There are SIX types of depression, say experts – which could explain why antidepressants don’t work for some

Experts say brain scans show there are six distinct types of anxiety and depression in a discovery that could lead to better treatments for people with the mental health conditions.

A mix of anxiety and depression is estimated to be Britain’s most common mental health problem, affecting about eight per cent of the population, with a similar rate in the US. 

However many people with the conditions are forced to cycle through different treatments, which include psychotherapy and medication, in the hope of finding one that works. 

Data suggests that as many as four in 10 patients don’t find a treatment that works on the first attempt, which can leave them suffering for longer.

Now a team of US and Australian scientists have used brain scan technology to find new specific types of depression and anxiety in a bid to one day help speed up this process.

To do this they collected data from a sample of 1,051 patients with depression and anxiety, 850 of which weren’t currently being treated.

Patients had brain scans done while they were both at rest and when asked to conduct an emotional task such responding to photos of sad people.

Experts, from the University of Sydney and Stanford University in California, then compared these results between the patients as well as healthy controls to spot any differences. 

The aim was to find if different parts of the brain ‘lit up’ between patients, showing that sections of the organ were behaving differently among some participants.

They also assessed each participant’s symptoms of depression and anxiety, such as insomnia or feelings of suicide, to also identify any common signs between patients with similar brain scan results. 

The end result was that scientists were able to group patients together and break down depression and anxiety into six different subtypes. 

These were called DC+SC+AC+, AC−, NSA+PA+, CA+, NTCC-CA− and finally DXSXAXNXPXCX. 

Subtypes were distinguished in the brain scans by certain neural pathways being hyper or under active when at rest or responding to certain stimuli. 

For example, CA+ (258) patients were found to have a hyperactive cognitive control circuit, the part of the brain responsible for planning and preparing. 

Whereas DC+SC+AC patients (169 participants) had slower than typical responses when it came to recognising photos of sad people. 

Some also had differences in symptoms. For example, DC+SC+AC+ patients suffered greater lapses in concentration and of impulsivity compared to other groups.

On the other hand, NSA+PA+ (154) patients had far more severe anhedonia which is a clinical term for someone having a lack of interest, enjoyment or pleasure from life’s experiences.

In the final part of their study the scientists also examined if, among patients receiving therapy or medication, any of these appeared to be more effective among certain subtypes.

They found DC+SC+AC+ patients responded better to behavioural treatment, such as cognitive behaviour therapy (CBT) offered by the NHS, compared to the other subtypes.

Prescriptions for antidepressants among teens have risen by a quarter in England in 2020 compared to 2016. The greatest growth was seen among 13 and 19-year-olds where prescription rates rose by about a third

Young adults, who are often leaving home for the first time and starting their careers also saw antidepressant prescription rates boom by about 40 per cent 

This was particularly the case for AC− (161) patients who, in contrast, had the worst response of any group to behavioural treatment.

Another key difference identified was that CA+ patients had a better response when prescribed the antidepressant venlafaxine. 

Authors of the study, published in Nature Medicine, said finding more specific diagnoses for depression and anxiety and, by extension, which treatments ere more effective for each type would improve out comes for patients.

‘The dominant ‘one-size-fits-all’ diagnostic approach in psychiatry leads to cycling through treatment options by trial and error, which is lengthy, expensive and frustrating, with 30–40 per cent of patients not achieving remission after trying one treatment,’ they wrote. 

While stating their results were promising they said they also be approached with caution and that other studies would need to replicate their findings.

Other experts have been concerned about ‘one size fits all’ approaches to patients suffering from depression for years.

These concerns have mainly focused on the use of a type of antidepressant called selective serotonin reuptake inhibitors (SSRIs), taken by millions, and its libido crushing side-effects.

Some users have reported being transformed into ‘sex-less’ zombies even years after they stopped taking the mind-altering pills. 

Uptake of the pills has soared in recent years, despite growing unease among experts about the effectiveness of the drugs in treating depression.

Some studies have even suggested they could raise the risk of heart problems in young people or even, paradoxically, increase their risk of suicide alongside the problems of sexual wellbeing.

Such research isn’t clear-cut however, with other experts pointing out such trends could be due to the patients suffering from the depression the drugs are designed to alleviate, rather than the medication itself. 

And plenty of people taking them insist they work. 

People with depression are thought to have low levels of serotonin, though there is scientific debate over this, and SSRIs combat this by boosting these levels.

However, some experts suspect that the drugs could be causing too much serotonin to be released, with consequences for people’s health. 

Psychiatrists advise patients concerned about the side effects, or potential side effects, of antidepressants to talk to their medical professional about their options.

Clinicians can sometimes offer an alternative dose, a different drug, or prescribe another medication to combat the side effects.

They urge patients who are taking them not to quit without talking to the medical professional responsible for their care first to ensure they are adequately supported.