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Using brain scans and personal history to predict best antidepressant choice

pills-in-brainStanford neuroscientist Leanne Williams, PhD, has focused her research career on how insights from brain science can help improve care for people with psychiatric conditions. She believes that advances in neuroscience can help physicians examine the brain, much like a cardiologist examines the heart.

Now, she has published a study showing that brain scans combined with a personal history of patients with depression can be used to predict with 80 percent accuracy whether antidepressants should be used as treatment. Williams explains in our press release why this is so important: "Currently, finding the right antidepressant treatment is a trial-and-error process because we don’t have precise tests. For some people this process can take years. As a result, depression is now the leading cause of disability."

In the study, Williams and her team focused on the effects of early childhood trauma on the amygdala — an almond shaped structure in the brain that deals with emotions. They conducted brain scans of 80 participants with depression before and after an eight-week treatment period with the most commonly used antidepressants: Zoloft, Lexapro and Effexor. The participants also completed a questionnaire on whether they were exposed to trauma such as abuse, neglect, or illness, during childhood.

Using the results of these two tests, Williams said, "We were able to show how we can use an understanding of the whole person — their experiences and their brain function and the interaction between the two — to help tailor treatment choices. We can now predict who is likely to recover on antidepressants in a way that takes into account their life history."

The researchers envision a future in which physicians ask about childhood trauma and order a five-minute brain scan to help determine the best line of treatment. "If we are thinking about trying to get this right the first time, it's useful to consider the option of ordering a scan," Williams told me. "It's already done for so many other things — a broken leg, a heart problem, a potential tumor."

As I also explain in our release:

The study also provides a table that the researchers say could ultimately be used by practicing physicians to determine the threshold at which antidepressant treatment is recommended depending on the varying levels of childhood trauma and brain-scan results from patients.

“We interacted with a lot of primary care providers during this study — about 200 of them,” Williams said. “The practitioners themselves like the idea of a scan. They want to know who is likely to benefit from antidepressants, and when they should refer for specialist psychiatric services including psychotherapy. Currently, there is nothing to help them make that decision.”

Previously: Stanford brain scientist's quest to personalize mental health care
Photo from Shutterstock

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