Researchers have found that specific patterns of activity on brain scans may help clinicians identify whether talk therapy or antidepressant medication is more likely to help a patient recover from depression.

"All depressions are not equal and like different types of cancer, different types of depression will require specific treatments," said lead researcher Helen Mayberg, Professor at Emory University School of Medicine in Atlanta, Georgia, US.

The study, published online in the American Journal of Psychiatry, randomly assigned patients to 12 weeks of treatment with one of two antidepressant medications or with cognitive behavioral therapy (CBT), a talking therapy aimed at helping people manage their problems by changing the way they think and behave.

At the start of the study, patients underwent a functional MRI (magnetic resonance imaging) brain scan, which was then analysed to see whether the outcome from CBT or medication depended on the state of the brain prior to starting treatment. 

The MRI scans identified that the degree of functional connectivity between an important emotion processing centre (the subcallosal cingulate cortex) and three other areas of the brain was associated with the treatment outcomes. 

Specifically, patients with positive connectivity between the brain regions were significantly more likely to achieve remission with talk therapy, whereas patients with negative or absent connectivity were more likely to remit with antidepressant medication.

"Using these scans, we may be able to match a patient to the treatment that is most likely to help them, while avoiding treatments unlikely to provide benefit," Mayberg added.

These results suggest that achieving personalised treatment for depressed patients will depend more on identifying specific biological characteristics in patients rather than relying on their symptoms or treatment preferences.