New Research Shows Individuals Respond Differently to Depression Treatment
You’ve been feeling low for a while, and now your doctor or psychiatrist has confirmed it: You’re officially depressed. Now what?
Until recently, many experts felt that doctors could pick any antidepressant or type of therapy at random, because with a few exceptions, there was little evidence to favor one treatment over another for each individual patient.
Although the goal of truly personalized therapy - either with psychotropic drugs or psychotherapy - has proved elusive, scientists have learned a lot recently about individual factors that might predict a better response to one type of treatment over another.
A recent study from scientists at Emory University identified a potential biomarker in the brain that could predict whether a depressed patient would respond better to psychotherapy or antidepressant medication. Using PET scans, lead researcher Dr. Helen Mayberg randomized a group of depressive patients to either 12 weeks of treatment with the SSRI antidepressant Lexapro or to cognitive behavior therapy (CBT), which teaches patients to correct their negative and distorted thinking.
Overall, about 40 percent of the depressed subjects responded to either treatment. But Dr. Mayberg found significant differences in the brains of people who did well with Lexapro compared with CBT, and vice versa. This finding fits with what’s been learned from previous brain imaging studies, which show that antidepressants and psychotherapy share some common effects but also have different effects in distinct brain regions.
These neurobiological differences may have important implications for treatment, because for most forms of depression, there is little evidence to support one form of treatment over another (the exceptions are psychotic depression, which is best treated with a combination of antidepressant and antipsychotic drugs or electroconvulsive therapy, and atypical depression, which may respond best to an older class of antidepressants called monoamine oxidase inhibitors.) One day soon, we may be able to quickly scan a patient with an M.R.I. or PET, check the brain activity “fingerprint” and select an antidepressant or psychotherapy accordingly.
Currently, doctors tend to prescribe antidepressants on a trial-and-error basis, selecting or adding one antidepressant after another when a patient fails to respond to the first treatment. (Interestingly, doctors who first prescribe antidepressants rarely suggest a patient tries psychotherapy, even after multiple failed trials of antidepressant drugs.)
While we don’t have a “magic scan” to test for the best treatment plan for individuals with depression yet, it doesn’t mean you can’t test yourself if you suffer from depression - if your antidepressant isn’t working, you might want to consider therapy, and vice versa. Just make sure to speak with your doctor before making any changes in your treatment plan.