Talk Therapy or Meds for Depression? Brain Scan May Help Decide

New research from Emory University in Atlanta has found that specific patterns of activity on brain scans may help clinicians identify whether psychotherapy or antidepressant medication is more likely to help individual patients recover from depression.

The study, called PReDICT, randomly assigned patients to 12 weeks of treatment with one of two antidepressant medications or with cognitive behavioral therapy (CBT).

At the start of the study, patients underwent a functional MRI brain scan, which was then analyzed to see whether the outcome from CBT or medication depended on the state of the brain prior to starting treatment.

The MRI scans identified that the degree of functional connectivity between an important emotion processing center — the subcallosal cingulate cortex — and three other areas of the brain was associated with the treatment outcomes, according to the researchers.

Specifically, patients with positive connectivity between the brain regions were significantly more likely to achieve remission with CBT, while patients with negative or absent connectivity were more likely to benefit from antidepressant medication.

“All depressions are not equal and like different types of cancer, different types of depression will require specific treatments. Using these scans, we may be able to match a patient to the treatment that is most likely to help them, while avoiding treatments unlikely to provide benefit,” said Helen Mayberg, M.D., a professor of psychiatry, neurology and radiology at Emory University School of Medicine.

Mayberg and her co-investigators, Boadie Dunlop, M.D., director of the Emory Mood and Anxiety Disorders Program, and W. Edward Craighead, Ph.D., a professor of psychiatry and behavioral sciences, sought to develop methods for a more personalized approach to treating depression.

Current treatment guidelines for major depression recommend that a patient’s preference for psychotherapy or medication be considered in selecting the initial treatment approach. However, in the PReDICT study, patients’ preferences were only weakly associated with outcomes — preferences predicted treatment drop-out, but not improvement, the study found.

These results are consistent with prior studies, suggesting that achieving personalized treatment for depressed patients will depend more on identifying specific biological characteristics in patients rather than relying on their symptoms or treatment preferences, the researchers noted.

The results from PReDICT suggest that brain scans may offer the best approach for personalizing treatment going forward, they add.

The researchers recruited 344 patients for the study from across the metro Atlanta area. Researchers note they were able to convene a more diverse group of patients than other previous studies, with roughly half of the participants self-identified as African-American or Hispanic.

“Our diverse sample demonstrated that the evidence-based psychotherapy and medication treatments recommended as first-line treatments for depression can be extended with confidence beyond a white, non-Hispanic population,” said Dunlop.

“Ultimately our studies show that clinical characteristics, such as age, gender, etc., and even patients’ preferences regarding treatment, are not as good at identifying likely treatment outcomes as the brain measurement,” concluded Mayberg.

The study results were published in the American Journal of Psychiatry.

Source: Emory University