Brain scan may provide biomarker guideposts to ideal depression treatment

Activity in certain parts of the brain appears to offer solid biomarker guideposts to whether drugs or psychotherapy works best to treat depression, researchers have found. And a pretreatment brain scan helps make the determination.

Helen Mayberg, a researcher at Emory University in Atlanta, developed the finding along with colleagues. Their NIH-funded work is detailed in the journal JAMA Psychiatry.

For their work, the research team conducted positron emission tomography (PET) scans of 63 depressed patients before treatment began. They determined that low levels of electrical activity in a portion of the anterior insula (on the right side of the brain) made it more likely patients would respond to the cognitive behavior therapy. By the same token, the same pretreatment brain activity raised a red flag indicating that the antidepressant escitalopram would be less likely to work. Similarly, if the same portion of the insula went wild, it accurately indicated that the drug would work better, but cognitive behavior therapy was more likely to fail.

It turns out the anterior insula is an ideal tool to help promote brain activity. The researchers note that it governs a lot of relevant factors in a person's psychological well-being, including self-awareness, decisionmaking and even emotional state.

Their work builds on previous research that showed certain depression treatments affected insula activity. More work must be done, of course, but if further research can back up this initial finding, a simple PET scan could give doctors a reliable biomarker of brain activity on which to make depression treatment decisions. And it would be a big step over the existing standard of care, which is essentially "trial and error" until something works. A more personalized treatment, in theory, has a greater chance of success.

- read the release
- here's the journal abstract