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Brain Scan May Predict Best Depression Treatment

Brain Scan May Predict Best Depression Treatment

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Published by: vomeditor on Jun 26, 2013
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06/26/2013

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Foro de comunicacion para Latinos del suroeste de los EEUU[LARED-L@LISTSERV.CYBERLATINA.NET]; on behalf of;franktalamantes [lactogen@MOUSEPLACENTA.COM]Brain Scan May Predict Best Depression TreatmentA brain imaging technique may help predict whether peoplewith major depression will respond best to treatment withpsychotherapy or a commonly prescribed drug. The approachmight eventually be used as a tool to identify treatmentsthat are most likely to succeed.In people with major depression, low resting brain activityin the front part of the insula (red area where green linesconverge on the right) predicted a higher likelihood ofsuccess with psychotherapy and a poor response toescitalopram. Source: Dr. Helen Mayberg, Emory University.People with major depressive disorder, or major depression,have feelings of sadness, loss, anger or frustration thatinterfere with daily life for weeks or longer. Symptoms canalso include memory loss and trouble focusing.Major depression is most commonly treated with medication,psychotherapy or a combination. Unfortunately, less than 40%of patients typically respond well to initial treatment.They may need to try several treatments over many weeks ormonths before finally getting symptom relief.A team led by Callie L. McGrath and Dr. Helen S. Mayberg atEmory University looked for a biological marker or
“biomarker” that could predict whether patients with
depression would respond best to medication or
psychotherapy. The study was funded by NIH’s National
Institute of Mental Health (NIMH) and National Institute ofGeneral Medical Sciences (NIGMS). Results appeared online onJune 12, 2013, in JAMA Psychiatry.
 
The researchers studied 63 adults, ages 18 to 60, with majordepression. Participants underwent a brain scan usingpositron emission tomography (PET). A small amount ofradioactively labeled glucose was used to reveal levels ofglucose metabolism
 —
a sign of brain activity
 —
in differentareas of the brain. Participants then completed 12 weeks oftreatment with cognitive behavior therapy or the drugescitalopram.Success rates were similar for both treatments: about 36%for psychotherapy and 40% for escitalopram. The rates of
those who didn’t respond were also similar: about 27% for
psychotherapy and 20% for escitalopram.Activity in a number of brain regions corresponded totreatment outcomes. The strongest correlation was in an areaknown as the anterior insula. Increased glucose metabolismin this area corresponded to successful treatment withmedication but poor response to behavior therapy.Conversely, decreased glucose metabolism in the area wasassociated with success using behavior therapy but notescitalopram. One limitation of this potential imagingbiomarker, the researchers note, is that it may not predictwhen neither of these therapies would work.
“Our goal is to develop reliable
biomarkers that match anindividual patient to the treatment option most likely to besuccessful, while also avoiding those that will be
ineffective,” says Mayberg. “If these findings are confirmed
in follow-up replication studies, scans of anterior insulaactivity could become clinically useful to guide moreeffective initial treatment decisions, offering a first steptowards personalized medicine measures in the treatment of
major depression.”
 Dr. Frank Talamantes, Ph.D,Professor of Endocrinology (Emeritus)

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