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DEPRESSION: Out of the Shadows
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Chapter 3: The Mysteries of the Adolescent Brain [5:34]

The Satows lost their college-aged son, Jed, to suicide. Why? Researchers use MRI scans to study the teen brain.

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Transcript: Chapter 3 - The Mysteries of the Adolescent Brain

NARRATION: (JED SATOW PHOTOGRAPHS) Jed Satow took his life his sophomore year in college.

Just 20 years old, he may have suffered from undiagnosed depression.

PHIL SATOW: (VO, JED SATOW PHOTOGRAPHS) He was dating a girl and she broke up with him that evening. And that was--

PHIL SATOW: (OC) that was the trigger that caused him to take his life.

NARRATION: (COLLEGE CAMPUS SHOTS, JED SATOW PHOTO) Suicide is the second leading cause of death among college students. Within the general population, it is far more common than people realize.

DR THOMAS INSEL: (OC) Suicide is almost twice as common as homicide in the United States. We have roughly 30,000 suicides a year. And 90% of those are associated with mental illness, most commonly depression.

NARRATION: (JED SATOW PHOTOGRAPHS) Jed grew up in a close knit family and was well-liked by his peers. But he sometimes showed signs of anxiety, impulsiveness, and anger that worried his parents.

DONNA SATOW: (VO, JED SATOW PHOTOGRAPHS) So many people said, "Oh, don't worry. He'll grow out of it.

DONNA SATOW: (OC) I knew so and so who was like that, and my goodness, it was much worse. And he grew out of it.

PHIL SATOW: (OC) It was very, very difficult as a parent to make that decision whether, "Does it really require treatment? And if so, what sorts of treatment? Or is it really adolescence that we're seeing, and he's an aggressive adolescent, and that's all it is?"

NARRATION: (JED SATOW PHOTOGRAPHS) The Satows had not been informed about depression during Jed's high school years.

DONNA SATOW: (VO, JED SATOW PHOTOGRAPHS) You have countless parent nights about alcoholism and drugs. But no one really ever

DONNA SATOW: (OC) brought up to us-- and I felt we lived in a fairly sophisticated world-- you know, you might be dealing with depression.

NARRATION: (DR. GEIDD AND DR. CASEY WALKING DOWN HALLWAY) Here at the national institute of mental health, neuroscientists and longtime collaborators, Dr. Jay Giedd and Dr. BJ Casey have taken on the challenge of depression and are beginning to unlock some of the mysteries of the adolescent brain.

New evidence shows that anxiety can be an early warning sign for depression.

DR. B.J. CASEY: (OC) It's rare that you have a depressed child that doesn't have some symptoms of anxiety. Um, and it's also the case that, uh, individuals with anxiety have some symptoms of depression. But it's very hard to diagnose during childhood and adolescence, too. And I think that's part of the problem, is picking up on the symptoms.

NARRATION: (BOY IN MRI MACHINE) Using magnetic resonance imaging or MRI, doctors Giedd and Casey have discovered dramatic and ongoing changes in the structure and function of the adolescent brain.

This was a major breakthrough.

NARRATION: (MRI SCAN OF LIVING BRAIN) Until recently, the adolescent brain was considered to be fully mature by the age of 18. But Dr. Giedd's research shows that the brain continues to grow and refine its connections well into adulthood.

DR. JAY GIEDD: (VO, DRS. CASEY AND GIEDD WORKING) It really shocked us when we, uh, started looking at the brain development that it wasn't 16 or 17 or even 18, but

DR. JAY GIEDD: (OC) that well into the 20s, the brain was still undergoing dynamic changes, particularly in the front part of the brain involved in regulating emotions and controlling impulses.

NARRATION: (ANIMATION #1 - 3D) Dr Casey's research further revealed that the emotional centers of the brain have the upper hand during this critical period of development when teenagers are exploring their world.

And, it's not until the prefrontal cortex fully matures in the mid twenties that greater reasoning and judgment are able to modify the more turbulent thoughts and feelings of adolescence.

NARRATION: (DRS. CASEY AND GIEDD WORKING) Hoping to pinpoint a predictable marker in the brain's shifting landscape,

NARRATION: (ANIMATION #2 - 3D) Dr. Casey zeroed in on the amygdala, an almond shaped node deep in the brain that plays a critical role in processing emotion.

NARRATION: (DR. CASEY'S COMPUTER SCREEN OF FEARFUL FACES AND AMYGDALA) In a simple experiment, anxious adolescents were exposed to pictures of fearful faces. Casey observed that their emotional center was overactive. This heightened emotional state lasted far longer than that of healthy volunteers.

DR. B.J. CASEY: (VO, DRS. CASEY AND GIEDD WORKING) The reason why we're interested in this heightened activity in the amygdala

DR. B.J. CASEY: (OC) and individuals who rate themselves as highly anxious is because in depression and anxiety, elevated activity in this region has been linked to the disorder. And so this may be a marker for those individuals who will be at risk. And you want to make sure you're monitoring them, um--

NARRATION: (DRS. CASEY AND GIEDD WORKING) And make sure you are treating the right illness, whether it is bipolar illness or depression.

DR. MANJI: (DRS. CASEY AND GIEDD WORKING) Quite often, someone who has manic depressive illness or bipolar disorder, their first episode

DR. MANJI: (OC) is depression. And the young person presenting in front of you may look identical, and you don't have a lot of ways to distinguish. Are they unipolar or bipolar? And the reason it's so important is that the treatment for depression, namely an antidepressant, could aggravate the bipolar illness. It can trigger manias. It can cause rapid cycling, et cetera.

JOSH LIPTON: (VO, JOSH LIPTON'S MOOD CHART) We made this chart, and...

NARRATION: (JOSH LIPTON'S MOOD CHART) For the Lipton family, tracking and carefully monitoring Hart's moods gave them a clearer picture. This daily chart became a tool that would lead to the successful diagnosis of bipolar illness.

DR. ELLEN LEIBENLUFT: (VO, JOSH LIPTON WITH MOOD CHART) It's, very good for the parents to be giving it a little rating every day. Just write on a calendar, "Today the irritability was a five, which is like the worst it ever is," or, "Today it was a three, which isn't too bad."

DR. ELLEN LEIBENLUFT: (OC) And the physician can look it over and make very systematic decisions. So every case

DR. ELLEN LEIBENLUFT: (VO, JOSH LIPTON WITH MOOD CHART) should be treated very scientifically, if you will.

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