National trial (US): EEG brain tests help patients overcome depression

Indigophoton · May 15, 2018

A new study finds that measuring electrical activity in the brain through electroencephalogram (EEG) can help predict a patient’s response to an antidepressant. The study is the first of several stemming from a national trial aimed at establishing biology-based, objective strategies to remedy mood disorders. Credit: UT Southwestern Medical Center

Imagine millions of depressed Americans getting their brain activity measured and undergoing blood tests to determine which antidepressant would work best. Imagine some of them receiving "brain training" or magnetic stimulation to make their brains more amenable to those treatments.

A national research trial initiated by UT Southwestern in 2012 is generating the first set of results this year that provides an early glimpse into how such high-tech strategies may change the field of mental health.

The first study—to be published in the June edition of the Journal of the American Medical Association Psychiatry - found that measuring electrical activity in the brain can help predict a patient's response to an antidepressant. In the coming months, at least four more studies evaluating the effectiveness of other predictive tests are expected to derive from the EMBARC trial, a major thrust of a national effort to establish biology-based, objective strategies to remedy mood disorders.

"When the results from these tests are combined, we hope to have up to 80 percent accuracy in predicting whether common antidepressants will work for a patient. This research is very likely to alter the mindset of how depression should be diagnosed and treated," said Dr. Madhukar Trivedi, who oversees EMBARC and is founding Director of UT Southwestern's Center for Depression Research and Clinical Care, a cornerstone of the Peter O'Donnell Jr. Brain Institute.
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The article, https://medicalxpress.com/news/2018-05-national-trial-eeg-brain-patients.amp

Pretreatment Rostral Anterior Cingulate Cortex Theta Activity in Relation to Symptom Improvement in Depression A Randomized Clinical Trial

Key Points
Question Does increased pretreatment rostral anterior cingulate cortex theta activity have incremental predictive validity with respect to treatment outcome in major depression?

Findings In a randomized clinical trial including 296 patients with major depressive disorder, higher rostral anterior cingulate cortex theta activity at both baseline and week 1 predicted greater improvement in depressive symptoms, even when controlling for clinical and demographic variables previously linked to treatment response.

Meaning Increased pretreatment rostral anterior cingulate cortex theta activity represents a nonspecific prognostic marker of treatment outcome that has now been replicated in several studies and thus warrants consideration for implementation in clinical care.

Abstract
Importance Major depressive disorder (MDD) remains challenging to treat. Although several clinical and demographic variables have been found to predict poor antidepressant response, these markers have not been robustly replicated to warrant implementation in clinical care. Increased pretreatment rostral anterior cingulate cortex (rACC) theta activity has been linked to better antidepressant outcomes. However, no prior study has evaluated whether this marker has incremental predictive validity over clinical and demographic measures.

Objective To determine whether increased pretreatment rACC theta activity would predict symptom improvement regardless of randomization arm.

Design, Setting, and Participants A multicenter randomized clinical trial enrolled outpatients without psychosis and with chronic or recurrent MDD between July 29, 2011, and December 15, 2015 (Establishing Moderators and Biosignatures of Antidepressant Response for Clinical Care [EMBARC]). Patients were consecutively recruited from 4 university hospitals: 634 patients were screened, 296 were randomized to receive sertraline hydrochloride or placebo, 266 had electroencephalographic (EEG) recordings, and 248 had usable EEG data. Resting EEG data were recorded at baseline and 1 week after trial onset, and rACC theta activity was extracted using source localization. Intent-to-treat analysis was conducted. Data analysis was performed from October 7, 2016, to January 19, 2018.

Interventions An 8-week course of sertraline or placebo.

Main Outcomes and Measures The 17-item Hamilton Rating Scale for Depression score (assessed at baseline and weeks 1, 2, 3, 4, 6, and 8).

Results The 248 participants (160 [64.5%] women, 88 [35.5%] men) with usable EEG data had a mean (SD) age of 36.75 (13.15) years. Higher rACC theta activity at both baseline (b = −1.05; 95% CI, −1.77 to −0.34; P = .004) and week 1 (b = −0.83; 95% CI, −1.60 to −0.06; P < .04) predicted greater depressive symptom improvement, even when controlling for clinical and demographic variables previously linked with treatment outcome. These effects were not moderated by treatment arm. The rACC theta marker, in combination with clinical and demographic variables, accounted for an estimated 39.6% of the variance in symptom change (with 8.5% of the variance uniquely attributable to the rACC theta marker).

Conclusions and Relevance Increased pretreatment rACC theta activity represents a nonspecific prognostic marker of treatment outcome. This is the first study to date to demonstrate that rACC theta activity has incremental predictive validity.
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The paper, https://jamanetwork.com/journals/jamapsychiatry/article-abstract/2678040

adambeyoncelowe · May 16, 2018

Interesting.

Trish · May 16, 2018

Interesting, but I think the thread title is misleading, @Indigophoton. As I read it, the EEG was not a treatment that helped the patients overcome depression, rather it provided a marker that helped predict which patients would improve.

Indigophoton · May 16, 2018

@Trish, the title refers to "EEG brain tests" rather than "EEG treatments", so I think it's accurate, and it's the title of the article, but you are welcome to change it if you would prefer something else, or think something else is more helpful.

Trish · May 16, 2018

Ah, thanks, @Indigophoton, I confess I hadn't notice that it was the same as the article title, I was going on the content of the paper, not the article. In that case, by all means leave it. Sorry to cause confusion.

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