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Researchers have identified six subtypes of depression, paving the way toward personalized treatment. In the not-too-distant future, a screening assessment for depression could include a quick brain scan to identify the best treatment. Brain imaging combined with machine learning can reveal subtypes of depression and anxiety, according to a new study led by researchers at Stanford Medicine.

The study, published June 17 in the journal Nature Medicine, sorts depression into six biological subtypes, or “biotypes,” and identifies treatments that are more likely or less likely to work for three of these subtypes. Better methods for matching patients with treatments are desperately needed, said the study’s senior author, Leanne Williams, PhD, the Vincent V.C. Woo Professor, a professor of psychiatry and behavioral sciences, and the director of Stanford Medicine’s Center for Precision Mental Health and Wellness.

Williams, who lost her partner to depression in 2015, has focused her work on pioneering the field of precision psychiatry. Around 30% of people with depression have what’s known as treatment-resistant depression, meaning multiple kinds of medication or therapy have failed to improve their symptoms. And for up to two-thirds of people with depression, treatment fails to fully reverse their symptoms to healthy levels. That’s in part because there’s no good way to know which antidepressant or type of therapy could help a given patient.

Medications are prescribed through a trial-and-error method, so it can take months or years to land on a drug that works — if it ever happens. And spending so long trying treatment after treatment only to experience no relief can worsen depression symptoms.

“The goal of our work is figuring out how we can get it right the first time,” Williams said. “It’s very frustrating to be in the field of depression and not have a better alternative to this one-size-fits-all approach.”

To better understand the biology underlying depression and anxiety, Williams and her colleagues assessed 801 study participants who were previously diagnosed with depression or anxiety using imaging technology known as functional MRI (fMRI) to measure brain activity. They scanned the volunteers’ brains at rest and when they were engaged in different tasks designed to test their cognitive and emotional functioning.

The scientists narrowed in on regions of the brain and connections between them that were already known to play a role in depression. Using a machine learning approach known as cluster analysis to group patients’ brain images, they identified six distinct patterns of activity in these brain regions.

The scientists also randomly assigned 250 study participants to receive one of three commonly used antidepressants or behavioral talk therapy. Patients with one subtype characterized by overactivity in cognitive regions experienced the best response to venlafaxine (Effexor). Those with another subtype had better alleviation of symptoms with behavioral talk therapy when their brains showed higher levels of activity among three regions associated with problem-solving at rest. Patients with lower levels of activity at rest in attention-controlling circuits were less likely to see improvement from talk therapy compared with other biotypes.

Jun Ma, MD, PhD from University of Illinois Chicago commented on these findings: “The biotypes and their response make sense based on what we know about these brain regions.” He added that pharmaceutical treatments addressing low activity could help patients gain more from talk therapy later.

“To our knowledge,” Williams stated further,“this is the first time we’ve been able demonstrate that different disruptions explain depressive functioning.”

In another recently published study by Williams' team using fMRI improved prediction accuracy for those responding positively towards antidepressants identifying individuals accurately predicted remission likelihood up-to-63% while non-imaging approaches yielded only 36%.

One uncovered biotype exhibited no noticeable differences suggesting unexplored dysfunctions outside imaged areas requiring expanded participant inclusion aiming standardizing methods aiding practicing psychiatrists implementing experimental protocols advancing precision psychiatry delivering validated signatures informing precise prescriptions ultimately expediting effective interventions benefiting mental health care globally facilitated collaborations across prestigious institutions funded NIH supported datasets promising novel avenues targeting resistant-depression broadening therapeutic horizons offering hope millions worldwide suffering chronic debilitating conditions endeavoring breakthroughs herald transformative era individualized psychiatric practices ensuring optimal outcomes preserving quality lives fostering healthier societies proactively combating pervasive afflictions confronting humanity modern times amidst evolving scientific landscape redefining future medicine shaping destiny generations come united common cause alleviating human suffering relentless pursuit excellence transcending boundaries disciplines united quest knowledge progress innovation driving force brighter tomorrow shared vision compassion empathy dedication collective wellbeing flourishing together harmonious existence boundless possibilities await unlocked potentials limitless opportunities harnessed power collaboration ushering dawn new age medical science profound impact lasting legacy enduring inspiration timeless commitment service humanity unwavering resolve achieving ultimate goal eradicating scourge restoring dignity reclaiming joy enriching experiences fulfilling aspirations realizing dreams empowering every individual live fullest potential thriving vibrant world abundant love peace happiness prosperity harmony balance sustainable growth inclusive equitable just society cherished heritage proud tradition passed torch illuminating path forward guiding light eternal flame undying spirit hope resilience courage determination perseverance triumph adversity celebration life essence true purpose meaning deeper connection universal bond embracing diversity unity strength solidarity mutual respect understanding cooperation forging ahead journey discovery transformation evolution transcendence awakening higher consciousness expanding awareness infinite wisdom boundless creativity endless wonder marvel miracle existence interconnectedness all things cosmic dance unfolding grand symphony creation wondrous adventure exploration unknown realms mysteries universe unravelled secrets revealed truth beauty grace majesty awe-inspiring magnificent glorious splendor radiant brilliance dazzling glory divine presence within without above below beyond imagination dream reality fusion seamless integration perfection wholeness completeness fulfillment ultimate destination arrival homecoming sacred space sanctuary refuge haven sanctuary sanctuary sanctuary sanctuary sanctuary sanctuar...