Review of: Fischer AS et al, JAMA Psychiatry 2018;75(5):493–502

One of our biggest in-office challenges is how to enhance teen resilience, the process of adapting to and recovering from stressful life experiences. Some neuroscientists hypothesize that resilience is related to the limbic system, which plays a vital role in emotion processing, motivation, and learning. According to one theory, when people can exert better modulation of the limbic system, they are at lower risk of depression. A group of researchers recently looked at these neural pathways in adolescent females, and there were some intriguing results.

Fischer and colleagues examined brain pathways of resilience in adolescent females at familial risk for depression. They conducted a longitudinal study at Stanford University from 2003 to 2017. Sixty-five subjects participated: 20 at high risk of MDD in whom depression did not develop (resilient), 20 at high risk in whom depression developed (converted), and 25 at low risk of MDD with no history of psychopathology (control). Outcomes measured via functional MRI scans included connectivity in the limbic, salience, and executive control networks. Participants were imaged once, on average at age 19, 6 years after beginning the study.

The researchers found that resilient adolescent females had greater connectivity between the limbic and executive control systems than did subjects who developed depression or even controls. The strength of the connection was correlated with positive life events.

CCPR’s take
This study is consistent with the hypothesis that high-risk but resilient adolescent females have greater executive system control over emotions and behavior arising from the limbic system, which perhaps insulates them against depression. What are the treatment implications of this small study? Theoretically, since positive life events were correlated with better neural resilience, we might want to focus on therapeutic approaches that have an activity-oriented style and are designed to strengthen adaptive coping and cognitions, thereby helping teens foster positive life experiences.