Depression is predicted to be the number one disability by 2020. Yet, finding the best treatment can be as trying as the illness.

Researchers from Sydney’s Westmead Institute for Medical Research and Stanford University say that PET scans of the brain can now help predict whether patients respond better with certain types of antidepressants. This will alleviate the agony of trial and error in prescriptions.

One third of patients will have a full response to their first choice of medication while the two thirds may have to search for a suitable antidepressant.

"People do find that difficult and I think that can be demoralising, particularly if people are significantly depressed," said Professor Philip Mitchell from the school of Psychiatry at the University of NSW and a research fellow at the Black Dog Institute.

MRI measures specific brain patterns that trigger emotions

The researchers set out by asking depressed patients to answer a questionnaire about their exposure to early life stress, and subsequently showing them pictures of different facial expressions.

An MRI machine was used to measure how the brain generates emotions. Published in the American journal Proceedings of the National Academies of Sciences, the study aimed to detect how the amygdala would react.

Happy faces were shown to the patients while their reactions were captured. Some reacted normally while others recorded a low reactivity, an indication of an impaired amygdala.

Dr Mayuresh Korgaonkar, from the Westmead Institute for Medical Research and one of the authors of the report, said, "The patients who did not react as well to the happy faces... were not responding well to antidepressants.”

The ones who preserved their reactivity to happy faces were the ones who actually responded to antidepressants.

This outcome, according to Dr Korgaonkar, suggested how a patient’s amygdala was impaired In patients who are more vulnerable for depression.

Another scientist, Dr Helen Mayberg at Emory University used PET scans to measure brain glucose metabolism and found that scan patterns prior to treatment can provide hints as to which treatment will be more effective.

Her team conducted brain scans on 63 patients before they began treatment, and then compared the brain activity of the patients who benefited from treatment to the ones who did not 12 weeks later.

They found that high activity on the anterior insula indicated that the patients would benefit from antidepressants over psychotherapy, whereas low activity in the area suggested the opposite.

But some doctors still advocate for combo treatments

‘This data suggests that if you treat based on a patient’s brain type, you increase the chance of getting them into remission,’ said Dr Mayberg.

But Dr David M. Reiss, a psychiatrist from San Diego, preferred the option of combining treatments.

“I cannot recall a single case in which I have not combined aspects of different therapeutic approaches in order to best address the distress, problems, symptomatology, and pathology present at any point in time for the specific patient being treated,” he said.

While findings are encouraging, researchers say that they are still preliminary and urge further research. Korgonkar said, “It points the way to how we’ll be understanding and treating mental illness in the future.”

Depression a major health concern illness in Malaysia

The mental health landscape in Malaysia is bleak.

“Depression is now the No. 2 disability in the world. It is expected to rank No.1 by 2020," said Malaysian Mental Health Association deputy president and consultant psychiatrist, Datuk Dr Andrew Mohanraj Chandrasekaran.

In Malaysia, the National Morbidity Survey 2015 showed that 29.9% of the adult population have some form of mental illness compared to 10.7% in 1996.

Children are not spared from depression too. The survey reported 2.1% of children as having issues which include conduct disorder, attention deficit disorder, hyperactivity disorder, as well as depression and anxiety.

"It's quite difficult to detect depression in teenagers because some of them could have turned morose due to hormonal changes or other aspects of growing up," he said.

Depression and anxiety are treatable if detected early. University Malaya Medical Centre psychiatry department head Prof Dr. Ahmad Hatim Sulaiman said, “But these treatments will be futile if patients are afraid to seek treatment.”

Depression has also been linked to suicide, especially among young adults.

"When young people commit suicide, it does not necessarily mean that they want to die, they want to leave the world because they find their situations, in their perception, intolerable and without any other escape," he said. MIMS

Read more:
One in three Malaysians have mental health problems as government action plan to be unveiled
Suicide rates on the rise among teenagers and in urban areas in Malaysia
Malaysia’s stigma of people with mental health problems: A pressing concern
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