Brain Function Altered by Psychodynamic Therapy for Depression

Psychodynamic therapy for depression can change brain function, and can possibly predict how a patient may react to that therapy, according to a study published October 16, 2014, in Psychotherapy and Psychosomatics.

Researchers from Massachusetts General Hospital (MGH) in Boston study enrolled 16 physician-diagnosed patients with major depressive disorder for whom prior medication treatment had not been successful. Before beginning the program, participants were instructed to complete assessments of their depressive symptoms and psychological mindedness: to recognize and understand their own emotions, motivations, and actions. Patients were also given a PET scan before their first therapy session to observe metabolic brain activity and glucose uptake.

Each patient received weekly, individualized psychodynamic psychotherapy sessions structured around a predefined theme and sequence, although each was adapted to suit the patient’s needs. If the patient granted permission, the sessions were videotaped and reviewed by the research team to not only insure the theme and sequence of the session was followed but also to assess how patients progressed through the sessions. For examples, researchers particularly noted how patients developed new insights in the therapy sessions.

At the end of the trial, patients were given a second PET scan within a week of the therapy conclusion and patients filled out a second depression symptom assessment. Seven patients discontinued the trial, and 9 completed the full sessions.

“Psychodynamic psychotherapy might be considered the original form of ‘personalized medicine,’ since it draws directly from a patient’s unique experiences to shape the course of treatment,” Joshua Roffman, MD, MGH Department of Psychiatry, lead author of the report, said in a press release. “While it has been a core part of psychiatric training for decades and continues to be widely practiced, psychodynamic psychotherapy hasn’t been studied as broadly as have other approaches for a number of reasons, including its greater subjectivity and treatment-by-treatment variability. We do know that psychodynamic treatments are effective for some patients, and this study examined whether differences in neural activity could predict which patients would complete the course of therapy and which would drop out, a common occurrence for any type of therapy.”

The first PET scan also seemed to reveal significant differences in patients’ metabolic activity in the brain’s right precuneus — especially in those patients who dropped out of the trial and those that completed the sessions. The precuneus has been previously associated with self-awareness and memory. However, in this study, the researchers linked it to the level of psychological mindedness, an element that is considered essential to a positive psychodynamic treatment experience.

“As with all psychiatric interventions, it is notoriously difficult to know ahead of time who is likely to have a good response to psychodynamic psychotherapy and who is not,” continued Roffman. “Identification of biological markers that could predict treatment success is a ‘holy grail’ in psychiatry; and while the measured differences in psychological mindedness between completers and noncompleters were insignificant, the significant difference in precuneus metabolism suggests that it may a sensitive predictor of treatment response, something that needs to be confirmed in larger trials.”