Brain scan may predict best depression treatment - national institutes of health (nih)
Brain Scan May Predict Best Depression Treatment
A brain imaging technique may help predict whether people with major depression will respond best totreatment with psychotherapy or a commonly prescribed drug. The approach might eventually be used as a
tool to identify treatments that are most likely to succeed.
People with major depressive disorder, or major depression, have
feelings of sadness, loss, anger or frustration that interfere with daily
life for weeks or longer. Symptoms can also include memory loss andtrouble focusing.
Major depression is most commonly treated with medication,
psychotherapy or a combination. Unfortunately, less than 40% of
patients typically respond well to initial treatment. They may need totry several treatments over many weeks or months before finally
A team led by Callie L. McGrath and Dr. Helen S. Mayberg at EmoryUniversity looked for a biological marker or “biomarker” that could
predict whether patients with depression would respond best to
In people with major depression, low
medication or psychotherapy. The study was funded by NIH’s National
resting brain activity in the front part
Institute of Mental Health (NIMH) and National Institute of General
of the insula (red area where green
Medical Sciences (NIGMS). Results appeared online on June 12, 2013, in lines converge on the right) predicted a
psychotherapy and a poor response to
The researchers studied 63 adults, ages 18 to 60, with major
depression. Participants underwent a brain scan using positron emissiontomography (PET). A small amount of radioactively labeled glucose was used to reveal levels of glucosemetabolism—a sign of brain activity—in different areas of the brain. Participants then completed 12 weeks of
treatment with cognitive behavior therapy or the drug escitalopram.
, Ph.D., Editor
Success rates were similar for both treatments: about 36% for psychotherapy and 40% for escitalopram. The
, Assistant Editor
rates of those who didn’t respond were also similar: about 27% for psychotherapy and 20% for escitalopram.
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Activity in a number of brain regions corresponded to treatment outcomes. The strongest correlation was in an
area known as the anterior insula. Increased glucose metabolism in this area corresponded to successful
treatment with medication but poor response to behavior therapy. Conversely, decreased glucose metabolism
in the area was associated with success using behavior therapy but not escitalopram. One limitation of thispotential imaging biomarker, the researchers note, is that it may not predict when neither of these therapieswould work.
“Our goal is to develop reliable biomarkers that match an individual patient to the treatment option mostlikely to be successful, while also avoiding those that will be ineffective,” says Mayberg. “If these findings areconfirmed in follow-up replication studies, scans of anterior insula activity could become clinically useful toguide more effective initial treatment decisions, offering a first step towards personalized medicine measuresin the treatment of major depression.”
Predicting Treatment Response to a Rapid Antidepressant:
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un 12:1-9. doi: 10.1001/jamapsychiatry.2013.143. [Epub ahead of print].
: NIH’s National Institute of Mental Health (NIMH) and National Institute of General Medical Sciences (NIGMS).
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