Research is shedding new light on what happens in the brains of children and adults affected by clinical depression, anxiety disorders and schizophrenia, according to Washington University in St. Louis studies presented at a recent mental health symposium sponsored by NARSAD, the world’s leading charity dedicated to mental health research.
The findings, which come as America celebrates Mental Health Awareness Month, point to new options for treating preschool-aged children with significant clinical depression, as well as those severely depressed adults who don’t respond to standard treatments, such as antidepressants and psychotherapy. The studies have immediate relevance in terms of new treatment options and more targeted therapies for the estimated 57 million Americans who suffer from a diagnosable mental disorder.
Highlights of research discussed at the symposium include:
Depression in preschoolers
Joan L. Luby, MD, associate professor of child psychiatry and founder and director of Washington University School of Medicine’s Early Emotional Development Program, is currently investigating the efficacy of a new treatment program for clinically depressed children as young as age 3 — a time of significant neurobiological change when there is the potential to alter the course of depression later in life.
“Clinicians used to think that very young children were not developed enough to experience depression, but studies going back to the 1980s changed this viewpoint,” said Luby. “Now, we know that depression is a major childhood illness with potentially debilitating consequences.”
A number of epidemiological studies have reported that up to 2.5 percent of children and up to 8.3 percent of adolescents in the U.S. suffer from depression. But until recently, very little was known about the impact of depression on very young children, which is why Luby and her colleagues are studying children between the ages of 3 years and 6 years old to identify what clinical depression looks like in preschool children.
Starting with a large-scale study funded by NARSAD and the National Institute of Mental Health, Luby and her team identified anhedonia — the inability to experience pleasure from activities and play — as a key symptom of depression in very young children. Another common symptom is that depressed children often use play to explore themes about death and sometimes even suicide.
“We learned that depressed children don’t derive pleasure from the same things as a typical 3- to 5-year-old child,” said Luby. “They’re less joyful when they encounter the pleasures of daily life.”
Now, Luby and her colleagues are testing a new treatment program for depressed preschoolers in their laboratory that applies these findings. Using a model similar to speech or other developmental therapies, this new program utilizes the interaction between parents and their children to teach depressed children how to experience positive emotions, manage negative emotions and more generally, how to enhance emotional development on a sustained basis. After pre-testing the new program in eight preschoolers, Luby’s team is now recruiting 30 more young children from the St. Louis area for the new treatment study.
“The normal developmental curve for any child is very steep at this point in life and being depressed and dysfunctional for a long period of time could actually impair normal development,” Luby explained. “It’s very important that we find a safe way to help them get better and to prevent future episodes.”
Understanding and regulating anxiety, the most prevalent mental illness
Christina Fales, Ph.D., a postdoctoral fellow in psychology in Arts & Sciences at Washington University, provided an overview of new research aimed at improving the functioning of the more than 40 million Americans or 18.1 percent of the population that suffer from anxiety disorders — the most common psychiatric illnesses.
Fales and colleagues discussed the latest thinking on how anxiety disorders affect decision-making, perceptions, learning and concentration.
Fales’ research suggests that people with general anxiety disorders (GAD) may process information differently than healthy people. They may be more susceptible to attention lapses, making reasoning and problem solving, as well as the avoidance of undesirable thought patterns, more difficult.
Fales has found that people with high levels of anxiety activate the regions of the brain involved in cognition and problem-solving — called the working memory network — in a much more transient manner than people with low anxiety. This doesn’t mean that anxious people are cognitively impaired but rather, they are less efficient in carrying out cognitive tasks, and have to work harder to process information. This extra effort may be necessary because unregulated emotional arousal interferes with normal cognitive processing.
What makes these findings significant is the potential for developing new therapies to improve the cognitive regulation of emotion, explained Fales. “Many GAD patients report that antidepressants have limited success in dealing with their anxiety,” she said. “The more we know about the interaction between the networks in the brain that process cognition and help regulate emotion, the easier it will be to design more targeted therapies for anxiety disorder.”
Living with schizophrenia: overcoming emotional and motivational challenges
New research findings may also pave the way for new therapies to regulate the memories and emotions of people with schizophrenia, one of the most debilitating psychiatric disorders, suggests Deanna M. Barch, Ph.D., director of the Silvio Conte Center for Neuroscience Research at Washington University.
Barch, an associate professor of psychology in Arts & Sciences and of psychiatry and radiology in the School of Medicine, is now focusing on the emotional and motivational problems that affect how people with schizophrenia function on a daily basis. Her studies complement other NARSAD-funded research, which showed people with schizophrenia can be assisted in remembering things if they are given proper cues and memory aids.
According to Barch, research has demonstrated that people with schizophrenia are able to experience the same pleasurable responses to stimuli, such as seeing a movie, listening to music, or drinking a beverage, but these reactions were much more intact than what subjects with schizophrenia reported in questionnaires that ask them to imagine how they would feel in various situations.
This inability to either retain pleasurable memories or to anticipate pleasurable experiences in the future may be a major factor contributing to what Barch calls “the negative symptoms” associated with schizophrenia – including the lack of energy, drive and motivation.
Using functional MRI, structural MRI and cognitive neuroscience methods, Barch and her research team are trying to identify the neurobiological disturbances in the brain that may cause these negative emotional symptoms. Between 50 and 70 percent of people with schizophrenia have these negative symptoms, especially those who have earlier onset of the disease, according to Barch.
“This is a very serious public health issue,” she said. “Current therapies for schizophrenia have not proven effective in treating negative emotional symptoms, making it harder for those who experience these symptoms to live independently and seek treatment. The goal is to explain what is happening in the brain so we can design better treatments in the future.”