According to a recent article in USA Today, the wicked combination of post-pandemic residue, social-media-induced loneliness and an overall state of uncertainty have seeded an online therapy boom. Therapists say they have never been busier.
At the same time, reports show antidepressants have become one of the most prescribed medications in the country.
Yet well into this three-year surge in medication and therapy, mental health struggles are still on the rise. Shouldn’t that trend be reversing?
This was the question I asked Leonardo Tozzi, M.D./Ph.D., part of a team at Stanford Medicine Center that has unveiled a breakthrough in depression treatment using a combination of brain scanning and AI.
Right now, typical U.S. health coverage options for those struggling with depression or anxiety boil down to some version of talk therapy or medication—or both.
But this dominant “one-size-fits-all” diagnostic approach to treating anxiety and depression is known to be a lengthy, expensive and frustrating process of trial and error. Up to half of patients don’t respond to first-time or “first line” treatment. This phenomenon is known as treatment-resistant depression or anxiety.
Observing the variability in symptoms among hundreds of patients with depression, Dr. Leanne Williams and her team at Stanford Medicine’s Center for Precision Mental Health and Wellness devoted the past 15 years to devising a more tailored approach to treatment.
One major challenge is having to rely on self-reported symptoms, with no way to test whether depressed or anxious feelings stem from an external or internal cause. And unlike other areas of health, physical conditions such as pain or fever don’t determine proper treatment.
The Stanford researchers used a method that combines brain imaging with machine learning to identify six subcategories of depression that respond differently to each form of treatment. Individualized treatment paths have been determined for three of the six, with more research to be conducted.
The team used Functional Magnetic Resonance Imaging (fMRI), a brain scanning technology that measures and maps brain activity. By tracking changes in blood oxygenation and flow, researchers can see which parts of the brain are involved in specific functions, like thinking, feeling or moving.
While fMRI technology has revolutionized our understanding of how the brain works, Stanford Medical’s new standardized image-processing procedure—called the Stanford Et Cere Image Processing System—results in more personalized and effective treatment plans.
These are the six biotypes:
Biotype 1—Overactive Thinking Areas: This group responded best to the antidepressant Effexor.
Biotype 2—High Resting Activity in Three Brain Areas: This group with higher activity in areas linked to depression and problem-solving responded well to talk therapy.
Biotype 3—Low Attention Control: This group with less activity in the brain area that controls attention benefited less from talk therapy compared to other groups.
Biotype 4—Overconnected Emotional and Attention Networks: People with slower emotional and attention responses did better with a combination of behavioral therapies.
Biotype 5—Low Attention Connectivity: This group had trouble concentrating and controlling impulses due to weaker connections in the attention-related brain areas.
Biotype 6—Heightened Emotion Processing: This group had increased activity in brain areas that process both sad and happy emotions. They were more likely to experience severe loss of pleasure and repetitive negative thoughts.
I asked Dr. Tozzi how our readers might benefit from this news. He responded they could participate in the Stanford studies, and that it may be as long as five years before this new technology is available to the public.
In the meantime, the research offers a ray of hope. By recognizing how depression manifests, we move closer to a future where treatment is not just a shot in the dark but a personalized path toward better mental health.
