Treatment for depression has historically taken a “one-size-fits-all” approach, but this may be about to change as new research has found six kinds of depression that are identifiable through brain scans. The different kinds, or “biotypes”, respond better to some treatments than others, and could aid us in delivering more effective care for people living with depression, and faster.
The study looked at the functional MRI (fMRI) scans of 801 participants who had been previously diagnosed with anxiety or depression. They looked at their brain activity both while at rest and during a series of cognitive and emotional function tests, paying special attention to which regions of the brain were active and looking for connections between them. With the help of machine learning, they were able to cluster the scan results based on similarities and identified six distinct patterns of brain activity.
The team then randomly assigned one of three common antidepressants or behavioral talk therapy to 250 of the participants and assessed how they responded to the treatment. It revealed patterns in the different subtypes of depression, referred to as biotypes, and the treatment approach that was most effective.
The goal of our work is figuring out how we can get it right the first time.
Dr Leanne Williams
For example, Venlafaxine, sometimes known as Effexor, proved to be the most effective medication for a biotype that was notable for overactivity in certain regions of the brain. Another biotype characterized by high levels of activity in three regions of the brain associated with problem solving and depression was found to respond best to behavioral talk therapy.
“To our knowledge, this is the first time we’ve been able to demonstrate that depression can be explained by different disruptions to the functioning of the brain,” said senior study author Dr Leanne Williams in a statement. “In essence, it’s a demonstration of a personalized medicine approach for mental health based on objective measures of brain function.”
Williams, the inaugural Vincent VC Woo Professor of Psychiatry and Behavioral Sciences, is a professor of psychiatry and behavioral sciences and the director of Stanford Medicine’s Center for Precision Mental Health and Wellness. She lost her partner to depression in 2015, and has focused her work on pioneering the field of precision psychiatry that centers around individualizing diagnosis and using a personal approach to tailor treatment.
Around a third of people with depression have treatment-resistant depression, which means despite multiple rounds of medication and talking therapy, their symptoms don’t improve. It’s hoped that by taking a more precise and personalized approach to depression management, physicians can better help patients to fully reverse their symptoms to healthy levels.
“The goal of our work is figuring out how we can get it right the first time,” Williams said. “It’s very frustrating to be in the field of depression and not have a better alternative to this one-size-fits-all approach.”
The study is published in the journal Nature Medicine.
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