Brain Scans May Predict Efficacy of Antidepressants
In a recent study, Stanford researchers used patients’ personal history and fMRI scans to predict with 80% accuracy whether an individual with depression would respond positively to antidepressant medication.
October 11, 2016
Medication combined with psychotherapy is the most effective treatment for severe depression, but antidepressants work slowly and somewhat inconsistently. Most people see no benefit for the first 10 to 14 days, and wait a full 8 to 10 weeks before experiencing an antidepressant’s full benefits. Finding the right prescription to control symptoms is often a long, frustrating guessing game for a condition that is the leading cause of disability worldwide, and accounts for nearly $12 billion in lost workdays each year in America.
A new study, published in Proceedings of the National Academy of Sciences of the United States of America, suggests that doctors could improve the speed and efficiency with which depression is treated by using brain scans and a detailed history to predict which patients would respond best to antidepressants.
The researchers, from Stanford University School of Medicine, asked 80 participants with depression to complete a questionnaire that evaluated early life stress, and exposure to abuse, neglect, family conflict, illness or death (or both), and natural disasters prior to the age of 18. Then, participants viewed images of happy faces and fearful faces while lying in an fMRI scanner before and after an eight-week treatment period with three common antidepressants: sertraline (Zoloft), escitalopram (Lexapro), and venlafaxine (Effexor). The research focused on studying how the amygdala, the circuit that responds to emotions, is impacted by childhood trauma.
Using predictive modeling, the scientists found that participants who experienced childhood trauma were most likely to respond positively to antidepressants if their brain scans showed high reactivity to happy faces; in other words, if their amygdalas were working well. Patients with a high level of childhood trauma whose amygdalas was impaired, or had low reactivity to happy faces, were less likely to experience success with antidepressants.
“We were able to show how we can use an understanding of the whole person – their experiences and their brain function and the interaction between the two – to help tailor treatment choices,” Leanne Williams, Ph.D. and study author said in a press release. “We can now predict who is likely to recover on antidepressants in a way that takes into account their life history.”
The researchers hope that this study can be used to avoid the heartache and time wasted searching unsuccessfully for the right treatment for depression. In the future, they hope it will lead to a treatment model based on a questionnaire and brain scan to determine the best first line of treatment.
Currently, using brain scans to diagnose and treat ADHD is not a widely accepted practice. Joel Nigg, Ph.D., presented the latest national research to ADDitude in June 2016, and warned that diagnostic brain scans are not reliable because scanners are not standardized or available everywhere. Currently, it is very expensive to run a brain scan, and the results could vary from scanner to scanner. The National Institutes of Health (NIH) is working to establish a baseline, normal scan with a study of 10,000 brain scans over 10 years. Down the road, this may be a helpful tool for diagnosing and treating ADHD, but it’s just simply too early to tell.
1. Andrea N. Goldstein-Piekarski, Mayuresh S. Korgaonkar, Erin Green, Trisha Suppes, Alan F. Schatzberg, Trevor Hastie, Charles B. Nemeroff, and Leanne M. Williams, Human amygdala engagement moderated by early life stress exposure is a biobehavioral target for predicting recovery on antidepressants. Proceedings of the National Academy of Sciences of the United States of America, October 10 2016; Published Online Ahead of Print. DOI: 10.1073.