Medical practitioners currently treat depression with psychotherapy or medication on a trial-and-error basis. Researchers say they have discovered that the brain has biomarkers a more accurate way of indicating which methods will best achieve remission, says the National Institutes of Health. The research findings were published in the June 12, 2013 issue of “JAMA Psychiatry.”
Clinicians usually try a treatment selected by themselves or the depressed patient for a month or two and observe whether it works. As a result, only 40 percent of patients go into remission after their first treatment. Researchers are seeking a more accurate method of determining which treatments will best achieve remission from depression.
“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,” explained researcher Helen Mayberg, M.D., of Emory University, Atlanta.
“For the treatment of mental disorders, brain imaging remains primarily a research tool, yet these results demonstrate how it may be on the cusp of aiding in clinical decision-making,” said Thomas R. Insel, M.D., director of the National Institute of Mental Health (NIMH).
Dr. Mayberg and her team used a positron emission tomography (PET) scanner to get images of pre-treatment resting brain activity in 63 patients with depression. PET points to the parts of the brain that is active by tracing the destinations of a sugar. This radioactively-tagged type of glucose fuels brain metabolism.
The types of activity in the right side of the brain known as the insula could predict the effectiveness of a serotonin specific reuptake inhibitor (SSRI) antidepressant medication called escitalopram or cognitive behavior therapy (CBT).
The insula regulates thinking tasks, self-awareness, emotions, and decision making. Low activity in the insula signaled that a patient will have a poor response to escitalopram and a much higher likelihood of remission with CBT. Hyperactivity in the insula indicated that patients will have a poor response to CBT and remission with escitalopram.
Researchers have observed activity changes in the insula in studies on depression treatment during vagal nerve stimulation, deep brain stimulation, and mindfulness training.
“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, offering a first step towards personalized medicine measures in the treatment of major depression,” said Mayberg.