Specific patterns of activity on brain scans may help clinicians identify whether psychotherapy or antidepressant medication is more likely to help a patient recover from depression.

For a new study, researchers randomly assigned patients to 12 weeks of treatment with one of two antidepressant medications or with cognitive behavioral therapy (CBT). At the start of the study, patients underwent a functional MRI brain scan, which was then analyzed to see whether the outcome to CBT or medication depended on the state of the brain prior to starting treatment.

depression
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Depression

“All depressions are not equal and, like different types of cancer, different types of depression will require specific treatments.”

The MRI scans identified that the degree of functional connectivity between an important emotion processing center (the subcallosal cingulate cortex) and three other areas of the brain was associated with the treatment outcomes.

Specifically, patients with positive connectivity between the brain regions were significantly more likely to achieve remission with CBT, whereas patients with negative or absent connectivity were more likely to remit with antidepressant medication.

“All depressions are not equal and, like different types of cancer, different types of depression will require specific treatments,” says Helen Mayberg, professor of psychiatry, neurology and radiology at Emory University School of Medicine. “Using these scans, we may be able to match a patient to the treatment that is most likely to help them, while avoiding treatments unlikely to provide benefit.”

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Current treatment guidelines for major depression recommend that a patient’s preference for psychotherapy or medication be considered in selecting the initial treatment approach. However, in the new study, patients’ preferences were only weakly associated with outcomes; preferences predicted treatment drop-out but not improvement.

These results are consistent with prior studies, suggesting that achieving personalized treatment for depressed patients will depend more on identifying specific biological characteristics in patients rather than relying on their symptoms or treatment preferences. The findings suggest brain scans may offer the best approach for personalizing treatment going forward.

For the study, published in the American Journal of Psychiatry, researchers recruited 344 patients made up of a for more diverse group of patients than other previous studies—roughly half self-identified as African-American or Hispanic.

“Our diverse sample demonstrated that the evidence-based psychotherapy and medication treatments recommended as first line treatments for depression can be extended with confidence beyond a white, non-Hispanic population,” says Boadie Dunlop, director of the Emory Mood and Anxiety Disorders Program.

“Ultimately our studies show that clinical characteristics, such as age, gender, etc., and even patients’ preferences regarding treatment, are not as good at identifying likely treatment outcomes as the brain measurement,” adds Mayberg.

  1. Edward Craighead, professor of psychiatry and behavioral sciences is a coauthor of the study. Grants from the National Institutes of Health funded the work.

Source: Emory University

Original Study DOI: 10.1176/appi.ajp.2016.16050517

Article by Robin Reese-Emory