Developing an Electroencephalography-Based Model for Predicting Response to Antidepressant Medication

Abstract

ImportanceUntreated depression is a growing public health concern, with patients often facing a prolonged trial-and-error process in search of effective treatment. Developing a predictive model for treatment response in clinical practice remains challenging.ObjectiveTo establish a model based on electroencephalography (EEG) to predict response to 2 distinct selective serotonin reuptake inhibitor (SSRI) medications.Design, Setting, and ParticipantsThis prognostic study developed a predictive model using EEG data collected between 2011 and 2017 from 2 independent cohorts of participants with depression: 1 from the first Canadian Biomarker Integration Network in Depression (CAN-BIND) group and the other from the Establishing Moderators and Biosignatures of Antidepressant Response for Clinical Care (EMBARC) consortium. Eligible participants included those aged 18 to 65 years who had a diagnosis of major depressive disorder. Data were analyzed from January to December 2022.ExposuresIn an open-label trial, CAN-BIND participants received an 8-week treatment regimen of escitalopram treatment (10-20 mg), and EMBARC participants were randomized in a double-blind trial to receive an 8-week sertraline (50-200 mg) treatment or placebo treatment.Main Outcomes and MeasuresThe model’s performance was estimated using balanced accuracy, specificity, and sensitivity metrics. The model used data from the CAN-BIND cohort for internal validation, and data from the treatment group of the EMBARC cohort for external validation. At week 8, response to treatment was defined as a 50% or greater reduction in the primary, clinician-rated scale of depression severity.ResultsThe CAN-BIND cohort included 125 participants (mean [SD] age, 36.4 [13.0] years; 78 [62.4%] women), and the EMBARC sertraline treatment group included 105 participants (mean [SD] age, 38.4 [13.8] years; 72 [68.6%] women). The model achieved a balanced accuracy of 64.2% (95% CI, 55.8%-72.6%), sensitivity of 66.1% (95% CI, 53.7%-78.5%), and specificity of 62.3% (95% CI, 50.1%-73.8%) during internal validation with CAN-BIND. During external validation with EMBARC, the model achieved a balanced accuracy of 63.7% (95% CI, 54.5%-72.8%), sensitivity of 58.8% (95% CI, 45.3%-72.3%), and specificity of 68.5% (95% CI, 56.1%-80.9%). Additionally, the balanced accuracy for the EMBARC placebo group (118 participants) was 48.7% (95% CI, 39.3%-58.0%), the sensitivity was 50.0% (95% CI, 35.2%-64.8%), and the specificity was 47.3% (95% CI, 35.9%-58.7%), suggesting the model’s specificity in predicting SSRIs treatment response.Conclusions and RelevanceIn this prognostic study, an EEG-based model was developed and validated in 2 independent cohorts. The model showed promising accuracy in predicting treatment response to 2 distinct SSRIs, suggesting potential applications for personalized depression treatment.

Barefoot walking improves cognitive ability in adolescents

“…This observation aligns with the intriguing link between serotonin, which is a pivotal neurotransmitter, and brainwave frequencies such as gamma and H-beta waves, an area of significant interest in neuroscience. The presence of gamma waves in EEG signals has been widely associated with higher-order cognitive functions, such as memory encoding, attentional control, and perceptual processing [ 25 - 28 ]. The observed increase in gamma wave activity following barefoot walking suggests a potential enhancement in cognitive performance and information processing.…”

On serotonin, psychedelics, entactogens and psychoplastogens in depression, anxiety, post-traumatic stress, and related disorders.

“…This is more difficult in human subjects, except upon extreme surgical procedures. However, some biomarkers can be used to determine the effects of various antidepressant such as electroencephalography (Cerda et al, 2021;Eckermas et al, 2023;Schwartzmann et al, 2023;Ort et al, 2023;Duerler et al, 2023), diffusivity/brain volume/synaptic density/neuroplasticity (Jorgensen et al, 2016;Lewis et al, 2020;Raval et al, 2021;Vargas et al, 2023), various imaging techniques, such as PET or FDG-PET (Vollenweider et al, 1997a(Vollenweider et al, , 1997b(Vollenweider et al, , 1997cCarhart Harris et al, 2014;Jorgensen et al, 2013Jorgensen et al, , 2017 or near infrared spectroscopy (Scholkmann and Vollenweider, 2023). When it comes to imaging, numerous PET ligands have been developed for SERT and various 5-HT receptors, but most of these radioligands are 5-HT receptor antagonists or SSRIs.…”