Study uses EEGs to guide treatment for depression

Electroencephalograms, or EEGs, which measure electrical activity in the brain, show promise in improving treatment for depression — and consequently lowering post-traumatic stress symptoms and suicidal tendencies, a new military medical study has found.

Using a program that feeds a depressed patient's resting EEG into a database and produces medication recommendations based on comparisons with other patients, Walter Reed National Military Medical Center researchers saw a 30 percent drop in depression symptoms among patients whose physicians followed the recommended protocols.

The control group, which also had EEGs but received medications prescribed by their psychiatrists in the traditional way — incorporating patient history and other factors — saw only a 12 percent decline in symptoms.

The study, accepted for publication in the journal Neuropsychiatric Disease and Treatment, also found that suicidal tendencies among patients using the technology, called Psychiatric EEG Evaluation Registry, or PEER, dropped by 75 percent and PTSD symptoms improved by 135 percent.

Lead study author Army Col. Brett Schneider said the results mirror those of earlier PEER-guided treatment. PEER, he said, appears to speed patient improvement compared with traditional treatment, which is often seen as a "trial by error" approach.

"Mental disorders present a profound challenge for the general population," Schneider wrote. "It is imperative to validate clinical practices and technologies to improve the prescription accuracy of psychotropic medications."

Replicating results

But critics of the EEG's potential as a mental health diagnostic tool say the study results must be replicated by independent researchers before the technology gains increasing acceptance in the psychiatric community.

Despite several research initiatives to prove that the combination of EEG and crowd-sourcing works, the American Psychiatric Association discourages the approach for general clinical use.

Dr. Alik Widge, director of the Translational Neuroengineering Laboratory at Massachusetts General Hospital and a psychiatry instructor at Harvard Medical School, said one reason for the skepticism is that often the study results can't be replicated by independent researchers.

There's also ongoing debate about what EEGs tell doctors about brain activity, Widge said.

"Right now, there is no solid evidence that the kind of resting-state activity you can measure with EEG really gives you a definite picture of what's abnormal about that individual brain," Widge said. "On average, a given drug might cause a brain change, but it is not proven it will consistently produce the same change in every patient."

The technology works like this: The company CNS Response has developed a database that uses information from a patient's resting EEG to produce a report of which drugs were effective for others diagnosed with the same disorder.

The report makes recommendations for doctors to follow or use along with patient history to determine a treatment course.

Historically, the success rate for finding a drug that works the first time is 33 percent. But some studies of EEG-assisted therapy indicate a first-time success rate of up to 80 percent.

The recent study at Walter Reed National Military Medical Center, Maryland, and Fort Belvoir Community Hospital, Virginia, focused on 150 active-duty and retired service members or military dependents diagnosed with a depressive disorder.

Patients were evaluated for symptom changes during mental health visits for up to six months.

According to the researchers, patients in the PEER group also displayed another positive outcome: They stayed in treatment. More than 40 percent of patients in the group remained through a full six-month treatment course.

"If your meds are working, you keep coming back. If they aren't, you say, 'Screw it.' What we are hoping to do is keep people in treatment," CNS Response CEO George Carpenter said.

The study will continue at both hospitals.

Widge, who was not involved in the research but has examined quantitative EEG to see whether it can predict a patient's response to transcranial magnetic stimulation for depression, said psychiatrists would love a test or biomarker to confirm mental health conditions or guide treatment.

But he's not yet ready to call quantitative EEG the answer.

"The technology needs to be shown to work when it's not used by the people who are selling it, and when it's evaluated directly and fairly against a human," Widge said. "That's the study that would make me think there's something here."