Tailored approach key to tackling teen mental health

It is not as simple as pointing to one single cause of mental ill health and swifty dealing with it. When we’re trying to find solutions to teen wellbeing, we have to accept that there is no silver bullet. Instead, by incorporating the full picture of where health emerges in adolescence, inlcuding factors such as diet, sleep, social media use and so on, we might be able to prevent the pattern from proliferating and treat those who are suffering. Camilla Nord, author of The Balanced Brain, spoke to James Tytko...

Camilla - I think, when thinking about the treatment of mental health conditions in adolescents, you can think about it from a policy angle, a prevention angle, and maybe those are the angles that are more likely to capture people with milder forms of mental health conditions, but then it's always very important to consider those adolescents where maybe, no matter what, maybe if they'd never had any exposure to social media, they had a perfectly aligned sleep schedule with their school and so on, they may have experienced a mental health condition. And so I think it's very important to think about people who are genuinely functionally impaired and are treatment seeking in adolescence and finding the right treatments for them. Not necessarily just mapping on a treatment that works in adulthood directly onto adolescents or even younger children because often there are quite important differences that need to be studied and experiments that need to be run.

But, on the bright side, I think there are very effective cognitive behavioural interventions in adolescence. I don't know if anyone's ever studied this, but you could argue that because adolescence is this vulnerable period for mental health conditions, maybe teaching someone and training someone the kind of cognitive behavioural techniques that come out in therapy could have not only a beneficial effect on their mental health then, but may be longer lasting afterwards, which is something we typically see in therapy - that it has this longer lasting effect afterwards. And then I also think there's space for other, more experimental treatments. So I know, for example, in the UK, there are researchers interested in expanding our provision of non-invasive brain stimulation like repetitive transcranial magnetic stimulation, which is a form of magnetic brain stimulation. It changes the electrical activity, mildly. You get several doses. It doesn't involve surgery or anything like that. I know that there are some initial trials showing its efficacy in depression. I think keeping a perspective on treatment that includes people from the milder end to people who are adolescents but who have really quite serious mental health conditions is important and we need to consider the whole range of treatments for all of them.

James - The role of drugs in treatment: I don't think anybody's advocating that we do away with drug treatments for mental health conditions, they've got a very important role to play. Do you get a sense of a shift, though, away from prescribing drugs for some mental health conditions? Is that a fair assessment that there's a general direction of travel away from them or is that far too simplistic?

Camilla - It's hard to say. You say that no one is advocating to stop drug treatments in mental health conditions, but actually I would say some people really are. Some people on the more radical end. Personally, I think all mental health treatments should be accessible if they've been demonstrated to work better than placebo in those conditions. And many drug treatments that we use far surpass that criteria and they're very effective. Something like antidepressants are very effective, but I do think it's really important to not just extrapolate from adult data, to actually use adolescent data, because the correct or the optimal drug treatment might not be the same for people at different developmental stages. This brings us a little bit closer to a precision medicine framework where I think ultimately what we need is not just a blanket: everyone should try a drug first or everyone should try therapy and no drugs, but actually a more nuanced decision process where, when someone is initially processed for treatment, we have some way of predicting what would be the best treatment for that person. This is often discussed only in the context of adults figuring out whether they'd be better off on therapy or antidepressants and which antidepressant and so on. But actually, it may be even more important in adolescents, just a little harder because you're hitting a moving target throughout development,

James - Is the fact that we are not always able to treat a mental health condition with a particular form of therapy or a particular drug necessarily a bad thing?

Camilla - I think it can initially seem pessimistic to say, as I would suggest, that there isn't a single cause of poor mental health or a single solution out of it. I think, if we better understand the diverse causes of poor mental health, the diverse roots towards a mental health condition or just worse mental health generally, then we can map those on better to the various treatments that we have in our arsenal. If we understood, for example, that one adolescent's poor mental health came from a combination of different particular circuits in their brain, or perhaps, if you want to think more psychologically, different kinds of beliefs about the world, then we could have a better way of mapping those dysfunctions onto the treatments that we know work to target those particular differences.