Summary: A new study using brain scans, computer algorithms, or AI found that all anxiety or depression patients can be classified into six different “biotypes.” They found that each biotype responds to different treatment approaches.
Anxiety and depression are the most common mental health issues globally. In a new brain imaging study, researchers have identified six distinct “biotypes” of depression and anxiety. This means that each biotype has a different clinical presentation due to changes in different brain parts.
Many such studies have become possible these days due to improvements in imaging methods and computation technology. This has enabled us to visualize even minute differences in brain scans of various patients.
What is incredible about these findings is that they may immediately impact how these conditions are treated. Such findings help doctors use personalized approaches toward the patients.
Can these findings help avoid trial and error?
Once the person is diagnosed with depression, doctors have much choice of different treatment methods. This may include the use of various pharmacological drugs and psychotherapies.
However, one of the issues remains that it is unclear what will work in a specific patient and what will not. So, doctors would often start therapy with selected drugs and then adjust therapy according to the patient’s response. This is essentially a “trial and error” method.
Till now, the therapeutic approach is more like “one-size-fits-all.” Doctors use specific treatment guidelines that classify various drugs as first-line, second-line, adjuvant, and so on. So, once they have diagnosed the condition, they will start with first-line treatment. If that does not work, they might change the treatment. If things get worse, they might add other medications.
However, this approach does not work in many patients. In fact, half of the patients do not respond well to drug therapy.
Of course, doctors have long noticed that anxiety and depression patients differ a lot in their clinical presentation. However, they still had no objective methods of classifying these patients into different groups. Hence, they had to make therapeutic decisions based on their knowledge and gut feeling.
However, this new finding may completely transform anxiety and depression treatment. This shows that it is possible to classify these patients into six sub-types or “biotypes.” They differ not only in the clinical presentation of the disease but also in brain scans, confirming that different brain areas are affected by pathological processes in different biotypes.
For this study, researchers analyzed brain scans of 801 adults diagnosed with anxiety or depression. They also used advanced computing methods to visualize the difference between them. This advanced computing algorithm was able to classify them into six different “biotypes.”
What has really excited researchers are the findings that each “biotype” responds to different treatment approaches. As already said, this can help eliminate a “trial and error” approach from the treatment. By identifying the patient’s specific biotypes, doctors can immediately start a specific kind of treatment.
Thus, for example, researchers noticed that if patients had overactivity in the cognitive region, then such patients responded really well to venlafaxine compared to other biotypes.
Whereas if patients had higher activity of three specific brain centers at rest when living with depression, those patients responded better to behavioral therapy.
Similarly, patients with lower activity of the brain center that controls attention span were less likely to benefit from behavioral therapy.
Of course, this is still a work in progress, as doctors are improving diagnosis algorithms using telehealth addiction treatments and better AI models. Nonetheless, this approach is good because it can be quickly introduced, as it requires less extensive clinical validation than creating new drugs. After all, it is more about helping doctors choose the right kind of treatment options that have already been approved. So, what this study is doing is taking out the guesswork from 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
