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Quantitative EEG in the Prediction of Antidepressant Response to Imipramine

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Abstract

This paper summarizes a research report written by Vemer J. Knott, John I. Telner, Yvon D.

Lapierre, Michael Browne, and Edward R. Horn in 1996. Their report discussed examining

the utility of quantitative electroencephalography (QEEG) in the prediction of

response to imipramine in depressed patients (Knott et al.,1996). This current work will

summarize their report, critically analyze the research methods and findings, and compare

and contrast their reports with science news reports on the original research paper

(Contributor, 2020)
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Quantitative EEG in the prediction of antidepressant response to imipramine

The study's purpose was to assess the utility of quantitative electroencephalography

(QEEG) in the prediction of response to imipramine in depressed patients. According to

Knott et al. (1996), predicting how patients respond to drugs is one crucial area during an

investigation on drug treatment of depression because of the time interval between

pharmaceutical intervention and the development of significant clinical improvement.

The study was conducted using 40 patients diagnosed with a condition of unipolar

depression. The forty patients were both from outpatient and inpatient groups at a psychiatric

hospital and were equally divided by gender. The criteria used to select the patients were; 18-

65 years as the age range, a depression Hamilton Rating of ≥18, and a major depressive

disorder diagnosis. Before the active drug phase, the patients were placed in a single-blind,

placebo-controlled designed where they were assessed for 4-7 days. The patients were then

assessed in the EEG laboratory at the end of placebo where they were given their first dose of

imipramine. After 3 hours, re-assessment of patients in the laboratory using the same

procedures as in the pre-drug recording phase was done. The patients were then kept for four

weeks on a flexible imipramine dosing as determined by the study psychiatrists. After four

weeks of open imipramine treatment, separation of patients was done, i.e., responder (R) and

non-responders (NR) groups. Group comparison in four frequency bands of power spectral

estimates from the multi-channel recordings were made through statistical analysis. R and NR

groups showed differentiated theta powers before treatment, after an acute test dose, and after

two weeks of active drug treatment.

The study made three findings; first, positive reaction to four weeks of imipramine

treatment correlated with a lower pre-treatment theta. Second, an increase of theta to a test

dose of imipramine was associated with a positive reaction to imipramine treatment; and
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third, an increase in theta observed two weeks into active treatment was also associated with

a good outcome.

Similarities Between The Two Articles

The study report conducted by Knott et al. (1996) suggests that quantitative

electroencephalography may be a useful early predictor of response to imipramine. The

results showed the electrocortical activity in the theta frequency band to be sensitive to the

outcome. The report showed that although general predictors derived from data

gathered before the start of treatment are likely to lead to non-reproducible results, the pre-

treatment differences between R and NR in theta power suggest that treatment-independent

electrocortical parameters may be useful in predicting antidepressant efficacy.

The science news by Contributor (2020) reports that brain wave patterns could

potentially help to predict how individual patients would respond to an antidepressant before

treatment even begins. According to the news report, more than three hundred brave wave

readings of patients diagnosed with depression were taken using electroencephalography.

Based on the EEG data, researchers designed an algorithm to predict patients' response to the

medication. They found that patients' brain wave patterns at the start of the study

were most likely to respond to an antidepressant after eight weeks of treatment positively.

The science news report shows that the use of Quantitative EEG when predicting

antidepressant response to imipramine is quite effective.

Weaknesses Of The Original Hypotheses

Knott et al. (1996) study was based on a backdated method whereby patients were

allocated to R and NR groups after four active treatment weeks. Therefore, no precise

specific prior predictions were made. The study by Knott et al. (1996) used a duration of 4-

7days for the placebo washout phase; it is certainly possible that a more extended washout

phase could have produced more responders than the one subject observed in the study. Thus
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non-responders could have been group R members. Another weakness of the study is that the

patients were not told when the placebo would be administered, which would have some bias

in the pre-treatment ratings. Another limitation of this study was that all patients' ratings were

made by the treating physicians, who also made decisions on an increase of imipramine

intake by the patients. This study's results need to be re-examined within a randomized,

placebo controlled design and a framework of a prior hypotheses and appropriate multivariate

procedures (Vasey and Thayer, 1987) to identify EEG parameters that best descriminate not

just R and NR groups but individual R and NR patients.

The science news report captured most of the original research paper. "Doctors could

be trained in a simplified version of EEG, and then that data could be uploaded and processed

by the algorithm. The doctor would then receive a report that detailed whether

the patient would be likely to respond to certain medications".

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References

Contributor, L. (2020). Your brain waves could predict if an antidepressant will work for you.

livescience.com. Retrieved 10 December 2020, from

https://www.livescience.com/brain-waves-depression-treatment.html.

Knott, V. J., Telner, J. I., Lapierre, Y. D., Browne, M., & Horn, E. R. (1996). Quantitative

EEG in the prediction of antidepressant response to imipramine. Journal of Affective

Disorders, 39(3), 175-184.

Vasey, M. W., & Thayer, J. F. (1987). The continuing problem of false positives in repeated

measures ANOVA in psychophysiology: A multivariate

solution. Psychophysiology, 24(4), 479-486.