Prof Mitul Mehta from the British Association of Psychopharmacology (BAP) teamed up with Elaine Snell from the International Neuroethics Society to convene a symposium entitled ‘Mental Illness in Children and Adolescents’ as part of the British Neuroscience Association (BNA) Festival of Neuroscience held in Dublin, April 14th-17th. The speakers were:
- Prof Judith Homberg, Radboud University – Psychopharmacology in the young and developing brain
- Dr Ciara McCabe, University of Reading – Anhedonia and adolescent depression
- Prof Paramala Santosh, King’s College London – Child psychopharmacology and development: perspectives from real world clinical practice
- Dr Gabriela Pavarini, University of Oxford – Early intervention and moral development in child psychiatry
Judith Homberg opened the symposium eloquently describing her work on the developing rat brain and the influence of maternal use of psychotropic drugs. With a particular focus on the serotonergic system she demonstrated that perturbations in serotonin levels affect later development of brain and behaviour. She focused on SSRIs and the anti-HIV agent efavirenz (which preferentially binds to the 5-HT2A transmission). The impact on development was striking with decreased body weight, developmental delays in sensory and motor function, and a decrease in social behaviour in adolescent rats. Administering fluoxetine increased repetitive behaviour and anxiety in adolescence. Pos
t-mortem analysis revealed numerous changes, including increased serotonergic innervation into the frontal lobes and increased cell death with efavirenz. Currently she is working in Africa testing the translational relevance of these findings in children of mothers trea
ted for HIV infection.
Ciara McCabe heads one of the few research groups looking at specific components of reward and aversion processing, including psychopharmacological investigations in humans. The audience were captivated by the descriptions of her approach which looks at the brain during the anticipation and consummation of pleasurable and aversive tastes. Chocolate was featured! She clearly showed a blunted response to both reward and aversive stimuli in adolescents with depression that also correlated with the subjective experience of anhedonia in young people. Some of her recent work suggested that adolescents with depression have a reduced expectation of how pleasurable they predict a consummatory experience will be, even though the actual experience was not blunted. She also reported that young people with depression symptoms underestimated how much effort they expended for reward. Finally, Ciara talked about how we can use this information to develop new treatments for depression in adolescents as a recent meta-analysis suggests only fluoxetine demonstrates any advantage at all for children and adolescents and Venlafaxine is even associated with an increased risk of suicidality (Cipriani et al., 2016).
Santosh gave a perspective from the real world at the coal face of child and adolescent psychopharmacology. He described his approach to clinical care in complex cases where little formal evidence exists. The shared decision making, including patients and carers, combined with slow dose escalation, was an elegant solution to balancing the potential effectiveness with side effects in individual patients. Santosh’s clinic is unique in having technicians who have developed tools to deal with physiological markers and online questionnaires. These are proving invaluable in predicting drug treatment choice and negative outcomes, including suicide attempts. It seems that if ever one needs to understand that medicine is an art that benefits from sound science you need look no further than child and adolescent clinical psychopharmacology.
The symposium then moved onto ethics and ethical implications of research with adolescents drawing upon the BeGOOD Citizen’s Project, presented by Gabriela. She highlighted the type of support young people said they would like following a predictive test, concerns around data privacy and issues surrounding trust in predictive algorithms.
An aim of the multidisciplinary format was to demonstrate that neuroscience need not sit in isolation from the clinical implications and clinical reality and the ethical issues and implications that are alive in the field. The case for a multidisciplinary conversation in adolescent and developmental issues in mental health is a case in point, but it is likely to be relevant in other areas of neuroscience.