Postnatal euphoria: are ‘the highs’ an indicator of bipolarity?

Research into postnatal mood disorders to date has concentrated on depressive syndromes of varying severity and full-blown acute puerperal mania. However, clinical experience, backed up by a review of the literature, indicates that milder hypomanic symptoms also occur in the early puerperium. Although these symptoms may often be regarded as clinically insignificant, there is evidence that the experience of minor puerperal elation may be a predictor of later postpartum depression. In addition, studying mild puerperal high mood may provide insights into the pathophysiology of more severe puerperal mania and psychosis. This paper critically reviews the literature on milder forms of high mood occurring in the puerperium and discusses the potential clinical and research significance of 'the highs'.     

‘Stockholm syndrome’: psychiatric diagnosis or urban myth?

Objective: ‘Stockholm syndrome’ is a term used to describe the positive bond some kidnap victims develop with their captor. High‐profile cases are reported by the media although the diagnosis is not described in any international classification system. Here we review the evidence base on ‘Stockholm syndrome’. Method: Databases (PubMED, EMBASE, PsycINFO, CINAHL) were systematically searched. We compared features of cases widely reported in the English language media to identify common themes which may form a recognizable syndrome. Results: We identified 12 papers that met inclusion criteria. The existing literature consists mostly of case reports; furthermore there is ambiguity in the use of the term. No validated diagnostic criteria have been described. Four common features were found between the five cases studied. Conclusion: There is little published academic research on ‘Stockholm syndrome’ although study of media reports reveals similarities between well publicized cases. This may be due to reporting and publication bias.     

‘D’ for depression: any role for vitamin D?

Parker G, Brotchie H. ‘D’ for depression: any role for vitamin D?. Objective: While there has long been interest in any nutritional contribution to the onset and treatment of mood disorders, there has been increasing scientific evaluation of several candidate nutritional and dietary factors in recent years. In this paper, we overview research into any vitamin D insufficiency and deficiency contribution to depression. Method: The relevant literature was reviewed. Results: Cross‐sectional studies have identified associations between depression and low vitamin D levels, but studies have failed to clarify whether vitamin D deficiency is an antecedent cause, correlate or consequence of depression. While vitamin D deficiency and insufficiency have been linked with seasonal affective disorder, suggested associations have not been rigorously tested. There has been insufficient research to establish whether and when vitamin D supplementation should be considered as an augmentation strategy with antidepressant drugs. Conclusion: There is currently insufficient evidence to argue strongly for vitamin D supplementation in patients with depression, but such a strategy is worthy of consideration in depressed patients whose lifestyle and geographical residence may indicate a risk of vitamin D insufficiency – or where low vitamin D levels have been quantified.