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Brain scans could predict how depression patients will respond to drugs

Brain scans could predict how a patient will respond to depression treatment, a groundbreaking new study claims.

Researchers from Harvard and Boston’s McLean Hospital monitored the brain activity of 300 patients before and during their antidepressant treatment, while tracking their reactions to the medication.

They found that people with strong activity in the brain region called ACC, which controls other areas of the brain, could expect successful results from a course of Zoloft, a commonly-prescribed antidepressant.

Those with a ‘weaker’ response fared better with a combination of drugs and psychotherapy.

The finding, published today, comes days after a report revealed tens of millions of Americans are addicted to antidepressants, and many may have been erroneously prescribed treatment that wasn’t appropriate for their specific case. 

Researchers from Harvard and McLean Hospital monitored the brain activity of 300 patients before and during their antidepressant treatment, while tracking their reactions to the drugs

This is not the first research into the relationship between depression and the rostral anterior cingulate cortex (ACC), but it is the first demonstrate its ‘predictive validity’.   

Diego A Pizzagalli, director of the McLean Imaging Center and the hospital’s Center For Depression, Anxiety and Stress Research, said the aim is to reach a point where clinicians could compare specific brain activity to drugs’ properties to decide, almost unequivocally, what treatment is best.

‘Our work shows that we could predict a patient’s response to an antidepressant by looking at the activation level of the ACC region of the brain by using a non-invasive monitoring system to test brain activity called an electroencephalogram – also known as an EEG,’ Pizzagalli said.

For this study, the team built upon Pizzagalli’s previous work showing that EEG recordings of rostral ACC activity could predict the eventual response. 

‘In that prior study, we saw that the higher the activity before the start of the treatment, the better the clinical response months later,’ Pizzagalli, also a professor of psychiatry at Harvard Medical School, said.

For the new study, more than 300 patients were tested at four sites in the United States, using sertraline (sold in the US as Zoloft) for the treatment group. 

‘We showed that the rostral ACC marker predicted clinical response eight weeks later, even when statistically controlling for demographics and clinical variables previously linked to treatment response,’ said Pizzagalli. 

‘For those with the marker of good response, a clinician could tell patients that they have a high chance of benefiting from the intervention, and they should stay engaged in treatment,’ he explained. 

On the other hand, he said, for patients with the marker of low response, ‘clinicians could decide to start with more aggressive treatment at the outset, such as a combination of pharmacology and psychotherapy, and importantly, monitor these patients more closely.’

Next on the agenda, Pizzagalli and his team plan to trial this method on patients at McLean Hospital.

‘Our vision is to determine if an optimal combination of markers – including brain-based but also clinical and demographic characteristics – might allow us to predict response to drug A but not drug B or psychotherapy, for example,’ Webb explained.

If an ACC marker predicts better response, researchers might develop cognitive training that specifically targets this region, which could increase brain activation to accelerate or boost response to more traditional intervention. 


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