FFFEmerging Mental Health Treatments in Adolescents

No. 141; April 2024

As science advances, new treatments are continually being developed and evaluated for safe and appropriate use in the field of mental health. While many of these therapies show promise in trials, not all are approved by the Food and Drug Administration (FDA) for use in teens. However, in some cases, doctors use these treatments when they believe it can help. It is important for parents to know about the potential benefits and risks of these treatments. This document focuses on several such treatments: Transcranial Magnetic Stimulation (TMS), esketamine and ketamine, and external Trigeminal Nerve Stimulation (eTNS). While these treatments are sometimes provided by non-mental health clinicians, such as anesthesiologists and neurologists, a licensed mental health clinician with experience working with adolescents should be involved in the evaluation and treatment planning.

Transcranial Magnetic Stimulation (TMS)

TMS is a noninvasive procedure that uses magnetic fields to stimulate nerve cells in the brain. It is currently FDA approved for the treatment of major depressive disorder (in patients 15 and older) and obsessive-compulsive disorder in adults only. Some studies suggest that TMS is safe and effective in younger adolescents with depression, especially when medication and therapy do not sufficiently help, but further research is needed to confirm its safety and efficacy in this age group.

Possible side effects of TMS that may occur during sessions include headache, lightheadedness, and discomfort at the treatment site. There is a very rare risk of seizures. When side effects occur, psychiatrists can adjust the protocol to make treatment more tolerable.

Ketamine and Esketamine

Ketamine, a medication originally used for anesthesia, has shown promise in treating severe depression and suicidal ideation when administered off-label in adults and adolescents. Esketamine (a form of ketamine) is an FDA approved, fast-acting medication for treatment-resistant depression in adults. Both medications work differently from traditional antidepressants, providing relief in hours or days instead of weeks. Ketamine can be given by IV, injection, or lozenge, and esketamine is given via a nasal spray.

These medications have potential side effects, which can be minimized by adjusting the treatment approach. These may include nausea, an increase in blood pressure and heart rate, disorientation or confusion, and hallucinations, resolving as the medication clears the system. There is some potential for misuse or addiction, which can be minimized when given in a medical office by clinicians trained in its use.

External Trigeminal Nerve Stimulation (eTNS)

External Trigeminal Nerve Stimulation is a noninvasive treatment that uses a small at-home device that is worn overnight to send very mild electrical stimulation to the brain via a patch on the forehead. The use of this device requires an evaluation and prescription by a physician. It is FDA approved for the treatment of ADHD in children aged 7 to 12 and sometimes clinicians use it off-label for adolescents. Effects are typically seen within four weeks. Possible side effects include skin irritation, sleepiness, and an increase in appetite.

Considerations

While these emerging treatments can provide hope for children and adolescents with mental health disorders that have not responded well to oral psychiatric medications, it's important to be aware of the following:

  • Safety and Efficacy: The safety and effectiveness of many of these treatments for adolescents have not been thoroughly evaluated by the FDA and further research is needed. They are used off-label based on clinicians' judgment and current scientific evidence.
  • Side Effects: All treatments can have side effects, some of which can be severe. It's crucial to discuss these potential risks with your child's psychiatrist.
  • Monitoring: Adolescents undergoing these treatments need to be closely monitored by healthcare professionals for changes in symptoms, side effects, and overall well-being.
  • Cost: These emerging treatments can be expensive and are often not covered by standard health insurance.
  • Comprehensive Care: These treatments should be part of a comprehensive treatment plan that may include psychotherapy, medication, lifestyle changes, and other appropriate interventions.

Informed decision-making is essential when it comes to mental health care. Families should have open, ongoing dialogues with their child and adolescent psychiatrist about the potential benefits and risks of emerging treatments, and how these may fit into their overall mental health care plan.

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