The following is Dr. Rosi’s response to the Blog The Importance of Treating Depression from a Sister’s Perspective.
Thanks for sharing your thoughts and perspective on your sister’s depression. Your observations on how Adolescent Depression can affect a person and family are shared by the hundreds of family members I have seen over my years of treating adolescents. Depression can be damaging to the person and the family on multiple levels. We can all recall the challenges faced in normal adolescence, whether it be who you are as a person, what you believe in, whom you trust, or what you choose to wear to school that day. Imagine having to deal with depression on top of all that, including continual sadness, low motivation and energy, and possibly disrupted sleep and appetite. How does one talk about that when the world of adolescence, and the world in general, may stigmatize you? Fortunately for those who seek help, there are effective treatments for Adolescent Depression and some exciting new research on the horizon.
We know there are both numerous therapies and medications for depression, but very few have received FDA approval for use in adolescence. In fact, only two medications (Fluoxetine and Escitalopram) are approved for use in adolescents age 12 and above (Fluoxetine approved down to age 8). In the realities of clinical practice, multiple medications are used “off label” (not FDA approved) for Adolescent Depression, including numerous antidepressant, mood stabilizer and antipsychotic medications. Unfortunately, the use of such medications is often limited by either side effects or lack of response. Adolescents typically have a higher risk of medication side effects compared to adults and their response to antidepressants is inconsistent. This equates to prolonged symptoms, the need for multiple treatments, and also highlights the importance of therapy. Additionally, this has led to the search for new treatments, including those in the field of neuromodulation, and Transcranial Magnetic Stimulation (TMS) appears to be at the forefront of this movement.
TMS was initially FDA approved for treatment resistant depression in adults in 2008. It is a non-invasive treatment that takes advantage of magnetic fields to induce electrochemical changes in specific brain regions associated with depression. This technology has actually been used for decades and is now gaining widespread use for its approved FDA use, but also for various anxiety disorders and medical conditions. Multiple insurance carriers are approving TMS for depression in adults and there is currently a trial underway for treatment-resistant depression in adolescents. It will be very exciting to see the results as there has already been a positive response in adults, with a significant percentage able to gain symptom remission from TMS. Since TMS does not involve taking medication or surgical intervention, side effects are minimal. If results continue on the positive trajectory, I believe TMS will usher in neuromodulation as the next frontier of psychiatric treatment. For adolescents suffering from depression, this will be a major step toward improving not only their symptoms but their future as well.
Since graduating from a Child & Adolescent Psychiatry Fellowship at Stanford University in 2007, Dr. Kevin Rosi has focused primarily on treating mood and anxiety disorders in children, adolescents, and young adults. He is Board Certified in Adult Psychiatry by the American Board of Neurology and Psychiatry and completed a visiting fellowship in Transcranial Magnetic Stimulation at Duke University in 2015.
Dr. Rosi’s areas of expertise include early-onset Bipolar Disorder, ADHD, and eating and developmental disorders. He also has extensive experience in dealing with behavioral disorders, such as Oppositional Defiant Disorder, as well as impulse control and psychotic disorders.
Dr. Rosi believes in building a trusting working relationship with his patients through open communication, and in educating them about all available modalities so treatment decisions can be made collaboratively.
Using a holistic approach that emphasizes pharmacologic and non-pharmacologic treatments, such as psychotherapy, neuromodulation, and developing healthy living habits, Dr. Rosi works together with his patients toward the goals of symptom elimination and restoring health.
Dr. Rosi joined Mindful Health Solutions in 2015 after serving over eight years in a community mental health outpatient clinic and maintaining a private practice in Davis, California.