Brain Scans Could Change How We Diagnose Depression

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Brain scans may redefine depression and help doctors target treatment.

Just as an electrocardiogram (EKG) shows the heart in action, a functional MRI shows the electrical activity of the brain.

“We’ll see brain scan information help patients in three to five years,” Dr. Helen Mayberg, a neurologist at Mount Sinai Hospital in New York, told Healthline. “We’re going to have precision psychotherapy the way we have precision cancer treatment.”

For some illnesses, we have “biomarkers” that can be seen on things such as a blood test. For other illnesses, doctors rely on a symptom history to make a diagnosis.

The hope of the brain scan research is to find biomarkers for depression, and transform the field.

“We’re trying to push the field so we can move away from the symptoms to the pathology,” Mayberg told Healthline.

A diagnosis of “major depression” today covers patients with vastly different symptoms —and possibly distinct illnesses.

But patterns of brain activity may reveal subtypes among depressed patients, clues to the underlying biology.

Other brain scan research zeroes in on clues to match patients to treatments.

The two go together. For example, identifying subtypes of breast cancer led to more precise, “personalized” recommendations for patients.

A long and winding road

People with depression now too often go through months or years of trial and error before they get relief.

Fewer than 40 percent of patients get better with the first treatment they try.

The two main options, psychotherapy and medication, are about equally effective, according to a 2015 review of existing research in the journal PloS One.

Most Americans try medication first. If they don’t feel better or can’t tolerate the side effects, they switch medications or add on a second.

Gene tests can help predict the chance of side effects, but the tests are expensive and often not covered by insurance.

A person’s best bet may be to see a therapist while taking medication, the PloS study suggested, but that doesn’t happen often.

Some patients are only likely to get better with therapy, according to a small but key study Mayberg led at Emory University in Atlanta.

Her team recruited 122 patients with untreated major depression, gave them MRI scans, and randomly assigned them to escitalopram (Lexapro), duloxetine (Cymbalta), or cognitive behavioral therapy (CBT).

After 12 weeks, slightly less than half of the patients were no longer depressed. The rest had some improvement or none at all. Those results are standard.

Here’s the wrinkle.

Patients who got better with CBT tended to show a particular pattern on their brain scans.

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