Brain scans identify six different types of depression and anxiety: ScienceAlert

In the future, getting help for depression may involve a quick brain scan to find the most effective treatment for you.

An analysis of brain activity at rest and while performing specific tasks in a large group of people with depression and anxiety has identified six different types of brain activity patterns, symptoms and responses to treatment.

The US and Australian team that conducted the study also identified treatments that are more likely to work for some of these categories. This means doctors may be able to match patients with the best therapies based on how their brains are functioning.

“The dominant ‘one-size-fits-all’ diagnostic approach in psychiatry leads to a trial-and-error process of treatment options,” write Stanford University neuroscientist Leonardo Tozzi and colleagues in their published paper, “which is lengthy, expensive and frustrating. where 30-40 percent of patients do not achieve remission after trying one treatment.”

The researchers studied 801 mostly unmedicated participants who had been diagnosed with major depressive disorder, generalized anxiety disorder, panic disorder, social anxiety disorder, obsessive-compulsive disorder or post-traumatic stress disorder, or a combination thereof. They also included 137 people without the conditions as a control group.

Functional MRI (fMRI) brain scans were used to achieve 41 activation and connectivity measures for each participant, focusing on six brain circuits known to play a role in depression. Scans were taken when participants were at rest and then in response to tasks involving cognition and emotion.

Machine learning was used to cluster people with depression and anxiety into six types, based on specific brain pathways that are overactive or underactive, relative to each other and the control participants.

“To our knowledge, this is the first time we have shown that depression can be explained by various disruptions in brain functioning,” said senior author Leanne Williams, a psychiatrist and behavioral scientist at Stanford University.

The team then randomly assigned 250 participants to receive one of three antidepressants or participate in talk therapy. The antidepressant venlafaxine worked best in one subtype: people whose cognitive brain areas were overactive.

Talk therapy worked better for people who had more activity in parts of the brain linked to depression and problem solving. In contrast, those with low activity in the brain’s attention circuitry benefited less from talk therapy, perhaps indicating that they have more to gain from initial treatment. the lower activity with medications.

“To really move the field toward precision psychiatry, we need to identify treatments that are most likely to be effective for patients and get them on that treatment as quickly as possible,” says public health scientist Jun Ma of the University of Illinois.

“Having information about their brain function… would help inform more precise treatments and prescriptions for individuals.”

In 2023, some of the same team identified a new cognitive biotype of depression, affecting 27 percent of people with major depressive disorder. The cognitive deficits – in attention, memory and self-control – are often unaffected by serotonin-targeted antidepressants.

And earlier this year, Williams and a colleague used fMRI to identify people with the cognitive biotype, predicting remission with 63 percent accuracy, compared to 36 percent without fMRI. New treatments for this biotype are being investigated.

Depression is complex, as are the factors that contribute to it. It can take a long time for people who have access to treatment to find one that helps, if they ever do. So every step towards a more effective, personalized approach is useful.

“It’s very frustrating to work in the field of depression and not have a better alternative to this one-size-fits-all approach,” says Williams. “The goal of our job is to figure out how to get it right the first time.”

The research was published in Naturopathy.