News | February 06, 2015

Brain Scans Predict Effectiveness of Depression Talk Therapy

Brain connectivity study points toward new image-based diagnostic model ensuring best treatment

UNC School of Medicine, depression, rs-fcMRI, talk therapy, connectivity

This image shows connectivity between the anterior insular cortex brain region (red and green spheres) and the middle temporal gyrus (orange-red gradient). Greater connectivity between these regions predicted better response to talk therapy for people with depression. Image courtesy of Andrew Crowther/Gabriel Dicther, Ph.D., UNC School of Medicine

February 6, 2015 — University of North Carolina (UNC) School of Medicine researchers have shown that brain scans can predict which patients with clinical depression are most likely to benefit from a specific kind of talk therapy.

The study, which was published in the journal Neuropsychopharmacology, is the first to use a technique known as resting-state functional brain connectivity magnetic resonance imaging (rs-fcMRI) to identify differences in brain wiring that predict therapeutic responses to talk therapy.

The research shows that brain scans could ultimately be used as a diagnostic tool to determine the best course of treatment for the millions of Americans that suffer from depression.

"In the future, we will be able to use non-invasive brain imaging technology to match patients with the treatment option that has the best chance of lifting their depression," said senior author Gabriel S. Dichter, Ph.D., associate professor of psychiatry and psychology. "In my mind, that's as important as developing new treatments. We already have a lot of excellent treatments but no way to know which one is best for a particular patient."

Dichter added that if doctors can identify the best treatment immediately, then doctors and patients could avoid months of trial and error, thus dramatically reducing the often-debilitating effects of depression for patients and their families.

Major depressive disorder, also known as clinical depression, is now the second leading cause of disability worldwide. Approximately 1 in 6 people will experience at least one bout of depression, and many will suffer multiple bouts over the course of their lives. Although antidepressant medications, different kinds of talk therapies and brain stimulation can be effective, 40 percent of people are not helped by the first treatment they try. As a result, Dichter said, it can take patients multiple attempts with different treatments before they experience any relief.

The researchers recruited 23 patients with major depressive disorder who were not yet being treated. The patients underwent rs-fcMRI, which visualizes the coordinated activity of various brain regions within known functional networks of neurons while the brain is not engaged in any particular tasks. By using this technique, the researchers could identify brain regions that light up or activate in unison. This, in turn, could help them uncover networks of activity that might be linked to certain behaviors or responses to therapy.

After the patients were scanned, they met with counselors for an average of 12 weekly talk therapy sessions using a method known as behavioral activation talk therapy. Whereas other forms of talk therapy might involve analyzing childhood experiences or altering thought processes, behavioral activation talk therapy focuses on the immediate behaviors associated with depression, such as difficulty getting to work on time or not spending time with loved ones. During the talk therapy sessions, patients set goals to address these behaviors.

Andrew Crowther, a graduate student in UNC's neurobiology curriculum and first author of the Neuropsychopharmacology paper, then analyzed the data to spot relationships between brain connectivity and responses to treatment. He found two connectivity patterns that stood out among patients who benefited most from talk therapy.

First, these patients had greater connectivity between the anterior insular cortex — a prune-sized region involved in assigning importance to events — and the middle temporal gyrus — a flattened section of brain tissue that plays a role in the subjective experience of emotion.

Second, patients had stronger connections between the intraparietal sulcus — a snake-like structure involved in maintaining focus — and the orbital frontal cortex — a crescent-shaped brain region behind the eyes involved in assigning positive or negative values to events.

"There's a complex interplay between the regions of the brain that are involved in cognitive control and those regions involved in understanding how something is going to feel," said Dichter, who is also a member of UNC's Carolina Institute for Developmental Disabilities.

"We've known for a long time that atypical connections between those regions are involved in depression, but now we know that they can also be involved in how a person responds to talk therapy."

Dichter and his colleagues plan to extend their imaging studies to explore responsiveness to other forms of talk therapy, anti-depressant medications, and brain stimulation.

For more information: www.med.unc.edu

Related Content

Doctor-Patient Discussions Neglect Potential Harms of Lung Cancer Screening
News | Lung Cancer | August 15, 2018
August 15, 2018 — Although national guidelines advise doctors to discuss the benefits and harms of...
Videos | Magnetic Resonance Imaging (MRI) | August 13, 2018
Haojie Wang, M.D., director of advanced cardiovascular MRI and a member of the heart valve clinic at Baylor Scott Whi
ACR LI-RADS Steering Committee Releases New Version of CT/MRI LI-RADS
News | Clinical Decision Support | August 13, 2018
August 13, 2018 — The American College of Radiology Liver Imaging Reporting and Data System (LI-RADS) steering commit
Indiana Hospital Installs First Vantage Titan/Zen Edition 1.5T MRI in U.S.
News | Magnetic Resonance Imaging (MRI) | August 10, 2018
Patients in Pulaski County, Ind., now have access to quiet, comfortable magnetic resonance (MR) exams thanks to the...
3T MRI Installed at The London Clinic Through Hospital Roof

Image courtesy of The London Clinic

News | Magnetic Resonance Imaging (MRI) | August 08, 2018
Patients at The London Clinic, a private hospital and charity, will be the first in the United Kingdom to access the...
Cardiac Imaging Reveals Roots of Preeclampsia Damage in Pregnant Women
News | Women's Health | August 07, 2018
Johns Hopkins researchers say a heart imaging study of scores of pregnant women with the most severe and dangerous form...
Cardiac Monitoring a Higher Priority for High-Risk Breast Cancer Patients
News | Cardio-oncology | August 07, 2018
August 7, 2018 — While heart failure is an uncommon complication of...
Videos | Contrast Media | August 03, 2018
Lawrence Tanenbaum, M.D., FACR, vice president and director of advanced imaging at RadNet, discusses the latest resea
Videos | Magnetic Resonance Imaging (MRI) | August 01, 2018
Robert Junk and Tobias Gilk, MRSO, MRSE, of architectural firm RAD-Planning, discuss the different types of safety ha
Thirty-Six Percent of Medical Facilities Not Compliant With MRI Safety Standards
News | Magnetic Resonance Imaging (MRI) | July 27, 2018
Global magnetic resonance imaging (MRI) safety firm Metrasens recently conducted a survey in which 36 percent of 162...
Overlay Init