Thursday, June 20, 2013
Brain Scans Predict Best Course of Treatment for Patients with Depression
June 13, 2013
Brain & Behavior Research Foundation Scientific Council Member and three-time NARSAD Grantee Helen S. Mayberg, M.D., was principal investigator for a study that showed that specific patterns of brain activity can help indicate how a depressed person will respond to treatment with medication or psychotherapy. The study results, published in JAMA Psychiatry online on June 12, 2013, offer a first step towards personalized medicine treatment decisions for major depression. The findings are especially important because at present less than half of patients experience remission with the treatment initially selected.
Dr. Mayberg has long been committed to improving the lives of patients with depression and other mental illnesses. She pioneered the use of positron emission tomography (PET) to investigate brain changes in depressed patients with her first NARSAD Young Investigator Grant 20 years ago. Since that time, with the support of two further NARSAD Grants―and countless other grants―she successfully identified a key locus of pathology in depression (the subcallosal cingulate or Brodmann Area 25) and piloted the use of deep brain stimulation (DBS) to target this “Area 25” to treat patients with resistant depression.
Her new study sought to identify a biomarker that could predict which type of treatment a patient would benefit from based on the individual’s brain activity. The research team measured brain glucose metabolism (a critical brain function) in two groups of participants during a span of 12 weeks. After having a PET scan, half of the participants were given an antidepressant medication and the other half were given cognitive behavior therapy (CBT).The researchers found that less activity in the brain’s anterior insula indicated response to CBT, and more activity indicated response to medication.
"To be ill with depression any longer than necessary can be perilous," says Dr. Mayberg, Dorothy C. Fuqua Chair in Psychiatric Imaging and Therapeutics, Emory University School of Medicine. "This is a serious illness and the prolonged suffering resulting from an ineffective treatment can have serious medical, personal and social consequences. Our goal is not just to get patients well, but to get them well as fast as possible, using the treatment that is best for each individual."
"These data suggest that if you treat based on a patient's brain type, you increase the chance of getting them into remission," says Dr. Mayberg. More study is needed to confirm how this approach may be used to deliver treatments more effectively and how to apply it to different types of depression.