James Linton is the Lab Manager
at the Brain Dynamics Centre (BDC), Westmead Millennium Institute.
In this article, James talks about BDC's current research in the
optimization of treatment in depression and how this research could
hold the key to an antidepressant prescription decision tool that
could greatly help GP's, Psychiatrists and patients alike.
A young person with depression walks into a doctor's office.
What happens next? You assess the patient and a find that they are
indeed suffering from Depression. Perhaps you next decide to refer
your patients for further specialist help put them on an
antidepressant medication. But which medication do you prescribe
them? You could prescribe them a common SSRI such as Lexapro or
Zoloft or maybe you prescribe them an SNRI such as Effexor. The
patient leaves and begins their course of medication. You then see
your patient again some months later and find out how they are
faring on their medication. Is it working? Is it not working? If
so, great! If not, repeat… repeat…repeat… But is guesswork
in prescribing serious life changing medications really
Now we know that three-quarters of the antidepressant
prescriptions prescribed in primary care management is initiated by
a GP1. We also know that
Depression is the fourth most commonly managed problem in general
practice in Australia2. So
what if there was a way you could assess your patient on that first
visit and using evidence based research, come up with an initial
prescription that is much more likely to work based on biological
factors uncovered on that initial assessment? This would take
out the trial and error factor of prescribing antidepressants and
give you a much better shot at nailing it the first time, greatly
increasing your patients' chance at recovery. Young people are in
their formative years and time is of the essence.
This research is currently well under way and that preliminary
data has shown tangible biological markers that can actually
predict treatment response in depression. The project is called
iSPOT-D (or International Study to Predict Treatment Optimization
in Depression) and is based at the Brain Dynamics Center, Westmead
Millennium Institute at Westmead Hospital. Over 1000 participants
with depression have participated in the study globally and we are
seeing some great results.
These results will be published soon, so watch this space. But
the underlying question we are trying to answer is a question that
we should all be asking. You are prescribing antidepressants and,
in general, they are working. There are definite benefits and a
need to explore these benefits. But how can we make this process
more efficient? How can we get better at this? We need these
Biomarkers to make educated treatment decisions, not 'stab in the
dark' decisions. How do you decide what treatments to give your
patients with depression?
For more information visit http://www.brain-dynamics.net/our-studies/depression
or phone 9845 8195.
Not familiar with mood disorders, and want to learn more? Visit the mood
disorders section of ReachOut Pro