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October 7, 2007
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Blues Hearing Test

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Treating the Blues (04.13.04) - New research may soon change the way doctors treat depression, unraveling the mystery of how mental illness begins while brain experts reveal how the mind responds to treatment.

Panic Disorder (09.16.04) - Patients suffering from attacks of panic brought on by a hard to define fear factor may soon have better treatment options. Researchers are a step closer to understanding how this disorder works to alter biology in the brain.


NIMH: Depression


Using Music in Therapy

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Scientists are finding that a simple listening test seems to help doctors find the right drug to battle depression. As this ScienCentral News video reports, doctors now often take a shotgun approach when prescribing antidepressants.

Listening to the Blues

When all the color drained from Judith Niosi's life, not even the childhood cheer of her seven-year-old son seemed to make life worth living.

"At that time, I felt that he was better off without me because I just felt so hopeless and helpless," recalls the 37-year-old graphic artist. "And if I couldn't help myself, how could I help this child? I felt that I was doing him more damage being around him."

Where joy ran from her so too did the energy required to accomplish seemingly simple tasks. "I couldn't get out of bed at all," she says. "I didn't want to do my hair. I didn't want to shower. I didn't want to do anything. It's not that I didn't want to, I couldn't. I didn't have the energy."

Finally, she sought medical help. But that consisted of round after round of trial and error treatment with antidepressants that left her even more depressed and frustrated. A few agonizing months later, her doctors finally hit on a drug that cleared Niosi's mental fog.

Researchers say Niosi's experience isn't by any means uncommon. Many psychiatrists lament the fact that there are currently no laboratory tools in place to determine who will— or who won't— succeed on the most popular antidepressant medications.

"We know pretty well how to figure out whether someone is depressed or not on the one hand, and we have terrific treatments, both medications and otherwise that often help a lot, on the other hand," says Jonathan Stewart, involved with depression evaluation services at the New York State Psychiatric Institute. "But we have no tools whatsoever to determine that this patient should or shouldn't get this particular treatment. Matching the patient to the treatment is totally trial and error."

Now, working with Stewart, clinical neuroscientist Gerard Bruder, also of the New York State Psychiatric Institute, has developed a simple listening test that seems to predict with great accuracy who will do well on selective serotonin reuptake inhibitor (SSRI) antidepressants, the most popularly prescribed medications for treating depression in the United States.

Bruder studied 114 depressed patients between 18 to 65 years of age and 110 adults who reported that they were not depressed. Both groups were told to wear headphones while they heard two words simultaneously. Patients then checked the word they heard most clearly from a list of four choices. Then, Bruder looked at their responses.

"In depressed women, particularly those who respond well to an SSRI antidepressant, they have a larger left brain advantage for hearing words than women who are not depressed," Bruder explains. Conversely, "women who respond poorly to a SSRI antidepressant actually have less left brain advantage."

Burder says hearing seems to correspond to depression, though he's not sure exactly how. He does know that brain activity is essential to hearing. What people hear in the right ear most directly activates the left brain. And what's heard in the left ear engages the right brain. "I guess our best guess is that we know that depression is related to biochemical imbalances in the brain," he explains. "One possibility is that those biochemical imbalances affect, differently, the left brain and the right brain and that there's an imbalance between what's happening in the left and right brain and that that imbalance is part of depression."

Nationwide, depression strikes about 19 million Americans each year and one in ten adults reported a depressive episode annually, statistics gathered by the National Institute of Mental Health show. Depression can bring on loss of appetite, decreased ability to think or concentrate, recurrent thoughts of death or suicide, changes in sleep patterns, and feelings of worthlessness, among other symptoms.

Nearly half of all patients being treated for depression don't respond to SSRI medications, which doctors prescribe to patients 80 percent of the time, Stewart says. When such treatment fails to offer relief, patients can get discouraged: "Part of being depressed is to be easily frustrated and so they get frustrated with the treatment and say, 'Treatment doesn't work. I might as well keep bungling along,' whereas if we could give them the treatment that's going to work for them the first time around you're going to have a lot less frustration."

Bruder's test results have been replicated in three separate studies, showing equal accuracy each time: "In the last study we did we found that women who had above normal left brain advantage for hearing words had about a 95% chance of doing well on Prozac. And that compares with the same women having only a 10% response to a placebo."

So, what will happen to patients whose listening test indicates that SSRIs won't work? "Unfortunately, it's not pinned down yet what is for you," Stewart says. "Now we know what's not for you. We know what not to try. We still have a laundry list of other things to try so the odds are still very good for you. I think they're actually improved because we're more likely to give you what's going to work for you than if we gave you the SSRI which is not going to work for you."

Bruder's next step is to try the listening test in a clinical setting such as doctors' offices. Should it prove as accurate there, Bruder's listening test may help patients like Niosi defeat the kind of depression that can crush life's small pleasures.

This research appeared in the September 2004 issue of the journal Neuropsychopharmacology and was funded by the National Institute of Mental Health.

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