Measuring brainwaves while sleeping can tell if you should switch antidepressants

September 12, 2020

Scientists have discovered that measuring brainwaves produced during REM sleep can predict whether a patient will respond to treatment from depression. This enables patients to switch to a new treatment rather than continue the ineffective treatment (and the depression) for weeks without knowing the outcome.

As study leader, Dr Thorsten Mikoteit said, "In real terms it means that patients, often in the depths of despair, might not need to wait weeks to see if their therapy is working before modifying their treatment". This work is presented at the ECNP Congress.

Around 7% of adults suffer depression (also known as MDD, Major Depression Disorder) in any one year. It's a huge health burden, costing economies hundreds of billions of Euros/dollars each year. Around 27m European and 17m Americans suffer from MDD every year.

The standard treatment is antidepressants, normally Selective Serotonin Reuptake Inhibitors (SSRI's), such as Prozac and Fluoxetine. However, these can take weeks or months to show an effect, meaning that patients often have to face the depth of their depression for several weeks before even knowing if the treatment they are taking will work. Around 50% of sufferers don't respond to initial antidepressant treatment, which means that after four weeks of ineffective treatment, doctors have to change treatment strategy, and again have to wait for response for another four weeks. Being able to predict the response as early as after one week of treatment would be of huge benefit to depressed patients, and would shorten the treatment response time.

A team led by Dr Thorsten Mikoteit, of the University of Basel, has conducted a randomised controlled trial on 37 patients with Major Depression. All were treated with antidepressants, but 15 were assigned to the control group, while the remaining 22 had their details given to the psychiatrist in charge of treatment. All then had their brainwaves monitored during REM* sleep (technically, this was a measurement of prefrontal theta cordance in REM sleep). The psychiatrists in charge of the treatment group patients were under instructions to interpret the brainwaves to see if the treatment was working, and if not to change the treatment. The overall aim was to see a 50% reduction in symptoms of depression, measured by the standard Hamilton Depression Rating Scale.

Doctors tested patients as early as one week after starting treatment, to see if the brainwaves indicated that the antidepressant treatment was likely to work. Those patients who were unlikely to have successful treatment were immediately switched to a different treatment. After 5 weeks it was found that 87.5% of these patients had an improved response, as opposed to just 20% in the control group.

Thorsten Mikoteit said:

"This is a pilot study, but nevertheless it shows fairly significant improvements. We have been able to show that by predicting the non-response to antidepressants we were able to adapt the treatment strategy more or less immediately: this enables us to significantly shorten the average duration between start of antidepressant treatment and response, which is vital especially for seriously depressed patients.

It needs to be repeated with a larger group of patients to make sure that the results are consistent. Patients need to be in a situation where their REM sleep can be monitored, so this requires more care than just giving the pill and waiting to see what happens. This means that the treatment monitoring will be more expensive, although we anticipate that will be offset by being able to give the right treatment much earlier. We are working on ways of streamlining this.

What it does mean is that we may be able to treat the most at-risk patients, for example those at risk of suicide, much quicker than we can currently do. If this is confirmed to be effective, it will save lives"

Commenting, Professor Catherine Harmer, University of Oxford and ECNP Executive Committee member, said:

"Most of the time, patients need to wait for around 4 weeks before they can tell if they are responding to a particular antidepressant or not. This is a hugely disabling and lengthy process and often a different treatment then needs to be started. The study results presented by Mikoteit are interesting and suggest that it may be possible to tell if a treatment is working much more quickly - even after a week of treatment - by using a physiological measure of response (REM sleeping pattern). If this is replicated in larger, blinded study then it would have enormous implications for the future treatment of individuals with depression".

Professor Harmer was not involved in this work, it is an independent comment.
*REM sleep is "Rapid Eye Movement" sleep. This is a normal period of sleep when one's eyes move rapidly from side to side. People tend to dream more during REM sleep.

Type of study: not peer-reviewed/experimental study/people

European College of Neuropsychopharmacology

Related Depression Articles from Brightsurf:

Children with social anxiety, maternal history of depression more likely to develop depression
Although researchers have known for decades that depression runs in families, new research from Binghamton University, State University of New York, suggests that children suffering from social anxiety may be at particular risk for depression in the future.

Depression and use of marijuana among US adults
This study examined the association of depression with cannabis use among US adults and the trends for this association from 2005 to 2016.

Maternal depression increases odds of depression in offspring, study shows
Depression in mothers during and after pregnancy increased the odds of depression in offspring during adolescence and adulthood by 70%.

Targeting depression: Researchers ID symptom-specific targets for treatment of depression
For the first time, physician-scientists at Beth Israel Deaconess Medical Center have identified two clusters of depressive symptoms that responded to two distinct neuroanatomical treatment targets in patients who underwent transcranial magnetic brain stimulation (TMS) for treatment of depression.

A biological mechanism for depression
Researchers report that in depressed individuals there are increased amounts of an unmodified structural protein, called tubulin, in lipid rafts compared with non-depressed individuals.

Depression in adults who are overweight or obese
In an analysis of primary care records of 519,513 UK adults who were overweight or obese between 2000-2016 and followed up until 2019, the incidence of new cases of depression was 92 per 10,000 people per year.

Why stress doesn't always cause depression
Rats susceptible to anhedonia, a core symptom of depression, possess more serotonin neurons after being exposed to chronic stress, but the effect can be reversed through amygdala activation, according to new research in JNeurosci.

Which comes first: Smartphone dependency or depression?
New research suggests a person's reliance on his or her smartphone predicts greater loneliness and depressive symptoms, as opposed to the other way around.

Depression breakthrough
Major depressive disorder -- referred to colloquially as the 'black dog' -- has been identified as a genetic cause for 20 distinct diseases, providing vital information to help detect and manage high rates of physical illnesses in people diagnosed with depression.

CPAP provides relief from depression
Researchers have found that continuous positive airway pressure (CPAP) treatment of obstructive sleep apnea (OSA) can improve depression symptoms in patients suffering from cardiovascular diseases.

Read More: Depression News and Depression Current Events is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to