Predicting the Success of Antidepressant Therapy

Predicting the Success of Antidepressant Therapy

by Jenny Picciotto

Jenny Picciotto

Jenny Picciotto

The National Institute of Health reported recently on a new model for predicting whether antidepressant therapy will lead to remission[1]. Researchers studied how measuring early life stress and evaluating how the brain processes emotions can predict the success of antidepressants. Results of the study were published by the Proceedings of the National Academy of Sciences this October.[2]

Depression is a common disorder that can have severe symptoms that interfere with many aspects of daily life. It frequently co-occurs with severe illness or chronic pain, but is also prevalent among the general population.

In 2015, 6.7 percent of the adult population of the United States was diagnosed with clinical depression, defined as:

“A period of two weeks or longer during which there is either depressed mood or loss of interest or pleasure, and at least four other symptoms that reflect a change in functioning, such as problems with sleep, eating, energy, concentration, and self-image.”[3]

Treatment may include antidepressant medication, with or without psychotherapy.

Over the last 50 years, the stigma that once accompanied seeking treatment for a mental disorder has largely faded, but many people still don’t get help. While some may not recognize that they are depressed, or don’t realize that help is available; some people internalize depression as a weakness, thinking they should be able to control their mood. This research points to the effect of changes in the structure and function of the brain because of stress as a causative factor in developing depression.

Previous research has linked early life stress (ELS) and changes in the amygdala as factors that individually increase the risk of developing depression as an adult. The amygdala is part of the brain that regulates emotion, fear, and response to stress. Increased levels of stress hormones can change the circuitry of this emotional processing center.

“Stress, especially ELS, produces the cascade of neurobiological changes that disrupt emotion regulation and generate depression in adulthood.”[4]

These changes in the brain reduce the ability to control emotion, which can lead to the “increased negative bias and overly negative evaluation of the self that are fundamental features of human depression.”[5] This is the first study to investigate how these factors can predict the effectiveness of treatment with antidepressants.

70 patients were surveyed to determine how much early life stress (ELS) they were exposed to. Using brain imaging technology, researchers measured emotional response to images representing a threat (angry faces) or a reward (happy faces). By evaluating various combinations of these factors, researchers were able to predict which patients would benefit from antidepressant therapy with 80% accuracy.

Patients who experienced lower levels of ELS, and had lower levels of reactivity to positive or negatively charged images, were more likely to respond. Patients who experienced high levels of ELS, and were more reactive to threat, were less likely to benefit from antidepressant therapy. These individuals may benefit from psychotherapy in addition to, or prior to, treatment with antidepressants.

While the authors recommend further research to factor in the effectiveness of newer medications and psychotherapy, this study has clinical application which could lead to more effective treatment.

Lead researcher Dr. Leanne Williams says “We were able to show how we can use an understanding of the whole person – their experiences and their brain function and the interaction between the two – to help tailor treatment choices.”[6]


[1] https://www.nih.gov/news-events/news-releases/predicting-usefulness-antidepressants
[2] http://www.pnas.org/content/113/42/11955.full?sid=e243499b-8c37-43eb-8e41-42d8711e5928
[3] https://www.nimh.nih.gov/health/statistics/prevalence/major-depression-among-adults.shtml
[4] ibid
[5] ibid
[6] https://www.nih.gov/news-events/news-releases/predicting-usefulness-antidepressants


Jenny Picciotto is a writer who has CRPS and facilitates a CRPS support group. She is currently working on a larger project that will include this article, but has given us permission to publish this article in the meantime. She is also a massage therapist and yoga instructor, and enjoys thinking deeply about simple things.

Authored by: Jenny Picciotto

There are 7 comments for this article
  1. Robert at 9:23 pm

    Is this study from the same people who’ve published peer-reviewed findings that opioids only provide a 30% reduction in pain, and then only in a small subset of the people given them? Basic research is a good thing, but I don’t believe in this for a second. Researchers have an incentive to bake the statistics in a way that justifies their grants. They, like everyone, are biased.

    If I have learned anything about the intersection between the Drug War and the Opioid “Epidemic,” it is that people like Nora Volkow LOVE brain scans and unproven hypotheses. Try to prove that depression is a clinical manifestation of a brain chemical imbalance, specifically serotonin. It can not be proved. Still Nora and others drink the kool aid.

  2. Maureen at 6:36 am

    Over the many years with my pain… been there, done that… with several ‘antidepressants’ as a treatment to help with ‘pain and sleep’, as told to me.
    And surely did not that I wanted those meds but…in my earlier, ignorant days of treatment I was told that this would be protocol for pain management.
    Well…each and everytime I was soooo zonked out and could barely function.
    Hence, by now I certainly know that I simply cannot take them!
    I’ve never been ‘depressed’ but of course I have days of feeling ‘down or sad’ because of living in pain. But, I know how to handle that just fine on my own.
    Folks, keep vigilant and keep aware of the doctors treatments. It’s tough enough that we need other meds in our body. It’s your body, not theirs. You have rights!

  3. Frances Hunt at 1:34 pm

    I am receiving antidepressants for uncontrolled chronic pain and have seen a Psychiatrist (also with uncontrolled pain) three times. I see the pain in her face. I don’t know if she is on antidepressants but it isn’t working for me & the doseage has been increased three times.

  4. Sandra at 12:46 pm

    I do believe that some medications can bring great harm. They are so good at pushing medications. We need to stop and look, how many medications are you taking, how many are you mixing.we have to have a say in our care. They don’t hear us …here take another pill. We are going to pay for doing this be wise about what you take. Are you one of them they are trying the medications out on . .

  5. Kathy C at 10:27 am

    This looks like one more “Study” they are doing now, after decades of over prescribing these medications. Many of the Deaths attributed to the “Opiate Epidemic” all have another common theme. More than half of the Dead, had been on these same Anti Depressants. One in four woman in the U.S is on one of these medications. The time to investigate the effectiveness of any of these drugs was years ago, perhaps before they were widely prescribed.
    A Study on the people who might benefit from these drugs after they were handed out and forced on people, who thought they were supposed to get “better”. Apparently the only “Research” on these drugs is by Big Pharma, anyway. The intent of this “Study” is to give the appearance that they are doing research. If the number of Americans on this class of drugs gets questioned, Policy Makers with no Scientific background will be placated by this “Study.”
    No one asks why this was not done before these drug were extensively marketed. There are millions of people on these Medications, enough to provide plenty of data, but where is it. Prescribing these drugs is routine, yet no one that we know of has questioned this.
    Recently the “Suicide epidemic” and the “Opiate Epidemic” both sensationalized, by Corporate Media, as they create another narrative. There is no reason to be concerned, they were “Drug Addicts” or “Broken people”, further stigmatizing these people by reducing their humanity. Now it is OK to ignore the people with Chronic Pain, they are broken, or they are drug addicts, the awful people they blame of all of societies ills. Journalists follow the narrative, even as they report the “fact” that more than 50% of these deaths involved Poly Pharmacy, which included long term Anti Depressants. Clearly they sought “help” and were given these Drugs, the ones that are given out for nearly anything.
    These Anti Depressants, were incredibly profitable for the drug Industry. Direct marketing has made them innocuous to a point where nearly one quarter of the population is on them.
    The Marketers did such a good job, that no one is questioning anything. Any research that might show any negative consequences is suppressed or ignored.
    The Marketing is so good that they are even advertising “New” drugs to add to the ineffective Anti depressants, one more pill. If they worked as well as advertised, they would not need to add another drug to the regimen. We never hear any of the Stories about the negative impact of taking these drugs. The side effects were either ignored by the Doctors who prescribed them or attributed to the “illness” the person sought help for in the first place. They did not like the data, it might have cut into profits, so it was never collected.
    No research was done on how many under insured and uninsured people were given these drugs, because they could not afford healthcare. They recently changed the DSMV to include distress from physical health issue as a another “Illness” only made this “New” condition Billable. It also codified this as another Mental Health Pathology. Now they can give these drugs to people with pain or other Physical health issues, because they can’t or will not treat it.
    They gave these drugs to people who were distressed over any number of things, as the reasons were ignored. Maybe it was considered “Humane” or an easy out for the Medical Profession. “Working Hard and pulling oneself up by their bootstraps” is the American way. So is Micro managing, and getting the maximum output from any employee. Maximizing profits without paying for Healthcare is another. This narrative is a boon for the Insurance Industry, since they can point out a Psychological problem with an injured employee. Does anyone think that the Big Insurers have not run the numbers, crunched the data,and used the enormous profits to ensure more profits.
    “Doctors ignore pain as an indicator of an underlying condition or injury, since they could be looking for drugs, or a malingerer, it would be bad to attempt to diagnose something. They are actually “helping” these people. In some cases the problem goes away on it’s own, and Medical Intervention can make it worse, so that makes it all alright. Study after study repeats how the wealthy get another kind of “Treatment” a Tennis Injury is taken seriously. They are diagnosed, treated, and back on the Tennis court in weeks. Compare this to the person who worked hard for years and ignored that pain in their Knee or back. They continued to work, even as that pain nagged them, and made other activities more difficult. If these blue collar types turned to Alcohol, or took prescription drugs they are now labeled as “Addicts’. Whatever the problem was that initiated it is not important, they are now stigmatized. If they sought out the “Help” available, the Mental Health clinics, where they might not even see a “professional,” they would have been given these drugs. This would be the only “Therapy” they are provided. They might even think they helped. The Placebo effect means that one in three would believe that these drugs helped, even if they did not. The most obvious thing about any of the Industry “Research” is that these drugs are barely better than Placebo. They are slightly better than nothing.

  6. MichaelL at 5:39 am

    My stress levels were out of sight, in the many ways I used to evaluate it. Yet, I seem to have overcome it, somehow, in my 64 years on earth. I wonder why?!

  7. Tim Mason at 5:24 am

    Depression in an individual or the lack thereof is an indicator of how well an individual is surviving in the world in which he/she lives. Depression is directionally proportional to ones socioeconomic status and health.
    For example: What do you think the level of depression would be in war torn Syria? Is there an antidepressant that can fix those affected? No. Would antidepressants have prevented people from jumping out of windows during the stock market crash some 80 years ago? No
    The human metabolic function are very sensitive to change. The brain is no different. The brain barrier exists for a reason.
    The question is this: A large portion of individuals cannot tolerate serotonin changes. I do not know what the number is but if you put all the people together that have to stop taking them with those that commit suicide while being treated with such drugs the number would be quite large. Add to that, the number of people that cannot stop taking drugs like duloxetine because the become violently ill. The brain has been damaged. About the only thing antidepressants do is prevent people from thinking in a rational manner.
    I do believe that people are brain damaged from early life trauma. In fact in can be seen in almost all species. The canine is a good example……..

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