A new type of depression changes treatment

A new type of depression changes treatment

For the first time, a team of scientists has identified a new subtype of depression that includes more pronounced cognitive impairment, which is missing any sign of helping to relieve its symptoms with current therapies.

Difficulty planning for the future

As reported in the journal JAMA Network Open, researchers at Stanford Medicine used surveys, tests, and brain imaging to map cognitive impairment, which is characterized by behaviors such as difficulty planning ahead, lack of self-control, poor focus, and other problems with executive function.

While difficulties with executive function have been known to be a factor in major depressive disorder for some time, scientists argue that for up to 27% of patients, most current medications do not target the dominant problem. Although they are in the minority, that percentage represents, for example, about five million people who suffer from depression in the United States.

Low-effective medications and treatments

“Depression presents in different ways in different people, but finding commonalities — such as similar features of brain function — helps medical professionals treat participants effectively through individualized care,” said lead researcher Leanne Williams, professor of psychiatry and behavioral sciences.

Generally, SSRIs are prescribed, but they are less effective in helping cognitive dysfunction.

In the course of the new study, 1008 adults with untreated major depressive disorder were given one of three common antidepressants: escitalopram (also known as Lexapro) and sertraline (Zoloft), which act on serotonin, and venlafaxine-XR (Effexor), which acts on Both serotonin and norepinephrine.

More significant cognitive impairment

After eight weeks, 712 participants completed the study. Before and after the trial, they underwent a physician-administered, self-assessed survey to measure levels of various symptoms, as well as behaviors such as changes in sleep or eating, and social and work-life effects. Participants also underwent cognitive tests that measured brain functions such as working memory, decision-making speed and sustained attention.

The brains of 96 of the participants were also scanned via functional magnetic resonance imaging (fMRI). The reflex test allowed the scientists to monitor brain activity compared to those without depression.

The researchers discovered that 27% of the participants had more significant cognitive impairment and decreased activity in certain frontal brain regions — namely, the dorsal prefrontal cortex and the dorsal anterior cingulate regions. They also showed little improvement with SSRIs.

fMRI

"This study is important because psychiatrists have few measuring tools for depression to help make treatment decisions," said Dr. Laura Hack, the study's principal investigator and assistant professor of psychiatry and behavioral sciences. They mostly make observations and self-report measures. [Also] [fMRI] imaging while performing cognitive tasks is fairly new in studies of depression treatment.”

Transcranial magnetic stimulation

Researchers hope that tests can be developed to detect this disorder and change treatment to better fit this subtype of major depressive disorder.

“One of the big challenges is finding a new way to tackle what is currently a process of trial and error so more people can get better faster,” Williams said. Introducing these objective cognitive measures such as imaging will ensure that we are not using the same treatment with every patient.”

Williams and Huck hope to conduct further studies in those with this cognitive biotype, using various therapies such as transcranial magnetic stimulation (TMS) and cognitive behavioral therapy (CBT), as well as other medications such as guanfacine, which is more commonly associated with ADHD. .

Suffering and hopelessness

Not surprisingly, the same brain regions identified in the study are also the areas affected by ADHD and the associated poor executive function.

Researcher Hack said she regularly witnesses “the anguish and hopelessness that occurs when [some patients] go through the process of trial and error with diagnosis. This is because doctors start prescribing medications, which provide the same mechanism of action for everyone with depression, even though depression is quite heterogeneous,” she said, expressing her belief that the results of the study “could help change that.”

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