EEG can determine if a depressed patient will do better on antidepressants or talk therapy

June 14, 2018 by Sharon Parmet, University of Illinois at Chicago
Credit: CC0 Public Domain

People react differently to positive events in their lives. For some, a small reward can have a large impact on their mood, while others may get a smaller emotional boost from the same positive event.

These reactions can not only be objectively measured in a simple office evaluation, but researchers from the University of Illinois at Chicago report that they can help clinicians determine whether a patient with anxiety or depression is responding to and if they will do better on an antidepressant drug, or in talk . Their results are published in the Journal of Clinical Psychiatry.

"About 50 percent of people prescribed either selective serotonin reuptake inhibitors, or SSRIs,—a class of antidepressants—or cognitive behavioral therapy get better with those treatments," said Katie Burkhouse, assistant professor of psychiatry in the UIC College of Medicine and lead author on the paper. "We haven't had an objective way to measure whether a patient is improving with treatment or which will do better on SSRIs versus cognitive behavioral therapy, until now."

In a previous study, Burkhouse showed that lower electrical activity in the brain in response to receiving a reward—known as the reward positivity—was associated with greater symptoms of depression. When someone experiences something rewarding in their environment, their brain reacts with an increase in activity. However, patients with depression tend not to respond to rewards at the same level as healthy controls. These differences in electrical activity in response to receiving rewards can be measured using electroencephalography, or EEG, which records electrical signals from the brain through the scalp using a cap embedded with electrodes. A larger reward positivity signal reflects an enhanced brain response to receiving a reward.

Burkhouse and her colleagues wanted to see if they could use reward positivity to predict which patients would do better on SSRIs versus , or CBT. They also wanted to see whether changes in reward positivity were associated with symptom improvement over the course of treatment.

"There are serious considerations that go into prescribing either of these treatments," Burkhouse said. "SSRIs can have unwanted side effects, while CBT requires a significant amount of time and commitment, and practitioners trained in delivering CBT can be hard to find and those that practice this form of therapy may be booked and not able to take on new patients."

For the study, Burkhouse and her colleagues recruited 63 patients who have a history of anxiety or depression and 25 healthy participants with no history of mental health problems. Participants wore the EEG cap while undergoing a simple computer task. They were asked to choose one of two doors on a computer screen and were instructed that if the right door was chosen, the participant would win a small amount of money. If the wrong door was chosen, they would lose money. Next, participants with anxiety or depression were randomly chosen to take an SSRI every day for 12 weeks, or receive 12 weekly sessions of CBT delivered by a psychotherapist. After treatment, all participants completed the monetary reward task again to assess whether there were changes in neural reactivity related to receiving a reward.

There were two significant findings of the study, according to Burkhouse.

"The more that reward positivity increased from the baseline measurement to the final post-treatment measurement, the more participants reported a lessening of their depression or anxiety symptoms with treatment. This means that reward positivity closely follows symptom improvement as treatment progresses, and as such, can be used to help determine if a particular treatment is working for a patient or not," said Burkhouse. The second finding was that participants with a blunted positivity before starting treatment had a greater reduction in depressive symptoms if they were assigned to receive SSRIs, but not talk therapy.

"These findings could help bring precision medicine closer to reality for patients with anxiety and depressive disorders," said Dr. K. Luan Phan, professor of psychiatry in the UIC College of Medicine and a senior author on the paper.

Many patients who seek treatment for their anxiety and don't always do well with the first therapy prescribed due to not being able to tolerate side effects of drugs or not being able to commit to weeks of talk therapy, said Phan, who holds the University of Illinois Center on Depression and Resilience Professorship.

"We can say with heightened certainty that being able to give them a treatment that will work for them is a big step towards helping more patients get relief from their symptoms sooner," said Phan.

Explore further: Quick evaluation can predict whether drugs, talk therapy work better for anxiety patients

More information: Katie L. Burkhouse et al, Neural Responsiveness to Reward as an Index of Depressive Symptom Change Following Cognitive-Behavioral Therapy and SSRI Treatment, The Journal of Clinical Psychiatry (2018). DOI: 10.4088/JCP.17m11836

Related Stories

Quick evaluation can predict whether drugs, talk therapy work better for anxiety patients

December 7, 2017
Clinicians and patients often struggle to find the right treatment for anxiety, sometimes cycling through various therapies for months before the patient begins to feel their symptoms improve.

Serotonin and confidence underlie patience in new study

June 1, 2018
People usually have the ability to put aside the desire for immediate gratification in anticipation of something good. But this isn't just a human trait—a new study shows that mice can be patient, too, revealing a link ...

Why bad sleep doesn't always lead to depression

September 18, 2017
Poor sleep is both a risk factor, and a common symptom, of depression. But not everyone who tosses and turns at night becomes depressed.

Brain imaging shows how prolonged treatment of a behavioral disorder restores a normal response to rewards

June 28, 2013
Attention-deficit/hyperactivity disorder (ADHD) is characterized by abnormal behavioral traits such as inattention, impulsivity and hyperactivity. It is also associated with impaired processing of reward in the brain, meaning ...

Antidepressant response within hours? Experts weigh evidence on ketamine as fast-acting treatment for depression

February 22, 2018
Recent studies suggest that ketamine, a widely used anesthetic agent, could offer a wholly new approach to treating severe depression—producing an antidepressant response in hours rather than weeks. Two reviews of recent ...

Afternoon slump in reward response

August 21, 2017
Activation of a reward-processing brain region peaks in the morning and evening and dips at 2 p.m., finds a study of healthy young men published in The Journal of Neuroscience. This finding may parallel the drop in alertness ...

Recommended for you

Psychiatric disorders share an underlying genetic basis

June 21, 2018
Psychiatric disorders such as schizophrenia and bipolar disorder often run in families. In a new international collaboration, researchers explored the genetic connections between these and other disorders of the brain at ...

One year of school comes with an IQ bump, meta-analysis shows

June 21, 2018
A year of schooling leaves students with new knowledge, and it also equates with a small but noticeable increase to students' IQ, according to a systematic meta-analysis published in Psychological Science, a journal of the ...

Ketamine acts fast to treat depression and its effects last—but how?

June 21, 2018
In contrast to most antidepressant medications, which can take several weeks to reduce depressive symptoms, ketamine—a commonly used veterinary anesthetic—can lift a person out of a deep depression within minutes of its ...

Mindful movement may help lower stress, anxiety

June 21, 2018
Taking a walk may be a good opportunity to mentally review your to-do list, but using the time to instead be more mindful of your breathing and surroundings may help boost your wellbeing, according to researchers.

Brain tingles—first study of its kind reveals physiological benefits of ASMR

June 21, 2018
Autonomous sensory meridian response (ASMR) – the relaxing 'brain tingles' experienced by some people in response to specific triggers, such as whispering, tapping and slow hand movements – may have benefits for both ...

New study debunks Dale Carnegie advice to 'put yourself in their shoes'

June 21, 2018
Putting yourself in someone else's shoes and relying on intuition or "gut instinct" isn't an accurate way to determine what they're thinking or feeling," say researchers from Ben-Gurion University of the Negev (BGU), the ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.