How do you predict which teenagers will develop clinical depression? Can you use brain activity, mood or behavior patterns, and other information? Are there targeted prevention strategies that could stop a vulnerable young person from plunging into depression? And for teenagers who are currently suffering, how do you ensure from the get-go that they receive the right treatment?
Researcher Christian A. Webb, PhD, who directs the Treatment and Etiology of Depression in Youth (TEDY) Laboratory, is focused on answering these and related questions.
TEDY is the newest lab in McLean’s Center for Depression, Anxiety and Stress Research (CDASR), which is revolutionizing our understanding of mood disorders, thanks to the leadership of its founding director, Diego A. Pizzagalli, PhD. Since its founding a decade ago, the CDASR has experienced significant growth. This is largely due to Pizzagalli’s extraordinary talent as a scientist and mentor, and philanthropy has played an important role. The CDASR was launched in 2010 with a bequest from a grateful patient.
The stakes are high: depression is relatively rare in young children, but surges during adolescence, with almost 15% of young people experiencing at least one episode of clinical depression by age 18. Depression also is a huge risk factor for suicide, which is on the rise among teens. After declining for two decades, the suicide rate among Americans ages 10 to 24 increased by 56% between 2007 and 2017, according to the Centers for Disease Control and Prevention.
“Gender differences begin to emerge during the teen years, with girls starting to experience more depression than boys. By the end of adolescence, girls experience twice as much depression as boys, a ratio that persists through adulthood,” said Webb. “So, adolescence is a critical time to intervene, particularly for girls.”
Behavioral Activation as an Antidepressant
One of the TEDY lab’s most promising studies examines the efficacy of an evidence-based treatment called behavioral activation to combat depression. Behavioral activation involves getting patients to engage in activities that reconnect them with sources of pleasure. “It’s common that depressed teens will withdraw from activities, isolate from friends, and spend more time alone ruminating about how bad things are,” explained Webb. “In behavioral activation, a therapist works collaboratively with a depressed teen to get them to systematically and gradually re-engage with naturally rewarding activities, hobbies, and people and to decrease patterns of avoidance that contribute to and sustain depression.”
After 12 weeks of behavioral activation therapy, adolescents in the study undergo brain imaging to see if the program has had any effect on the circuitry in their brain’s reward center, which is involved in the ability to experience pleasure and interest. (Subjects undergo the same brain scan at the beginning of the study so a comparison can be made.) The TEDY lab has been able to expand the study to more participants and add a follow-up phase, thanks to the generosity of The Tommy Fuss Fund, a private foundation established by the Fuss family in memory of their son.
“We’ve been impressed with how McLean has been able to leverage our gifts in the past—using them to attract more funding from other sources, so we are pleased to support this study,” said RoseMary Fuss.
Like other labs in the CDASR, the TEDY lab uses interdisciplinary investigatory techniques, including machine learning—sophisticated computer algorithms that make sense of large quantities of data. These algorithms get “smarter” as data are added. One TEDY study uses machine learning to predict depression risk in individuals. “If, for a given adolescent, we could predict whether they are at high risk of developing depression, we could recommend a preventive intervention targeting their specific risk factors,” explained Webb.
In addition to Webb’s TEDY lab, the CDASR includes three other labs that are investigating underlying causes and potential treatments for emotional disorders. “Our goal is to translate new scientific knowledge into improved outcomes for patients,” said Pizzagalli. “Each lab has its unique character and focus. With each of these, philanthropy plays a critical role in accelerating studies, jump-starting projects, and enabling the launch of new collaborations.”
Philanthropic support for the CDASR has totaled more than $3 million since its founding. In addition to the Tommy Fuss Fund, a number of other individuals and foundations generously support the center, including the William Rosenberg Family Foundation.
“My mother and I have been supporting Diego Pizzagalli’s work for years through our family’s foundation. We are drawn to his use of imaging, as well as behavioral and electrophysiological techniques to develop personalized treatments for depression,” said Jill Gotlieb, of the William Rosenberg Foundation. “Diego and his team offer hope.”
Depression and anxiety are two of the most common psychiatric disorders and have become a major public health problem. Mentored by Pizzagalli, Webb and the other talented researchers in the CDASR use multidisciplinary approaches to understand the psychological, environmental, and neurobiological aspects of these illnesses in hopes of developing ever-better interventions.