Music therapy proves effective in treating depression for ADHD in children and adolescents

By Dr. Liji Thomas, MDMar 30 2023Reviewed by Lily Ramsey, LLM

A current study published in the BMC Complementary Medicine and Therapies Journal researched how music therapy can improve the treatment of depression in children with Attention deficit-hyperactivity disorder (ADHD).

Study: Effects of music therapy as an alternative treatment on depression in children and adolescents with ADHD by activating serotonin and improving stress coping ability Image Credit: nya_wild/Shutterstock.com

Introduction

ADHD includes several symptoms besides the characteristic attention deficit and hyperactivity that has lent it its name. These include symptoms often associated with anxiety, depression, learning disability, and defiant disorder.

ADHD affects a child's social functioning, family life, and academic prowess, consequently causing them to experience reduced quality of life.

Subsequently, this predisposes individuals to depression. Those with ADHD suffering from depression often have lower serotonin levels than others. This suggests that a long-term reduction in serotonin levels could be linked to the clinical features of ADHD.

Serotonin mediates impulsive behavior with dopamine. It is also key to the mechanism of ADHD seen within frontal neural circuits.

Too low serotonin levels could cause a lack of emotional control and depression—the most commonly used treatment for ADHD is selective serotonin reuptake inhibitors (SSRIs).

Acute stress causes the pituitary gland to react by releasing corticotropin, which stimulates the adrenal glands to secrete glucocorticoids, mainly cortisol. This could interfere with normal growth and immune pathways. Stress levels are raised in ADHD children and adolescents relative to others, who also have higher rates of depression.

ADHD with depression may be considered a more serious condition than ADHD alone, as concurrent depression further reduces the individual's functioning and may promote unemployment by hindering skills acquisition.

Happily, children and adolescents are better subjects for intervention than adults due to their higher emotional flexibility. In other words, "if appropriate treatment is performed in children and adolescents with ADHD before they develop adult depression, the therapeutic effect can be much higher."

Music therapy has been shown in prior research to promote cognitive and sensory function in depression, as well as promoting self-awareness ad thus restoring self-esteem. It allows the subjects to use music to express their stress and anxiety, with a corresponding shift in emotions being felt over time as the music develops.

Music therapy is supposed to activate the brain's limbic system, which is vital to basic functions like blood pressure. The auditory components, such as the music's tempo, chord, and tone, are also thought to modulate stress and depression.

Coping with stress is an important part of ADHD treatment, as it helps protect such children and adolescents from social harm.

"Coping skill refers to the ability to balance the secretion of hormones and neurotransmitters with the operation of the body's immune system." This, too, has been related to music therapy.

The Study

The researchers randomized 36 children or adolescents with ADHD, with half receiving music therapy and standard care while the others receiving only standard care.

Music therapy includes both active and receptive components— active therapy comprises improvisation. Conversely, listening to music made up the receptive part.

Both were conducted for 30 minutes twice a week; the therapy is continued for three months. Thus, each individual in the treatment group received 24 music therapy sessions. Each session began with resonance frequency breathing, moving on to musical elements to promote auditory involvement.

The sessions were carried out at home, using monitors to record the Blood Pressure and Heart Rate of the participants. This reduced the cost and space required for treatment and added to its ease.

What did the study show?

Neurophysiological parameters showed changes in depression and stress, as shown by increased serotonin levels and lower cortisol secretion, with corresponding changes in blood pressure (BP), heart rate (HR), and psychological parameters.

Serotonin levels increased after music therapy, though both groups showed comparable baseline levels. Conversely, cortisol expression dropped, as did the BP and HR. All these parameters were initially comparable between groups.

Thus, the results indicate a reduction in stress following music therapy.

Clinically, the participants were assessed using the Children's Depression Inventory (CDI) and Daily Hassles Questionnaire (DHQ) psychological scales. Both showed improved functioning with music therapy.

What are the implications?

"This study would like to propose a new alternative to medicine for preventing and treating depression through various uses of music therapy."

Earlier studies have emphasized the need for pharmacological therapy to be complemented by non-pharmaceutical approaches to reduce the adverse effects of the former, making it more effective.

Music therapy is easily available and can be continued over a long period with minimal intervention. The current study looked at depression in ADHD, exploring the differences caused by music therapy. This is in contrast to earlier studies that have focused mostly on academic ability or cognitive functioning mediating improvements in impulsive behavior and attention span.

Further follow-up studies are essential to confirm that the recovery process is successful in individuals with depression, stress, and ADHD.