By Amir Khan
Depression can seriously impact your life and wading through treatments to figure out which one will work for you can be time-consuming and frustrating. But now, there may be a way to get past the inefficiency of trial-and-error and figure out which course of treatment will confer the most benefit, according to a small study published today in the journal JAMA Psychiatry.
Using a brain scan, researchers identified a biomarker that indicates whether patients who need treatment for their depression would be better off undergoing psychotherapy or using antidepressants.
"Our goal is to develop reliable biomarkers that match an individual patient to the treatment option most likely to be successful, while also avoiding those that will be ineffective," Helen Mayberg, MD, study author and researcher with Emory University in Atlanta, said in a statement.
Researchers conducted brain scans on 63 patients before they began treatment, and then compared the brain activity of the patients who benefited from treatment to the ones who did not 12 weeks later. They found that high activity on one specific area of the brain known as the anterior insula signaled that the patients would benefit from antidepressants over psychotherapy, whereas low activity in the area indicated the opposite – a finding that researchers say can lead to better treatment options for patients with depression.
“At present, treatment failure with antidepressant medication often leads to the addition of a second drug and not a categorical switch to an evidence-based psychotherapy,” the researchers wrote in the study. “Results herein suggest that patients who require [psychotherapy] have a distinct neurophysiology that differs categorically from patients who require [antidepressants].”
But David M. Reiss, MD, a psychiatrist based in San Diego, said combining treatments is likely a better option.
“In every one of the over 10,000 cases I have evaluated and treated, the mode of intervention has changed with time based upon the patient’s response to treatment, condition, and life circumstances, etc. – none of which stay static,” he said. “I cannot recall a single case in which I have not combined aspects of different therapeutic approaches in order to best address the distress, problems, symptomatology, and pathology present at any point in time for the specific patient being treated.”
The researchers admitted that the findings are still preliminary, and said it’s too early to recommend brain scans for patients with depression prior to treatment. However, they urged further research, and said they one day treating depression could become much easier.
"If these findings are confirmed in follow-up replication studies, scans of anterior insula activity could become clinically useful to guide more effective initial treatment decisions,” Dr. Mayberg said in the statement, “offering a first step towards personalized medicine measures in the treatment of major depression."
Steve Maraboli, PhD, a behavioral scientist and author of the Everyday Health blog The Healthy, Empowered Life, said he looks forward to the day when this technique comes to fruition.
“In this age of high-tech computer calculations, we’re seeing the results of medical research data being gathered and examined for critical use as predictors for effective personalized medical management,” Dr. Maraboli said. “With so many variables in initial diagnosis and treatment considerations, it will be interesting to see if doctors find this biomarker effective in accurately predicting the most effective course of medical action.”
"Brain Scan Hints at Best Treatment for Depression" originally appeared on Everyday Health.