Neuroimaging-based biomarkers for treatment selection in major depressive disorder

Summary & key facts

Researchers looked at brain scans taken before treatment to see if patterns of brain activity can predict who will get better with therapy or with antidepressant medicine. They found that activity in a small brain area called the fronto-insular cortex might help pick between psychotherapy and medication. They also found that high activity in another area called the subgenual anterior cingulate cortex was linked to poor results from both usual treatments. These results are early and need more testing before doctors can use them in clinics.

Key facts:

• Scientists used brain imaging to measure how active certain brain areas were when people were at rest, before they started treatment for major depression.
• Higher activity in the fronto-insular cortex before treatment may help distinguish which people are more likely to respond to psychotherapy versus medication.
• Higher activity in the subgenual anterior cingulate cortex before treatment was linked to worse outcomes from both psychotherapy and medication.
• Because of that link, the researchers suggest that people with high activity in that subgenual area might be considered for nonstandard or different treatments earlier than usual.
• The findings are preliminary. The researchers say these results need to be repeated in more studies before brain scans can be used to choose treatment in regular medical practice.

Abstract

The use of neuroimaging approaches to identify likely treatment outcomes in patients with major depressive disorder is developing rapidly. Emerging work suggests that resting state pretreatment metabolic activity in the fronto-insular cortex may distinguish between patients likely to respond to psychotherapy or medication and may function as a treatment-selection biomarker. In contrast, high metabolic activity in the subgenual anterior cingulate cortex may be predictive of poor outcomes to both medication and psychotherapy, suggesting that nonstandard treatments may be pursued earlier in the treatment course. Although these findings will require replication before clinical adoption, they provide preliminary support for the concept that brain states can be measured and applied to the selection of a specific treatment most likely to be beneficial for an individual patient.

Topics

Functional Brain Connectivity Studies Neural dynamics and brain function Treatment of Major Depression

Categories

Cognitive Neuroscience Life Sciences Neuroscience

Tags

Humanities Medicine Neuroimaging Neuroscience Philosophy Psychology Psychotherapist

Conditions & symptoms

Depression Lack of energy or motivation Sadness or low mood