Personalizing Depression Treatment

An innovative NIMH-funded research study on personalizing depression treatment is under way at Columbia and the New York State Psychiatric Institute, as well as three other sites nationwide. Patrick J. McGrath, MD, professor of clinical psychiatry at Columbia, is principal investigator of “Establishing Moderators and Biosignatures of Antidepressant Response for Clinical Care” (EMBARC) at Columbia.

For the first eight weeks of the 16-week study, participants are randomly assigned to receive either an SSRI (Zoloft) or a placebo (sugar pill). After eight weeks, patients who have not improved on Zoloft switch to Wellbutrin for an additional eight weeks, and those who have not improved on the placebo switch to Zoloft. Before receiving medication, each participant has MRI, psychological testing, and an EEG, which records electrical signals in the brain. Both the MRI and EEG are used to assess brain function. Blood samples are collected for genetic testing and analysis of blood proteins, which may signal medication response.

“This isn’t the first study to use some of these technologies to look at physiologic differences in people with depression, but it is the first to incorporate a whole battery of them in a single randomized research study of this size,” says Dr. McGrath.

Collaborators on the study are Myrna Weissman, PhD, the Diane Goldman Kemper Family Professor of Epidemiology at Columbia; Ramin Parsey, MD, PhD, formerly at Columbia and now chair of psychiatry at Stony Brook University; and Maria Oquendo, MD, professor of psychiatry and vice dean for education in the Department of Psychiatry.

The results of EMBARC are anticipated by researchers and particularly by patients who have tried multiple medications but found the side effects intolerable or have found improvement only after months and months of trial and error.