Brain Imaging Helps Identify and Treat Different Types of Depression

Millions of Americans suffer from depression. And few find relief even after several months on antidepressants. Research suggests the problem may stem from the way mental illness is diagnosed.

Diseases such as cancer or heart disease can be physically confirmed with objective lab tests, but the problem with diagnosing psychiatric conditions is that they are classified somewhat vaguely as clusters of reported symptoms. A person can be diagnosed as clinically depressed if they say they have low mood and meet at least four additional criteria. Depression can manifest differently from person to person – and symptoms can vary wildly. There really hasn’t been away to differentiate patients who have different kinds of depression. Until now, this has been a
big obstacle in understanding the neurobiology of depression.
Previous studies have shown that stress throws off the flexibility circuits in certain depressed individuals – whereas other people become depressed for different reasons. That is consistent with the view that depression is not just ‘one biological thing.’ In 2008, the National Institute of Mental Health initiated a new set of research priorities which encourages scientists studying mental illness to drill down to core mechanisms rather than placing disorders under blanket labels. This shift in thinking has invigorated the search for a range of biomarkers for depression
—toxic free radicals, the stress hormone cortisol and even epigenetics (environmental triggers that switch genes on and off).
Researchers have previously used functional magnetic resonance imaging (fMRI) to check for differences in brain connectivity between depressed and healthy people. The analysis showed depressed people could be distinguished from healthy ones based on brain connectivity differences measured by fMRI in the limbic and frontostriatal areas. The limbic system controls emotions and frontostriatal networks help coordinate motor and cognitive functions. One brain area, called the subgenual cingulate cortex, has unusually strong connections with other regions of the brain in people who are depressed.
But in the most recent study, researchers used fMRI, to measure the strength of brain connections between neural circuits. Four subtypes of depression were analyzed. These fMRI-based subdivisions could be linked to particular symptoms. Patients falling into the first two subtypes reported more fatigue whereas those in the other two reported more trouble feeling pleasure. This subtyping has implications not just for diagnosis but potentially for non-pharmaceutical treatment.
People with depression subtype 1 were three times as likely to benefit from a newer therapy known as transcranial magnetic stimulation, or TMS. This technology uses a magnet to produce small electric currents in brain areas affected by depression.  Another technology being successfully used is trans cranial direct stimulation or alternating current, tDCS/tACS.  The brain will mimic or emulate the tDCS/tACS fed into it and the capillary blood flow increases.
These findings and future research could help develop clearer diagnoses and enable doctors to tailor more personalized and new therapies targeting the specific form of depression in each individual patient.

Is There a Link between Depression, Anxiety and Minor Injuries?

One out of 10 U.S. adults goes to an emergency department every year for injury.  Most injuries are considered relatively minor and providers often don’t look beyond what’s initially required to help that person heal.  But what happens when a person arrives in the emergency department needing help for a minor injury and who also expresses symptoms of depression and anxiety?

Researchers wanted to find out how such patients fared long-term, something relatively well-studied for people with severe injury but uncharted for minor emergency treatment.  They turned to data they had collected from previous work about long-term recovery from minor injuries.

In that initial study, the researchers used standard criteria to identify 1,110 patients who had sustained minor injuries, after excluding those with head trauma, those with a previous psychiatric diagnosis and those hospitalized during the past year for another minor injury.  From this group, 275 men and women were randomly selected and interviewed at intake in the emergency room, as well as at three, six and 12 months after injury.

Along with the larger diagnostic exams that were given, they collected each patient’s symptoms of depression and anxiety using symptom-severity scales called the Hamilton Depression Rating Scale and Hamilton Anxiety Rating Scale.

They learned that people with more symptoms of depression at the time of their injury still had trouble working a year later and more frequently required bed rest due to health problems. They found connections, though less substantial, for anxiety, too.

Although it’s unclear what’s driving the relationship between psychological symptoms at the time of injury and long-term recovery, they do know there is a range of symptoms which, if identified and evaluated, could change the way we allocate resources or suggest more intensive follow-up for certain people who might be at higher risk for poor recoveries.

It’s an important link between physical and mental well-being for these patients.

The study further validates that health care providers can’t separate people into psych and physical because there’s an interplay between both that’s important to understand.  If the goal is to get patients back to their normal activities, psychological wellness must be incorporated to treatment after injury in order to meet that goal.

The researchers noted that future research should focus on building a better understanding of the pathways through which psychological symptoms influence long-term recovery.

What the Brain Waves Can Tell Us About Depression!!

A UCLA study finds noninvasive method that may help speed relief from depression disorder.

Depression is a major public health problem and leading cause of disability that affects 17 million people in the United States every year. The good news is: There are several antidepressant drugs on the market that are effective in treating depression. The bad news is: Less than one-third of people with the disorder find relief from depression with the first antidepressant that is prescribed for them. Finding the right antidepressant for individuals is a process of prolonged trial-and-error. Patients must wait weeks, months or even up to a year to see if the antidepressant will be effective for them.

Ready for some GOOD NEWS?

A 10-minute procedure in your doctor’s office can significantly help speed relief from this disorder by shortening this process of prolonged trial-and-error. A study by researchers at the Semel Institute for Neuroscience and Human Behavior at UCLA has found a new noninvasive way to predict which individuals will respond favorably to the most commonly used medications to treat depression — using brain wave recordings. This biomarker- a simple pair of brain-wave recordings, or electroencephalograms (EEGs) can predict whether the person will enter remission after just one week of treatment. Knowing whether a medication is going to work could eliminate months of waiting by the patient, and get them on effective treatment more quickly.

The researchers used the electroencephalogram recordings to predict recovery from depression in those taking escitalopram, a common antidepressant sold under the brand name Lexapro. Escitalopram works by increasing the levels of serotonin, a chemical messenger or neurotransmitter in the brain that helps to regulate mood.

Serotonin levels in the brain also maintain the ratio between slow ‘delta-theta’ brain waves and faster “alpha” brain waves. The brain uses this ratio between fast and slow waves to form chemical or electrical networks that support normal mood and thinking. Researchers reasoned that the effect of escitalopram in shifting the balance between delta–theta and alpha activity would predict the effectiveness of the drug in relieving symptoms of depression.

The researchers tested whether brain wave recordings in the first week of treatment would show that the antidepressant (as compared with a placebo) corrected the frequency imbalance — and predict a beneficial effect of medication on an individual’s depression after seven weeks of treatment.

After one week of taking escitalopram, the brain wave recordings of the people who eventually responded favorably to the treatment differed significantly from the measurements of those who did not benefit. The people whose brainwaves showed a large shift toward producing more delta–theta waves were less likely to enter remission with escitalopram treatment. Conversely, those people who shifted toward producing more alpha oscillations after one week of treatment with escitalopram were significantly more likely to find relief from their depression.

The study is notable in a number of ways, the researchers say. For example, although some previous studies have reported on biomarkers that can predict response — that is, whether an individual will get better — few have been able to predict whether a patient will enter remission.  The other important finding — and the pleasant surprise — is that the biomarker was also tested in a group of subjects treated with placebo. Many patients with depression who are treated with placebo also get better or well, but frequently this improvement is only short-lived.
The biomarker selectively predicted remission with medication, but did not when a placebo was used. This confirmed that we can differentiate a true, specific response to a drug from a non-specific placebo response. This is the first time that a biomarker that differentiates placebo remission from drug remission has been reported.
The researchers next plan to use brain wave recordings to evaluate other antidepressant medications as well as cutting-edge non-medication treatments such as trans cranial magnetic stimulation, a magnetic method used to stimulate small areas of the brain.
At the Brain Performance Center we do use brain wave recording to guide treatment plans that do offer magnetic therapy to treat depression.  These include pEMF pulsed electrical magnetic frequencies) and tDCS/tACS, (trans cranial direct or alternating current stimulation).  Please watch the video to get an overview of what we do, or call 817-500-4863 to learn more.

Use tDCS to Improve Depression, Memory and Brain Plasticity

Transcranial Direct Current Stimulation, or tDCS has been used for years to treat patients suffering from conditions such as stroke, depression and bipolar disorder. A new breakthrough study from the researchers at the Catholic University Medical School in Rome shows that this non-evasive treatment could also improve how people learn and retain information.

The study, sponsored by the Office of Naval Research (ONR) Global, involved the use of tDCS on mice. tDCS is applied using two small electrodes placed on the scalp, delivering short bursts of extremely low-intensity electrical currents. After exposing the mice to single 20-minute tDCS sessions, the researchers saw signs of improved memory and brain plasticity (the ability to form new connections between neurons when learning new information), which lasted at least a week. This intellectual boost was demonstrated by the enhanced performance of the mice during tests requiring them to navigate a water maze and distinguish between known and unknown objects. Using data gathered from the sessions, it was discovered that synaptic plasticity in the hippocampus, a region of the brain critical to memory processing and storage, was increased.

While tDCS has been used for years, this study is unique as it supports the theory that there is a direct link between tDCS and improved brain plasticity. Understanding how this technique works biochemically may lead to advances in the treatment of conditions like post-traumatic stress disorder, depression and anxiety–which affect learning and memory in otherwise healthy individuals. The implications of this research also have great potential to strengthen learning and memory in both healthy people and those with cognitive deficits such as Alzheimer’s.

More important, the researchers identified the actual molecular trigger behind the bolstered memory and plasticity, increased production of BDNF, a protein essential to brain growth. BDNF, which stands for “brain-derived neurotrophic factor,” is synthesized naturally by neurons and is crucial to neuronal development and specialization.

While the technique and behavioral effects of tDCS are not new, this study is the first to describe the technique and potential behavioral effects of tDCS which could help improve how people learn and retain information.

Is Depression All In Your Head?

Brain Scans May Predict Recurrence Risk in Major Depression

A recent study funded by the Medical Research Council and published online in JAMA Psychiatry has found that neuroimaging/neurofeedback can add value in psychiatry, in this case specifically in major depressive disorder.

The study focused on 64 non-medicated patients who had been in remission from major depressive disorder for at least 6 months and 39 healthy control participants who had no personal or family history of MDD.

During fMRI, participants were asked to imagine acting badly toward their best friends, and they experienced self-blaming emotions such as guilt. Over the next 14 months, 37 patients remained in remission (stable group), and 27 developed a recurrent major depressive episode.

During the experience of emotions of guilt, the group with recurring MDD showed higher RSATL-SCSR connectivity than the group with stable MDD and the control group, the researchers reported. They noted “We corroborated our hypothesis that during the experience of self-blaming vs. other-blaming emotions, RSATL-SCSR connectivity predicted risk of subsequent recurrence.”

“The group with recurring MDD also exhibited RSATL hyperconnectivity with the right ventral putamen and claustrum and the temporoparietal junction. Together, these regions predicted recurrence with 75% accuracy (48 out of 64 predicted cases),” the researchers say.

The importance of the finding is to show a likely causal relationship between depression and altered functional connections in a neural network that is selective for blaming oneself relative to blaming others. This is in contrast with a common assumption that an overall increase in negative emotion–related brain responses is key to understanding depression.

Although more clinical study is needed to convince healthcare stakeholders to apply these findings to daily clinical practice, this exciting research has reinforced the concept that neurofeedback can be a way to help identify those individuals who are more likely to suffer from recurrent episodes of depression and will therefore benefit most from long-term treatment.