Brain Inflamed
Brain Inflamed

Brain Inflamed: How Physiological Dysfunction Feeds Mood Disorders in Adolescents and Teens

February 5, 2021

By Kenneth Bock, M.D.


I’ve treated children, teens, and adolescents for decades at my integrative medical practice in Red Hook, and it’s clear to me that this generation of young people is stressed in ways they’ve never been before, resulting in increasing prevalence of anxiety, depression, and other mood disorders.

National statistics support my observations. By the time they turn 18, as many as 50 percent of all children and teens will meet the diagnostic criteria for at least one mental health disorder. Compared to young people of the same age surveyed during the Great Depression, five times as many high school and college students today say they are dealing with anxiety and other health disorders.

Anxiety—which manifests as social anxiety, separation anxiety or phobias, among other symptoms—is the most prevalent diagnosis, affecting as many as one-third of adolescents today.

There are many contributors to chronic stress in adolescents. They include peer pressure; social media and its constant demands for attention and perfection; bullying; “FOMO” (fear of missing out); and social instability due to a sense of vulnerability in foundational institutions like school and houses of worship.

Additionally, increased pressure to perform in school, work and sports often results in less time for basic healthy, fun exercise and relaxation (besides screen time and video games, which pose their own potential detrimental effects). Add to this increased pandemic-related isolation and loneliness, and it’s no wonder our teens are cauldrons of brewing and overflowing angst.

Not Just Psychology

Many parents take their kids to primary care physicians and psychiatrists for psychotropic medication such as SSRIs, and seek the expertise of psychologists or licensed social workers for cognitive behavioral therapy or similar treatment. Unfortunately, these psychological-based treatments, while certainly important, often fail to significantly resolve symptoms in many adolescents. Why?

I believe that this increased prevalence of mood disorders with varying symptoms and degrees of severity—what I’ve coined the “Mood Dysregulation Spectrum” (MDS)—is not just psychological in origin, but has underpinnings in abnormal physiological function. The primary one is systemic inflammation, which can affect the gut, the immune system, and the brain—the so-called gut-brain-immune axis.

Chronic stress has many correlations with chronic disease. For example, dysbiosis (imbalance of the intestinal flora) and increased intestinal permeability (“leaky gut”) are two common downstream effects of stress. Both conditions allow inflammatory mediators to pass through the gut and beyond, triggering immune inflammation and ultimately reaching the blood-brain barrier, the cellular barrier that separates the brain from toxins and inflammatory perpetrators. This contributes to an escalating onslaught of brain inflammation, which can lead to psychiatric symptoms in teens and adolescents, including all those we see on the MDS—anxiety, depression, panic attacks, OCD, severe mood swings, and even psychotic features.

There’s so much research linking neuropsychiatric disorders to brain inflammation and even autoimmunity (where the body attacks its own tissues) that it led to the creation of a new scientific field, immuno-psychiatry. Besides exploring neuropsychiatric disorders, immuno-psychiatry contributes new treatment approaches targeting the immune and inflammatory issues behind psychological symptoms.

In addition, I’ve found that hidden medical contributing factors can cause symptoms that propel a teen onto the MDS. They include tick-borne disorders; infection-triggered autoimmune brain inflammation (ITABI/PANS/PANDAS); adrenal and thyroid imbalances; toxicants such as mercury and lead; nutritional deficiencies; and metabolic imbalances.

Multifaceted Approach

Being aware of these contributing factors is the first step toward healing, but medical detective work may be required to solve the puzzle and construct a truly effective road map of treatment. So to help these struggling teens and adolescents, we must consider a multifaceted approach. In addition to psychotropic medications and therapy, we can prescribe changes in diet; increased exercise, especially outdoors; free time for fun and play; relaxation exercises such as meditation or yoga; and treatment with herbs and/or nutrients that can be anti-inflammatory, strengthen the blood-brain barrier and mitigate the effects of stress. Medications such as antimicrobials, anti-inflammatories, or more intensive immune-modulating treatments may be needed to address contributing medical factors.

About Neuropsychiatric Disorders and the Author

This article provides a brief introduction to complex diagnostic and treatment considerations for teens and adolescents with neuropsychiatric disorders. I offer more detail in my book Brain Inflamed: Uncovering the Hidden Causes of Anxiety, Depression, and Other Mood Disorders in Teens and Adolescents, published by HarperCollins.

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