The importance of assessment and treatment of mental illness in teens
This blog post is part of a weekly series focusing on different aspects of public health leading up to Public Health Thank You Day on Monday November 23, 2015. Join the conversation on social media with the hashtag #PHTYD and visit http://www.publichealththankyouday.org for more information.
Dr. Carrie Bearden, clinical neuroscientist at UCLA seeks to understand the underlying biology of mood disorders in teens
The rate of mood disorders nearly doubles when children enter adolescence. Dr. Carrie Bearden, Professor of Psychiatry and Biobehavioral Sciences and Psychology at UCLA, seeks to understand why. She uses interdisciplinary approaches to examine the role of circadian rhythms, changes in the structure of the brain, and genetics as risk factors for the development of neuropsychiatric disorders in teens.
In one such study, presented this month in a webinar by the Brain and Behavior Research Foundation, Dr. Bearden and colleague Dr. Nelson Freimer examined genetically isolated populations in Latin America where the rate of severe bipolar disorder (BPD) is high. BPD is a mood disorder characterized by major ups and downs in activity, mood, and energy and can lead to profound impairment in daily functioning and even suicide if untreated.
To understand some of the underlying biological mechanisms driving the illness, she collected large amounts of data from family members with and without BPD. In addition to psychiatric interviews, brain scans, and blood tests for gene expression, participants wore watches that tracked their activity and light levels throughout the day and night. Dr. Bearden and colleagues were able to separate this data on their circadian rhythms into distinct traits that were both genetically linked and associated with having BPD. These traits included later sleep onset, longer duration of sleep, and greater variability in sleep and activity between days.
Dr. Bearden and colleagues were able to link these traits to specific regions of the genome using genome-wide association studies, providing clues about which genes could play a role in the development of bipolar disorder. Her work demonstrates the power of neurogenetics in identifying genetic causes and biomarkers that can help diagnose diseases like BPD.
In this Q&A, Dr. Bearden discusses the implications of her work in diagnosing and treating mood disorders and the overall state of research into mental illness. This interview was lightly edited for brevity and clarity.
Q: Do you feel there is enough research into mood disorders?
I would really like to see more funding for research on mood disorders. I think there is a growing appreciation and understanding among the general public that these are brain disorders that affect millions of people, but there is still a long way to go in terms of reducing stigma and just simply increasing awareness of what these disorders are, how to recognize them, and how to respond to someone – a friend or family member- that is suffering from a mood disorder.
Q: Can you tell us a little more about what made you interested in studying neuropsychiatric disorders, specifically in teens?
I really wanted to understand trajectories of brain development and what could go wrong that may affect outcomes. This adolescent period really fascinates me, maybe because I was an incredibly difficult adolescent myself!
Q: What are the implications of your research to treating mood disorders in this country?
Lifestyle changes can make a big difference. Circadian rhythm disruption is a fundamental part of bipolar disorder, and it is something that can be targeted with behavioral interventions.
Q: How is your work going to make it easier to diagnose and treat these conditions?
If we can recognize the biological vulnerability - due to a family history, or sleep problems, or early signs of mood dysregulation - we can get in there earlier to intervene. In other areas of medicine there is a lot of evidence that the invasiveness of the intervention scales with how far advanced the disorder is, e.g. surgery vs. diet and exercise changes. The same principle applies to mental health.
Q: In this tech-driven world, people and especially teens are becoming increasingly attached to their screens. Do you think this could have a significant impact on sleep and thus mood dysregulation?
Yes. In fact the light from screens (computer and tablets) is likely to adversely affect sleep. This is something that we really don’t know a lot about, and warrants more study.
Q: Your research used an activity watch to collect data that helped identify behavior linked to Bipolar Disorder. With the popularity of fitness trackers, do you see applications to health IT in managing and perhaps even pre-screening people with mood disorders?
Absolutely. This is in fact something we are launching now at UCLA on a large scale with The Depression Grand Challenge (http://grandchallenges.ucla.edu/depression/). Mobile devices for tracking things like mood, activity, and sleep are going to be a big part of this effort.
Q: What types of interventions are promising in treating early-onset neuropsychiatric illness?
The good news is that there are a lot of psychosocial interventions that are shown to be effective- such as family focused therapy (focused on improving family communication). Social rhythm therapy developed by Dr. Ellen Frank and colleagues at the University of Pittsburgh School of Medicine has been used and shown good efficacy in adults, but has promise for youth as well.
Q: What would you do with unlimited research funds? What type of research would you like to see more of in the field of mood disorders?
What a question! Since you asked, I would start a translational center on adolescent brain and emotional development. To be investigated via prospective studies in humans, with paradigms that are also investigated in animal models and/or in vitro cellular models, so that we can really understand the basic circuitry. I really think we need more of that kind of environment where basic and clinical scientists really talk to each other. This is the kind of work we need to see more of in the field of mood disorder: more on development and more translational.
Dr. Carrie Bearden is the Joanne and George Miller Family Endowed Term Chair in the Department of Psychiatry and Biobehavioral Sciences and Brain Research Institute at UCLA. She received her Ph.D. in Clinical Psychology from University of Pennsylvania and joined the UCLA faculty in 2003.