Fewer than 40% of those treated for major depression are helped by the first treatment they’re prescribed. Most are referred to either cognitive behavioral therapy or a pill—it’s part of the reason why prescription rates for seratonin reuptake inhibitors (SSRI’s) like Prozac, Zoloft, and Lexapro have spiked some 400% since 1988. But what if, as many suspect, a pill can’t fix you? What if therapy would be better—or vice versa?
A recent study published in JAMA Psychiatry shows that researchers may have discovered a way to predict who could be better off with pills, therapy, or neither. PET scans measuring how much sugar was being used by parts of the brain aligned with certain treatment outcomes: If a part of your brain called the right anterior insula showed higher activity, an SSRI (escitalopram oxalate) helped those patients with their depression. If the right anterior insula registered lower activity, cognitive behavioral therapy was likely to do the trick.
The study only amounted to the initial investigation—and researchers are hesitant to slam down their findings as law before they can replicate those results again. "But this study finding we believe is very exciting because for the first time we showed that the state of the brain determined whether you would benefit from one treatment over the other," Dr. Boudie Dunlop, one of the study authors, said.
Another group of researchers is looking at cognitive clues to solve the treatment problem—specifically for people who are suicidal. For these people, pills and/or talk therapy as a comprehensive strategy "does not seem to be curative," Harvard University’s Dr. Matthew Nock told the New York Times earlier this year.
According to the Times, Nock wants to see if suicide arises as a result of problems with memory, cognition, or attention. His approach, though, is to test patients through a series of computer tests to see how they associate selfhood with terms of life or death. The conclusion could be that neither talk therapy nor a pill would work on a patient whose cognitive tests showed a predisposition toward suicide—but "training" could instead.
For the brain scan researchers, if a subsequent study did support the first—and perhaps if researchers were able to find a cheaper way to measure brain activity than a brain scan—it also could have a major impact on pharmaceutical prescribing rates. "Right now, SSRIs are the treatment most people apply when they receive treatment," Dunlop said. "But if we do have a test that can tell us what’s the best treatment for a person, that would lead to a reduction in SSRI prescribing."
The scan findings also support the diversity of depression researchers see clinically. "One person’s depression is going to be different biologically from another person’s depression," Dunlop said. "There really are different brain states that people enter into when they’re depressed."