MRI May Help Determine Treatment for Patients with Depression

Brain activity detected by functional MR imaging may help determine whether psychotherapy or antidepressant medication is more likely to help individual patients recover from depression, according to a study published in the American Journal of Psychiatry. Researchers from Emory University in Atlanta, Ga., performed a study to determine if a neuroimaging biomarker identified through MR imaging may aid in the selection of first-line treatment choice between cognitive-behavioral therapy (CBT) or an antidepressant medication for treatment-naive adults with major depressive disorder. A total of 122 patients who were part of the Prediction of Remission to Individual and Combined Treatments (PReDICT) study underwent resting state functional MRI of the brain before starting randomized treatment to either 12 weeks of CBT or antidepressant medication. The depression rating was obtained with the Hamilton Depression Rating Scale (HAM-D). "All depressions are not equal and, like different types of cancer, different types of depression will require specific treatments. Using these scans, we may be able to match a patient to the treatment that is most likely to help them, while avoiding treatments unlikely to provide benefit," lead author Helen Mayberg, MD, said in a release. Mayberg is a psychiatry, neurology, and radiology professor and the Dorothy C. Fuqua Chair in Psychiatric Imaging and Therapeutics at Emory University School of Medicine. The results showed 58 of the 122 participants achieved remission with a HAM-D score 7 or lower at weeks 10 and 12. Twenty-four had treatment failure, with a less than 30 percent decrease from baseline in HAM-D score.  “The resting-state functional connectivity of the following three regions with the [subcallosal cingulate cortex (SCC)] was differentially associated with outcomes of remission and treatment failure to CBT and antidepressant medication and survived application of the subsample permutation tests: the left anterior ventrolateral prefrontal cortex/insula, the dorsal midbrain, and the left ventromedial prefrontal cortex,” the authors wrote.  Using the summed SCC functional connectivity scores for these three regions, overall classification rates of 72 percent to 78 percent for remission and 75 percent to 89 for treatment failure was demonstrated. Positive summed functional connectivity was associated with remission with CBT and treatment failure with medication, whereas negative summed functional connectivity scores were associated with remission to medication and treatment failure with CBT. The authors concluded that functional imaging could identify probability of remission or treatment failure with first-line treatment options for major depression, and this should be explored in future research through prospective testing and as a component of multivariate treatment prediction models.