Neuroimaging-based biomarkers for treatment selection in major depressive disorder

Summary & key facts

Researchers are studying brain scans to help predict which treatment will work best for people with major depressive disorder. Early results show that activity measured at rest in certain brain areas before treatment may point to whether someone will respond to psychotherapy or medication. High activity in the subgenual anterior cingulate cortex was linked to poorer outcomes for both standard medication and psychotherapy. These findings are preliminary and need replication before they can be used in clinics.

Key facts:

• Neuroimaging studies are exploring whether resting-state metabolic activity can predict treatment outcomes in major depressive disorder.
• Higher pretreatment metabolic activity in the fronto-insular cortex may distinguish patients likely to respond to psychotherapy versus medication.
• High metabolic activity in the subgenual anterior cingulate cortex was associated with poorer outcomes to both medication and psychotherapy in these studies.
• The fronto-insular activity pattern is described as a potential "treatment-selection biomarker"—a brain measure that could help choose the most likely effective treatment for a patient.
• Authors state these findings are preliminary and require replication before being adopted in clinical practice, so they are not yet ready for routine use.

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 Sadness or low mood