Early Bloomers: Do We Really Know Everything About Precocious Puberty?

In the United States, the average start of puberty and menstruation has commonly been accepted as somewhere between 10 and 11 [1]. However, the nation has been seeing a steady drop in pubertal age. Since 1997, the prevalence of precocious puberty among girls has nearly doubled, showing that in a group of 1200 females, nearly 15% had shown signs of sexual development at barely seven years old [1]. Women who undergo maturation at an early age are at higher risk for severe mental issues, including major-depressive disorder (MDD) as well as dysthymic disorder (DD), due to a change in the circadian rhythm and increased psychological pressures leading to self-esteem issues [2]. Currently, precocious puberty is not seen as a serious issue, however an understanding of the causes and the situations of the minority of people affected would benefit society. Precocious puberty has been shown to bring “long-term negative effects” to those affected, and medical care for patients can burden the economy in the long run [3,4].

Precocious puberty is a cause of fatigue, and when normal adolescents begin maturation, the body controls the release of serum-melatonin (MT) to match the hectic schedules and changing lives of teenagers. Even though those affected are much younger, precocious puberty limits MT. Studies show “that nocturnal serum MT levels are… similar in precocious puberty and normal pubertal children [5].” This alteration in the natural circadian rhythm may lead to depression due to fatigue and insomnia. Numerous journals note that patients suffering from endogenous depression generally possess low melatonin levels, furthering the idea that MDD or DD is a direct result of circadian alteration [5,6,8]. Doctors attempted to augment the effects of anti-depressants by concurrently injecting slow-release melatonin into patients suffering from depression; however, the addition did not sufficiently improve the medicines [6]. In 1980, Brooks-Gunn postulated that body image is “the psychological variable more affected by early maturation in females [3].” Girls who develop earlier feel that they differ psychologically from their peers, and as a result they may suffer social pressure in forms such as inferiority complexes.
The interconnectedness of precocious puberty and depression has been shown to directly relate to a girl’s ethnicity. In the United States, it is generally known that African-Americans mature at earlier ages than their Caucasian counterparts. Statistics showed that among girls who showed breast development at age 7, 10% were white while 23% were black [7]. The effects of precocious puberty were studied on symptoms of depression in a group of 639 African Americans. Results supported the hypothesis that girls suffer from increased chances of depression and substance abuse [8]. Coupled with bullying and low self-esteem, African American girls are more likely to experience suicidal thoughts than their Caucasian contemporaries, and the same can likely be hypothesized about Hispanic girls, about 15% of whom experience breast development by age 7 [1].

How does this relationship actually impact society? As the rate of precocious puberty steadily increases, the frequency of MDD and DD will as well. In the United States, a study was done to predict the economic burden of depression, adding up all the costs from suicides and preventions, hospitalizations, therapist and physician visits, nursing home funding, and pharmaceuticals. In total, society spends roughly $16.3 billion dollars on depression, and a similar experiment done in Sweden found that “the cost of depression has doubled during the past eight years making it a major public health concern [4,9].”

Both studies “further emphasize the need for timely recognition and treatment to potentially minimize the negative impact of the illness on society.”4 In order to prevent the aforementioned long-term repercussions, doctors must become more aware of the growing issue. Development of specialized anti-depressants to treat MDD and DD at an earlier age will prevent the need for expensive treatment later in life. Additionally, children can be exposed to the ideas of puberty and maturation earlier, so as to prevent bullying.

Though precocious puberty is not considered a relevant concern at the moment, the United States medical force needs to crack down on the rise of this condition and recognize, determine the cause that underscores it, and realize that it poses a threat to the economy and to society. As the rates of early maturation continue to rise, the prevalence of MDD and DD will become more common. Additionally, the causes of precocious puberty need to be narrowed down in order to effectively prevent early development and its long-term consequences.

1.Carrol L. Growing up too soon? Puberty strikes 7-year-old girls [Internet].[place unknown]; [updated 9 August 2010]. Available from: http://www.msnbc.msn.com/id/38600414/ns/health-childrens_health/t/growing-too-soon-puberty-strikes–year-old-girls/#.ULlhvKw0WSp
2. Birmaher B, Ryan N, Williamson D, Brent D, Kaufman J, Dahl R, et al. Childhood and Adolescent Depression: A Review of the Past 10 Years. Part 1. J Am Acad Child Adolesc Psychiatry [Internet]. 1996 Nov; 35(11). Available from: http://www.sciencedirect.com/science/article/pii/S0890856709664030
3. Petersen A, Sarigiani P, Kennedy R. Adolescent Depression: Why More Girls? J Youth Adolesc [Internet]. 1991; 20(2): 266. Available from: http://link.springer.com/article/10.1007%2FBF01537611?LI=true#page-1
4. Stoudemire A, Frank R, Hedemark N, Kamlet M, Blazer D. The Economic Burden of Depression. Gen Hosp Psychiatry [Internet]. 1986 Nov; 8(6): 387-394. Available from: http://www.sciencedirect.com/science/article/pii/0163834386900186
5. Kellner M, Yassouridis A, Manz B, Steiger A, Holsboer F, Wiedemann K. Corticotropin-Releasing Hormone Inhibits Melatonin Secretion in Healthy Volunteers – A Potential Link to Low-Melatonin Syndrome in Depression? Neuroendocrinol [Internet]. 1997; 65(4): 284-290. Available from: http://content.karger.com/ProdukteDB/produkte.asp?Aktion=ShowAbstractBuch&ArtikelNr=127186&ProduktNr=234573
6. Depression Clinic, Centre for Addiction and Mental Health. Use of slow-release melatonin in treatment-resistant depression. J Psychiatry Neurosci [Internet]. 2000 January; 25(1): 48–52. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1407707/
7. Miller T, Study: Early Puberty in Girls on the Rise [Internet]. [place unknown]; PBS. 2010 August 13. Available from: http://www.pbs.org/newshour/rundown/2010/08/study-early-puberty-on-the-rise-in-american-girls.html
8. Ge X, Kim I, Brody G, Conder R, Simons R, Gibbons F, et al. It’s about timing and change: Pubertal transition effects on symptoms of major depression among African American youths. Dev Psychol [Internet]. 2003 May; 39(3): 430-439. Available from: http://psycnet.apa.org/journals/dev/39/3/430/
9. Sobocki P, Lekander I, Borgström F, Ström O, Runeson B. The economic burden of depression in Sweden from 1997 to 2005. Euro Psychiatry: J Assoc of Euro Psychiatrists [Internet]. 2007; 22(3): 146-152. Available from: http://europepmc.org/abstract/MED/17194573

Maya Nandakumar is a student at The Harker School. Follow The Triple Helix Online on Twitter and join us on Facebook.