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February 24, 2020 10:23 am
BRAIN WAVES SHOW WHO’LL RESPOND TO ZOLOFT
FEBRUARY 23RD, 2020
"I will be surprised if this isn't used by clinicians within the next five years," says Amit Etkin. (Credit: Getty Images)
A new method for interpreting brain waves could potentially help determine the best depression treatment, according to a new study.
The researchers used electroencephalography, a tool for monitoring electrical activity in the brain, and an algorithm to identify a brain-wave signature in individuals with depression who will most likely respond to sertraline, an antidepressant marketed as Zoloft.
The study emerged from a decades-long effort to create biologically based approaches, such as blood tests and brain imaging, to help personalize the treatment of depression and other mental disorders. Currently, there are no such tests to objectively diagnose depression or guide its treatment.
“This study takes previous research showing that we can predict who benefits from an antidepressant and actually brings it to the point of practical utility,” says Amit Etkin, professor of psychiatry and behavioral sciences at Stanford University. “I will be surprised if this isn’t used by clinicians within the next five years.”
THE PROBLEM WITH DEPRESSION TREATMENT
Instead of functional magnetic resonance imaging, an expensive technology often used in studies to image brain activity, the scientists turned to electroencephalography, or EEG, a much less costly technology.
The paper is one of several based on data from a federally funded depression study launched in 2011—the largest randomized, placebo-controlled clinical trial on antidepressants ever conducted with brain imaging—which tested the use of sertraline in 309 medication-free patients.
The trial was called Establishing Moderators and Biosignatures of Antidepressant Response for Clinical Care, or EMBARC. The researchers designed the trial to advance the goal of improving the trial-and-error method of treating depression that is still in use today.
“It often takes many steps for a patient with depression to get better,” says co-senior author Madhukar Trivedi, professor of psychiatry at the University of Texas-Southwestern who led the research team.
“We went into this thinking, ‘Wouldn’t it be better to identify at the beginning of treatment which treatments would be best for which patients?'”
DIAGNOSING DEPRESSION
Major depression is the most common mental disorder in the United States, affecting about 7% of adults in 2017, according to the National Institute of Mental Health (NIMH). Among those, about half never get diagnosed.
For those who do, finding the right treatment can take years, Trivedi says. He points to one of his past studies that showed only about 30% of patients with depression saw any remission of symptoms after their first treatment with an antidepressant.
Current methods for diagnosing depression are simply too subjective and imprecise to guide clinicians in quickly identifying the right treatment, Etkin says. In addition to a variety of antidepressants, there are several other types of treatments for depression, including psychotherapy and brain stimulation, but figuring out which treatment will work for which patients is based on educated guessing.
To diagnose depression, clinicians rely on a patient reporting at least 5 of 9 common symptoms of the disease. The list includes symptoms such as feelings of sadness or hopelessness, self-doubt, sleep disturbances—ranging from insomnia to sleeping too much—low energy, unexplained body aches, fatigue, and changes in appetite, ranging from overeating to undereating. Patients often vary in both the severity and types of symptoms they experience, Etkin says.
“As a psychiatrist, I know these patients differ a lot,” Etkin says. “But we put them all under the same umbrella, and we treat them all the same way.”
Treating people with depression often begins with prescribing them an antidepressant. If one doesn’t work, a second antidepressant is prescribed. Each of these “trials” often takes at least eight weeks to assess whether the drug worked and symptoms are alleviated.
If an antidepressant doesn’t work, other treatments, such as psychotherapy or occasionally transcranial magnetic stimulation, may work. Often, doctors combine multiple treatments, Etkin says, but figuring out which combination works can take a while.
“People often feel a lot of dejection each time a treatment doesn’t work, creating more self-doubt for those whose primary symptom is most often self-doubt,” Trivedi says.
PREDICTING WHETHER ZOLOFT WILL WORK
The EMBARC trial enrolled 309 people with depression who randomly received either sertraline or a placebo.
For their study, Etkin and his colleagues set out to find a brain-wave pattern to help predict which depressed participants would respond to sertraline. First, the researchers collected EEG data on the participants before they received any drug treatment. The goal was to obtain a baseline measure of brain-wave patterns.
Next, using insights from neuroscience and bioengineering, the investigators analyzed the EEG using a novel artificial intelligence technique they developed and identified signatures in the data that predicted which participants would respond to treatment based on their individual EEG scans.
The researchers found that this technique reliably predicted which of the patients did, in fact, respond to sertraline and which responded to placebo. They replicated the results at four different clinical sites.
Further research suggests that participants who researchers predicted would show little improvement with sertraline were more likely to respond to treatment involving transcranial magnetic stimulation, or TMS, in combination with psychotherapy.
“Using this method, we can characterize something about an individual person’s brain,” Etkin says. “It’s a method that can work across different types of EEG equipment, and thus more apt to reach the clinic.”
“Part of getting these study results used in clinical care is, I think, that society has to demand it,” Trivedi says. “That is the way things get put into practice. I don’t see a downside to putting this into clinical use soon.”
DATA GUIDING CARE
When researchers launched EMBARC, it was part of a broader effort by the NIMH to push for improvements in mental health care by using advances in fields such as genetics, neuroscience, and biotechnology, says Thomas Insel, who served as director of that institute from 2002 to 2015.
“We went into EMBARC saying anything is possible,” Insel says. “Let’s see if we can come up with clinically actionable techniques.” He didn’t think it would take this long, but he remains optimistic.
“I think this study is a particularly interesting application of EMBARC,” he says. “It leverages the power of modern data science to predict at the individual level who is likely to respond to an antidepressant.”
In addition to improving care, the researchers say they see a possible side benefit to the use of biologically based approaches: It could reduce the stigma associated with depression and other mental health disorders that prevents many people from seeking appropriate medical care.
“I’d love to think scientific evidence will help to counteract this stigma, but it hasn’t so far,” says Insel. “It’s been over 160 years since Abraham Lincoln says that melancholy ‘is a misfortune, not a fault.’ We still have a long way to go before most people will understand that depression is not someone’s fault.” (President Lincoln suffered bouts of depression.)
A paper on the work appears in Nature Biotechnology. Additional researchers from South China University of Technology, the Netherlands Research Institute, Harvard Medical School, the New York State Psychiatric Institute, Columbia University, and the Netherlands neuroCare Group contributed to the work.
Etkin is on leave from Stanford, working as the founder and CEO of the startup Alto Neuroscience, a company based in Los Altos, California that aims to build on these findings and develop a new generation of biologically based diagnostic tests to personalize mental health treatments with a high degree of clinical utility. Insel is an investor in Alto Neuroscience.
Funding came from the National Institutes of Health, the Stanford Neurosciences Institute, the Hersh Foundation, the National Key Research and Development Plan of China, and the National Natural Science Foundation of China.
Source: Stanford University
August 12, 2024 8:45 pm
I've had friends who have tried Zoloft in their adult lives and I have a friend who was prescribed Zoloft as a teenager. To this day I do not understand why my teenage friend was prescribed Zoloft. Her mother could not control her, so the dr put her on Zoloft? Sounds a bit shady to me.
August 12, 2024 8:58 pm
No one else replied to this topic, so I will do it three times. SSRIs like sertraline work by boosting serotonin levels, which can help you regulate your emotions and feel less inhibited by any disruptive symptoms of your mental health condition. You may know that Zoloft is working if you: Experience emotional stability. Feel an increase in happiness and well-being. I get that people get depressed, as I have struggled with it as well, but now I feel like I can never get off of my meds and feel normal.
August 12, 2024 8:59 pm
Sertraline (Zoloft) is an antidepressant that can cause various side effects, such as nausea, dry mouth, and diarrhea. Sleep changes are also possible. These side effects often improve after you've been taking sertraline for a few weeks. Other sertraline side effects include weight changes and sexual side effects.
August 14, 2024 3:01 pm
I am glad we have meds to help us with our mental health. There just may be times in our lives that are more challenging where we need a little help. My problem with meds are the trial and error, which is why the brain wave test is a great tool. I think there is a blood test that can determine which would be better for your body.
August 14, 2024 3:06 pm
@torimcneilliectskin-com I have had family members that were on Zoloft and it helped them greatly. I guess after a while, do we know what normal feels like to us? The normal may be completely different than what the normal was at the time we were prescribed the med.
August 14, 2024 3:10 pm
@torimcneilliectskin-com I feel like meds are freely prescribed, like anyone could get them. Probably over-prescribed. Like the Ozempic. When people start to get "Ozempic face" they can come to us to help them with it...will probably be a face lift situation but we will be there. Kind of off topic, but fit into the over-prescribed area.
August 16, 2024 10:44 am
Low key disappointed that none of my mental health providers have ever decided to do a brain wave test on me. I do not like having to try so many meds just to feel worse.
August 16, 2024 10:45 am
@melissalandersiectskin-com There's a swab test! It tests your genes and DNA to see what medicine will work best and what medicine will be resistant to the person. I'd love to do a brain wave test and the swab test.
August 16, 2024 10:50 am
@torimcneilliectskin-com just remember that it is okay if you don't ever stop taking meds. Its not you, its your brain. Depression can be temporary due to life events or , depression can be clinical. The brain is an organ, and the brain malfunctions just like any other organ and sometimes medicine is necessary in order to the get the brain/organ working properly. Trauma also rewires the brain as well. Hugs girly, and remember, nobody is "normal".
September 23, 2024 10:56 am
@torimcneilliectskin-com That sounds as if the doctor prescribed a medication without looking far enough into her healthy history.
September 23, 2024 10:58 am
@melissalandersiectskin-com I feel as if being on any medication overtime can have anyone question what it is like to feel "normal"
September 23, 2024 11:01 am
During my younger years of life I struggled mentally everyday and eventually my doctor prescribed me Zoloft, it was something my mom always had to take so she had no issue with being ok with it. It takes awhile for your body to regulate being on medication no matter what it is, therefore I went through many ups and downs eventually I gave up with the medication. I believe if you can't mentally handle trying to let it regulate in your body then you are doing more harm then good.
October 27, 2024 1:29 pm
@alizasaundersiectskin-com It is good that you realized that the med just wasnt going to be for you. I know that there are people that don't know what they should feel like. It is easy to forget.
October 27, 2024 1:31 pm
@rebeccamatuskaiectskin-com Seems like that would be the first thing that they try before prescribing meds for mental health. Having preventative procedures should be a regular part of Dr. visits, not an extra. Dr.'s are so driven by insurance companies. Its kind of gross.
December 9, 2024 1:20 am
My sister was prescribed Sertraline for a mix of anxiety and depression. The Sertraline has helped her, but it did take time. When she was at the doctors office, they had her fill out two forms; PHQ and GAD. I thought these forms were good to determine a patient's severity of anxiety or depression and see what strength and what type of medication they need. Things like those questionnaires are a good alternative to the EEG equipment, especially if it is a small practice the patient goes to, they may not have access to those machines.
December 9, 2024 1:23 am
@alizasaundersiectskin-com The same thing happened to my sister when she first started taking Zoloft. She was discouraged and wanted to stop taking it, but she stuck with it and it did end up helping her.
December 9, 2024 1:26 am
@rebeccamatuskaiectskin-com I did not know they even offered brain wave tests before prescribing depression medication. I wonder if the tests would look different after your body adjusts to the meds.
March 30, 2025 1:40 pm
I know a lot of people on zoloft and they said it has helped them alot but I also know a lot of people that said it didn't work for them. I think zolofot is good for people who it works for and who need it but I don't think people should be pushed onto the drug I think they should try other methods first instead of doctors just prescribing them Zoloft
March 30, 2025 2:00 pm
@torimcneilliectskin-com I didn't know the symptoms could be that changing which is crazy
March 30, 2025 2:14 pm
@torimcneilliectskin-com I feel that If you tried to get off you meds slowly that you would be able to get off your meds
June 27, 2025 10:13 am
I really enjoyed reading this article because it hit so close to home in so many ways. When I was first diagnosed with PTSD over 10 years ago I was put on Zoloft to help increase my seretonin levels, but it totally wrecked my world. I felt like a complete zombie and getting off the medication was horrendous! My last 2 years in the military ( with the help of my civilian therapist) I ended up going to a place and getting neurofeedback therapy. They have a very similar brain mapping process like the one this article mentioned. The goal of that therapy was to view your brain waves and then calm them down throughout the session. You end up training your brain and then eventually it will grow new neuropathways and stop the cycle of what ever the diagnose was. It's pretty much like an ultra sound for your brain. Looking at those waves can help someone diagnose you with much better precision rather than filling out that brief questionnaire you get at most doctor offices. It quite literally changed my life. Im hoping with new discoveries like this, that we will eventually start looking at mental health and health care in general with a more holistic approach rather than a one size fits all program. A lot of SSRI's are really pushed on patients with no real answers and no resolve. From my personal journey with medications like these I've learned that SSRI's can be very beneficial short term, but that unfortunatley isnt how they are used. You have to get to the root cause like everything else.
Also, touching on the comment that someone mentioned above that the DNA testing, I know several people who have done that and found out that the meds they were taking were not right for them. I always encourage everyone to ask their providers what they think about tools like DNA testing, brain mapping and various different therapies before they get on medication. Everyone is so quick to jump to SSRIs because they BELIEVE that your seretonin levels are low and that's what's causing x, y, and Z..but they actually dont know. Its a guessing game. The only way to actually fact check that theory is analyzing your brain waves. If they dance around the subject then you can tell they are just another doctor who is pushing a medication because they get kick backs if they do.
With all of this said, I think we as a society are working towards understanding mental health more and more and as individuals (thank God for the internet) we are learning how to advocate for ourselves more and have access to an abundant amount of information in order to help guide us along the right path. More articles like this please!
June 27, 2025 10:55 am
@jaydenwilsoniectskin-com It really all depends on how long you've been on the medication but you most probably will suffer from many symptoms. A slow taper doesn't guarantee that you wont experience any negative side effects. You can get off eventually but its a long road!
