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Brain Scans May Someday Help Choose Best Depression Treatment

Brain Scans May Someday Help Choose Best Depression TreatmentProvocative new research suggests a brain scan can determine if a depressed individual would do better with an antidepressant medication or psychotherapy.

The National Institutes of Health funded study discovered that brain imaging, a technique primarily used for research, may be a new method to aid clinical decision-making.

“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 Helen Mayberg, M.D., of Emory University, Atlanta, a grantee of the NIH’s National Institute of Mental Health.

Mayberg and colleagues report on their findings in JAMA Psychiatry.

“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 NIMH Director Thomas R. Insel, M.D.

Currently, physicians use trial and error to determine whether a particular patient with depression would best respond to psychotherapy or medication.

Clinicians typically try a treatment that they, or the patient, prefer for a month or two to see if it works. As a result, only about 40 percent of patients achieve remission following initial treatment.

Obviously, this practice is costly in terms of human suffering as well as health care spending.

Mayberg’s team hoped to identify a biomarker that could predict which type of treatment a patient would benefit from based on the state of his or her brain.

Using a positron emission tomography (PET) scanner, they imaged pre-treatment resting brain activity in 63 depressed patients. PET pinpoints what parts of the brain are active at any given moment by tracing the destinations of a radioactively-tagged form of glucose, the sugar that fuels its metabolism.

They compared brain circuit activity of patients who achieved remission following treatment with those who did not improve.

Activity in one specific brain area emerged as a pivotal predictor of outcomes from two standard forms of depression treatment: cognitive behavior therapy (CBT) or escitalopram (Lexapro), a serotonin specific reuptake inhibitor (SSRI) antidepressant.

If a patient’s pre-treatment resting brain activity was low in the front part of an area called the insula, on the right side of the brain, it signaled a significantly higher likelihood of remission with CBT and a poor response to escitalopram (Lexapro).

Conversely, hyperactivity in the insula predicted remission with escitalopram and a poor response to CBT.

Activity within the anterior insula of the brain best predicted whether an individual did or did not respond to a particular treatment.

The anterior insula is known to be important in regulating emotional states, self-awareness, decision-making and other thinking tasks.

Changes in insula activity have been observed in studies of various depression treatments, including medication, mindfulness training, vagal nerve stimulation and deep brain stimulation.

“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.

The cost for a PET scan varies widely, but current estimates are from $1,000 to $4,000.

Source: National Institutes of Health

Brain Scans May Someday Help Choose Best Depression Treatment

Rick Nauert PhD

Rick Nauert, PhDDr. Rick Nauert has over 25 years experience in clinical, administrative and academic healthcare. He is currently an associate professor for Rocky Mountain University of Health Professionals doctoral program in health promotion and wellness. Dr. Nauert began his career as a clinical physical therapist and served as a regional manager for a publicly traded multidisciplinary rehabilitation agency for 12 years. He has masters degrees in health-fitness management and healthcare administration and a doctoral degree from The University of Texas at Austin focused on health care informatics, health administration, health education and health policy. His research efforts included the area of telehealth with a specialty in disease management.

APA Reference
Nauert PhD, R. (2015). Brain Scans May Someday Help Choose Best Depression Treatment. Psych Central. Retrieved on August 16, 2018, from https://psychcentral.com/news/2013/06/13/brain-scans-may-someday-help-choose-best-depression-treatment/55980.html

 

Scientifically Reviewed
Last updated: 6 Oct 2015
Last reviewed: By John M. Grohol, Psy.D. on 6 Oct 2015
Published on PsychCentral.com. All rights reserved.