Dr Shock MD PhD

The way adolescents act and react such as poor decision making, recklessness, and emotional outbursts makes many parents hopeless. At least that's what I remember from my parents although I was a very agreeable adolescents. The title of this post is by Dr. Huxtable, Bill Cosby in The Cosby Show who has the same opinion as many parents.
As a psychiatrist I am also a consultant for a adolescent unit in our hospital. The consults are very few but mostly about depressed adolescents. I find it very hard to diagnose depression in this category of patients, they do have symptoms comparable to adults but they can also differ in their symptoms.
Can adolescents be depressed, is it the same as with adults? I wonder. So I have chosen to explore this topic from a more scientific, biological view point. Are the brains of adolescents different than those from adults, can these brains become depressed or are their differences explaining a different symptom pattern and treatment needs?
Brain maturation continues into the teen years and continues even into the 20's. During the teen you get an overproduction of gray-matter. Gray matter is distributed at the surface of the cerebral hemispheres (cerebral cortex) and of the cerebellum (cerebellar cortex) mostly, but also in the deeper centres of the brain.
After the overproduction of gray matter the brain undergoes a proces called "pruning". Pruning is a neurological regulatory process, which facilitates a productive change in neural structure by reducing the overall number of overproduced or "weak" neurons into more efficient synaptic configurations. It is often a synonym used to describe the maturation of behavior and cognitive intelligence in children by "weeding out" the weaker synapses. Connections among neurons in the brain that are not used wither away. This is also called: the use it or lose it principle.
This pruning proces makes the brain more efficient by strengthening the connections that are used most often, and eliminating the clutter of those that are not used at all.
Functional magnetic resonance imaging (fMRI) research found that compared to adults teens' frontal lobes are less active during the showing of pictures of people with fearful expressions and their amygdala is more active. The frontal lobe is the seat of goal oriented rational thinking and the amygdala is involved in discriminating fear and other emotions.
Teens often misread facial expressions, the judgement insight and reasoning power of the frontal cortex is not up up to the task yet as it is in adults. Adolescents process information differently from adults.

What does this mean?
1 Adolescents are "hard wiring" their brains during this period in life, that's probably why this is the period for education
2 This explains why adolescents fail to to heed adults' warnings, they may simply not be able to understand and accept logical arguments
3 It is also possible that adolescents misperceive or misunderstand the emotions of adults, leading to miscommunication
4 Adolescence seems not to be the right time to experiment with alcohol and drugs

The question about depression and adolescence in view of brain development remains for a next article, to be continued

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