was revealed that the soldier had never seen combat.

Then again, when Aaron Alexis opened fire with a shotgun at Washington, D.C.’s Navy yard, the immediate question was whether he suffered from PTSD from his time in the Navy. CNN’s Peter Bergen even wrote: “It’s a deadly combination: men who have military backgrounds — together with personal grievances, political agendas or mental problems — and who also have easy access to weapons and are trained to use them.” We again later learned that Alexis never saw combat, worked as an aviation electrician’s mate, and was never trained to use a shotgun. Lopez, it should also be noted, never saw combat either.

None of this is to say that there isn’t reason to be concerned for the mental health of veterans. Lopez was reportedly suffering from anxiety and depression and undergoing treatment for mental illness. As the RAND study shows, my community is certainly at an increased risk for mental illness. Every day, 22 Americans who served in uniform take their own lives. Veterans with PTSD are more prone to alcoholism. Drug abuse is also more common in our community. While errant reports portray veterans as volatile community risks, my comrades are far more likely to hurt ourselves than anyone else.

TIME Mental Illness

Rick Warren: Churches Must Do More to Address Mental Illness

Pastor Rick Warren speaks onstage at 'The Bible: SON OF GOD Tour 2014' Kick-Off at Saddleback Church on March 20, 2014 in Lake Forest, Calif.
Pastor Rick Warren speaks onstage at 'The Bible: SON OF GOD Tour 2014' Kick-Off at Saddleback Church on March 20, 2014 in Lake Forest, Calif. Imeh Akpanudosen—Getty Images for Word Entertainment

According to the National Alliance on Mental Illness (NAMI), 60 million Americans experience a mental health condition every year – that’s one in four adults and one in ten children. People of every race, age, religion or economic status are affected. Whether we are aware of it or not, we all know someone who is living with some form of mental illness.

Mental illness is something we are intimately acquainted with as our youngest son, Matthew, struggled with a variety of mental illnesses from a young age. Even as a toddler there were signs that things were not right. At 7, he was diagnosed as clinically depressed which surprised us as we were unaware that children that young could be that depressed. As the years went by, he began to experience major depressive episodes as well as panic attacks, extreme mood swings, obsessions/compulsions, personality disorder, and heartbreaking problems in school and relationships. Life became a painful revolving door of doctor appointments, medication, therapy, and adjustments to school classes. There were periods of relative stability but then Matthew’s suicidal ideation became a part of our daily life. Our hilariously funny, immensely creative, intensely compassionate son struggled to make sense of his life and the mental pain he was experiencing. His anguish was our anguish. On April 5, 2013, impulse met opportunity in a tragic way. Our beautiful son ran into the unforgiving wall of mental illness for the last time.

Nearly a year later, we are still reeling from his death. We’ve been devastated, yet not destroyed. Mental illness took our son’s life, as it did many of the 38,000 other Americans who took their lives last year, but we refuse to let his death be just another statistic. One way we can honor his life and use our grief is to help others living with a mental illness and also their families who suffer. On March 28, we are hosting a one-day event, The Gathering on Mental Health and the Church.

There are hundreds of conferences around the world by health professionals, government officials and NGO’s which address mental illness from medical, social, and policy perspectives, but the Church, with its vast network of volunteers and resources is rarely included in the discussion. What do churches have to offer to the mentally ill and their families in light of the multi-layered, complex set of issues that surround mental illness? The answer is – a lot! There are biblical, historical, and practical reasons that churches must be at the table with this issue.

First, from the Gospels, we know that Jesus cared for and ministered to mentally ill people during his ministry on earth. As Christ followers, we are compelled to continue His work today. In Christ’s name, the Church extends compassion, acceptance, and unconditional love to all who suffer from the pain of mental illness, and as his Body, we offer hope and the healing power of God’s grace.

Second, the church has been caring for the sick, both physically and mentally for 2,000 years longer than any government or agency. Most people are unaware that it was the Church that invented the idea of hospitals. For centuries the Church has been a refuge for the outcast, those on the margins, and anyone enduring societal stigma and shame.

Finally, studies have shown that when families or individuals experience the chaos caused by mental illness, the first place they typically call in a crisis is not a doctor, a law office, the school, or the police, but rather they call or go see their priest or pastor. Anyone who’s served as a receptionist for a church knows that they often are required to do triage in mental illness cases. Why is that? Because people instinctively know that churches are called by God to be places of refuge, comfort, guidance, and practical help for those who suffer.

It’s time to stand with those who are suffering.

Pastor Rick and Kay Warren lead Saddleback Church. They will co-host www.mentalhealthandthechurch.com [a one-day event streamed live online] on March 28 to encourage individuals with mental illness and to equip family members and church leaders to care for them.

TIME ADHD

Doctors’ New ADHD Frontier: Diagnosing Adults

153360650
Gary John Norman—Getty Images

Figuring out the difference between stress overload and legitimate attention disorder is a fine line

When Peter Coyne’s 6-year-old son was diagnosed with ADHD 12 years ago, Coyne, 53, hardly knew what the disorder was. So he decided to read up on it.

“Suddenly I thought, ‘oh my God,’ this is what I’ve had my entire life,” says Coyne, a designer at a public relations firm. He flashed back to his younger years in school. He never thought he was stupid, but as classes progressively required more reading and attention, he suffered.

“It was frustrating. I used to think, maybe I don’t try hard enough. Maybe I don’t care. Maybe I’m lazy,” says Coyne. He scheduled an appointment with a psychiatrist, and Coyne got his own ADHD diagnosis the same year as his son. He finally had an answer for why he was the way he was. It was a relief.

The number of adults taking ADHD drugs rose by more 50% between 2008 and 2012, according to a report out this week from pharmacy management company Express Scripts. In 2001, 0.5% of adults ages 20 to 44 were on ADHD drugs, says Dr. David Muzina, vice president of specialist practice at Express Scripts. It crossed the 1% mark for men in 2004, and for women in 2005, and has been steadily rising ever since.

Parents educating themselves for the past decade about a problem that afflicts more and more children has led to greater awareness about the disorder. “What commonly brings someone in is they see their child being evaluated and recognize symptoms in themselves,” says Dr. Len Adler, the director of adult ADHD at New York University’s School of Medicine.

But diagnosing adults isn’t the same as diagnosing children—it’s harder. Since adults in general deal with a greater cognitive load than kids, there’s a fine line when it comes to distinguishing stress overload from legitimate ADHD symptoms. According to the DSM V, adults and children are assessed based on long list of symptoms for both inattentiveness and hyperactivity. Kids must meet six symptoms in each category for a period of at least six months, while adults need only meet five in each for the same time period—since adults tend to learn to cope and lose some of the more obvious symptoms with age. Some of the symptoms sound like your average overworked adult: difficulty with organization, easily distracted, unable to sustain attention, fidgeting, talking too much, interrupts often.

Most importantly, though, adults need to show that the roots of their disease took hold in childhood. “The consensus is that you cannot develop ADHD as an adult. You must have had symptoms in childhood,” says Dr. Joseph Austerman, a children’s psychiatry and psychology clinician at Cleveland Clinic. But ascertaining that is inherently problematic, since reporting often comes from the distracted adult in question. Significant others or parents are sometimes consulted, but the amount of information physicians can assess for adult patients is limited compared to that for children. Research has found that, among adults with ADHD, only 11% are diagnosed and treated.

The alarming rise in medication among children and adults has skeptics questioning the accuracy of so many diagnoses. Many also point to the successful marketing push from big pharma, which in 2012 saw profits nearing $9 billion for stimulant medications, compared to $1.7 billion just a decade ago, according to a report from The New York Times. And that’s from what has been predominantly a kids market. Online quizzes from ADHD advocacy groups can also prompt adults to seek help. “There’s no denying there’s a strong possibility that these numbers speak to clinicians’ proclivity to easily prescribe these medications to adults who are asking for them,” says Dr. Muzina.

While there may be growing cases of questionable ADHD diagnoses, for those who do have the disorder, it’s a relieving answer to a confusing and frustrating childhood. Men, who are more commonly diagnosed with ADHD, struggle more with holding down jobs and relationships.

“People at my age, we learn to adapt,” says Coyne. “It’s not like I can’t sit in my chair anymore. Now, I am just distracted.”

Dr. Muzina estimates that ADHD drug use in adults will grow by 25% over the next five years. But the chicken or egg question prevails. “The part that we are concerned about is how much of this drug use is related to over-diagnosis and over-treatment of symptoms that aren’t really a condition,” Dr. Muzina says.

TIME mental health

More Bad News for Older Dads: Higher Risk of Kids With Mental Illness

Getty Images

The effect of paternal age on autism, schizophrenia, and ADHD may be greater than previously thought

For so long, mothers – particularly older moms — bore the brunt of responsibility for genetic disorders in their children. And for good reason. Eggs are stockpiled from birth, not made anew with each monthly reproductive cycle, so eggs stored for decades until childbearing can develop genetic mutations. The older the mother, the greater the chance of abnormalities that can contribute to conditions such as Down syndrome, especially after age 35. Fathers, on the other hand, constantly make sperm, so their reproductive contribution was supposed to be fresher and free of accumulated DNA damage.

That may not actually be the case, however, according to the latest study in JAMA Psychiatry investigating how advanced paternal age can affect rates of mental illness and school performance in children. After a groundbreaking genetic analysis in 2012 highlighted the surprising number of spontaneous mutations that can occur in the sperm of older men, scientists have been delving into the relationship to better quantify and describe the risk. While some studies confirmed the connection, others failed to find a link.

MORE: Older Fathers Linked to Kids’ Autism and Schizophrenia Risk

In the latest research, Brian D’Onofrio, associate professor of psychological and brain sciences at Indiana University, and his colleagues attempted to address one of the biggest problems with studying the trend. Most of the previous investigations compared younger fathers and their children to different older fathers and their offspring. “That’s comparing apples and oranges,” says D’Onofrio. “We know young fathers and old fathers vary on many things.”

So his team turned to birth registry data from Sweden and compared children born to the same fathers, evaluating the siblings on various mental health and academic measures. The study included 2.6 million children born to 1.4 million fathers.

What they found surprised them – so much so that they spent about two months re-evaluating the data to make sure their numbers were correct. While the previous genetic study found that an older father’s DNA may account for about 15% of autism cases, D’Onofrio’s group found that the increased risk for children of fathers older than 45 years soared to 3.5 times compared to that of younger fathers. Children of older fathers also showed a 13 fold higher risk of developing attention deficit-hyperactivity disorder (ADHD), a 25 times greater chance of getting bipolar disorder, and twice the risk of developing a psychosis. These kids also had doubled risk of having a substance abuse problem and a 60% higher likelihood of getting failing grades in school compared with those with younger fathers.

MORE: Too Old to Be a Dad?

“What this study suggests is that the specific effect of older paternal age may actually be worse than we originally thought,” says D’Onofrio.

The scientists controlled for some of the well-known factors that can account for poor grades and psychoses and mental illnesses, such as the child’s birth order, the mother’s age, the mother’s and father’s education level, their history of psychiatric problems, and their history of criminality. Even after adjusting for these possible effects, they still found a strong correlation between higher rates of mental illness among younger siblings compared with their older ones.

The 2012 genetic study pointed to a possible reason for the higher rates of mental illnesses – because genetic mutations tend to accumulate each time a cell divides, older men may build up more spontaneous, or de novo, changes each time the sperm’s DNA is copied. While a 25-year-old father may pass on an average of 25 mutations to his child, a 40-year-old dad may bequeath each offspring as many as 65; the researchers calculated that the de novo mutation rate doubled with every 16.5 years of the father’s age. In contrast, regardless of her age, a mother tends to pass on about 15 mutations via her eggs.

The findings still need to be repeated by other groups, but the large sample size and the careful way that the researchers designed the study – to analyze the same fathers over time – suggest that the association is significant and worth considering for those who put off having a family. “This study suggests that paternal age does need to be considered as one of many risk factors associated with children’s mental health,” says D’Onofrio.

MORE: Fewer Drugs Being Prescribed to Treat Mental Illness Among Kids

Whether it gains the same amount of weight that maternal age does in family planning decisions isn’t clear yet, but even if it is confirmed, he notes that the correlation doesn’t predict that every child born to an older father will develop a mental illness. Older parents also have protective factors against these disorders, including more maturity and financial and social stability, that can offset some of the effect.

TIME mental health

Study: Switching Schools May Give Your Kids Psychotic Symptoms

Chronic marginalization and chronic exclusion could cause hallucinations and delusions

Changing schools can be a wrenching social and emotional experience for students, say researchers from Warwick Medical School in the U.K. And the legacy of that struggle may be psychosis-like symptoms of hallucinations and delusions.

Dr. Swaran Singh, a psychiatrist and head of the mental health division at Warwick, became curious about the connection between school moves and mental health issues after a study from Denmark found that children moving from rural to urban settings showed increased signs of psychoses. The authors also noted that the students had to deal with not just a change in their home environment, but in their social network of friends at school as well.

Singh was intrigued by whether school changes, and the social isolation that comes with it, might be an independent factor in contributing to the psychosis-like symptoms.

MORE: Homeland and Bipolar Disorder: How TV Characters Are Changing the Way We View Mental Illness

Working with a database of nearly 14,000 children born between 1991 and 1992 and followed until they were 13 years old, Singh and his colleagues investigated which factors seemed to have the strongest effect on mental health. The children’s mothers answered questions about how many times the students had moved schools by age nine, and the children responded to queries about their experiences either bullying others or being victims of bullying. The survey even included a look at the children’s in utero environments, and their circumstances from birth to age 2, by asking the mothers about where they lived (in urban or village areas, for example), and about financial difficulties or other family social issues.

Based on their analysis, says Singh, switching schools three or more times in early childhood seemed to be linked to an up to two-fold greater risk of developing psychosis-like symptoms such as hallucinations and interrupting thoughts. “Even when we controlled for all things that school moves lead to, there was something left behind that that was independently affecting children’s mental health,” he says.

MORE: Do Psychotic Delusions Have Meaning?

Factors such as a difficult home environment – whether caused by financial or social tension, or both – living in an urban environment, and bullying contributed to the mental health issues, but switching schools contributed independently to the psychosis-like symptoms.

Singh suspects that repeatedly being an outsider by having to re-integrate into new schools may lead to feelings of exclusion and low self-esteem. That may change a developing child’s sense of self and prime him to always feel like an outlier and never an integrated part of a social network; such repeated experiences of exclusion are known to contribute to paranoia and psychotic symptoms.

Bullying created a secondary way in which repeated school moves could lead to mental health issues — bullying is known to be associated with psychotic symptoms, and mobile students are more vulnerable to bullying,

The negative emotional experiences students go through in trying to adjust to new schools can have physiological consequences as well. “Repeated experiences of being defeated in social situations leads to changes in the brain and in the dopaminergic system,” says Singh. That makes the brain more sensitive to stress, and stress, with its surges of cortisol, can lead to unhealthy neural responses that can contribute to mental health problems. “Something about chronic marginalization, and chronic exclusion, is neurophysiologically damaging,” he says.

MORE: Lasting Legacy of Childhood Bullying: Psychiatric Problems In Adulthood

Singh and his team plan to continue to follow the students for several more years, to determine how frequently the psychosis-like symptoms manifest into true psychotic disorders like schizophrenia. So far, the findings don’t suggest that kids who move schools three or more times are priming themselves for future mental health problems – what the data suggest instead is that children who are more mobile early in development may need more attention and help to settle into their new environments and make strong social connections. “If we start thinking of mobile students as a potentially vulnerable group, then we can shift how we view school moves,” he says. Psychiatrists and psychologists, for example, often ask young children about their family and friends, but rarely inquire about how often they have moved schools. In his continuing investigation, Singh also hopes to dissect the reasons why students moved, to see if that can be another factor explaining the intriguing connection – if children move frequently because they are bullying others or being bullied, for example, that may suggest that the association to psychosis-like symptoms may have more to do with the students’ pre-existing behavioral state than the experience of uprooting themselves so frequently.

Your browser, Internet Explorer 8 or below, is out of date. It has known security flaws and may not display all features of this and other websites.

Learn how to update your browser