Brain Scan May Help Decide Treatment for Depression

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New research from Emory University in Atlanta has 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 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, according to the researchers.

Specifically, patients with positive connectivity between the brain regions were significantly more likely to achieve remission with CBT, while patients with negative or absent connectivity were more likely to benefit from 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,” said Helen Mayberg, M.D., a professor of psychiatry, neurology and radiology at Emory University School of Medicine.

Mayberg and her co-investigators, Boadie Dunlop, M.D., director of the Emory Mood and Anxiety Disorders Program, and W. Edward Craighead, Ph.D., a 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, the study found.

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 researchers noted.

The results from PReDICT suggest that brain scans may offer the best approach for personalizing treatment going forward, they add.

The researchers recruited 344 patients for the study from across the metro Atlanta area. Researchers note they 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,” said 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,” concluded Mayberg.

The study results were published in the American Journal of Psychiatry.

The Ten Rules For Being Human

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1. You will receive a body.

2. You will be presented with lessons.

3. There are no mistakes, only lessons.

Dog with glasses using laptop computer

4. Lessons are repeated until learned.

5. Learning does not end.

6. “There” is no better than “here.”

7. Others are only mirrors of you.

8. What you make of your life is up to you.

9. All the answers lie inside of you.

10. You will forget all of this at birth.

Positive Traits Handout

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This handout is a quick way to start the conversation in groups. I have folks circle the 10 traits that they (think/feel) have. Than I ask them to put them in a numbered order (1 to 10), best to worst. One day someone suggested that they had way more negative traits so…. I started asking folks (after they shared the positive traits) to write their negative traits on the back and share.

Most of the people that I worked with for the last 10 years were men between 20 and 35. Most had started using intoxicants as teens with cannabis and moved onto oxie and later stronger opioids and/or fentanyl. Most had felony possession charges and/or were on probation.

I kept a lose record of what people chose as their top 3 positive traits: 1. Hardworking, 2. Reliable, 3. Strong. One last thing, I usually asked folks at the end of group would their loved ones and/or family (however they chose to define that) agree with their list of positive traits. Most said (hell) no.

Arts appear to play role in brain development

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Brain research in the past several years is just beginning to uncover some startling ideas about how students learn. First came the proof, some years ago, that our brains do not lose brain cells as we get older, but are always capable of growing.

Now neuroscientists are investigating how training students in the arts may change the structure of their brains and the way they think. They are asking: Does putting a violin in the hands of an elementary school student help him to do math better? Will learning to dance or paint improve a child’s spacial ability or ability to learn to read?

Research in those areas, Harvard professor Jerome Kagan said, is “as deserving of a clinical trial as a drug for cancer that has not yet been shown to be effective.”

There aren’t many conclusions yet that can be translated into the classroom, but there is an emerging interdisciplinary field between education and neuroscience. Like Hopkins, Harvard also has created a center to study learning and the brain.

Much of the research into the arts has centered on music and the brain. One researcher studying students who go to an arts high school found a correlation between those who were trained in music and their ability to do geometry. Yet another four-year study, being conducted by Ellen Winner of Boston College and Gottfried Schlaug of Harvard, is looking at the effects playing the piano or the violin has on students who are in elementary school.

Winner said she was quite skeptical of claims that schools that had introduced the arts had seen an increase in test scores and a generally better school climate. She had previously looked at those claims and found they couldn’t be backed up by research.

However, she is in the midst of a four-year study of elementary students that has shown some effects: One group is learning an instrument, and another is not. “It is the first study to demonstrate brain plasticity in young children related to music playing,” Schlaug said.

The study Winner is working on has shown that children who receive a small amount of training — as little as half an hour of lessons a week and 10 minutes of practice a day — do have structural changes in their brains that can be measured. And those students, Winner said, were better at tests that required them to use their fingers with dexterity.

About 15 months after the study began, students who played the instrument were not better at math or reading, although the researchers are questioning whether they have assessments that are sensitive enough to measure the changes. They will continue the study for several more years.

Charles Limb, a Johns Hopkins doctor and a jazz musician, studied jazz musicians by using imaging technology to take pictures of their brains as they improvised. He found that they allowed their creativity to flow by shutting down areas that regulated inhibition and self-control. So are the most creative people able to shut down those areas of the brain?

Most of the new research is focusing on the networks of the brain that are involved in specific tasks, said Michael Posner, a researcher at the University of Oregon. Posner has studied the effects of music on attention. What he found, he said, was that in those students who showed motivation and creativity, training in the arts helped develop their attention and their intelligence. The next great focus in this area, he said, is on proving the connection that most scientists believe exists between the study of music and math ability.

The imaging is now so advanced that scientists can already see the difference in the brain networks of those who study a string instrument and those who study the piano intensely.

The brain research, while moving quickly by some measures, is still painfully slow for educators who would like answers today. Morgan, the Washington County schools chief, said some research did help her support the drive to build the Barbara Ingram School for the Arts in Hagerstown.

Mariale Hardiman, the former principal of Roland Park Elementary/Middle School, was once one of those principals who focused a lot of attention on reading and math scores. But she saw what integrating the arts into classrooms could do for students, she said, and she then began her own research into the subject.

She is now the co-director of the Hopkins Neuro-Education Initiative. She said there are a myriad of questions that could be answered in the research that is just starting, but there are two she would like to see approached: Do children who learn academic content through the arts tend to hold onto that knowledge longer? And are schools squeezing creativity out of children by controlling so much of their school day?

Even without research though, Kagan of Harvard said there is ample evidence of the value of an arts education because so many children who aren’t good at academics can gain self-confidence through the arts.

“The argument for an arts education is based not on sentimentality but on pragmatism,” he said. “If an arts program only helped the 7 million children in the bottom quartile, the dropout rate would drop.”