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Vital Signs

Fall 2008

BRITE: Study sheds light on depression

A simple, noninvasive office test appears to be effective in predicting whether a given antidepressant medication will improve a patient’s symptoms, according to results from a UCLA-led national clinical trial.

Vitals Signs Fall 2008 article: Study sheds light on depressionWith more than 20 antidepressants on the market, choosing the right one to prescribe has involved a certain amount of guesswork for physicians. This trial-and-error approach is a particular problem given that it typically takes at least four to six weeks before it becomes clear whether an antidepressant is working, and the first drug prescribed is successful in fewer than half of patients with major depression.

“One of the main challenges in caring for people with depression is that we haven’t had good predictors to say which medication is most likely to make an individual patient well,” says Ian A. Cook, M.D., a psychiatrist who heads the UCLA Depression Research Program. “As a result, patients often have to put up with side effects and waiting for many weeks without getting a benefit. Many of these patients become discouraged and stop seeking treatment, leading them to become even more disabled.”

BRITE-MD (Biomarkers for Rapid Identification of Treatment Effectiveness in Major Depression), which grew out of more than a decade of research in the laboratory of Dr. Cook and his colleagues, tested the efficacy of analyzing the brain’s early response to antidepressants for changes associated with the treatment’s ultimate success or failure. Measuring study subjects’ brainwaves with a simplified electroencephalogram (EEG) within seven days of a drug’s initiation — at least several weeks before there would be any meaningful change in symptoms — the researchers at UCLA and nine other sites found that the test accurately predicted a positive response to the antidepressant nearly 70 percent of the time. A follow-up study is about to get under way.

“Our hope is that eventually this could be used by physicians to guide the decision about which medication to use and whether to stay with a particular medication or switch to something else,” Dr. Cook says. “Most people with major depression can benefit from the right treatment, but it often takes time to find out what that treatment is. If we can reduce the length of that process, it would be a major advance.”

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