Therapy or Medications for Depression?

9-6-2013 7-37-04 PMA new study published in the most prestigious psychiatric journal (JAMA Psychiatry – see reference below) strongly suggests that a brain scan might be able to help people decide whether therapy or medications are more likely to treat their depression.

As background, although some people feel that for more severe depression medications are more effective, the fact is that most studies find that both types of treatment are about equally effective.

And although the notion that it is possible to identify a “biological depression” based on the presence or absence of psychological reasons for the depression is widely held, there is no evidence to suggest that that distinction is really helpful in deciding between the two approaches to treatment.

This study, which comes from researchers at Emory University in Atlanta, reports that a particular type of brain scan (positron emission tomography or PET scan) was able to tell which people would respond to psychotherapy (and probably would not respond well to medications) and vice versa.

Don’t rush to get your PET scan, though. The study needs to be replicated before we can be sure the technique is reliable.

What is at least as exciting is that the particular abnormality (either increased or decrease activity in a region of the brain called the anterior cingulate) may help us unlock some of the secrets about how depression happens, and how to make useful distinctions between types of depression.

What do we know about the anterior cingulate?Anterior_cingulate_gyrus_animation

Well, it is about midway between the frontal cortex (conscious thought) part of the brain – where psychotherapy seems to work to treat depression and the limbic (emotional) part of the brain – where medications seem to work.

We also recently learned that meditation activates the anterior cingulate gyrus (increases activity). So we know that things that are more conscious and cognitive and move the brain away from depression increase activation of the anterior cingulate.

This study showed that low activity in the anterior cingulate predicted a good response to cognitive therapy.

This makes sense if therapy, like meditation, increases activity in the anterior cingulate.

By contrast, if your anterior cingulate is already hyperactive, therapy is unlikely to work and medications are more likely to work.

Stay tuned for more on this story, but it could be a very significant finding in terms of our understanding of depression and perhaps other psychiatric problems.


McGrath, Callie L., et al. “Toward a Neuroimaging Treatment Selection Biomarker for Major Depressive Disorder.” JAMA psychiatry (Chicago, Ill.)(2013): 1-9.