Depression associated with traumatic brain injury may be a separate disorder

A new study led by Shan Siddiqi, M.D., of Brigham and Women’s Hospital, a founding member of the Massachusetts General Brigham Health System, suggests that depression after traumatic brain injury (TBI) is not a traditional major depressive disorder. suggesting that it may be a clinically distinct disorder. may affect patient care. The survey results are Scientific translational medicine.

Our findings help explain how physical trauma to specific brain circuits can lead to the development of depression. If we are correct, then depression after traumatic brain injury should be treated like any other illness. Many clinicians suspected this to be a clinically distinct disease with unique symptom patterns and unique treatment responses, including poor response to conventional antidepressants, but so far, no evidence has been found to prove this. There was no clear physiological evidence. ”

Shan Siddiqi, M.D., corresponding author, Brigham Department Psychiatry and Brain Circuit Treatment Center

Siddiqi collaborated with researchers from Washington University in St. Louis, Duke University School of Medicine, University of Padua, and Uniform Service College Health Sciences on this study. This research began seven years before him as a side project. Siddiqui was motivated by a patient she shared with David Brody, M.D., Ph.D., a co-author of the study and a neurologist at the University of Uniform Service. The two started a small clinical trial targeting brain stimulation using personalized brain mapping as a treatment for traumatic brain injury patients with depression. In the process, they noticed a specific pattern of abnormalities in the brain maps of these patients.

The current study included 273 adults with traumatic brain injuries, usually from sports injuries, military injuries, or motor vehicle accidents. This group of people was compared to other groups without traumatic brain injury or depression, depressed patients without traumatic brain injury, and people with post-traumatic stress disorder. Study participants underwent a resting-state functional connectivity MRI, a brain scan that examines how oxygen moves in the brain. These scans provided information on oxygenation of up to 200,000 points in the brain at approximately 1,000 different time points, yielding approximately 200 million data points for each person. Based on this information, individual maps of each person’s brain were generated using machine learning algorithms.

Although the locations of brain circuits involved in depression were the same in people with and without traumatic brain injury, the nature of the abnormalities was different. The connectivity of this circuit decreased in depression without traumatic brain injury and increased in depression associated with traumatic brain injury. This suggests that traumatic brain injury-related depression may be a separate disease process, leading the study authors to propose a new name: ‘traumatic brain injury affective syndrome’.

“I always suspected that this wasn’t the same as regular major depressive disorder or other mental health conditions not related to traumatic brain injury,” Brody said. “There are still many things we don’t understand, but we are starting to make progress.”

One of the limitations of this trial was that there was too much data, so the researchers were unable to make a detailed assessment of each patient beyond brain mapping. As a future step, the researchers believe it may be possible to assess participants’ behavior in more sophisticated ways and define different types of traumatic brain injury-related neuropsychiatric syndromes.

Siddiqi and Brody are using this approach to develop personalized treatments. Initially, they used this brain-mapping technique to target specific brain regions in patients with traumatic brain injury and depression, and set out to design new treatments using transcranial magnetic stimulation (TMS). bottom. They enrolled 15 of him in pilots and confirmed the success of the treatment. They have since received funding to replicate their research at the Multi-Center Military Tribunal.

“We hope our findings will guide precision medicine.” “It’s an approach to managing depression and mild traumatic brain injury, and perhaps even intervening in neurologically vulnerable trauma survivors before chronic symptoms develop,” said Professor of Psychiatry at Duke University School of Medicine. Yes, said co-author of the study, Rajendra Morley, M.D., Ph.D. .