Posts Tagged Depression

[ARTICLE] User Acceptance of Computerized Cognitive Behavioral Therapy for Depression: Systematic Review – Full Text

ABSTRACT

Background: Computerized cognitive behavioral therapy (cCBT) has been proven to be effective in depression care. Moreover, cCBT packages are becoming increasingly popular. A central aspect concerning the take-up and success of any treatment is its user acceptance.

Objective: The aim of this study was to update and expand on earlier work on user acceptance of cCBT for depression.

Methods: This paper systematically reviewed quantitative and qualitative studies regarding the user acceptance of cCBT for depression. The initial search was conducted in January 2016 and involved the following databases: Web of Science, PubMed, the Cochrane Library, and PsycINFO. Studies were retained if they described the explicit examination of the user acceptance, experiences, or satisfaction related to a cCBT intervention, if they reported depression as a primary outcome, and if they were published in German or English from July 2007 onward.

Results: A total of 1736 studies were identified, of which 29 studies were eligible for review. User acceptance was operationalized and analyzed very heterogeneously. Eight studies reported a very high level of acceptance, 17 indicated a high level of acceptance, and one study showed a moderate level of acceptance. Two qualitative studies considered the positive and negative aspects concerning the user acceptance of cCBT. However, a substantial proportion of reviewed studies revealed several methodical shortcomings.

Conclusions: In general, people experience cCBT for depression as predominantly positive, which supports the potential role of these innovative treatments. However, methodological challenges do exist in terms of defining user acceptance, clear operationalization of concepts, and measurement.

 

Introduction

Depressive disorders are among the most common and serious mental illnesses [1]. Globally, 350 million people of all ages are estimated to suffer from depression. If depressive disorders are detected at an early stage, they are highly treatable in the majority of cases [2]. There are known effective psychological treatments, for example, cognitive behavioral therapy (CBT) [3]. However, individuals suffering from depression often find themselves confronted with barriers to receiving appropriate care such as social stigma associated with mental disorders, long waiting times, or the logistical difficulties of appearing in person for treatment [4,5]. For these reasons, computerized programs present an innovative approach to improving access to psychological treatments for depression. There is evidence that computerized cognitive behavioral therapy (cCBT) is effective in the treatment of various mental disorders, including depression [610]. There are a number of advantages that are associated with cCBT such as anonymity, wide availability, or location-independent and around-the-clock access [9,11]. Well-known cCBT programs such as Beating The Blues and MoodGYM have been shown to provide a promising option for the treatment of mental health problems [9,12,13]. A prerequisite for cCBT programs to be effective is its user acceptance, as the implementation of an innovative intervention such as cCBT can be affected negatively because of individuals being unwilling to use it. For example, the absence of a contact person and the resulting anonymity can have a negative impact on the user’s motivation to start or keep up with a cCBT program. Therefore, it is of utmost importance to consider user acceptance when developing and implementing a cCBT program for the treatment of depression.

The concept of user acceptance arose as a key term in the scientific discourse. Definitions of the term differ widely depending on the intended use [14]. One of the most popular approaches is the technology acceptance model (TAM) developed by Davis [15]. TAM illustrates user acceptance determined by two factors: perceived usefulness and perceived ease of use. According to Davis [15], both have a significant impact on a person’s attitude toward using a new technology. Kollmann [16] and Rogers [17] went one step further and combined different phases in their acceptance models. Therefore, the user passes through phases from getting to know a new technology, to forming an attitude toward it, to a decision whether to use or not to the confirmation of the decision. On this basis, user acceptance can be defined as the willingness of individuals to employ information technology for the tasks it is designed to support, the realization, and approval of the decision to employ. All of these models have one thing in common: user acceptance is considered to be a process beginning with an attitude toward the innovation and developing into satisfaction with the innovation; it is not an instantaneous act. Accordingly, we have conceived acceptance as the act of accepting, experiencing, and being satisfied.

Since the emergence of the first cCBT programs, there have been a number of reviews addressing the user acceptance of cCBT; however, they have utilized different approaches. In their reviews, Titov [18], Andrews et al [8], and Vallury et al [19] focused broadly on effectiveness and user acceptance of cCBT for several mental disorders, including depression and anxiety disorders. Waller and Gilbody [20] reviewed quantitative and qualitative studies examining adverse consequences, accessibility, and acceptability of cCBT programs for treating anxiety and depression. However, Kaltenthaler et al [21] provide the only review with a very comprehensive and focused insight into the user acceptance of cCBT for depression, including research up to June 2007. They systematically reviewed sources of information on acceptability to patients of cCBT for depression. As a result, they documented several studies reporting positive expectancies and high satisfaction in routine care cCBT services for those completing the treatment and argued that studies should reveal more detailed information on patient recruitment methods, dropout rates, and reasons for dropping out. Furthermore, they drafted well-designed surveys and qualitative studies included alongside trials to determine levels of patient acceptability as implications for further research.

On this basis, we provide a systematic overview on user acceptance of cCBT for depression over the last 10 years and widen the perspective to include the notion that the process of user acceptance spans a number of phases, including accepting, experiencing, and being satisfied with cCBT. We intend to answer the following research questions: (1) which measures were used to examine the user acceptance of cCBT for depression? and (2) to what degree do users accept cCBT for depression? […]

Continue —> JMIR-User Acceptance of Computerized Cognitive Behavioral Therapy for Depression: Systematic Review | Rost | Journal of Medical Internet Research

Figure 2. Recommended examination of user acceptance.

Advertisements

, , , , , ,

Leave a comment

[Dissertation] Perceived Self-Efficacy in Individuals with Moderate-to-Severe Brain Injury: The Effects of Rehabilitation Outcomes and Depression – Full Text PDF

Abstract

Brain injury represents a major public health issue in the United States, accounting for a largely underestimated figure of 2.5 million cases in 2010. The pervasive effects of this chronic medical condition contribute to a growing economic burden, as the physical, cognitive, behavioral, and emotional sequelae of brain injury demand long-term care for those with moderate-to-severe brain injuries. The Centers for Disease Control and Prevention recently proposed new recommendations for improvements in monitoring the incidence of and research on brain injury. The goals of this public health initiative are to better inform health service delivery and ultimately improve quality of life for those affected, as well as their loved ones.
In addition to improved quality of life, community reintegration is a primary goal
of brain injury rehabilitation. Engagement in rehabilitation is largely dependent upon an individual’s level of impairment, as well as other personal factors. For example, research examining the relationship between targeted interventions and community participation has established support for the protective effects of self-efficacy, or personal belief in one’s abilities to achieve a desired goal. Additional research on the importance of selfefficacy to psychological health has provided further support for the protective effects of this construct against depression and anxiety. Therefore, further research into the relationship between rehabilitation outcomes, psychological health, and self-efficacy is necessary to inform recommendations for improving health service delivery and quality of life for this vulnerable population.

The aim of the present study is to examine factors that may be related to self
efficacy in persons with moderate-to-severe brain injury who receive treatment at along term post acute brain injury program. The implications of this research include baseline assessment of self-efficacy in this sample that could potentially inform future staff training and overall clinical practice geared towards cultivating self-efficacy in persons with brain injury. The primary limitations of this study are its small sample size and constrained external validity. Despite these limitations, more research is necessary to understand the role of psychological protective factors in brain injury rehabilitation and to inform strategies for improved health service delivery and increased quality of life.

Full Text PDF 

,

Leave a comment

[WEB SITE] Magnetic Therapy Can Provide Alternative Treatment For Depression

Depression is a leading cause of poor health, disability and suicide — and medications only help some depression patients.

Many also cannot take the side effects.

But as CBS2’s Dr. Max Gomez reported, magnets might offer relief by rewiring the patient’s brain.

Each year, Americans spend billions of dollars on antidepressants. But studies show they can be ineffective in up to 40 percent of all patients.

Bob Holmes was one of them.

“They tried to adjust my medication, but the medication had side effects that weren’t desirable,” Holmes said.

Holmes is among the 16 million people in the U.S. who suffer major depressive episodes each year — a number that has increased 18 percent over the last decade. For that reason, some doctors at UCLA are taking a different approach.

Doctors beam magnetic pulses deep inside patients’ brains to change the way depression symptoms are perceived.

“We are used to thinking of the brain as a chemical organ, but it’s also an electrical organ,” said Dr. Andrew Leuchter of UCLA Health.

“The idea that by using non-chemical means, we can change the brain and how it functions,” said Dr. Ian Cook of UCLA Health.

It is called transcranial magnetic stimulation, or TMS. It is currently approved by the Food and Drug Administration only to treat depression, but doctors say it may prove helpful in a wide range of conditions by rewiring a network of signals in the brain.

“What TMS is doing is changing how that network functions, really rebooting the network to improve symptoms of mood, anxiety and chronic pain,” Leuchter said.

That may be why patients treated for depression also say it helps relieve their pain, raising provocative questions about whether TMS could one day become a viable alternative to opioids.

“This is a really transformative kind of therapy,” Cook said.

But for now, it has made a dramatic difference in Holmes’ depression.

“It provided that kind of jolt to get my brain to start work again normally,” he said.

Reportedly, TMS can feel a bit uncomfortable at first — but many patients quickly get used to it. They report substantial relief from their symptoms of depression within a few weeks.

Even though the NeuroStar system has been approved for depression since 2008, it is only recently that doctors have realized its effectiveness for everything from post-traumatic stress disorder to obsessive-compulsive disorder.

Source: https://medium.com/@pemfindia/magnetic-therapy-can-provide-alternative-treatment-for-depression-941a687a79f

Source: Magnetic Therapy Can Provide Alternative Treatment For Depression | Samir Singhal | Pulse | LinkedIn

, , ,

Leave a comment

[BLOG POST] Vagus Nerve Stimulation…Is it for YOU?

Epilepsy Talk

Having a Vagus Nerve Stimulator implanted can be a tough decision.  Is it right for you? Will it work? What are the side effects and consequences?

I did some research and got the low-down on what it is, how it works and some interesting statistics.  (If you are already acquainted with the VNS and are on the fence, you might want to just skip down to risks and benefits sections.)

How it works

Vagus Nerve Stimulation (VNS) has been used to treat more than 30,000 epilepsy patients worldwide. It’s designed to prevent or interrupt seizures or electrical disturbances in the brain for people with hard to control seizures. Used in conjunction with anti-seizure medications, the VNS uses electrical pulses that are delivered to the vagus nerve in the neck and travel up into the brain.

The good news is that the vagus nerve has very few pain fibers, so it’s…

View original post 912 more words

, , , , , , , , ,

Leave a comment

[WEB PAGE] Faster-acting antidepressants may soon be a reality

Understanding where antidepressants act is the key to improving their function.

 

Using cutting-edge techniques, researchers have investigated the mechanism by which common antidepressants work, finally pinning down the specific receptors responsible for their action. The findings might pave the way to designing improved, faster-acting antidepressants.

Depression is characterized by persistent low mood and feelings of hopelessness, and it is one of the most common mental disorders in the United States. In 2014, there were an estimated 15.7 million U.S. adults who experienced at least one major depressive episode, representing around 6.7 percent of the country’s adults.

Treatments for depression generally include talking therapies in conjunction with medication. The class of drugs most commonly prescribed is selective serotonin reuptake inhibitors (SSRIs), and these include brands such as Prozac and Zoloft.

SSRIs can help some people with depression, but they are not perfect; not everyone responds well to them, and side effects including nausea, insomnia, agitation, and erectile dysfunction can be unpleasant.

Also, SSRIs can take some time to kick in; although some people might feel some benefit within hours or even minutes, most people do not feel the full antidepressant effect until they have been taking the drugs for weeks or even months.

How do SSRIs work?

In the brain, messages are sent between neurons by releasing neurotransmitters into a gap between the cells, or the synapse. Serotonin is one such neurotransmitter. It is released from the first neuron and binds to receptors on the second neuron.

Normally, once serotonin has been released into the synapse and relayed its message, the majority is reabsorbed into the first nerve cell for reuse at a later date. SSRIs prevent serotonin from being reabsorbed. In this way, they ensure that serotonin hangs around in the synapse for a longer time, exerting more of an effect.

Although SSRIs have been known to medical science since the 1950s, their exact mechanism is not understood. This is because there are at least 1,000 types of neuron that can be influenced by a surge in serotonin, and some of these neurons may be excited, while others might be inhibited.

The mixed response is because there are 14 subtypes of serotonin receptor throughout the body and any single nerve could have a cocktail of receptor types. Teasing out which receptor subtype is playing the most significant role has proven challenging.

The role of the dentate gyrus

A group of scientists from Rockefeller University in New York City, NY, recently set out to take a closer look at the action of SSRIs on a particular type of nerve cell. The team was headed up by Lucian Medrihan and Yotam Sagi, both research associates in the Laboratory of Molecular and Cellular Neuroscience, and Paul Greengard, Nobel laureate.

Their findings were recently published in the journal Neuron.

Many different types of synapses throughout the brain use serotonin as their neurotransmitter. An issue of major importance has been to identify where in the myriad of neurons the antidepressants initiate their pharmacological action.”

Paul Greengard

The team concentrated on a group of cells in the dentate gyrus (DG). According to the authors, they chose the DG because previous work has established that “SSRI treatment promotes a variety of synaptic, cellular, and network adaptations in the DG.”

Specifically, the team investigated cholecystokinin (CCK)-expressing neurons within the DG. These neurons were of interest because they are heavily influenced by neurotransmitter systems that are associated with mood disorders, such as depression.

Finding the right receptor

Using a technique called translating ribosome affinity purification, the team were able to identify the serotonin receptors on CCK cells. Sage explains, “We were able to show that one type of receptor, called 5-HT2A, is important for SSRIs’ long-term effect, while the other, 5-HT1B, mediates the initiation of their effect.

The next step in the study involved efforts to mimic SSRIs’ effects by manipulating CCK neurons in mice. They used chemogenetics to switch nerve cells on or off and implanted tiny electrodes inside the mouse brains.

The findings were clear. When the CCK neurons were inhibited, the pathways important for the mediation of SSRI responses lit up. In other words, the scientists had recreated a Prozac-like effect without using the drug.

To back up these findings, the team used behavioral experiments in a pool and observed swimming patterns. Again, silencing the CCK neurons created behavior that was similar to that displayed by the mice that had been given SSRIs: they swam for longer with increased vigor.

According to the researchers, understanding the importance of the DG and the specific cells important for treating depression will help to design faster-acting, more effective antidepressants with fewer side effects.

The work was carried out using techniques that would have been impossible just 5 years ago, and the studies that follow are likely to improve our understanding even further.

Source: Faster-acting antidepressants may soon be a reality

, , , , , , , ,

Leave a comment

[WEB SITE] Electric Brain Stimulation No Better Than Meds For Depression: Study

Wednesday, June 28, 2017

HealthDay news imageWEDNESDAY, June 28, 2017 (HealthDay News) — For people who battle depression and can’t find relief, stimulating the brain with electric impulses may help. But a new study by Brazilian researchers says it’s still no better than antidepressant medication.

In a trial that pitted transcranial, direct-current stimulation (tDCS) against the antidepressant escitalopram (Lexapro), researchers found that lessening of depression was about the same for either treatment.

“We found that antidepressants are better than tDCS and should be the treatment of choice,” said lead researcher Dr. Andre Brunoni. He’s director of the Service of Interdisciplinary Neuromodulation at the University of Sao Paulo.

“In circumstances that antidepressant drugs cannot be used, tDCS can be considered, as it was more effective than placebo,” he said.

The researchers used the Hamilton Depression Rating Scale. This test has a score range of zero to 52, with higher scores indicating more depression.

People who received brain stimulation lowered their depression score by 9 points. Those taking Lexapro had depression scores drop by 11 points. Patients receiving placebo experienced a drop of 6 points in their depression score, the researchers found.

“tDCS has been increasingly used as an off-label treatment by physicians,” Brunoni said. “Our study revealed that it cannot be recommended as a first-line therapy yet and should be investigated further.”

The report was published June 29 in the New England Journal of Medicine.

Dr. Sarah Lisanby is director of the Division of Translational Research at the U.S. National Institute of Mental Health. “When you consider if this treatment adds anything to the ways we have to treat depression, you want to know that a new treatment is better than or at least as good as what’s available today,” she said.

“But this study failed to show that tDCS was better than medication,” said Lisanby, who wrote an accompanying journal editorial.

Lisanby pointed out that unapproved tDCS units are being sold on the internet. She cautioned that trying brain stimulation at home to relieve depression or enhance brain function is risky business, because side effects can include mania.

“There are people who are doing do-it-yourself tDCS,” she said. “People are trying to find ways to treat depression, but it’s important for them to know that tDCS is experimental and not proven to be as effective or more effective than antidepressant medications.”

To get a better idea of how well brain stimulation worked for depression, Brunoni and colleagues randomly assigned 245 patients suffering from depression to one of four groups. One group had brain stimulation plus a placebo pill, another had fake brain stimulation plus Lexapro. The third group had brain stimulation plus Lexapro, and the final group had fake brain stimulation plus a placebo.

Brain stimulation involved wearing sponge-covered electrodes on the head. The treatment was given for 15 consecutive days at 30 minutes each, then once a week for seven weeks.

Lexapro was taken daily for three weeks, after which the daily dose was increased from 10 milligrams (mg) to 20 mg for the next seven weeks.

After 10 weeks, patients receiving brain stimulation fared no better than those taking Lexapro. Patients receiving brain stimulation, however, suffered from more side effects, the researchers found.

Specifically, patients receiving brain stimulation had higher rates of skin redness, ringing in the ears and nervousness than those receiving fake brain stimulation.

In addition, two patients receiving brain stimulation developed new cases of mania. That condition can include elevated mood, inflated self-esteem, decreased need for sleep, racing thoughts, difficulty maintaining attention and excessive involvement in pleasurable activities.

Patients taking Lexapro reported more frequent sleepiness and constipation.

Brunoni, however, is not ready to write off brain stimulation as a treatment for depression based on this study.

“We did not test, in this study, the combined effects of tDCS with other techniques, such as cognitive behavior therapy and other antidepressant drugs,” he said.

“Previous findings from our group showed that tDCS increases the efficacy of antidepressant drugs, however, it should not be used alone, and its use must be supervised by physicians due to the side effects,” Brunoni said.

Lisanby said the tDCS dose in the study may be in question. She said it may have to be adjusted to each individual patient in terms of how strong the electrical stimulation should be. The treatment length also needs to be individualized, as does what part of the brain it should be directed toward.

Also, “we need larger studies to give us the definitive answer about whether tDCS is better than the treatments we have today,” Lisanby said.

SOURCES: Andre Brunoni, M.D., Ph.D., director, Service of Interdisciplinary Neuromodulation, University of Sao Paulo, Brazil; Sarah Lisanby, M.D., director, Division of Translational Research, U.S. National Institute of Mental Health; June 29, 2017, New England Journal of Medicine

Source: Electric Brain Stimulation No Better Than Meds For Depression: Study: MedlinePlus Health News

, , ,

Leave a comment

[BLOG POST] UCLA offers transcranial magnetic stimulation to treat patients with depression

Download PDF Copy

Americans spend billions of dollars each year on antidepressants, but the National Institutes of Health estimates that those medications work for only 60 percent to 70 percent of people who take them. In addition, the number of people with depression has increased 18 percent since 2005, according to the World Health Organization, which this year launched a global campaign encouraging people to seek treatment.

The Semel Institute for Neuroscience and Human Behavior at UCLA is one of a handful of hospitals and clinics nationwide that offer a treatment that works in a fundamentally different way than drugs. The technique, transcranial magnetic stimulation, beams targeted magnetic pulses deep inside patients’ brains — an approach that has been likened to rewiring a computer.

TMS has been approved by the FDA for treating depression that doesn’t respond to medications, and UCLA researchers say it has been underused. But new equipment being rolled out this summer promises to make the treatment available to more people.

“We are actually changing how the brain circuits are arranged, how they talk to each other,” said Dr. Ian Cook, director of the UCLA Depression Research and Clinic Program. “The brain is an amazingly changeable organ. In fact, every time people learn something new, there are physical changes in the brain structure that can be detected.”

Nathalie DeGravel, 48, of Los Angeles had tried multiple medications and different types of therapy, not to mention many therapists, for her depression before she heard about magnetic stimulation. She discussed it with her psychiatrist earlier this year, and he readily referred her to UCLA.

Within a few weeks, she noticed relief from the back pain she had been experiencing; shortly thereafter, her depression began to subside. DeGravel says she can now react more “wisely” to life’s daily struggles, feels more resilient and is able to do much more around the house. She even updated her resume to start looking for a job for the first time in years.

During TMS therapy, the patient sits in a reclining chair, much like one used in a dentist’s office, and a technician places a magnetic stimulator against the patient’s head in a predetermined location, based on calibrations from brain imaging.

The stimulator sends a series of magnetic pulses into the brain. People who have undergone the treatment commonly report the sensation is like having someone tapping their head, and because of the clicking sound it makes, patients often wear earphones or earplugs during a session.

TMS therapy normally takes 30 minutes to an hour, and people typically receive the treatment several days a week for six weeks. But the newest generation of equipment could make treatments less time-consuming.

“There are new TMS devices recently approved by the FDA that will allow patients to achieve the benefits of the treatment in a much shorter period of time,” said Dr. Andrew Leuchter, director of the Semel Institute’s TMS clinical and research service. “For some patients, we will have the ability to decrease the length of a treatment session from 37.5 minutes down to 3 minutes, and to complete a whole course of TMS in two weeks.”

Leuchter said some studies have shown that TMS is even better than medication for the treatment of chronic depression. The approach, he says, is underutilized. “We are used to thinking of psychiatric treatments mostly in terms of either talk therapies, psychotherapy or medications,” Leuchter said. “TMS is a revolutionary kind of treatment.”

Bob Holmes of Los Angeles is one of the 16 million Americans who report having a major depressive episode each year, and he has suffered from depression his entire life. He calls the TMS treatment he received at UCLA Health a lifesaver.

“What this did was sort of reawaken everything, and it provided that kind of jolt to get my brain to start to work again normally,” he said.

Doctors are also exploring whether the treatment could also be used for a variety of other conditions including schizophrenia, epilepsy, Parkinson’s disease and chronic pain.

“We’re still just beginning to scratch the surface of what this treatment might be able to do for patients with a variety of illnesses,” Leuchter said. “It’s completely noninvasive and is usually very well tolerated.”

Source: UCLA offers transcranial magnetic stimulation to treat patients with depression

, , , ,

Leave a comment

[VIDEO] Brain Injury and Depression – YouTube

Why do people experience depression after brain injury? Learn about the connection between traumatic brain injury and depression in this video. Dr. Frank Lewis, Ph.D., a cognitive psychologist and NeuroRestorative’s Director of Clinical Outcomes, addresses the symptoms and causes of depression following brain injury. He provides advice to family members and treatment options to help individuals cope with depression and continue to heal from their injury.

,

Leave a comment

[Abstract] Use of Computer and Mobile Technologies in the Treatment of Depression

HIGHLIGHTS

  • Studies in technology-assisted self help for anxiety and depression found that therapist assisted treatment was optimal for clinical depression and technology-based treatment alone may be efficacious for subthreshold mood disorders.
  • There has been no robust evidence of health benefits from peer-to-peer electronic support groups, however, for patients who have social isolation, there may be some benefit.
  • Despite the preponderance of mental health apps and widespread acceptance, there is a significant lack of empirical data documenting likely uptake, best strategies for engagement, efficacy, or effectiveness of mHealth initiatives.
  • Biosensing technology offers the ability to reach an immense volume of people through automated monitoring which could lead to more widespread achievement of early diagnosis and intervention and ameliorate rising medical costs of acute or ineffective treatment.
  • mobile technologies can be used to record and monitor the type, intensity, frequency, and duration of exercise as a means to motivate users and enhance the potential effectiveness of exercise for treating depression.

ABSTRACT

Major depression (MDD) is a common and disabling disorder. Research has shown that most people with MDD receive either no treatment or inadequate treatment. Computer and mobile technologies may offer solutions for the delivery of therapies to untreated or inadequately treated individuals with MDD.

The authors review currently available technologies and research aimed at relieving symptoms of MDD. These technologies include computer-assisted cognitive-behavior therapy (CCBT), web-based self-help, Internet self-help support groups, mobile psychotherapeutic interventions (i.e., mobile applications or apps), technology enhanced exercise, and biosensing technology.

Source: Use of Computer and Mobile Technologies in the Treatment of Depression – Archives of Psychiatric Nursing

, , , ,

Leave a comment

[WEB SITE] MRI brain scans may help clinicians decide between CBT and drug treatment for depression

Researchers from Emory University have found that specific patterns of activity on brain scans may help clinicians identify whether psychotherapy or antidepressant medication is more likely to help individual patients recover from depression.

The study, called PReDICT, randomly assigned patients to 12 weeks of treatment with one of two antidepressant medications or with cognitive behavioral therapy (CBT). At the start of the study, patients underwent a functional MRI brain scan, which was then analyzed to see whether the outcome from CBT or medication depended on the state of the brain prior to starting treatment. The study results are published as two papers in the March 24 online issue of the American Journal of Psychiatry.

The MRI scans identified that the degree of functional connectivity between an important emotion processing center (the subcallosal cingulate cortex) and three other areas of the brain was associated with the treatment outcomes. Specifically, patients with positive connectivity between the brain regions were significantly more likely to achieve remission with CBT, whereas patients with negative or absent connectivity were more likely to remit with antidepressant medication.

“All depressions are not equal and like different types of cancer, different types of depression will require specific treatments. Using these scans, we may be able to match a patient to the treatment that is most likely to help them, while avoiding treatments unlikely to provide benefit,” says Helen Mayberg, MD, who led the imaging study. Mayberg is a Professor of Psychiatry, Neurology and Radiology and the Dorothy C. Fuqua Chair in Psychiatric Imaging and Therapeutics at Emory University School of Medicine.

Mayberg and co- investigators Boadie Dunlop, MD, Director of the Emory Mood and Anxiety Disorders Program, and W. Edward Craighead, PhD, J. Rex Fuqua Professor of Psychiatry and Behavioral Sciences, sought to develop methods for a more personalized approach to treating depression.

Current treatment guidelines for major depression recommend that a patient’s preference for psychotherapy or medication be considered in selecting the initial treatment approach. However, in the PReDICT study patients’ preferences were only weakly associated with outcomes; preferences predicted treatment drop-out but not improvement. These results are consistent with prior studies, suggesting that achieving personalized treatment for depressed patients will depend more on identifying specific biological characteristics in patients rather than relying on their symptoms or treatment preferences. The results from PReDICT suggest that brain scans may offer the best approach for personalizing treatment going forward.

In recruiting 344 patients for the study from across the metro Atlanta area, researchers were able to convene a more diverse group of patients than other previous studies, with roughly half of the participants self-identified as African-American or Hispanic.

“Our diverse sample demonstrated that the evidence-based psychotherapy and medication treatments recommended as first line treatments for depression can be extended with confidence beyond a white, non-Hispanic population,” says Dunlop.

“Ultimately our studies show that clinical characteristics, such as age, gender, etc., and even patients’ preferences regarding treatment, are not as good at identifying likely treatment outcomes as the brain measurement,” adds Mayberg.

Source: MRI brain scans may help clinicians decide between CBT and drug treatment for depression

, , , , , ,

Leave a comment

%d bloggers like this: