Brain stimulation therapies treat adolescents with severe depression
May 19, 2015 0 Comments
Adolescent depression can take many forms, from mild disinterest to catatonia. Depression can occur with or without substance abuse and can lead to suicide. Although girls are more commonly diagnosed with depression, adolescent boys are at particular risk of death from suicide. Of a sample of 10- to 24-year-olds who had committed suicide, 81 percent were male. Prevention measures must include identifying the problem, getting an accurate diagnosis and beginning treatment promptly.
Today, adolescent depression is viewed as a complex interplay between many factors. Past and present conditions like prenatal conditions, developmental stages, social interactions, nutrition, relationships, socioeconomic level and memory all affect neuromodulation of pathways. These pathways determine cognitive processing of the present and perceptions about the future. Scientific research on these pathways has led to greater understanding and the development of targeted interventions to improve cognitive processing and decision making.
Signs and symptoms of depression
Although depression symptoms haven’t changed significantly through the ages, diagnosis and treatment have. The American Psychiatric Association has a lot of influence over defining mental health disorders and guiding clinical practices. The organization’s Diagnostic and Statistical Manual of Mental Disorders 5th Edition (DSM-5), published in 2013, is used by most mental health care providers for patient evaluations. This latest edition no longer classifies depression as a mood disorder, but as its own distinct group of depressive disorders. Some depression symptoms in adolescents include:
- Loss of energy almost every day
- Loss of interest or pleasure in usually enjoyable activities
- Change in appetite, weight loss or gain for unknown reason
- Difficulty concentrating or making decisions
- Irritability or anger outbursts
- Feeling worthless or guilty
- Depressed mood
- Trouble sleeping
- General, persistent thoughts about death or suicide
Accurate diagnosis is necessary because treatment modalities differ accordingly. Experts can differentiate biological depression from other factors, such as normal grief or medication side effects. Symptom duration and severity are measured through diagnostic criteria. In addition, different types of depression and associated features need to be distinguished from one another, such as dysthymia versus major depressive disorder with anxious distress.
Once an accurate diagnosis of depression is made, treatment can begin. Many teens respond to psychotherapy, family counseling, peer groups, lifestyle modifications, medications and other supportive measures. Treatment-resistant and suicidal cases of adolescent depression might benefit from brain stimulation therapy.
New approaches to an old therapy
Thousands of years ago, various forms of depression treatment have been described, ranging from the use of herbs to surgical methods, like the frontal lobotomy. Electroshock therapy has survived the centuries and a modified method, electroconvulsive therapy (ECT) is still used today. The past 50 years has shown ECT to be as effective in youth as it is for many adults.
Although “electric shock therapy” has some rather barbaric connotations, modern brain stimulation techniques deliver a measured amount of electric or electromagnetic current to a targeted part of the brain in a painless fashion. Few side effects are reported and long-term results for patients with depression or other mental illnesses are quite promising.
ECT’s treatment success has led to other methods of brain stimulation. Some use electric currents, others use magnets. Some require surgical implantation of an impulse generator and electrodes; others just require a series of treatments. Some purposefully induce a grand mal seizure; others do not. None are reportedly associated with significant discomfort or disability.
- Electroconvulsive therapy (ECT):
ECT is the modern version of electroshock therapy. ECT is commonly performed on patients with very severe depression that does not respond to other treatments. Suicidal depression or catatonia are common indications. ECT is now done under general anesthesia, so there is no pain or discomfort. Electric currents are administered to the brain which causes it to have a small seizure (or convulsion).
Many people experience relief from depression symptoms after about six to 12 treatments done over a period of weeks. Remission rates vary among treatment centers, but overall are very good. Some adult patients do experience some cognitive side effects, such as memory loss, particularly memories surrounding the time of the procedure(s). However, a small study of adolescents who had ECT showed no measurable cognitive impairment from the procedure at long-term follow-up.
- Repetitive transcranial magnetic stimulation (rTMS): Like ECT, rTMS was originally used to treat seizures, but found to be helpful with depression treatment as well. This technique uses magnets to manipulate electrical currents in the brain. No seizures are induced, so no anesthesia is required. The rTMS is gaining popularity in pediatric and adolescent psychiatry to treat depression and other mental illnesses in teens.
- Vagus nerve stimulation (VNS): VNS involves an internal generator implanted under the skin in the chest that delivers intermittent impulses to the vagus nerve in the neck through electrodes threaded up through the skin. Originally designed to treat seizure disorders, this treatment was also found to improve symptoms of depression.
- Deep brain stimulation (DBS): DBS also involves an implanted generator in the chest, but requires brain surgery to place electrodes inside the cranium to target a specific area of the brain. Also called “a pacemaker for the brain,” DBS was developed to treat Parkinson’s Disease but found to be useful for depression and obsessive-compulsive disorder.
- Magnetic seizure therapy (MST): MST is like ECT, except that electromagnetic impulses are used to accomplish the same goal without cognitive side effects. MCT also induces seizures in the brain, so general anesthesia is required.
- Other developments: A new field combining genetically-customized medications and external activation of behavioral targets in the brain using light is called optogenetics. Researchers are using optogenetics to modify and control behavior in mice and primates. The application of this mind control technology appears promising for its application to addiction and mental illness treatment, but has obvious capacity to be misused and thus raises serious ethical concerns.
Prepare a treatment plan
Because of the complexity of adolescent depression, a comprehensive assessment and treatment plan is critical. Many teens respond to psychotherapy, family counseling, peer groups, lifestyle modifications, medications and other supportive measures. Others benefit from brain stimulation therapy. Clinicians and researchers are currently exploring rTMS as an alternative to ECT for children and adolescents with treatment-resistant, suicidal depression.
White River Academy is a boarding school for adolescent males who struggle with addiction and mental health disorders. For help with adolescent depression or to learn more about available treatments, please call 866-520-0905.