Host I: For people with depression, trial and error is how treatment selection goes. My co-host Arianna Skibell tells us about new research that suggests there might be a better way to match patients with the right depression for their treatment.
When doctors treat cancer, heart disease or even a broken leg, they follow certain rules and guidelines. First, they figure out what’s happening in the body, and then, they prescribe a cure based on that information. But depression doesn’t follow the same rules. That’s what’s been bugging Dr. Helen Mayberg for the last decade.
Mayberg: You know, about 40 percent of people will get better with whatever you treat them with. But the problem is that people don’t necessarily get better with the first thing you treat them with.
It can often take months of trial and error to find the best treatment option, whether that’s a drug or therapy or a combination of both. And choosing the wrong first treatment can have some serious costs.
Mayberg: A sustained period of being depressed can be very dangerous; people can harm themselves.
Dr. Mayberg says that to get depression treatment right the first time around we need to understand what goes wrong in the brain. So she conducted an experiment.
AMBI: PET Scan
This is the sound of a PET scan, which is a giant metal tube that scans your whole body and then captures images of changes in your metabolism. And this is exactly how Dr. Mayberg looked at her test subjects’ brains.
Mayberg: We enrolled people who had a major depressive episode, so they were currently ill and not being treated.
And every participant’s brain was scanned.
Mayberg: And then we flipped a coin to randomize them to receive either 12 weeks of cognitive behavioral therapy or to receive medication commonly used to treat depression.
Cognitive behavioral therapy is a type of psychotherapy that is especially good at treating depression. At the end of the 12 weeks, some people were better and some people were not. And by looking at the brain scans, Dr. Mayberg found an indicator, or biomarker, that could predict who would get better from taking drugs and who would get better from receiving therapy.
Mayberg: But it also equally told us who would do badly with a given choice.
Clinicians have always assumed that combining therapy with drug, that having both treatments, could only help the patient. The more intervention, the better. But for some people in this study, receiving drug treatment didn’t help at all, it was completely unnecessary.
Mayberg: The biomarker in the PET scan was very good, or best, at identifying the people who should never see a drug.
Dr. Mayberg’s findings are preliminary. She still needs to run some follow up experiments. But this biomarker may be the key to helping people get the depression treatment they need faster and more efficiently.
Mayberg: It’s possible, with additional testing that we can better match people to the treatment that’s optimal for them.
Dr. Mayberg’s study is an important first step in a larger plan to find targeted treatments for depression. Traditionally, we’ve understood mental illness by looking at people’s behaviors.
Ochsner: Now that’s not necessarily bad, those symptoms and signs are important. They’re what brings someone in to get assistance.
Dr. Kevin Ochsner is a psychology professor at Columbia University.
Ochsner: But the problem is there wasn’t a set of guiding principles that would explain why.
The National Institute for Mental Health is moving in that direction. It recently released new parameters for classifying mental illness, saying it is essential to use advances in genetics and neuroscience technology, like the PET scan, to better understand and treat mental illness in the same way we treat cancer or a knee injury.
Ochsner: It’s a lofty goal, it’s one we’re all trying, you know, we’re all like making little bricks in the giant wall of understanding.
Dr. Mayberg’s findings are an important first brick, but there is still a lot of work to be done before the wall is built.
Arianna Skibell, Columbia Radio News