[HN Gopher] Brain circuit scores identify clinically distinct bi...
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Brain circuit scores identify clinically distinct biotypes in
depression/anxiety
Author : MBCook
Score : 74 points
Date : 2024-06-18 03:49 UTC (1 days ago)
(HTM) web link (www.nature.com)
(TXT) w3m dump (www.nature.com)
| Spod_Gaju wrote:
| IS it just me or is this ridiculous? They separated people who
| were having different symptoms and they showed it in MRIs. All
| this does is prove that you can derive these brain "biotypes"
| without the MRI. Why is this new or special or needed? We need
| treatment, not more tests to tell us what we already know.
| johnchristopher wrote:
| > All this does is prove that you can derive these brain
| "biotypes" without the MRI.
|
| From the article:
|
| > There is an urgent need to derive quantitative measures
|
| > We need treatment, not more tests to tell us what we already
| know.
|
| Testing for objective markers can/should lead to choosing the
| most adequate treatment faster than relying on self reported
| symptoms or subjective opinion from therapists (even if
| experienced or informed).
| Spod_Gaju wrote:
| My point is that this was a waste of effort and money. They
| just need to listen to us patients and stop thinking we
| cannot be objective. Whenever it comes to mental health
| people think there is a total loss of objectivity. All you
| have to do is look at the patient. Is there a need to get a
| brain scan to see if I am anxious if I am acting objectively
| anxious?
|
| This need to measure everything is almost pathological.
| Youden wrote:
| Patients generally can't be relied upon to be objective.
| There may be exceptions but patients will often say they
| don't have symptoms that they do and that they do have
| symptoms that they don't.
|
| Speaking as a patient myself.
|
| I wish there was a way I could get an objective test that
| spits out exactly what's wrong with me and which treatments
| are most effective. I've been through several psychiatrists
| and treatments and am yet to find something effective.
|
| I'm glad research like this is being done.
| the_sleaze_ wrote:
| It's always been interesting to me that psychiatrists and
| psychologists just have to sort of trust the story
| they're being told. Recently CVS and other pharmacies
| have started denying prescriptions from some telehealth
| based psychiatrists because they believe they're over-
| prescribing amphetamines. How do they know?
|
| This article also makes me think of the neurologist that
| unknowingly analyzed his own brain scan only to discover
| he was a psychopath.
|
| https://www.smithsonianmag.com/science-nature/the-
| neuroscien...
| Spod_Gaju wrote:
| > Patients generally can't be relied upon to be
| objective.
|
| Neither can doctors, or researchers. They obviously see
| something wrong with you, as they did with me, so do we
| worry about their objectivity? No. Because bias and
| stigma.
|
| And if you are looking for answers, like I have been for
| 20 year, you might want to look at the role the purine
| pathway plays in mood disorders. Here is an article I
| wrote about it.
|
| https://christianbonanno.substack.com/p/what-caused-my-
| menta...
|
| Best of luck because I objectively know the crap you are
| dealing with.
| virtue3 wrote:
| Honestly a lot of these diagnosis issues are incredibly
| difficult.
|
| depression with anxiety is dramatically more difficult to
| treat than either or.
|
| Bipolar can come across as ADHD in certain parts of the
| cycle or just usually depression. In fact, you can even
| have uni-polar depression that does not respond to
| traditional anti-depressants and you don't necessarily
| exhibit hypomanic episodes.
|
| Relying on patients to know and understand what they are
| experiencing other than "this is just normal I assume
| everyone else experiences this" is not reliable.
|
| Having something that can reliably diagnose and find
| markers for these conditions would be _huge_.
|
| I wade through whitepapers and books on this stuff because
| of my own issues. I don't expect the average person to even
| remotely know about all of this; it's a lot and very
| subtle.
|
| To add on to all of this, people tend to not seek treatment
| until there IS a problem. Sometimes this can be really life
| alteringly bad, sometimes it's benign. But it would be
| helpful if people could just "take a test" and know or at
| least have an idea.
|
| The issue with being "objective" is also that your doctor
| has to be "objective" and I've had a lot of friends that
| are clearly ADHD and end up with DRs that think they are
| just trying to get medication and don't have ADHD.
|
| Worse yet; they do get medications and they have to cycle a
| few different ones because of the way they tolerate it. It
| would be really nice if we had an idea to correlate your
| ADHD, your body chemistry, and which drugs would be most
| effective for you rather than the 3-12 month ordeal of
| figuring that out.
| webnrrd2k wrote:
| It's true that doctors should listen to patients, and that
| diagnosing medical problems, especially psychological
| problems, can be very difficult.
|
| However, your post has a very "we don't need x-rays, we can
| just tell the bone is broken" vibe. It reads like you think
| better and more objective, quantitative diagnosis is not
| worth pursuing.
| johnchristopher wrote:
| > This need to measure everything is almost pathological.
|
| What's pathological is the tendency to see everything in
| black or white, right or wrong. There are many different
| causes for fatigue and tiredness: the flu, atypical
| depression, chronic fatigue, etc. But those conditions can
| overlap with depression. Putting the symptoms through a
| sieve by eliminating some causes helps pinpoint the origin
| (I over-simplify of course).
|
| edit: this complaint about measuring things is a bit
| surprising considering what needed to be measured so this
| article https://christianbonanno.substack.com/p/what-
| caused-my-menta... (edit: interesting reading btw) could be
| written ?
| ajb wrote:
| From the article:
|
| "To enable more precise diagnosis and selection of the best
| treatment for each individual, we need to dissect the
| heterogeneity of depression and anxiety. The dominant 'one-
| size-fits-all' diagnostic approach in psychiatry leads to
| cycling through treatment options by trial and error, which is
| lengthy, expensive and frustrating, with 30-40% of patients not
| achieving remission after trying one treatment"
| funnym0nk3y wrote:
| Depression presents with many symptoms, some of the are
| mutually exclusive. Take for example psychomotor changes. It
| could be retarded or agitated. Some people have anxiety, some
| don't. Some are irritable, some sleep very much and some sleep
| very little. There have been the classifications of melancholic
| and atypical depression, but they aren't used very often as
| many patients have features of both.
|
| Now consider the poor response to available medication (IIRC
| 30% remit and 60% respond, which leaves roughly 40% with a
| potential deadly disease without medication). Some symptoms of
| depression occur in other mental illnesses, like the similarity
| between bipolar and unipolar depression. Maybe the disease we
| currently call depression is acutally a cluster of diseases.
| That's the reason to look for biomarkers that separate those
| different diseases and the develop treatments specifically for
| one disease. Similar to the development of brexanolone for
| postpartum depression.
| MBCook wrote:
| Right. What if this were to be conformed and we could find
| out that A is best treated by Prozac but C responds really
| badly to it?
|
| Right now we just try lots of drugs, one after another, on
| each patient until something works or the patient gives up.
| What if we could confidently predict the drugs that were the
| most likely to succeed for each group? It may cut treatment
| times and help people find relief faster.
|
| Even if we don't find new treatments or gain a better
| understanding of cause/effect it could still be useful.
| Liquix wrote:
| how is causality established? the data seems to support either
| conclusion:
|
| A.) we found the types of brains that are inherently prone to
| depression/anxiety
|
| B.) we found the patterns that depressive/anxious thoughts make
| on MRIs
| jvanderbot wrote:
| Either is sufficient for a diagnosis, I'd imagine, since you're
| looking at two sides of the same coin.
| MBCook wrote:
| I think this is B so far.
|
| But even being able to do something objective m (an MRI) and
| come up with a prediction that is halfway accurate would be a
| big step forward.
|
| Could this lead to A? Maybe, assuming it's confirmed. Or maybe
| cause and effect is backwards.
|
| Either way, it's _something_ i'm not sure we've had before.
| hn_throwaway_99 wrote:
| I think this research is great. I've often said (and I'm sure I
| heard it somewhere else first) "Depression is not a disease, it's
| a symptom". The treatment for depression is kind of "throw stuff
| against the wall and see what works", because while different
| treatments target different parts of the brain, if someone comes
| in with depression we often don't know what the underlying
| etiology of that depression is.
|
| I suffer(ed) from chronic depression, and I'd get "bouts" of
| severe episodes every 5-6 years or so. I was very fortunate in
| that ketamine infusion therapy was a complete and amazing godsend
| for me - it was like it fixed a switch in my head. But I know
| other people with chronic depression that did ketamine therapy
| that got no benefit (but at least in one case they did get a lot
| of benefit from a different treatment, TMS, transcranial magnetic
| stimulation). My point is that basically everyone in the field of
| psychiatry knows that some interventions work great for some
| people while having no effect on others. More research like this
| should allow us to better target treatments.
| andoando wrote:
| I think the same is true for all the psychiatric disorders, but
| people talk about diagnosing and "having" these disorders as if
| they're definite things.
|
| I don't understand for example why ADHD is any more real than
| any other collection of seemingly related symptoms one might
| conjure up. Just going by the criteria of the DSM, its
| logically possible for two people to be diagnosed while sharing
| only 3 of the 9 symptoms. And if one someone without ADHD can
| have 5/9 symptoms, and someone with ADHD can have the first 6
| symptoms, and another can have the last 6, and another
| 1,3,5,7,8,9 of the symptoms, it says to me these symptoms can
| arise out of completely independent causes. So might it be
| possible someone meeting the clinical definition of ADHD can
| have just happen to have 6 independently caused symptoms?
|
| Thats not to say I don't think people truly have physical
| issues, but there is nothing at all to say any two people who
| "have" depression or ADHD are anything at all alike.
| JohnMakin wrote:
| > I think the same is true for all the psychiatric disorders,
| but people talk about diagnosing and "having" these disorders
| as if they're definite things.
|
| This kind of reasoning is completely faulty and rampant in
| discussions that usually hold a fair amount of stigma towards
| people experiencing mental health conditions (it's also
| extremely insulting fyi).
|
| I can have a headache, and there may be an unknown biological
| mechanism, but that doesn't mean I'm not experiencing a
| headache.
| andoando wrote:
| As I said "Thats not to say I don't think people truly have
| physical issues".
|
| I have diagnosed ADHD, and I take mental health very
| seriously. I have zero such prejudice.
|
| By "definite" things I mean, singular, physical causes
| which can be pointed to.
| JohnMakin wrote:
| I understand that you believe this, I am merely pointing
| out that the type of reasoning you're using is typically
| seen in the type of psychiatric gatekeeping used in
| discussions that are laden with stigma against people
| experiencing mental conditions.
| dfgtyu65r wrote:
| I don't think that's entirely fair. There does seem to be
| something distinct about mental disorders - namely, they
| are defined by the symptoms.
|
| With physical ailments, symptoms are surface manifestations
| of an underlying physical cause. For example, fever and
| fatigue in flu are the result of the influenza virus.
| Crucially, you can have the physical cause without symptoms
| (such as in the presymptomatic period), so the two are
| dissociable. Even where the physical cause is unknown,
| there's still this symptom-cause distinction.
|
| In the case of mental disorders, they're essentially
| defined by the symptoms. To have depression is to be
| depressed. To have anxiety is to be anxious. What would it
| even mean to have depression without being depressed?
|
| While on some level these are physical in a sense (insofar
| as they result from brain activity), I don't necessarily
| think we should think about their cause in the same way as
| a physical ailment.
|
| More to the point, there's a much more obvious sociocultral
| element to mental disorders. There's no 'objective' line
| between being sad and being depressed so while we clearly
| can and should treat depression, it seems to be very
| different from other diseases.
|
| None of this is to take away from the real suffering people
| undergo with these disorders. I just don't think that
| treating them through a strict biological-pathological lens
| is as useful as people think it is.
| jaggederest wrote:
| > namely, they are defined by the symptoms.
|
| This is what we see historically, in the 19th and early
| 20th centuries, in "body medicine". We're just at an
| earlier stage of understanding and treating psychiatric
| disorders. I assume in a couple hundred years we'll look
| back at the current state of the art as hopelessly
| outmoded.
|
| > In the case of mental disorders, they're essentially
| defined by the symptoms. To have depression is to be
| depressed. To have anxiety is to be anxious. What would
| it even mean to have depression without being depressed?
|
| What would it mean to have typhoid without an actual
| fever? The disease is something else, some causative
| factor that is not the actual symptom itself, but is no
| less real for that.
|
| > I just don't think that treating them through a strict
| biological-pathological lens is as useful as people think
| it is.
|
| Agreed, but that's with the current state of the art. I
| would be surprised indeed if by 2080 we didn't have a
| different lens to view these things through.
| jaggederest wrote:
| ADHD in particular is located to very specific areas in the
| brain. Primarily the dorsolateral prefrontal cortex and areas
| in the cingulate cortex. We can see neuroanatomy differences
| on scans, which, while not specific or sensitive enough for
| diagnosis, are definitely real physical changes in the brain,
| and they're pretty consistent across diagnosed vs baseline.
|
| There are lots of psychiatric disorders where that doesn't
| take place, but developmental neuropsychiatric disorders
| don't fall under that "are they even alike at all" kind of
| umbrella. In some kind of awful alternate universe we could
| pretty reliably induce them with gamma knife surgery, for
| example.
|
| Depression is much easier to argue that it's a less specific
| symptom of a larger constellation, with lots of causes and
| lots of manifestations.
| andoando wrote:
| Can you point me to a study showing these brain scans being
| different from those with diagnosed ADHD and not? The
| evidence would furthermore have to show that this
| difference is apparent not just from adhd vs non adhd but
| adhd vs anxiety, depression etc. And lastly, are these
| changes perhaps an affect of taking stimulants?
|
| And how significant are these results? Are we talking about
| a few percent difference? Are 10% of diagnoses ADHD shown
| to have statistically significant differences, 20, 50, 90?
| Depending on the figure, my criticism of the diagnostic
| criteria remains. Because if it is a low figure like 10%,
| that means 90% of the diagnoses aren't supported by any
| scientific evidence.
|
| From what I've been told, including professionals this
| evidence does not exist.
|
| I've also seen studies which indicate that psychiatric
| evaluations are entirely inconsistent across physicians.
| jaggederest wrote:
| > The morphometric findings predicted an ADHD diagnosis
| correctly up to 83% of all cases.
|
| https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5391018/
|
| It's not good enough for diagnosis - you want to hit 95+%
| accuracy for diagnostic. And MRIs are extremely expensive
| compared to 2-3 outpatient psychology appointments. But
| it's real.
| SubiculumCode wrote:
| I am finding the article frustrating to read, as the methods to
| derive the six networks is in an older paper [1][pdf link]
|
| Its basically: a) Use Neurosynth.org to perform metanalytic
| analysis associated with these search terms: "Default Mode,
| Salience, Attention, Threat, Reward, and Cognitive Control"
| Neurosynth is awesome, check it out.
|
| b) Resulting region pairs were quantified for intrinsic
| functional connectivity after regressing out task effects. * I
| don't understand the word 'pairs' here since Neurosynth does not
| provide pairs of anything (i.e. ROI's), unless they mean pairs of
| voxels.
|
| c) quote: then it gets really messy with : "o identify regions of
| interest (B) we considered the default mode, salience, and
| attention circuits to be task-free and the negative affect,
| positive affect, and cognitive control circuits to be task-evoked
| (details in Table S3). We refined our circuit features by first
| excluding regions based on low tSNR and low fit to gray matter
| (C). We evaluated internal consistency and excluded region pairs
| whose connectivity showed stronger associations with out-of-
| circuit region pairs than within-circuit region pairs in our
| healthy sample (E). From the resulting set of regions (E) we
| identified the subset implicated in hypothesized dysfunction and
| derived circuit clinical scores references to a healthy sample
| (F; details in Table S5)."
|
| [1][pdf link]
| https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9511971/pdf/nih...
| SubiculumCode wrote:
| To be clear, I am not dissing the work..there were just a lot
| of steps they used to identify key regions of interest in size
| networks and then constrict those further to ones associated
| with depression and anxiety, and that process seems murky to
| me. This can totally be understandable situation: there are
| lots of decision that can be made in preprocessing and
| analysis, and not all get expanded on in a paper, and not an
| indication of p-hacking or anything.
|
| Importantly, they provide data and ROI masks so that others can
| examine this in their own datasets:
| https://github.com/leotozzi88/cluster_study_2023
| zzzeek wrote:
| Study is very dense. Did the study show that SSRI and other
| antidepressants change brain chemistry? That is, are we finally
| done with "SSRIs are essentially placebos" ?
| Zak wrote:
| This is the kind of result I expected to see after reading that
| antidepressant drugs are highly effective in about 15% of
| patients and relatively ineffective for everyone else.
|
| https://news.ycombinator.com/item?id=34337529
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