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Novel mechanism-based treatments for pediatric anxiety and depressive disorders

Neuropsychopharmacology volume 49, pages 262–275 (2024)Cite this article

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Abstract

Pediatric anxiety and depressive disorders are common, can be highly impairing, and can persist despite the best available treatments. Here, we review research into novel treatments for childhood anxiety and depressive disorders designed to target underlying cognitive, emotional, and neural circuit mechanisms. We highlight three novel treatments lying along a continuum relating to clinical impact of the disorder and the intensity of clinical management required. We review cognitive training, which involves the lowest risk and may be applicable for problems with mild to moderate impact; psychotherapy, which includes a higher level of clinical involvement and may be sufficient for problems with moderate impact; and brain stimulation, which has the highest potential risks and is therefore most appropriate for problems with high impact. For each treatment, we review the specific underlying cognitive, emotional, and brain circuit mechanisms that are being targeted, whether treatments modify those underlying mechanisms, and efficacy in reducing symptoms. We conclude by highlighting future directions, including the importance of work that leverages developmental windows of high brain plasticity to time interventions to the specific epochs in childhood that have the largest and most enduring life-long impact.

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Fig. 1: Attention bias modification (ABM) as a mechanism-based treatment for anxiety disorders.
Fig. 2: Parent Child Interaction Therapy: Emotion Development (PCIT: ED) as a mechanism-based treatment for preschool onset depression.
Fig. 3: Key findings in research on the interface among resting state functional magnetic resonance imaging (rsfMRI), major depressive disorder (MDD), and transcranial magnetic stimulation (TMS).

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Funding

Funding is through the National Institute of Mental Health (R01MH122389 and R01MH131584 to CMS; R01MH098454 to JLL) and the Taylor Family Foundation (to CMS); NIMH Intramural Research Program ZIA-MH002781.

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Authors and Affiliations

  1. Washington University Department of Psychiatry, St. Louis, MO, USA

    Chad M. Sylvester & Joan L. Luby

  2. Washington University Department of Radiology, St. Louis, MO, USA

    Chad M. Sylvester

  3. National Institute of Mental Health, Emotion and Development Branch, St. Louis, MO, USA

    Daniel S. Pine

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All three authors contributed to the conception and interpretations offered in this review. The authors worked together to draft the work, make revisions, and approval the final version. All authors agree that they are accountable for all aspects of the work.

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Sylvester, C.M., Luby, J.L. & Pine, D.S. Novel mechanism-based treatments for pediatric anxiety and depressive disorders. Neuropsychopharmacol. 49, 262–275 (2024). https://doi.org/10.1038/s41386-023-01709-x

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