New depression type discovered — and medication can’t treat it

A new study out of Stanford Medicine has found a “new category of depression” that impacts 27% of diagnosed individuals and is “not effectively” treated by standard antidepressants.

Specifically, this variation of depression shares many traits with that of attention deficit disorders, including having little self-control, struggling to plan ahead, not being able to keep focus in the midst of distractions and difficulty suppressing inappropriate behavior.

Commonly prescribed antidepressants target serotonin in the brain, but that strategy is “less effective for patients with cognitive dysfunction” such as the above, according to Stanford.

“One of the big challenges is to find a new way to address what is currently a trial-and-error process so that more people can get better sooner,” lead author Leanne Williams said.

Depression has been diagnosed in one out of five adults, according to new research from the Centers for Disease Control and Prevention.

“Depression presents in different ways in different people, but finding commonalities — like similar profiles of brain function — helps medical professionals effectively treat participants by individualizing care,” Williams added.

The study sample of 1,008 unmedicated adults who had a major depressive order were all given typical serotonin-driven treatments like Lexapro, Zoloft and Effexor. Only about 38% of the new depression subset saw symptoms go into remission as opposed to the nearly 48% without it. Zoloft patients saw the most drastic difference at 35.9% vs. 50%.

A select 96 also underwent functional magnetic resonance imaging, or fMRI, for a series of cognitive tests to further understand mood disorder variation.

Those who had the fMRI participated in a task called “GoNoGo.” They simply had to press a button when they say the word “go” in green and refrain from doing so when “NoGo” appeared in red.

“The researchers found that 27% of the participants had more prominent symptoms of cognitive slowing and insomnia, impaired cognitive function on behavioral tests, as well as reduced activity in certain frontal brain regions,” according to the research, which labeled the conditions as a “cognitive biotype.”

Upon the new data, Williams and fellow lead author Dr. Laura Hack are now advising that patients with this biotype should be sent for medical imaging prior to beginning their treatments.

“This study is crucial because psychiatrists have few measurement tools for depression to help make treatment decisions,” said Hack. “It’s mostly making observations and self-report measures. Imaging while performing cognitive tasks is rather novel in depression treatment studies.”

Another medication, guanfacine, is being studied at Stanford for this kind of depression. It particularly targets the brain’s dorsolateral prefrontal cortex — an area of cognizance where “significantly reduced activity” had been reported from the “GoNoGo” patients.

Another potential treatment for this could be transcranial magnetic stimulation, where magnetic fields are utilized to stimulate nerve cells.

Cognitive behavior therapy — where patients are shown ways to use problem-solving strategies to negate “thoughts that contribute to both emotional dysregulation and loss of social and occupational abilities” — was also suggested by Hack and Williams.

“I regularly witness the suffering, the loss of hope and the increase in suicidality that occurs when people are going through our trial-and-error process,” Hack said. “And it’s because we start with medications that have the same mechanism of action for everyone with depression, even though depression is quite heterogeneous. I think this study could help change that.”