One size does not fit all: Does the brain ‘remember’ antidepressants?

Study offers more proof for the pow­er of place­bo, say UCLA researchers (UCLA press release):
— “While the rela­tion­ship between pri­or treat­ment and the brain’s response to sub­se­quent treat­ment is unknown, a new study by UCLA researchers sug­gests that how the brain responds to anti­de­pres­sant med­ica­tion may be influ­enced by its remem­ber­ing of past anti­de­pres­sant exposure.”
— “Sub­jects who had nev­er been treat­ed with an anti­de­pres­sant exhib­it­ed large increas­es in pre­frontal brain activ­i­ty dur­ing place­bo treat­ment. But those who had used anti­de­pres­sant med­ica­tion in the past showed slight decreas­es in pre­frontal activ­i­ty — brain changes that were indis­tin­guish­able from those pro­duced by the actu­al drug.”
— “While med­ica­tion can have a pow­er­ful effect on our phys­i­ol­o­gy, said Hunter, “the behav­iors and cues in the envi­ron­ment that are asso­ci­at­ed with tak­ing med­ica­tion can come to elic­it their own effects. One’s per­son­al treat­ment his­to­ry is one of the many fac­tors that influ­ence the over­all effects of treatment.”

Pre­vi­ous relat­ed arti­cle: Could study­ing the place­bo effect change the way we think about medicine?

New study: Does pri­or anti­de­pres­sant treat­ment of major depres­sion impact brain func­tion dur­ing cur­rent treat­ment? (Euro­pean Neuropsychopharmacology)

Abstract: The rela­tion­ship between pri­or anti­de­pres­sant treat­ment and pre­frontal brain func­tion­al response to sub­se­quent treat­ment with anti­de­pres­sant med­ica­tion or place­bo is unknown. Eighty-nine adults with Major Depres­sive Dis­or­der (MDD), char­ac­ter­ized as anti­de­pres­sant-expe­ri­enced or anti­de­pres­sant-naive, received one week of sin­gle-blind place­bo treat­ment pri­or to eight weeks of ran­dom­ized treat­ment with med­ica­tion (flu­ox­e­tine or ven­lafax­ine; n=47) or place­bo (n=42) in one of three sim­i­lar place­bo-con­trolled tri­als. Brain func­tion was assessed at base­line, end of place­bo lead-in, and dur­ing ran­dom­ized treat­ment using quan­ti­ta­tive elec­troen­cephalog­ra­phy (qEEG). The authors assessed change in pre­frontal theta-band cor­dance (PFC) in anti­de­pres­sant-expe­ri­enced vs. anti­de­pres­sant-naive sub­jects. Treat­ment his­to­ry groups dif­fered sig­nif­i­cant­ly on PFC change dur­ing the place­bo lead-in even when con­trol­ling for clin­i­cal and demo­graph­ic vari­ables (F(1,62)=4.27, p=.04). As assessed in lin­ear mixed mod­els that exam­ined treat­ment his­to­ry (anti­de­pres­sant-expe­ri­enced or anti­de­pres­sant-naive), treat­ment assign­ment (med­ica­tion or place­bo), and their inter­ac­tion as pre­dic­tors, treat­ment his­to­ry also pre­dict­ed PFC change dur­ing the ran­dom­ized phase of treat­ment even when con­trol­ling for pre­treat­ment clin­i­cal and demo­graph­ic and symp­tom improve­ment dur­ing treat­ment (F(1,5o)=5.20, p=.03). The inter­ac­tion was not sig­nif­i­cant. Post hoc analy­ses showed that anti­de­pres­sant-expe­ri­enced sub­jects treat­ed with place­bo showed PFC changes that did not dif­fer from PFC changes seen in the med­ica­tion group. Results sug­gest that pre­frontal brain func­tion­al changes dur­ing treat­ment for MDD may dif­fer depend­ing upon pri­or treat­ment with anti­de­pres­sant medication.