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Mental Health Matters Journal for Psychiatrists & GP's

MHM Volume5 Issue5

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Brain Scans Could Help Customize Treatment for Clinical Depression

By Jeanie Lerche Davis

Talk therapy, a treatment mainstay for clinical depression, actually creates changes in the brain much like antidepressants do, new research shows.

Researchers are viewing these changes via functional brain scans. In fact, doctors may use these brain scans one day to determine the best plan of attack in treating each patient's specific depression, researchers say. The study appears in the latest issue of the Journal of the American Medical Association (JAMA).

Studies have shown that antidepressants trigger a chain of events in various regions of the brain, it is considered a 'bottom -up' approach to treatment because it changes the chemistry of lower parts of the brain -- those involved with motivation, which eventually leads to changes in the upper brain regions. These upper brain regions are areas involved with abnormal mood states and depressive thinking explains researcher Kimberly Goldapple, MSc, with the Rotman Research Institute at the University of Ontario in Toronto.

However, little is known about the effects that cognitive therapy, a type of talk therapy that involves changing a person's negative thought patterns.

Cognitive behavioral therapy (CBT) on the other hand is considered a 'top- down' approach treatment for clinical depression. CBT targets upper brain regions involved in emotion, and memory and attention involved in depression. This new study is a first step toward understanding the effects both types of treatment have -- and in the future may help doctors determine which specific treatments work with different patients, writes Goldapple.

Brain Changes Made Visible

The 14 patients in her study were all diagnosed with clinical depression; none were taking antidepressants for it at the study's outset. The group had 15 to 20 cognitive therapy sessions. Brain scans using positron emission tomography (PET) were done before and after treatment. The brain scans of the subjects receiving CBT were compared with a group who had received Paroxetine for clinical depression.

All the patients showed significant improvements in their depression, and all showed brain changes, reports Goldapple. However, the cognitive therapy group showed a significantly different pattern of brain changes from those seen in the Paxil group.

In fact, cognitive therapy created a distinct change in functional brain scans. Brain scans from those who received CBT showed a decrease in activity in upper brain regions and an increase in activity in lower brain regions. While those who received the antidepressants showed the complete opposite change.

She concludes, the study reflects specific treatment effects on the brain and may help explain the way different treatment therapies work. This work may provide important targets for future studies looking at what treatment strategies work best in depression, she writes.


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