Diagnoses of mental illnesses such as depression, bipolar disorder, and schizophrenia spike in adolescence and early adulthood, but researchers may one day be able to identify children at higher risk and prevent later onset, a leading neuroscientist said at a AAAS Capitol Hill briefing.
Mental illness “is really a different disease for every individual, which is one of the things that makes mental health such a hard thing to study,” said Abigail Baird, a psychology professor at Vassar College. Genetics, experience, and environmental toxins can all affect mental health, but “with enough science, we can start to understand how all these factors intermingle and, hopefully, create more effective interventions earlier in the disease process.”
Baird spoke at a 19 July briefing on Capitol Hill organized by AAAS, underwritten by The Dana Foundation, and moderated by Alan I. Leshner, the AAAS CEO and executive publisher of Science. About 50 people, including congressional staff and federal scientists, attended the second in the summer 2012 series of AAAS Capitol Hill briefings on neuroscience.
U.S. Representative Chaka Fattah (D-Pennsylvania) provided opening remarks for the briefing, saying that it would help him and others attending to “focus on critical issues [surrounding] mental health and adolescence.” Many of these issues could have implications for health care costs as well as education and crime.
[Video by Carla Schaffer]
Adolescence is a period of rapid brain growth, similar to toddlerhood, and with that growth comes changes in behavior and an increased risk for certain mental illnesses. This stage in development coincides with many stressful life events—which can range from sleep deprivation to drug use to the general challenges of college life—that may trigger the onset of these diseases.
“Adolescence itself can be stressful,” Baird noted, and it’s a period of “enormous and highly dynamic interaction between pre-programmed development and environmental experience.”
Depression, for example, spikes in the seventh and eighth grades, likely due to the onset of puberty, body changes, and perception of those changes. And as rates of teen depression have risen in recent years, so have rates of teen suicide, something that Baird emphasized needs to be studied more aggressively.
“[Teens] don’t have as much life experience as grown-ups do,” Baird said. “That might sound overly simple, but when you don’t have a lot of life experience, it sometimes is harder to see that things might be better, particularly with the right treatment.”
For depression, the right treatment—medication combined with psychotherapy—can be incredibly effective; about half of teenagers who experience depression will never have another episode. But treatments for two other major mental illnesses that are often first diagnosed in young adulthood, bipolar illness and schizophrenia, may be less effective.
Lithium has traditionally been used to treat bipolar disease, but the medication comes with side effects, such as hand tremors and an overall dazed feeling, that prompt many people to stop taking it. There are newer medications being used to treat bipolar illness, but a number of them may not be appropriate for teens. And while there are myriad pharmacological treatments for schizophrenia that may help reduce symptoms, no cure yet exists.
Although these illnesses may first present themselves during adolescence, scientists are finding clues that something is going on much earlier in the brain development of these individuals. In one classic study of schizophrenia, for example, Elaine Walker and her colleagues at Emory University viewed childhood home movies that contained footage of children who would eventually go on to become schizophrenic as well as footage of their healthy siblings.
“Observers, who had no formal training in psychology or mental illness, were almost always able to pick out the children, usually under the age of 5, who would go on to become schizophrenic,” Baird said. The differences may have been subtle—some of the children smiled less, or their movements were a little odd—but they were still noticeable.
Researchers have found that there is a connection between movement issues early on in development and later mental illness, and the severity of those movement issues may actually be predictive of later mental health outcomes.
However, those early signs do not mean that psychiatrists should begin labeling and medicating young children who are, say, having difficulty tying their shoes, long before a diagnosis of a mental illness. “We need to be very careful about not labeling people too quickly or assuming that people are going to become ill too quickly, because that could be dangerous,” Baird said.
She also cautioned against medicating young individuals, even those already diagnosed with depression or other mental illnesses, without considering other alternatives.
“Medicating a developing brain is a last resort,” Baird said, and something to be considered only if mental illness is disrupting an adolescent’s ability to function in their everyday life. “The brain grows based on experience and a sort-of pre-programmed biological plan that has a lot to do with genetics. But without experience, the brain will not grow. So if [an] illness is preventing [an individual] from interacting with others and from leading a quasi-normal life, then medication might be a reasonable choice, but one that should be made as a last resort.”
Early detection and treatment is the eventual goal, and researchers hope to one day be able to identify early symptoms or other factors that put an individual at risk of mental illness and then provide support or guidance that helps them to temper or even prevent the emergence of the disease.
“If we knew you were at high risk, given your family profile, given your birth history, given your early years, [then] going far away to college at a really competitive, socially intense place might not be the best choice for you,” Baird said. Avoiding such a stressful situation may help someone who is inclined to develop a mental illness minimize or avoid the onset of that disorder.
For most people, everything goes right in terms of brain development, and mental illness won’t ever be a personal concern. But inevitably, some people will have an episode of mental illness on their way to adulthood. “If we could better understand what causes those people to stumble and help them get back up more quickly,” Baird said, “I think we will have done a great service.”
View Abigail Baird’s presentation slides.
Read an article on the first briefing in the Capitol Hill neuroscience series organized by AAAS with the support of The Dana Foundation.