Medication or Talk Therapy? PET Scans May Personalize Depression Treatment Through the use of high-tech brain imaging, scientists can now tell if a person with depression would be better helped by talk therapy or medication. 

Researchers have identified a region of the brain that “lights up” in response to either counseling or medication.

Currently, most doctors treat patients on a trial-and-error basis, and unfortunately, the first treatment for depression often fails, said Helen Mayberg, M.D., a researcher at Emory University in Atlanta, Georgia.

“The problem is that whatever you get, the published numbers, even in randomized studies, is getting people well — the remission rate is about 40 percent, which means, for most people, the first thing you are given is not likely to work,” said Mayberg.

The result is that most patients have to try several different treatments until they find something that does work.

Now, Emory researchers, led by Mayberg, are using PET (positron emission tomography) to try to identify which individuals with depression would most likely benefit from medication and who would be helped by a form of talk therapy called cognitive-behavior therapy.

PET uses a radioactive sugar molecule that traces the brain circuitry, lighting up areas that become activated by stimuli.  While using PET on 63 depressed patients, researchers identified the anterior insula as a particular brain region that appears to be predictive.

They found that patients with a sluggish insula at the beginning of the study did best with cognitive therapy, while those with overactive insulas gained more relief from the study medication, Lexapro (escitalopram).

Mayberg says the insula is part of a system in the brain associated with monitoring the internal state of the body, and becomes activated during times of extreme distress.

Using the insula as a possible biomarker for depression needs to be researched more, according to Mayberg, who says her findings could help put treatment of mental disorders on an equal plane with other medical conditions.

Source:  Emory University