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And Your Brain Says...

By Robin Reese

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Is therapy or medication the best way to treat your depression? A brain scan might be the most efficient way to decide.

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, a recent study has found.

The study, called PReDICT, randomly assigned patients to 12 weeks of treatment with one of two antidepressant medications or with cognitive behavioral therapy. At the start of the study, patients underwent a functional MRI brain scan, which was then analyzed to see whether the outcome of therapy or medication depended on the state of the brain prior to treatment.

The imaging study was led by Helen Mayberg, professor of psychiatry, neurology, and radiology, and the Dorothy C. Fuqua Chair in Psychiatric Imaging and Therapeutics at Emory’s School of Medicine.

"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," Mayberg says.

Mayberg and co-investigators Boadie Dunlop, director of the Emory Mood and Anxiety Disorders program, and W. Edward Craighead, J. Rex Fuqua Professor of Psychiatry and Behavioral Sciences, are hoping to develop methods for a more personalized approach to treating depression.  

Current treatment guidelines for major depression recommend that a patient’s preference for therapy or medication be considered in selecting the initial treatment approach. The PReDICT study, however, showed that patients’ preferences were only weakly associated with outcomes—preferences predicted treatment dropout but not improvement.

These results are consistent with prior studies showing that personalized treatment for depression will likely depend more on identifying specific biological characteristics in patients than relying on their symptoms or treatment preferences. The results from PReDICT suggest that brain scans may offer the best approach for personalizing treatment going forward.  

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

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Related Link

"Brain scans may help clinicians choose between talk therapy and medication treatment for depression" (News Release, 3/4/2017)

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