2024 research you probably missed, part one. If you deal with depression or anxiety, I've got some great science news for you. The current system for diagnosing and treating these issues is not great. More than a third of those diagnosed with depression and half of those with anxiety don't respond to the first treatment that they're given. That's not the exciting part. The problem is that those words are big umbrella terms. The way you feel when waking up for work on a Monday morning might be totally different from the way I feel after working alone in my basement for a month without any human interaction. we shall hurl the gauntlet of science into the frightful face of death itself. I'm working on fixing that. But the clinical diagnosis of major depressive disorder doesn't really sub-categorize much. And there are few good objective measures to help clinicians. There's no easy strep test for, my brain feels like I'm running on Windows XP. Until now. Or soon. Stanford researchers put people inside of MRI machines and measured their brains while both at rest and doing various different cognitive tasks. six distinct biotypes, showing that each was linked to different activation levels of known brain networks, and these corresponded to different symptoms that people reported. For example, biotype number six was all about an overactive threat response, whereas number two combined brooding with anhedonia, which is a lack of interest or enjoyment in activities that someone previously liked. Anhedonic, incapable of experiencing pleasure. But they didn't stop there. 250 of those participants were enrolled in subsequent randomized controlled trials to test Three, to be precise. They found that people's biotypes, at least partially predicted, which treatments they would respond to. One type had a better response to behavioral treatment, another type had a worse response to it, and one specifically had a better response to one type of medication. Venlofaxine, aka Fexor, which sounds like a transformer villain. I am FXOR. Flee before me. So what does this mean for you? I doubt that we'll be using MRIs to diagnose depression anytime soon, given the cost. But if we can run more studies like this one with larger samples, or even behavioral questions to diagnose between these different subtypes, and predict which treatments will work best on the first try. I believe that the next decade will be defined by precision medicine, where we can start using better diagnostics and analysis techniques to figure out medical solutions for each person's individual unique biology and psychology. And this is just scratching the surface on that, so stay tuned. Next up, psychedelics versus concussions.
Additional notes
This isn’t the first study to use fMRI to measure depression and predict treatment response, but most previous studies either only looked at a single treatment (e.g. antidepressants, or brain stimulation), or used only task-free imaging. That’s when we measure the brain without giving subjects anything specific to do while in the scanner. This study used both task-free and task-evoked measurements, which is like measuring heart-health both while at rest and while on the treadmill. It turned out that some of the biotypes were distinguished more by task-free measures, others by taske-evoked ones. The study had N=801 patients with depression and anxiety, 95% of whom weren’t using any medications. 📚 REFERENCES Main Study: DOI: 10.1038/s41591-024-03057-9 Anxiety treatment resistant : DOI: 10.9740/Mhc.2020.11.326 Depression treatment resistant: DOI: 10.3390/ph13060116
References
- Personalized brain circuit scores identify clinically distinct biotypes in depression and anxiety. DOI: 10.1038/s41591-024-03057-9. https://doi.org/10.1038/s41591-024-03057-9
- Anxiety treatment-resistant reference listed in caption. DOI: 10.9740/Mhc.2020.11.326. https://doi.org/10.9740/Mhc.2020.11.326
- Depression treatment-resistant reference listed in caption. DOI: 10.3390/ph13060116. https://doi.org/10.3390/ph13060116