Today, fewer than 40% of patients treated for major depressive disorder achieve remission with initial treatment, largely because depression remains somewhat of a medical mystery.
Using positron emission tomography (PET) to map the minds of depressed patients, researchers at Emory University have learned more about how certain treatments affect brain activity.
Writing in JAMA Psychiatry this week, Emory’s Helen Mayberg, M.D., and her colleagues describe their imaging work and propose a biomarker that could help physicians choose the right treatment for patients with depression right off the bat, improving the odds that initial interventions might work.
In a study on men and women between 18 and 60 who were untreated for major depressive disorder at the time, Dr. Mayberg’s team found that relative to whole-brain mean, insula hypometabolism as measured by PET was associated with remission to cognitive behavior therapy (CBT) and poor response to escitalopram oxalate (Lexapro), while insula hypermetabolism was associated with remission to escitalopram and poor CBT response.
“If verified with prospective testing, the insula metabolism-based treatment-specific biomarker defined in this study provides the first objective marker, to our knowledge, to guide initial treatment selection for depression,” Dr. Mayberg et al., write.
In a statement, the lead author adds that brain scan patterns prior to treatment could provide important clues as to treatment choice. “These data suggest that if you treat based on a patient's brain type, you increase the chance of getting them into remission,” Dr. Mayberg says.
She adds that her team’s work is an important first step toward “the development of brain-based treatment algorithms that match a patient to the treatment with the highest likelihood of success, while also avoiding those treatments that will be ineffective,” though the results must first be validated through further study.
"Toward a neuroimaging treatment selection biomarker for major depressive disorder" appeared online in JAMA Psychiatry June 12.