PET May Indicate Which Patients Benefit from Antidepressants

PET brain images of patients with major depression may indicate who will respond best to either antidepressant treatment or psychotherapy, according a study published in JAMA Psychiatry.

Currently, physicians must use trial and error to find the appropriate treatment for patients who are clinically depressed, but this is not an effective approach. Initial treatments have only about a 40 percent success rate in achieving remission. To address this issue, researchers from Emory University in Atlanta sought to identify a biomarker that could predict which type of treatment would better suit individual patients, based on the state of the patient’s brain.

The researchers performed pre-treatment resting brain activity in 63 patients who were diagnosed as depressed. The patients were treated with cognitive behavior therapy (CBT) or the selective serotonin re-uptake inhibitor escitalopram. The brain circuit activity of patients who achieved remission with their treatment was then compared with the activity of those who did not respond.

They found that if a patient’s pre-treatment resting brain activity was low in the anterior insula, there was a higher likelihood that the patient would achieve remission through cognitive behavior therapy and not through medication. Conversely, hyperactivity in the insula predicted that the escitalopram would be more effective and the CBT not.

“If these findings are confirmed in follow-up replication studies, scans of anterior insula activity could become clinically useful to guide more effective initial treatment decisions, offering a first step towards personalized medicine measures in the treatment of major depression,” researcher Helen Mayberg, MD, said in a release.