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Brain scans determine best treatment for depression

Positron emission tomography scans can help predict whether psychotherapy or antidepressants would be the best treatment option for patients with major depressive disorder, results from a study conducted by the NIH indicate.

The study was conducted to determine whether a biomarker exists in pretreatment brain activity to guide treatment options. Although previous studies have suggested that a treatment-specific biomarker exists, none have correlated pretreatment brain activity images with response to treatment. Without a treatment-specific biomarker, treatment is usually determined through trial and error, according to an NIH press release.

“Our goal is to develop reliable biomarkers that match an individual patient to the treatment option most likely to be successful, while also avoiding those that will be ineffective,” Helen Mayberg, MD, of Emory University, grantee of the NIH’s National Institute of Mental Health, said in the press release.

PET scans of pretreatment brain glucose metabolism were imaged in 63 male and female participants aged 18 to 60 years who had not been treated for major depressive disorder. Comparison of scans of patients who achieved remission against those who did not revealed that low pretreatment brain activity in the insula indicated higher likelihood of remission with cognitive-behavioral therapy. Hyperactivity in the insula indicated remission was more achievable with escitalopram.

“If verified with prospective testing, the insula metabolism-based treatment-specific biomarker defined in this study provides the first objective marker, to our knowledge, to guide initial treatment selection for depression,” researchers wrote.

Disclosure: Mayberg reports receiving consulting and intellectual property licensing fees from St. Jude Medical. See the study for a full list of financial disclosures.