Medicalisation of young minds: new study reveals 28% rise in antidepressant prescribing amongst 6-18 year olds « Swansea University

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Antidepressant prescribing amongst children and young people has shown a significant increase of 28% in the past decade, even though recorded diagnoses of depression have gone down, according to new research published today.

One in ten children and young people suffer from some kind of mental health problem, including depression and anxiety. Concerns about under-diagnosis and under-treatment contrast with worries about over-prescribing and the medicalisation of unhappiness in young people.

The research, published in Psychological Medicine, and carried out by a team which included several Swansea University experts, was led by Ann John, associate professor at Swansea University Medical School, who is also a qualified GP. The team looked at data from 358,000 registered patients between 6 and 18 years old, living in Wales, UK, between 2003 and 2013. The data was drawn from GPs and other NHS primary care services.

The research found that:
• Antidepressant prescribing rose significantly, by 28%, mainly in older adolescents
• Depression diagnoses showed a steady decline by just over a quarter, while symptoms of depression more than doubled
• Unlicensed citalopram prescribing occurs outside current guidelines, despite its known toxicity in overdose
• Just over half of new antidepressant prescriptions were associated with depression. The rest were associated with diagnoses such as anxiety and pain

The findings led the researchers to call for new strategies to implement current guidance for managing depression in children and young people.

Dr Ann John, associate professor at Swansea University Medical School, said: “These findings add to the growing debate over increasing prescribing of anti-depressants to children and young people.

The main issue is whether they being prescribed with enough cause. The rise in prescribing may reflect a genuine increase in depression and its symptoms, or increased awareness and better treatment by GPs, or poor access to psychological therapies and specialist care, or even increased help-seeking.

Whatever the explanation it’s important that each individual young person is listened to and gets the right kind of help for their problem. We need to support those who support young people and their families, helping them to act in keeping with current guidance.”

Dr John underlined the importance of responding appropriately to the needs of young people:

“The teenage years are a phase of gaining independence, engaging with the world and testing boundaries. This can result in a normal developmental range of emotional responses- stress, loneliness, sadness and frustration. For others the mental health issues are more serious, and historically they were often not recognised, talked about or treated.

Teenagers may be moving into adulthood without many of the skills necessary to deal with these issues if we don’t manage them well at an early age.

It can be hard to distinguish between what is emotional turmoil and what warrants a mental health diagnosis in a young person.

We need to ensure GPs are trained to really understand the lives and moods of young people, as well as knowing what warning signs they should look out for. For some young people reassurance that this is within the range of normal human experience may be appropriate. For others, talking therapies may be the best option, as they have a proven track record of improving symptoms for those with mild and moderate depression.
In more serious cases, anti-depressants should be used together with talking therapies. Improving access to talking therapies is very important. Otherwise, if waiting times are too long, it’s more likely that a prescription will be given. If an antidepressant is required, fluoxetine should be the first option.”

via Swansea University – Medicalisation of young minds: new study reveals 28% rise in antidepressant prescribing amongst 6-18 year olds

The full paper, published in Psychological Medicine, “Recent trends in primary-care antidepressant prescribing to children and young people: an e-cohort study” by A. John, A. L. Marchant, D. L. Fone, J. I. McGregor, M. S. Dennis, J. O. A. Tan and K. Lloyd has been published Open Access and can be viewed here free of charge.

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Emotion-processing networks disrupted in sufferers of depression – via UIC News Center

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Regions of the brain that normally work together to process emotion become decoupled in people who experience multiple episodes of depression, neuroscientists report. The findings may help identify which patients will benefit from longterm antidepressant treatment to prevent the recurrence of depressive episodes.

The study, led by researchers at the University of Illinois at Chicago, is published in the journal Psychological Medicine.

“Half of people who have a first depressive episode will go on to have another within two years,” says Scott Langenecker, associate professor of psychiatry and psychology at UIC and corresponding author on the study.

Disruptions in the network of areas of the brain that are simultaneously active during problem-solving and emotional processing have been implicated in several mental illnesses, including depression. But in addition, “hyperconnectivity,” or too much connection, within the “resting network,” or areas active during rest and self-reflection, has also been linked to depression.

“If we can identify different network connectivity patterns that are associated with depression, then we may be able to determine which are risk factors for poorer outcomes down the line, such as having multiple episodes, and we can keep those patients on preventive or maintenance medication,” Langenecker explained. “We can also start to see what medications work best for people with different connectivity patterns, to develop more personalized treatment plans.”

In previous research, Langenecker found that the emotional and cognitive brain networks were hyperconnected in young adults who had depression. Areas of the brain related to rumination – thinking about the same thing over and over again – a known risk factor for depression, were also overly connected in adolescents who had experienced depression.

In the new study, Langenecker said he and his coworkers wanted to see if different patterns of network-disruption would show up in young adults who had experienced only one episode of depression versus several episodes.

The researchers used functional magnetic resonance imaging, or fMRI, to scan the brains of 77 young adults (average age: 21.) Seventeen of the participants were experiencing major depression at the time of the scan, while 34 were currently well. Of these 51 patients, 36 had experienced at least one episode of depression in the past, and these individuals were compared  to 26 participants who had never experienced a major depressive episode. None were taking psychiatric medication at the time they were scanned.

All fMRI scans were done in a resting state — to show which areas of the brain are most synchronously active as one relaxes and lets their mind wander.

The researchers found that the amygdala, a region involved in detecting emotion, is decoupled from the emotional network in people who have had multiple episodes of depression. This may cause emotional-information processing to be less accurate, Langenecker said, and could explain “negative processing-bias”  in which depression sufferers perceive even neutral information as negative.

The researchers also saw that participants who had had at least one prior depressive episode — whether or not they were depressed at the time of the scan — exhibited increased connectivity between the resting and cognitive networks.

“This may be an adaptation the brain makes to help regulate emotional biases or rumination,” Langenecker said.

“Since this study provides just a snapshot of the brain at one point in time, longer-term studies are needed, to determine whether the patterns we saw may be predictive of a future of multiple episodes for some patients and might help us identify who should have maintenance treatments and targets for new preventive treatments,” he said.

Rachel Jacobs, Alyssa Barba, Jennifer Gowins, Heide Klumpp, Lisanne Jenkins, Dr. Olusola Ajilore and Dr. K. Luan Phan of the UIC College of Medicine, and Dr. Brian Mickey, Dr. Marta Pecina, Margaret Sikora, Kelly Ryan, David Hsu, Robert Welsh and Jon-Kar Zubieta of the University of Michigan are co-authors on the paper.

This study was funded in part by the UIC Center for Clinical and Translational Science and grants RO1 Q2 601, MH091811 and RO1 MH101487 from the National Institutes of Health. – See more at: http://news.uic.edu/emotion-processing-networks-disrupted-in-sufferers-of-depression#sthash.2snQXaQd.dpuf

Source: Emotion-processing networks disrupted in sufferers of depression | UIC News Center

The full paper, published in Psychological Medicine, “Decoupling of the amygdala to other salience network regions in adolescent-onset recurrent major depressive disorder” by  S. A. Langenecker et al. can be viewed here free of charge until 31st March 2016.

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