Scientists want to look beyond drugs to find effective treatments for mental health disorders. Work that began at UT Southwestern in 2012 will offer insight into how brain activity measurements, magnetic stimulation and personalized medicine might be applied to people suffering from depression. Reporting in the Journal of the American Medical Association Psychiatry, the investigators have found that brain electrical activity measurements can help determine how responsive a patient will be to an antidepressant. At least four more studies are forthcoming; they will show how useful other predictive assessments are.
Researchers are aiming to use biological research and objective science to learn more about mood disorders, as part of the EMBARC trial. "When the results from these tests are combined, we hope to have up to 80 percent accuracy in predicting whether common antidepressants will work for a patient. This research is very likely to alter the mindset of how depression should be diagnosed and treated," said Dr. Madhukar Trivedi, who manages EMBARC and is founding Director of UT Southwestern's Center for Depression Research and Clinical Care.
Dr. Trivedi collaborated with several other institutions on EMBARC. He had led the largest-ever depression study only to find that patient care was inadequate. That work, STAR*D, showed that the majority of patients were not responding adequately to the first antidepressant they received. To make diagnostics and therapies more effective, EMBARC was launched to look at biomarkers in about 300 people with major depressive disorder.
This first study focused on whether EEGs, that measure electrical activity in one part of the brain, can be used to indicate the likelihood that a depressed person would be helped by the most common kind of antidepressant: SSRI (selective serotonin reuptake inhibitor), the most common class of antidepressant.
People that showed higher activity levels were more likely to improve after two months of taking the SSRI. It may also be time to investigate how boosting neural activity might make SSRIs more effective. Dr. Trivedi suggested that magnetic stimulation on the cortex could be one potential therapy.
"Like STAR*D, I expect these studies will have a widespread effect on how we design and plan treatment approaches," Dr. Trivedi said. "My goal is to establish blood tests and brain imaging as standard strategies in the treatment of depression."
Depression rates in the United States are getting higher all the time. We have to meet the challenge presented by this serious disorder. By using tests that measure biological activity, there is a better chance of finding the proper treatment on the first try. It may be that some patients benefit more from a systematic method, but it’s time to find out.
"Although we continue to study brain imaging and blood biomarkers, I do recommend patients ask for these tests when seeking an antidepressant," Dr. Trivedi said. "Your performance on them, when appropriate, will tell you to try this or avoid that. The bottom line is to reduce the trial-and-error process that can be so devastating to patients."
There are other large studies by Dr. Trivedi underway. D2K will have 2,000 patients with bipolar disorder and depression and will follow them over two decades. Another study, RAD, with 1,500 enrollees aged 10-24 is looking at risk factors for mood and anxiety disorders.