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A Blood Test May Help Pinpoint the Right Antidepressant for You

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When doctors determine the best medication for a person with depression, they generally rely upon little more than guesswork and patient self-reports, due to insufficient medical evidence. Research out of UT Southwestern Medical Center (UTSMC) previously suggested that such practices were insufficient, and a new study, published in Psychoneuroendocrinology, provides additional diagnostic information that may change the way depression is treated.

The research team drew upon a large body of research that links low levels of inflammation in the body with depression. They say a blood test for an inflammatory biomarker, known as C-reactive protein (CRP), can significantly improve the success rate of two common antidepressants for depressed patients.

Lead author Madhukar Trivedi, a professor of psychiatry at UTSMC and director of the Center for Depression Research and Clinical Care, says doctors typically pick an antidepressant for their patients in one of three ways: personal experience; matching the perceived benefits of one drug with a certain type of patient’s needs; or having the patient pick a drug by ruling out the unwanted side effects of other drugs. “There isn’t a strong evidence base to support one way [of choosing an antidepressant] over another,” he tells mental_floss.

Trivedi says that because many doctors are pressed for time and overloaded with patients, they don't thoroughly address a depressed patient’s needs. “If you have diabetes, the doctor spends a lot of time explaining that it’s a serious illness—there are consequences for ignoring it, and there are treatments you need to do. In depression, that does not happen as much. Patient engagement is not that strong,” he says.

Trivedi led a landmark study more than a decade ago that revealed how serious the medication problem is: Up to one-third of depressed patients don’t see an improvement in their first month of medication, and approximately 40 percent of people who take antidepressants quit within the first three months.

This failure rate is exacerbated by the lingering social stigma accompanying the illness. “It is not fashionable to say, ‘I have depression,’ so people around you may put in their uninformed advice … 'Just go for a walk,' or 'Why are you depressed?'” says Trivedi.

The CRP blood test is traditionally used as a measure of inflammation for such diseases as cardiovascular disease, diabetes, and rheumatoid arthritis, among others, where doctors are looking for high levels of C-reactive protein—approximately 3 to 5 milligrams per blood liter. In the new study, which Trivedi refers to as a “secondary analysis” of a study he led in 2011 (the Co-MED trial), he says, “Our hypothesis was that for depression there may be stress related inflammation in lower levels.”

Trivedi’s lab measured depression remission rates of 106 patients, culled from 440 patients involved in the 2011 study, each of whom had given blood samples. Fifty-one of them had been prescribed only escitalopram (Lexapro), while 55 of them had been prescribed escitalopram plus bupriopion (Wellbutrin), both commonly prescribed SSRI antidepressant drugs.

After analyzing blood samples, the researchers found that for patients whose CRP levels were less than 1 milligram per liter of blood, escitalopram alone was more effective—patients experienced a 57 percent remission rate of their depression versus 30 percent on the other drug. For patients with higher CRP levels, escitalopram plus bupropion was more effective. These patients experienced a 51 percent remission rate, compared to 33 percent on only escitalopram.

Not only do these SSRI antidepressant drugs promote higher levels of retention of the “feel good” neurotransmitters serotonin and dopamine, they trigger an immune response that blocks inflammatory molecules called cytokines.

“The magnitude of the effect was really thrilling,” Trivedi says. “The bottom line in depression is we have not had objective tests that help us with any component of diagnosis or treatment matching—and this is a very solid first step.”

His next step will be to do a clinical trial in which researchers will go to primary care practices and randomize patients, so that half of the participants will get “the best care the provider is willing to do,” he says, and the other half will do the blood test and then get matched with one of the two drug approaches. “We want to show that if you have the treatment matching based on the blood tests, that group of patients will have significantly better outcomes than those who do usual care.”

He hopes that other studies will use the CRP test with other antidepressant drugs, as well. “It’s not a perfect solution for 100 percent of patients, but it helps.”

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Medicine
The World's First VR Brain Surgery Is Here
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A lot of consumers are focused on virtual reality as a means of immersing themselves in games or traveling to exotic locales, but the technology holds some incredible potential as a learning tool. One recent—and graphic—example is VR brain surgery, which allows viewers to examine the amygdala like they never thought possible.

In the experience, which was produced and overseen by Fundamental VR at the Royal London Hospital, users will be able to follow along with surgeons as a patient is wheeled into the operating room and undergoes a real neurosurgical procedure to repair two aneurysms (balloon-like bulges in an artery that can rupture). Cameras installed in the OR and GoPro units on the surgeons provide a first person-perspective; you can also switch to the POV of the patient as instruments enter and exit your field of view.

The idea was embraced by surgeons at Royal London, who see it as having the potential to be a valuable training tool for neurosurgeons by mimicking "hands on" experience. Although the footage is best seen using a VR headset, you can get a feel for the experience in the YouTube footage below. Did we mention it's very, very graphic?

More sophisticated versions of the program—including tactile feedback for users—are expected to be implemented in Fundamental VR's surgical training programs in the future. Currently, programs like Surgical Navigation Advanced Platform (SNAP) are being used at major institutions like Stanford University and University of California, Los Angeles to map the brain prior to incision.

If this whets your appetite for witnessing brain operation footage, don't forget we filmed and broadcast a live brain surgery in partnership with National Geographic. You can still check it out here.

[h/t Wired]

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Health
How Dangerous Is a Concussion?
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It's not football season, but the game is still making headlines: In a new study published in the Journal of the American Medical Association, neuropathologist Ann McKee and her colleagues examined the brains of 111 N.F.L. players and found 110 of them to have the degenerative disease chronic traumatic encephalopathy (CTE).

The condition has been linked to repeated blows to the head—and every year in the U.S., professional and novice athletes alike receive between 2.5 and 4 million concussions. This raises the question: What happens to the human brain when we get a concussion or suffer a hard blow to the head, and how dangerous are these hits to our long-term health?

Expert Clifford Robbins explains in the TED-Ed video below:

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