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Non-Invasive Test May Help Determine Whether to Switch Antidepressant Therapy LOS ANGELES -- September 11, 2009 -- Clinicians may be able to accurately predict within a week whether an antidepressant medication will be effective by using a non-invasive test that takes less than 15 minutes to administer, according to the findings of a nationwide study conducted by the University of California, Los Angeles. The test will allow physicians to quickly switch patients to a more effective treatment, if necessary. The study, called the Biomarkers for Rapid Identification of Treatment Effectiveness in Major Depression, or BRITE-MD, measured changes in brain-wave patterns using quantitative electroencephalography (QEEG), which is a non-invasive, computerised measurement that recognizes specific alterations in brain-wave activity. These changes precede improvement in mood by many weeks and appear to serve as a biomarker that accurately predicts how effective a given medication will be. The study results appear in 2 articles published in the September issue of the journal Psychiatry Research. Nine sites around the country collaborated on the study, which enrolled a total of 375 patients diagnosed with major depressive disorder (MDD). Each individual was given a baseline QEEG at the beginning of the trial and then prescribed the selective serotonin re-uptake inhibitor escitalopram. After 1 week, a second QEEG was taken. The researchers examined a biomarker called the antidepressant treatment response (ATR) index -- a specific change in brain-wave patterns from the baseline QEEG. Subjects were then randomly assigned to continue with escitalopram or were given a different drug. A total of 73 patients who remained on escitalopram were tracked for 49 days to see if their results matched the prediction of the ATR biomarker. The ATR predicted both response and remission with an accuracy rate of 74%, much higher than any other method available. The researchers also found that they could predict whether subjects were more likely to respond to a different antidepressant, bupropion. “Until now, other than waiting, there has been no reliable method for predicting whether a medication would lead to a good response or remission,” said lead author Andrew Leuchter, MD, UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, California. “And that wait can be as long as 14 weeks. So these are very exciting findings for the patient suffering from depression. The BRITE results are a milestone in our efforts to develop clinically useful biomarkers for predicting treatment response in MDD.” An estimated 15 million people in the United States experience a depressive episode each year, and nearly 17% of adults will experience major depression in their lifetime. “BRITE study results suggest that the ATR biomarker could potentially provide the greatest clinical benefit for those patients who might be receiving a medication that is unlikely to help them,” Dr. Leuchter said. “Our results suggest that it may be possible to switch these patients to a more effective treatment quickly. This would help patients and their physicians avoid the frustration, risk, and expense of long and ineffective medication trials.” Dr. Leuchter noted that research has shown that patients with depression who do not get better with a first treatment experience prolonged suffering, are more likely to abandon treatment altogether, and may become more resistant to treatment over time. “So the benefits to the individual and to society are enormous,” he said. An added benefit of the biomarker test, according to Dr. Leuchter, is that it is non-invasive, painless, and fast -- about 15 minutes -- and involves the placement of 6 electrodes around the forehead and on the earlobes. Aspect Medical Systems, which developed the ATR biomarker, provided financial support for the study. Aspect also participated in the design and conduct of the study; the collection, management, analysis and interpretation of the data; and the preparation and review of the manuscript. Final approval of the form and content of the manuscript rested with the authors. Dr. Leuchter is chair of Aspect’s neuroscience advisory board and has provided scientific consultation to them. SOURCE: University of California, Los Angeles, Health Sciences E-mail this page to a friend or colleague! To print, use this version