‘The young are heated by nature as drunken men by wine.”
Aristotle made that observation 2,300 years ago, and since then, not much has changed about the way the adolescent brain behaves. But these days, researchers are beginning to understand exactly why a teenager’s brain is so tempestuous, and what biological factors may make teens’ brains vulnerable to mood disorders, substance abuse, and suicide.
Suicide is the third leading cause of death among teens 15 to 19 years old, according to the National Centers for Disease Control and Prevention. The percentage of high school students who reported seriously considering suicide increased from 14 percent in 2009 to 16 percent in 2011. Locally, the city of Newton is reeling from the suicide of Roee Grutman, 17, a high school junior, in February, the third suicide in a single school year. The towns of Needham and New Bedford have experienced similar spates of teen suicides in recent years.
Misconceptions about teen suicide abound, says Dr. Barry N. Feldman, director of psychiatric programs in public safety at the University of Massachusetts Medical School, and a suicide prevention expert who has worked with many Massachusetts high schools.
Neither bullying, pressure to succeed in sports or academics, nor minority sexual orientation can cause suicide, he says, but are among a number of possible risk factors. “If you focus too much on just bullying or sexual orientation, you take your eye off the underlying vulnerability a kid may have,” Feldman says.
Suicide is typically caused by a constellation of risk factors and underlying vulnerabilities. “It’s an attempt to solve a problem of intense pain with impaired problem-solving skills,” he says.
Researchers have long known that the basic problem with the teenage brain is the “asymmetric” or unbalanced way the brain develops, said Dr. Timothy Wilens, a child psychiatrist at Massachusetts General Hospital specializing in adolescents, addictions, and attention deficit disorder.
The hippocampus and amygdala, which Wilens calls the “sex, drugs, and rock ’n’ roll” part of the brain, feels and stores emotions and is associated with impulses. It matures well ahead of the section of the brain that regulates those emotions and impulses, the prefrontal cortex.
Throughout the teenage years and up until about age 25, this executive section of the brain, also responsible for planning and decision, lags behind, Wilens says.
Until the front part of the brain catches up, if kids get sad, “they really experience sadness un-tethered.” He adds. “It’s why first love really does break the heart.”
It’s during this period of brain development that kids often act out based on their moods, get involved in substance abuse, and when they may be at a heightened risk to commit suicide, Wilens says. This is also when adolescents have a higher susceptibility to psychiatric disorders including depression, drug addiction, and schizophrenia.
Dr. Mai Uchida, a child and adolescent psychiatrist at Mass. General, is leading two joint studies at the MGH Biederman Lab and the Gabrieli Lab at the Massachusetts Institute for Technology that are searching for biomarkers to identify the underlying vulnerability in teens. The studies are funded by The Tommy Fuss Fund, which memorializes a Belmont Hill teen who committed suicide in 2006.
Just as hypertension and high cholesterol are biomarkers for heart attack, mood disorders are indicators of kids at risk for suicide, Uchida said.
In a healthy teen, even though brain structure is unbalanced, the developing prefrontal cortex still should be communicating and working in concert with the brain section that feels and stores emotion, according to Uchida.
In one of the studies, researchers used magnetic resonance imaging to compare the brains of 38 children between the ages of 8 and 14 who had a parent with a depressive disorder with a control group of 25 children with no genetic predisposition.
Looking at the brains while the children were in a resting state the researchers saw less synchronized activation between the amygdala and the medial prefrontal cortex in the kids who had a genetic predisposition for depressive disorder than in the control group.
The fact that these two brain regions are not activating together could be a potential biomarker, indicating a vulnerability for potential mental or mood disorders.
In the second study — in which 62 subjects between ages 18 and 24 were given pictures of people crying and asked to think about a positive way to interpret the picture — the subjects who could not spin a positive narrative also showed less connectivity between the brain regions.
“These deficits could represent a unique biological vulnerability that puts youth at risk for depression and suicide,” Uchida said.
Uchida and her team are currently readying these two studies for publication. She says there is a lot more work to do, but she is hopeful the results might eventually lead to early-intervention screening.
In a study published in December, researchers at the Douglas Institute Research Centre affiliated with McGill University identified the gene known as DCC as having a possible role during the maturation of the prefrontal cortex and in healthy brain connectivity.
Higher function or expression of DCC appears to be associated with a greater risk of psychiatric disorders, depression, and suicide, according to Cecilia Flores, a professor of psychiatry at McGill and lead author of the study.
“We are very excited to discover the function of this gene,” she said. Experiments in mice also showed that DCC gene function could be altered by both positive and negative experiences, and influences behaviors later in a rodent’s adult life. If the results translate to humans, Flores said, it offers hope that early therapy and support during the critical time in adolescent brain development could have long-term positive impact.
Wilens says that one of the most useful early interventions for adolescents who might have depression, mood, or attention deficit disorders is cognitive behavioral therapy, a non-pharmaceutical approach that can help teach kids how thoughts and thought patterns influence behaviors.
These are areas in which kids are lacking because of the imbalance of brain development, and could assist them in making better connections between what they are feeling and what they are thinking.
“It helps put it all together and has a component that gets you to stop doing something that may harm you,” Wilens said.
Feldman encourages parents and school systems to create protective “buffers” — a caring relationship with an adult, whether that is a parent, guardian, teacher, or someone in the community. UMass Medical is currently collaborating with the Department of Public Health and Department of Elementary and Secondary Education to train school personnel to develop comprehensive programs that include suicide intervention and prevention.
And parents and students are urged to take the warning signs of a troubled and potentially suicidal teen seriously. “Don’t casually dismiss signs as a cry for help,” Feldman says. Teens at risk for suicide should be taken to a hospital emergency room or somewhere where they can get immediate mental health services. “Don’t make an appointment for a doctor down the road.”