In the future, treating depression may involve simple brain scans to identify the most effective treatments.
By analysing brain activity in a large group of people with depression and anxiety, both at rest and while performing specific tasks, six distinct types of brain activity patterns, symptoms and responses to treatment were identified.
The US and Australian research team that carried out the study also identified treatments that may be effective in several of these categories, meaning doctors may be able to choose the best treatment for a patient based on their brain function.
“The dominant ‘one size fits all’ diagnostic approach in psychiatry leads to a cycle of trial and error treatment options,” say neuroscientist Leonardo Tozzi of Stanford University and his colleagues. write “Treatment is time-consuming, expensive and frustrating, and 30-40% of patients do not achieve remission after a single treatment attempt,” the published paper states.
The researchers studied 801 participants who were primarily not taking medication. Major depressive disorder, Generalized anxiety disorder, panic disorder, Social anxiety disorder, Obsessive-compulsive disorderor Post-traumatic stress disorderor a combination of these. We also included 137 people who did not meet these criteria as a control group.
Functional MRI (Functional MRI) Brain scans were used to obtain 41 activation and connectivity measurements for each participant, focusing on six brain circuits known to be involved in depression. Scans were taken while participants were resting and while they were responding to tasks involving cognition and emotion.
They used machine learning to classify patients with depression and anxiety into six types based on specific brain pathways that were overactive or underactive compared to each other and to control participants.
“To our knowledge, this is the first time that it has been demonstrated that depression can be explained by multiple disturbances in brain function.” To tell Lead author Leanne Williams, a psychiatrist and behavioral scientist at Stanford University.
The team then randomly assigned 250 participants to receive either one of three antidepressants or talk therapy. Venlafaxine The subtype that benefited most was people with overactivity in cognitive brain areas.
Talk therapy was more effective for people with higher activity in parts of the brain associated with depression and problem-solving, while people with lower activity in the brain’s attention circuits saw less benefit from talk therapy, suggesting that they might be better off treating it first. Decreased activity due to medication.
“I really want to develop this field. Precision Psychiatry“We need to identify the treatments that are most likely to be effective for patients and get them on those as soon as possible,” said Jun Ma, a public health scientist at the University of Illinois. To tell.
“Having information about brain function will help provide more precise treatments and prescriptions for individuals.”
In 2023, part of the same team identified a new cognitive biotype of depression, which affects 27% of people with severe depression: cognitive impairments in attention, memory and self-control are often not affected by serotonin-targeting antidepressants.
And earlier this yearWilliams and colleagues used fMRI to identify patients with the cognitive biotype and predicted remission with 63% accuracy compared to 36% without fMRI. New treatments for this biotype are being investigated.
Depression is complex, as are the factors that contribute to it. It can take a long time for people who can access treatment to find a treatment that helps them (if they even find one at all), so every step toward a more effective, personalized approach is beneficial.
“It’s very frustrating to be in the depression field and not have a better alternative than this one-size-fits-all approach.” To tell “The goal of our work is to figure out how to do it right the first time,” Williams said.
This study Nature Medicine.