One day soon, doctors may be able to quickly scan a depression patient’s brain, check his brain activity “fingerprint,” and select an antidepressant or psychotherapy accordingly.
Currently, psychiatrists use a trial-and-error method to prescribe antidepressants and psychotherapy. But the dawn of personalized depression treatments — be it with drugs and/or psychotherapy — is close, with doctors better able to predict a particular patient’s response to one type of treatment over another, The New York Times
Helen Mayberg, M.D., a professor of psychiatry at Emory University, recently published a study in JAMA Psychiatry that identified a potential biomarker in the brain that can predict whether a depressed patient would respond better to psychotherapy or antidepressant medication.
Using PET scans, she compared a group of depressed patients who underwent 12 weeks of treatment with the antidepressant Lexapro to those receiving cognitive behavior therapy, which teaches patients to correct their negative and distorted thinking.
About 40 percent of the depressed subjects responded to either treatment. But Dr. Mayberg found striking brain differences — identified through PET scans — between patients who did well with Lexapro compared with cognitive behavior therapy.
Patients who had low activity in a brain region called the anterior insula measured before treatment responded quite well to CBT but poorly to Lexapro. At the same time, those with high activity in this region had an excellent response to Lexapro, but did poorly with CBT.
Past studies have linked the insula to decision making, emotional self-awareness, and cognitive control — all of which are impaired by depression. Dr. Mayberg suggested CBT may have a more powerful effect than an antidepressant in patients with an underactive insula because it teaches patients to control their emotionally disturbing thoughts in a way that an antidepressant cannot.
This finding fits with what we’ve learned from previous brain imaging studies
, which show that antidepressants and psychotherapy share some common effects, but also have different effects in distinct brain regions.
Another study, led by Charles Nemeroff, M.D., at the University of Miami, suggests that notable differences in another region of the brain — the hippocampus, which is critical to memory and learning — may help doctors tailor treatments to depressed adults.
His research showed that in patients without a history of abuse, there was a clear ranking order of treatment efficacy: Combined psychotherapy (using a form of CBT) and an antidepressant was superior to either treatment alone. But for those who had a history of childhood trauma, combo therapy was not significantly better than psychotherapy alone. What’s more, 48 percent achieved remission with psychotherapy alone, while only 33 percent benefited from an antidepressant alone.
The results of such studies confirm that some patients respond better to psychotherapy than medication — and vice versa — or prefer one type of treatment over another.
But they also indicate scans of specific regions of the brain may offer clues to which treatment options — and combinations — are likely to be successful and begin effective therapies earlier.
This can be critical to depressed patients, who are at increased risk for suicide.
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