Brain scans may help depression patients find the right treatment
ATLANTA - Sharon Smith of Temple, Georgia, is happiest with her Bernese Mountain Dogs, grooming them, training them, showing them.
And, even when they don't take Best In Show, she's okay with that.
"You're still going home with the dog you love," Smith laughs.
But a few years ago, Smith hit a wall.
"I didn't want to go to dog shows anymore," she says. "It seemed like too much work. Everything just seemed like too much work."
And it wasn't just the dogs.
"I started to feel like I didn't want to go out, I just wanted to stay home," Smith says. "I just said, this is, something is wrong. Something is wrong."
One day, while listening to the radio, Smith heard about a depression study at Emory University in Atlanta.
Psychiatrist Dr. Helen Mayberg and her team at the Emory Brain Health Center were looking for patterns in brain activity that might help doctors predict whether a patient will respond better to antidepressant medication or talk therapy.
Because depression doesn't have one cause, or one treatment, finding the right treatment is like navigating heavy traffic, Mayberg says.
"To go from here to the airport, there are different routes," she says. "And they may be more or less efficient. How do you find the route that is best for you?"
Smith and the other volunteers had depression, but had never been treated for it.
In the study, they were randomly assigned either 3 months of medication or 3 months cognitive behavioral therapy, or talk therapy.
Throughout the study, Dr. Mayberg and her team used functional MRI scans to study how different areas of the study participants' brains were communicating with one another.
"And it isn't just one place in the brain," Mayberg explains. "It's the choreography of different regions in the brain talking to each other. And, if the communication is off in these essential mood circuits, you can become depressed."
The fMRIs allowed the researchers to look for both overactive and underactive areas of the brain.
Dr. Mayberg and her team found patterns of activity in three regions of the brain that seem to track with whether a patient will do better with talk therapy or with medication.
"If they're talking well, if they're connected to each other, and communicating, you do great on therapy, terrible on drug (therapy)," Mayberg says. "But if those same regions are not communicating with each other, you need medication. And therapy won't work."
Back in Temple, Sharon Smith says she is feeling much better, thanks to a combination of both medication and talk therapy.
The research is still in the early stages, and most depression patients don't have access to brain imaging.
But, Dr. Mayberg hopes the study will encourage patients who aren't being helped by their current treatment to talk to their doctor about other options.
"Instead of another drug, when you've failed the first drug, maybe you should ask to have therapy as a second choice," Mayberg says.
Likewise, if you're undergoing therapy, and it's not helping, she says, ask if you might be able to switch to medication.
"Because these experimental data basically say you need to get the treatment that matches your brain," Dr. Mayberg says.
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