WILL AN SSRI WORK FOR DEPRESSION? AN EASY LISTENING TEST MAY PREDICT TREATMENT SUCCESS

New York, NY (September 23, 2004)— A depressed patient walking into a doctor’s office for the first time will most likely be prescribed an SSRI antidepressant to abate symptoms. There is about a 50% chance that the patient will return to that doctor’s office having failed to get any relief from the medication. This is the state of depression treatment today when psychiatrists, limited by the lack of laboratory tests to aid treatment selection, run the risk of frustrating patients to the point of non-compliance. But change may be on the horizon.

A study by New York State Psychiatric Institute (NYSPI) researchers released in the September issue of Neuropsychopharmacology points to the potential of simple dichotic listening tests as predictors of just who is likely to respond well to the class of antidepressants known as SSRIs or selective serotonin reuptake inhibitors.

Dr. Gerard Bruder, Chief of the Department of Biopsychology at NYSPI, studied 114 depressed patients (46% of whom were women) between 18 and 65 years old and 101 healthy adults (60% of whom were women). Before starting treatment with fluoxetine (known as Prozac), patients were given listening tests in which a different word or tone was simultaneously presented, one to each ear. Healthy adults tend to show dominance of the left hemisphere of the brain—the language or verbal center of the brain—on the words test and the opposite hemisphere of the brain is dominant for tones. The researchers found that patients who responded well to fluoxetine “had a larger left-hemisphere advantage for words and a smaller right-hemisphere advantage for tones when compared to non-responders.”

In depressed women, investigators found an even greater tendency for responders to have a “larger left-hemisphere advantage” on the words test. “This finding is quite interesting and surprising given that we know that women, in general, tend to have reduced left-hemisphere dominance for language,” said Dr. Bruder. “But in depressed women who respond to fluoxetine, there is a stronger than normal dominance. This may be an indication of a biochemical imbalance that shows up as a hemispheric imbalance as well.”

Dr. Bruder’s results have gotten the attention of clinicians, who, should the listening tests make it to doctors’ offices, would have an inexpensive and reliable way to predict medication response. The next step is to confirm that the laboratory-based listening tests will work in routine clinical practice.

“What this article says to me, the clinician,” said Dr. Jonathan Stewart, a clinician/researcher associated with the study at NYSPI, “is that we’re this much closer to knowing who should be prescribed an SSRI and who should not be. From a clinical standpoint, this is the most exciting thing in the literature today.”

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