A brain scan could determine which depression medication will work best for each person, say Australian and American researchers — a significant finding for the millions of people who suffer from the mental illness.
The team of researchers from Sydney’s Westmead Institute for Medical Research and Stanford University said it could mean that the average two to three years it currently takes for an individual to find a depression medication that works for them, could instead be determined in a matter of weeks.
About a million people per year are diagnosed with depression in Australia, and with that comes one of the highest rates of antidepressant use in the world — with more than one in 10 Australians using them.
Professor Philip Mitchell, from the school of Psychiatry at the University of NSW and a research fellow at the Black Dog Institute, said while 30 per cent of people will have a full response to their first choice of medication, that leaves two thirds who do not.
“People do find that difficult and I think that can be demoralising, particularly if people are significantly depressed,” he said.
MRI measures part of brain which generates emotions
The researchers’ study, published in the American journal Proceedings of the National Academies of Sciences, used two measures:
First, they asked depressed patients to answer a questionnaire about their exposure to early life stress.
Then, an MRI machine measured particular brain reactions while the patients were shown pictures of different facial expressions.
They wanted to see how the amygdala — which is the part of the brain which generates emotions — would react.
Dr Mayuresh Korgaonkar, from the Westmead Institute for Medical Research and one of the authors of the report, said they showed the patients happy faces and studied their reactions.
While some of the patients reacted normally, and others had a low reactivity —signifying that they had an impaired amygdala.
“And what we found was that information was actually linked to how they would respond to antidepressants,” he said.
“The patients who did not react as well to the happy faces… were not responding well to antidepressants,” he said.
“Where those who had normal or preserved a reactivity to happy faces, they were the ones who actually responded to antidepressants.”
Dr Korgaonkar said the reason for this outcome came down to how a patients amygdala was impaired.
“In a patient who are more vulnerable for depression — in other words early life stress has actually impaired their amygdala — and hence the reactivity to those happy faces are the ones who are not responding to antidepressants.”
Professor Mitchell said while the finding was an exciting one, they needed other groups around the world to come up with similar findings before they could have strong confidence in their own.
“But I think it points the way to how we’ll be understanding and treating mental illness in the future,” he said.
“That as well as good clinical assessment, we’ll be able to use tools like sophisticated brain imaging to be able to help us in these decisions of who will respond, and who won’t to medications like antidepressants.”
‘Stigma remains around complex mental illnesses in Australia’
For now, it seems Australia is handling mental health treatment fairly well, compared to 15 Asia-Pacific countries.
The Mental Health and Integration Report by The Economist has ranked Australia at number two behind New Zealand, for helping people with mental illness integrate into the community.
But Jack Heath, the CEO of SANE Australia, said there remained a lot of work to be done in Australia around dealing with mental illnesses.
“Whilst we’ve reduced the stigma around conditions like depression, we haven’t had the same results in terms of reducing stigma around the more complex mental illnesses like schizophrenia and bipolar.
“And that’s another area where we’ve got a lot more work to do and I think New Zealand has done that better than Australia.”
Mr Heath said while Australia was making progress by offering mental health care plans through GPs, those plans and services were not going far enough.
“If you’re living out in rural and regional Australia, you’ve got around a third the number of psychologists, about half the number of psychiatrists that you can get to,” he said.
“So the issue is not so much about the service provision, but actually being able to get the professionals to deal with your particular condition.
“And I think one of the things that identified here is that we need to start looking at smarter ways of using technology so that we can start to involve people in conversations in communities.”
This piece was first seen on ‘ABC News’ on October 11, 2016.