Researchers have identified six distinct types, or biotypes, of anxiety and depression. A new study used brain scans and computer analysis to sort patients into six groups. Each group had its own pattern of brain activity. Each one also responded to different treatments.
Summary: A new study used brain scans, computer programs, or AI. It found that all anxiety or depression patients fit into six different “biotypes.” Each biotype responds to a different kind of treatment.
Anxiety and depression are the most common mental health problems in the world. In a new brain scan study, researchers found six distinct “biotypes” of depression and anxiety. Each biotype looks different in the clinic, because different parts of the brain have changed.
Better brain scans and faster computers make studies like this possible today. They let us see even tiny differences between the brain scans of different patients.
The amazing part is that these findings may change treatment right away. They help doctors fit care to each patient.
Can these findings help avoid trial and error?
Once a person is diagnosed with depression, doctors have many treatments to choose from. These include many drugs and many kinds of talk therapy.
But one problem remains: no one knows what will work for a given patient. So doctors often start with certain drugs. Then they adjust based on how the patient responds. This is really a “trial and error” method.
Up to now, treatment has been more like “one-size-fits-all.” Doctors follow treatment guidelines that rank drugs as first-line, second-line, add-on, and so on. Once they make the diagnosis, they start with a first-line drug. If that fails, they may switch. If things get worse, they may add more drugs.
But this approach fails many patients. In fact, half of the patients do not respond well to drugs.
Doctors have long seen that anxiety and depression patients look very different from each other. But they had no objective way to sort these patients into groups. So they had to choose treatments based on their knowledge and gut feeling.
This new finding may change anxiety and depression treatment completely. It shows that these patients can be sorted into six sub-types, or “biotypes.” The biotypes differ in how the illness shows up. They also differ on brain scans. This confirms that the illness hits different brain areas in different biotypes.
For this study, researchers looked at brain scans of 801 adults with anxiety or depression. They used advanced computer methods to map the differences between them. The computer program sorted them into six different “biotypes.”
What really excites researchers is that each “biotype” responds to a different treatment. As noted, this can help end the “trial and error” approach. Once doctors know a patient’s biotype, they can start the right treatment right away.
For example, some patients had overactivity in the thinking region of the brain. These patients responded very well to venlafaxine, compared to other biotypes.
Other depressed patients had higher activity in three specific brain centers at rest. Those patients responded better to behavioral therapy.
In the same way, patients with lower activity in the brain center that controls attention were less likely to benefit from behavioral therapy.
This is still a work in progress. Doctors keep improving the diagnosis programs with better AI models. Still, this approach is good because it can roll out fast. It needs less clinical testing than a new drug does. After all, it just helps doctors pick the right treatments from ones already approved. In short, this study takes the guesswork out of anxiety and depression treatment.
Source:
Tozzi, L., Zhang, X., Pines, A., Olmsted, A. M., Zhai, E. S., Anene, E. T., Chesnut, M., Holt-Gosselin, B., Chang, S., Stetz, P. C., Ramirez, C. A., Hack, L. M., Korgaonkar, M. S., Wintermark, M., Gotlib, I. H., Ma, J., & Williams, L. M. (2024). Personalized brain circuit scores identify clinically distinct biotypes in depression and anxiety. Nature Medicine, 30(7), 2076–2087. https://doi.org/10.1038/s41591-024-03057-9
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