Friday, June 14, 2013

Who Should Take Antidepressants?

 A brain scan could help objectively identify who will benefit, and who won't.  

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Amid calls for more science in psychiatry, part of the $100 million the U.S. government is spending this year on the BRAIN Initiative will go toward "mapping the human brain" in the interest of more concrete diagnoses. Basing treatments on harder data, better understanding the science of psychiatric pathology, could cut down on variations from doctor to doctor and get people healthier faster. For example, a recent study at Johns Hopkins found that over 60 percent of adults who were diagnosed by their doctor as having depression actually did not meet the official diagnostic criteria for the disorder upon re-evaluation by Hopkins psychiatrists. Some of them may have been prescribed antidepressant medications when their real problem was something else entirely.

"It could presage a new era when treating depression depends less on trial and error, less on whether you see a psychiatrist or a psychologist, less on your insurance coverage, and more on science."

Even when diagnosis is accurate, only some depressed people respond well to antidepressants. For others, they don't really help. Dr. Thomas Insel, director of the National Institute of Mental Health, explained to me, "We have reasonably good treatments for depression; both medications and psychotherapies. But we don't know who will respond best to medication and who will respond best to psychotherapy."

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