05-24 Brain scans to suggest between talk therapy and antidepressants in treating depression, says study
Posted in Depression, Depression Treatment, Therapy
The onset of depression can be influenced by the interplay of several biological and personal factors. Although there can probably be no universal treatment approach for depression due to a patient’s varied needs, scientists are trying to find methods which may suggest personalized treatment options for effective recovery.
A study called “Predictors of Remission in Depression to Individual and Combined Treatments”, or PReDICT, published as two papers in the American Journal of Psychiatry in March 2017, has attempted to address the problem of selecting the correct treatment option for individuals with depression. Researchers at Emory University have found that an MRI brain scan may help in deciding whether talk therapy or antidepressants are the most effective course of treatment for depressive disorders.
As part of the study, 344 participants with depression were made to undergo 12 weeks of randomized treatment with either antidepressant medicines or cognitive behavioral therapy (CBT). In addition, the researchers also carried out a functional MRI brain scan on 122 participants at the beginning of the study. The MRI scans were examined to understand if the effect of CBT or antidepressants was contingent on the brain’s condition before commencing the treatment.
The analysis of MRI scans showed that treatment outcomes were related to the connection between the subcallosal cingulate cortex, an important area of the brain that processes emotions, and three other brain regions. It was found that the likelihood of achieving remission with CBT was significantly higher in the case of participants with greater connectivity between the brain regions. On the other hand, the likelihood of achieving remission with antidepressant medicines was higher in the case of participants with poor or absent connectivity between the brain regions.
Different depressive disorders need personalized approach
Helen Mayberg, professor of psychiatry, neurology and radiology at the Emory University School of Medicine and lead researcher of the study, explains that various types of depression are not alike and hence, need specific treatment just like different types of cancer. The brain scans can help in matching patients with the treatment option that is most beneficial to them, while doing away with the one not likely to provide any benefit. The aim of Mayberg and her co-researchers was to develop a more personalized approach for treating depressive disorders.
At the beginning of the study, the researchers also asked the participants about their preferred option for treating depression – psychotherapy or medication. This was done keeping in mind current guidelines which recommend that patients’ preferences be taken into account while selecting a treatment approach for depression. It was found that there was a higher likelihood of drop-out among participants who were not assigned to their preferred treatment method. However, among those who continued participating in the study, there was only a weak connection between preferences and remission rates. This established the efficacy of brain scans in predicting the appropriate treatment option.
The study group had a higher diversity compared to other studies conducted in the past. Participants were picked from the metro Atlanta area and nearly half of them identified as Hispanic or Blacks. It helped the researchers to confidently establish that evidence-based talk therapy and antidepressants suggested as initial treatments for depression are not restricted to white, non-Hispanic people only.
Future scope of depression treatment
The findings of the study suggest that the ability to offer personalized treatment to individuals with depression should be based more on detecting precise biological attributes in them instead of relying on the individuals’ symptoms or treatment preferences. According to Mayberg, the research shows that factors such as age, gender and patients’ treatment preferences are not as reliable as brain scans in predicting the likely result of treatment.
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