Pharmacological Treatments, Related Clinical Characteristics and Brain Function in Adolescent Depression

Major depressive disorder (MDD) in adolescents, which tends to be a particularly malignant and intractable condition, somatic condition, increases the likelihood of recurrence and is a major cause of suicide attempt and death, and chronicity in adulthood. Increases in alpha- or theta- band activity, or asymmetries in the alpha band may predict successful responses to treatment with selective serotonin uptake inhibitors. Reward-related brain function, such as greater reactivity in the lower medial prefrontal cortex, and greater right-side frontal brain activity predict MDD symptoms. Greater activation of both the amygdale, related to functional connections, has been reported as the neurobiological bases of adolescent MDD. An increased imbalance of resting-state brain activity between the frontal cognitive control system and the limbic-striatal emotional processing system was recognized. Inherited risks, such as developmental factors and psychosocial adversity, interact to increase the risk of depression through hormonal factors and the associated perturbation of the relevant neural pathway. These multiple complex pathophysiological factors might contribute to the development of a particularly malignant and intractable adolescent depression, and cause increased likelihood of recurrence and chronicity in adulthood.

Daily doses of escitalopram and fluoxethine (10-20 mg) have been demonstrated as effective in treating adolescents with MDD. However, a recent review article has proposed that escitalopram should be considered as a second-line treatment option for adolescents with MDD. It should be noted that escitalopram treatment has been recommended on the basis of a single study of positive behavioral cognitive therapy because of lack of evidence.

Keywords: Adolescent depression, somatic symptoms, suicide, recurrent depression, emotional processing system, Amygdale function, escitaoroprum, fluoxethine, behavioral cognitive therapy.