Effects of music therapy as an alternative treatment on depression in children and adolescents with ADHD by activating serotonin and improving stress coping ability

Abstract

Objective: The objective of this study was to determine the effect of music therapy as an alternative treatment on depression in children and adolescents with attention-deficit hyperactivity disorder (ADHD) by activating serotonin (5-HT) and improving stress coping ability.

Methods: This study is designed based on randomization method. A total of 36 subjects participated in the experiment, consisting of an ADHD control group (n = 18) and ADHD music therapy group (n = 18). The ADHD control group received standard care, while the ADHD music therapy group received music therapy and standard care. The ADHD music therapy group received both active music therapy (improvisation) and receptive music therapy (music listening) for 50 minutes, twice a week, for 3 months: a total of 24 times. From a neurophysiological perspective, changes in depression and stress were tracked by measuring 5-HT secretion, cortisol expression, blood pressure (BP), heart rate (HR), and CDI and DHQ psychological scales.

Results: The ADHD music therapy group's 5-HT secretion increased (p < 0.001), whereas cortisol expression (p < 0.001), BP (p < 0.001) and HR (p < 0.001) decreased. The CDI and DHQ psychological scales also showed positive changes (p < 0.01 and p < 0.001, respectively). However, the ADHD Con G's (who did not receive music therapy) 5-HT secretion did not increase, whereas cortisol expression, BP, and HR did not decrease. In addition, the CDI and DHQ psychological scales did not display positive changes.

Conclusions: In conclusion, the application of music therapy as an alternative treatment for ADHD children and adolescents showed positive neurophysiological and psychological effects. Therefore, this study would like to propose a new alternative to medicine for preventing and treating depression through various uses of music therapy.

Keywords: Ability to address stress; BP; Children and adolescents with ADHD; Cortisol; Depression; HR; Music therapy; Serotonin (5-HT).

Scheme 1

A: ADHD music therapy group: Before application of music therapy, in a condition stabilization situation after 30 minutes of rest, 5-HT was analyzed by collecting blood twice for each session (1st) and 24th session before execution and immediately after music therapy (2nd). Cortisol was analyzed through saliva collection under the same conditions. Psychological measurements (CDI, DHQ) were performed 24 times after the end of the program before music therapy was applied. B: ADHD music therapy group: SBP and DBP were measured before and after music therapy application. HR measurement was performed by naturally sitting on a chair with knees folded after listening to music for 2 minutes. Measurements were performed twice before and after music therapy. The average value of measurement results was recorded as a numerical value and analyzed. C: ADHD control group: Measurements carried out using the same method as the music therapy group but without the application of music therapy. 5-HT, serotonin; SBP: systolic blood pressure; DBP: diastolic blood pressure; HR: heart rate; CDI: Children’s Depression Inventory; DHQ: Daily Hassles Questionnaire

Scheme 2

Alternative to Depressive Stress-Application Procedures and Effects of Music Therapy (Dotted line?? Reference). Step 1: Resonance frequency breathing [45, 46] (8 min). While listening to music with a stable tempo (60–80 bpm), resonance frequency breathing is performed, inducing stability relaxation and emotion control. Step 2: Listening to music with the applications of auditory stimuli receptive music therapy (music listening) (12 min). Based on emotional stability effect aroused by internal projection of depression into the musical structure, elements of auditory stimuli (tempo, tonality, chord, contrast effect of emotions) [30, 31] are applied, inducing 5-HT activation and cortisol decrease. Step 3: Improvisation and positive self-expression activities based on music as an auditory stimulus [47] active music therapy (improvisation) (30 min). This step aims to induce decreases of SBP, DBP and HR by improving positive self-awareness and stress coping skills. After the three-step music therapy is applied, psychological effects can be induced based on neurophysiological effects. 5-HT, serotonin; SBP: systolic blood pressure; DBP: diastolic blood pressure; HR: heart rate

Fig. 1

Flow chart: Participant flow

Fig. 2

Values (n = 36) are presented as mean ± SD. Results of the serotonin (5-HT) analysis of the ADHD control group (ADHD Con G) and the ADHD music therapy group (ADHD MT G). The results of the analysis of the serotonin expression level of the ADHD MT G showed a statistically significant increase compared to before they had music therapy (***p < 0.001). However, the 5-HT analysis of the ADHD Con G showed that the serotonin expression levels had not significantly increased after, as compared to before. Statistically significant differences between ADHD Con G and ADHD MT G (#p < 0.05). Thus, the application of music therapy can contribute to 5-HT activation

Fig. 3

Values (n = 36) are presented as mean ± SD. Cortisol levels in the ADHD control group (ADHD Con G) and the ADHD music therapy group (ADHD MT G). The ADHD MT G showed statistically significantly lower cortisol levels after the music therapy (***p < 0.001). However, analysis of the ADHD Con G showed that cortisol level expression had not significantly decreased after, as compared to before. Statistically significant differences between ADHD Con G and ADHD MT G (#p < 0.05). Thus, the application of music therapy may contribute to a decrease in cortisol levels

Fig. 4

Values (n = 36) are presented as mean ± SD. Results of depression analysis according to Children’s Depression Inventory (CDI) scale: The ADHD control group (ADHD Con G) vs. the ADHD music therapy group (ADHD MT G). The ADHD MT G showed statistically significantly lower CDI depression scores after the music therapy (**p < 0.01). However, the ADHD Con G had CDI depression scores that were not significantly lower after, as compared to before. Statistically significant differences between ADHD Con G and ADHD MT G (##p < 0.01). The results confirm that the application of music therapy can contribute to the reduction of symptoms of depression in children and youths with ADHD

Fig. 5

Values (n = 36) are presented as mean ± SD. Daily Hassles Questionnaire (DHQ) scale analysis: ADHD control group (ADHD Con G) vs. ADHD music therapy group (ADHD MT G). The ADHD MT G showed statistically significantly lower DHQ stress scale scores after the music therapy (***p < 0.001). However, the DHQ stress scale scores of the ADHD Con G were statistically significantly not lower after, as compared to before. Statistically significant differences between ADHD Con G and ADHD MT G (##p < 0.01). The results confirm that the application of music therapy can contribute to the reduction of symptoms of stress in children and youths with ADHD