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Brain Scans May Guide Depression Therapy

June 17, 2013
Written by: , Filed in: Neuroradiology, Nuclear Medicine
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PET brain scans can predict whether psychotherapy or medication will work better for specific patients with depression, according to a new study published online last week in JAMA Psychiatry.

Only about 40 percent of depression patients experience effective initial treatment. The choice of whether to try psychotherapy or medication first is more or less random, governed by the preference of the clinician or the patient. So a biomarker that could predict which treatment had the better chance of success would save not only considerable misery on the part of the patient but also money spent on ineffective therapy.

The study found that activity in the anterior insula, an area on the right side of the brain, did in fact indicate which treatment would be more effective. The anterior insula is known to be important in self-awareness, decision making, the regulation of emotional states, and other “thinking” tasks.

Patients whose pretreatment resting anterior insula activity was low tended to respond well to cognitive behavior therapy but poorly to escitalopram (a selective serotonin reuptake inhibitor marketed under the brand name Lexapro). In contrast, those with anterior insula hyperactivity did better with escitalopram and not so well with psychotherapy.

Thomas R. Insel, MD, director of the National Institute of Mental Health, explained the significance of the study:

For the treatment of mental disorders, brain imaging remains primarily a research tool, yet these results demonstrate how it may be on the cusp of aiding in clinical decision making.

Dr. Insel was quoted in an NIMH news release. The NIMH funded the study.

“If these findings are confirmed in follow-up replication studies,” said Helen Mayberg, MD, the study’s senior author and chair of psychiatric neuroimaging and therapeutics at Emory University in Atlanta, “scans of anterior insula activity could become clinically useful to guide more effective initial treatment decisions, offering a first step towards personalized medicine measures in the treatment of major depression.”

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Reluctance by the Centers for Medicare & Medicaid Services to approve reimbursement for some PET scans may hamper the growth of that imaging modality. For details, see our Facebook page.

Related CME seminar (up to 21 AMA PRA Category 1 credits™): UCSF Neuro and Musculoskeletal Imaging

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