View Full Version : Brain Imaging Predicts Response to Treatment in Depression


APSJ
06-13-13, 09:16 PM
I found this interesting, as I haven't read a lot about brain scans providing direct benefit in treating mental illness.

I wonder if similar approaches may guide treatment of ADHD in the future?

Pre-treatment scans of brain activity predicted whether depressed patients would best achieve remission with an antidepressant medication or psychotherapy, in a study funded by the National Institutes of Health.Activity in one specific brain area emerged as a pivotal predictor of outcomes from two standard forms of depression treatment: cognitive behavior therapy (CBT) or escitalopram, a serotonin specific reuptake inhibitor (SSRI) antidepressant. If a patientís pre-treatment resting brain activity was low in the front part of an area called the insula, on the right side of the brain, it signaled a significantly higher likelihood of remission with CBT and a poor response to escitalopram. Conversely, hyperactivity in the insula predicted remission with escitalopram and a poor response to CBT. http://www.nih.gov/news/health/jun2013/nimh-12.htm

atSWIMtooboreds
06-13-13, 09:23 PM
Really interesting. The insular cortex seems like a fascinating part of the brain.

SB_UK
06-14-13, 01:59 AM
http://www.addforums.com/forums/showpost.php?p=1498158&postcount=30

Just looking at the insular and anterior cingulate cortex.

Something interesting going on here.

First - very brief literature search - there's some sort of inverse reciprocal relationship between insular and anterior cingulate cortex - whereby tendency towards insular cortex activation is bad - tendency to anterior cingulate cortex is good.

Really tentative - never thought about the insular cortex (or even heard about it!) until yesterday.

Strongest feeling that there's some sort of relay (switch) between:
material world -> insular cortex activation
mind (virtual world) -> anterior cingulate cortex activation

So - this is re-iterated by chemistry (material world) remission in insular cortex hyperactivity and information (virtual world,CBT) remission in insular cortex hypoactivity.

Which is nice.

Never heard about the insular cortex until yesterday though - so could well be rubbish.

Fortune
06-14-13, 02:02 AM
Fascinating.

I'd love to get a brain scan. Maybe find the best way to treat this depression.

SB_UK
06-14-13, 02:18 AM
So - the idea from previously:

orbitofrontal cortex -> 'selfish' reward (material world attachment behaviours - money,power)
versus
anterior cingulate cortex activation -> 'social' reward (behaving morally)

is echoed by:
Connectivity of the orbitofrontal cortex with limbic areas includes reciprocal projections to granular, dysgranular, and agranular insular cortex ... ...

http://en.wikipedia.org/wiki/Orbitofrontal_cortex

SB_UK
06-14-13, 02:32 AM
Now ... ... Attention deficit hyperactivity disorder (ADHD) has also been implicated in dysfunction of neural reward circuitry controlling motivation, reward, and impulsivity, including OFC systems.

What if we're (ADDers're) simply re-wired away from orbitofrontal and into anterior cingulate cortex reward system - that is - are re-wired away from the 'selfish' reward system and are innately social.

Makes sense - nature has a proven track record in generating social organisms.

Human beings aren't social organisms (just look at all of the many wars going on currently) ... ... we're about due for an evolutionary change which'd drive emergence of a social species which can prevent us from active pursuit of species demise (because of an ignorant reward system supported in place by money and the legal system).

-*-

So - to be clear - I'm suggesting a species born into a dominant 'social' reward mechanism (not interested in money,power etc) and this 'type' is also metabolically more efficient (geared towards life in ketosis).

So - population level data can be used to suggest that evolutionary selection for survival ('no food availability') and social species formation has operated - and resulted in the emergence of what we call ADDers.

But but but - the disorder of ADHD isn't (of course) a positive evolutionary outcome - it's the result of a new 'type' with a very specific metabolic need, cortisol hypersensitivity (because of our very specific metabolic need) and cortisol hypersensitivity (because of our very specific psychological needs) ... ... that is - that we feel (hypersensitivity to) physical stress (cortisol) upon eating the wrong foods and (hypersensitivity to) psychological stress (cortisol) upon behaving immorally ... ... and we live in a society where we have to eat the wrong foods (they're the ones that're available and affordable) and have to behave immorally (everything people do in a world of money is immoral)
- resulting in the disorder element of ADHD.

So - ADHD is simply a profoundly debilitating state resulting from stress hypersensitivity being triggered by environmentally mandated social behaviour (money, competition, 'cheat thy neighbour') and immediately secondarily - too much of the wrong foods (we're built to live in the starvation/ketosis state).

In genetics speak - we'd call this a social environmental interaction which increases the penetrance of the underlying ADDer genometype to 1.
It's possible to remove ADHD (As defined by the medical model which states no disorder no ADHD) by changing our collective social environmental context - by (in effect) eliminating money and ensuring food/shelter production locally by each person contributing effort.

That's all - we don't need any financial sector, legal sector, medical sector, chemical sector, nuclear industry, pharmaceutical sector ... ... ... it's all just nonsense.

SB_UK
06-14-13, 02:51 AM
http://openi.nlm.nih.gov/imgs/rescaled512/3117594_DialoguesClinNeurosci-12-433-g005.png

http://openi.nlm.nih.gov/detailedresult.php?img=3117594_DialoguesClinNeuros ci-12-433-g005&req=4

Something very interesting going on here - which involves the prefrontal cortex - LPFC, anterior insula - Ant Insula and anterior cingulate cortex - ACC ... ...

SB_UK
06-14-13, 03:48 AM
ACCg = mirror reward neurones [Emotional Intelligence = Empathizing]
ACC(g) = spindle cells [Standard Intelligence = Systematizing]

refs:
1 (http://m.today.duke.edu/2012/12/socialprimate) Empathy [Empathizing/Emotional intelligence] encoded by ACCg
2 (http://en.wikipedia.org/wiki/Cetacean_intelligence) Intelligence [Systematizing/Classical intelligence] related to ACC spindle cells
3 (http://www.ncbi.nlm.nih.gov/pubmed/7636011) Spindle cells in ACCg

The mind:body connection operates at the level of the anterior cingulate cortex.
In The Astonishing Hypothesis, Francis Crick identifies the anterior cingulate ... as a likely candidate for the center of free will in humans.I think that the anterior insular cortex relates to the physical state and the anterior cingulate cortex relates to the psychological state
- and that (as we know) - there are 2 causes of stress in man:
[1] Toxic physical stress - generally food/shelter related
[2] Toxic psychological stress - generally immorality related (the mind is meant to be a model of what's rationally best for the species ie morality).

So - physical stress relates to loss of physiological homeostasis (if you've insufficient food or insufficient shelter and so are cold.
Psychological stress relates to loss of psychological homeostasis - which relates to the mind forcing the body to behave immorally (everything to do with money, supporting social hierarchy).

-*-

Looking at the anterior insular cortex and anterior cingulate cortex representing the material world body and virtual world mind RESPECTIVELY - whereby imbalance (lack of homeostasis in either - as described above) - triggers 'pain' - which disseminates via the CNS/PNS throughout the body to generate inflammation -> underlying the diseases of Western living.
Now - refer back to:
http://www.addforums.com/forums/showpost.php?p=1498158&postcount=30

And one of the references from the lovely Richard Davidson (of Dalai Lama brain imaging fame):
... ... and we arrive at:
"Affective neural circuitry and mind–body influences in asthma"
http://www.investigatinghealthyminds.org/pdfs/RosenkranzAffectiveNeuroImage.pdf

So ... ... ... we've nailed (at the level of anterior insular cortex and anterior cingulate cortex) the all important connection between physiological and psychological homeostasis - whereby failure to maintain homeostasis on either of these 2 levels results in systemic inflammation.

Reference to Barliman's mention of Neuroimmunology.

SB_UK
06-14-13, 03:56 AM
Toxic Psychological stress avoidance - we need to live in a world without hierarchy; see Noam Chomsky on anarchy.
Toxic Physical stress avoidance - we need to eat the right profile of food (and live in an insulated house); see tier 1 of Maslow pyramid.

Lunacie
06-15-13, 11:23 AM
I found this interesting, as I haven't read a lot about brain scans providing direct benefit in treating mental illness.

I wonder if similar approaches may guide treatment of ADHD in the future?

http://www.nih.gov/news/health/jun2013/nimh-12.htm

Ah, a way to tell whether a person has situation-dependant depression or
chemical-imbalance despression, and therefore which treatment would help
the most. Sounds like a step in the right direction.

I wonder if there's any coorelation to diagnosing and treating anxiety also?

Amtram
06-15-13, 12:57 PM
The brain scans weren't meant for the diagnosis or treatment, but to provide a variable for splitting up the participants and see if it turned out to be a valid method of predicting response.

As a start, it's a good one, because it could reduce the number of people being treated with medications who don't necessarily need them. Problem is that it's a prohibitively expensive test, compared to a professional assessment, but who knows how that will change as time goes on? Other problem is that all it demonstrates is medication vs. therapy. This is great for the people who need therapy alone, but not so good for those who need medication, because it doesn't narrow down the type of medication.

There is such a variety even within each classification of antidepressant that knowing which chemicals, and maybe even which specific receptors, need to be targeted is really the ultimate goal.