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Brain scans could personalize depression treatment

Posted by Hugh on January 1, 2020, at 14:06:46

By his late 20s, Moe had attained the young adult dream. A technology job paid for his studio apartment just blocks from the beach in Santa Barbara, California. Leisure time was crowded with close friends and hobbies, such as playing the guitar. He had even earned his pilot's license. "There was nothing I could have complained about," he says.

Yet Moe soon began a slide he couldn't control. Insomnia struck, along with panic attacks. As the mild depression he'd experienced since childhood deepened, Moe's life collapsed. He lost his job, abandoned his interests, and withdrew from his friends. "I lost the emotions that made me feel human," Moe says. (He asked that this story not use his full name.)

Although many people with depression respond well to treatment, Moe wasn't one of them. Now 37, he has tried antidepressant drugs and cycled through years of therapy. Moe has never attempted suicide, but he falls into a high-risk group: Though most people with depression don't die by suicide, about 30% of those who don't respond to multiple antidepressant drugs or therapy make at least one attempt. Moe was desperate for relief and fearful for his future. So when he heard about a clinical trial testing a new approach to treating depression at Stanford University in Palo Alto, California, near his home, he signed up.

To qualify for RAD-AT, volunteers must score higher than normal on a standard questionnaire of anhedonia. Those who do are offered one of the two treatments. (Because pramipexole can increase impulsivity, actively suicidal people are excluded from the study for safety reasons.) Participants get their brains scanned beforehand to gauge activity in the reward and other depression-related circuits. After 8 weeks, they'll get scanned again to see whether treatment altered the circuits' activity and whether that change is associated with a change in symptoms.

Moe's brain scans are among those now being analyzed and considered alongside his clinical history. So far, the two appear to match up: He maxed out at an anhedonia score of 50, the highest possible, and had abnormally low activity on a task that activates the reward circuit: looking at photos of happy faces. If Moe's inability to experience pleasure is driven by too little dopamine, pramipexole could help, Williams says. In July, Moe agreed to take it.

Moe is providing another, still provisional, data point. After 2 weeks on pramipexole, he felt better than he had in years. While driving to Stanford for an appointment, Moe switched on his car radio and heard the indie rock he'd loved in college. To his amazement, the music moved him. "I teared up for the first time in a long time, not because I was sad but because I was connecting with something again," he says.

Moe knows it's too early to tell whether what he describes as his reawakening will endure. If he continues to benefit, he'll keep taking pramipexole under a psychiatrist's supervision. But right now, he feels hope. "It's so weird," he says, "that you can take a medication and then wake up and say, 'I think there's a future now.'"

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