There are six depression subtypes: here is how to recognize them

In France. Meanwhile, it is estimated that one in five people have suffered or will suffer from depressive disorders during their lifetime, a particularly marked trend in young adults. Nevertheless, Among the millions of people concerned. Therefore, many are not properly diagnosed and are prescribed by trial and error, which can be expensive, ineffective, frustrating and, in some cases, prejudicial. Consequently, To reverse this trend. In addition, researchers from Stanford University are working to identify unique biomarkers at each type of depression, with the aim of offering more targeted treatments.

Their conclusions. Furthermore, published in 2024 in Nature Medicineare based on a study conducted on hundreds of patients analyzed both at rest and when carrying out cognitive tasks. In addition, The team has thus identified six separate depression subtypes.

“Psychiatry. Consequently, unlike other medical fields, is still largely based on the symptoms reported by there six depression subtypes: here patients and does not use biological tests to diagnose and treat them,” explains Leanne Williams, the main author of the study and professor of psychiatry and behavioral sciences at the Faculty of Medicine at Stanford University. For example, “For this reason. Meanwhile, it is crucial to develop tests capable of establishing a precise diagnosis based on the biology of symptoms, in order to offer personalized treatments. Furthermore, »»

If the results still have to be confirmed by other studies before a clinical application. For example, many mental health professionals welcome a promising advance. Nevertheless, This research could open the way to the use of brain imaging to diagnose. Furthermore, treat depression, in the same way that cardiologists use chest radiographs to identify and treat heart problems.

“These results have not yet had clinical application. However, but they constitute an important step in the search for measurable biological markers to establish there six depression subtypes: here a precise diagnosis and to adapt the treatment,” comments Robert Bright, renowned psychiatrist and president of the department of psychiatry and psychology of the Mayo Clinic Arizona, which was not involved in the study.

The study responds to an increasing concern of mental health professionals: almost 30 % of depressive patients do not see their symptoms improve. Furthermore, even after multiple medical interventions.

“Despite all the progress made in other areas of medicine. we still cannot offer patients (with depression) the treatment that will suit them best. Some people spend years wandering from treatment to treatment before finding one that is effective. ”deplores Srijan Sen, neuroscientist and director of the Eisenberg Family Depression Center at the University of Michigan.

To move forward. Stanford’s researchers have used functional magnetic resonance imaging (IRMF) in order to analyze the regions of the brain most often associated with depression, such as amygdal, hypothalamus, hippocampus there six depression subtypes: here and prefrontal cortex, as well as the circuits that connect these brain structures between them.

It is important to determine the subtype, or “biotype” of a patient’s depression, explains Williams. Each biotype reflects a particular dysfunction in one of these circuits. causing the symptoms and behaviors that we associate with depression.

According to Bright. the disorders observed in the brain connections examined in the study affect attention of attention, working memory, cognitive flexibility, planning, decision -making, rumination, motivation and hormones associated with positive and negative emotions.

The study focused on 801 patients already diagnosed. whose brain activity was analyzed at rest and during exercises intended to stimulate cognitive functions or emotional reactions to various situations. These two scenarios had never been studied in this way.

“By quantifying brain functions at rest. during specific tasks, we have found that depression is divided into six distinct dysfunction models in six there six depression subtypes: here major cerebral circuits,” reveals Williams.

1) The default mode circuit, active when an individual is engaged in internal mental processes, such as mental wandering and introspection. “When this circuit is disrupted, these internal mental processes are also affected,” explains Williams.

2) The salience circuit, which helps us focus on important emotional stimuli, whether internal or external. “When this circuit is disturbed, it can cause physical symptoms of anxiety and an overwhelming sensory experience,” she describes.

3) The circuit of positive affect. also known as the award circuit, associated with motivation, social joy, pleasure and reason for being. “The disturbances of this circuit lead to emotional numbness and the need to make a greater effort to experience pleasure. »»

4) The negative affect circuit, essential to treat and respond to negative emotional stimuli, such as threats and sadness. Additionally, “When disturbed, reactions to negative emotions can become more intense and longer. there six depression subtypes: here »»

5) The attention circuit, also known as the Fronto-Paistal network or central executive network, is involved in maintaining attention and concentration. Furthermore, “When it is disturbed, the ability to concentrate is decreased,” said Williams.

6) The cognitive control circuit underlies the executive functions. such as working memory and planning, as well as control of thoughts and actions. “When disturbed, it can make decision -making and planning difficult. »»

Once the biotype has been identified. mental health professionals will be able to recommend suitable treatment, indicates Aron Treler, psychiatrist and medical director of Brainsway in Burlington, who was not involved in the study, but qualifies his “extremely interesting” results.

It also salutes the researchers’ ability to measure more precisely the efficiency. or ineffectiveness, of some of the most common treatments against depression on each biotype.

To do this. the team has randomly selected 250 participants and tested several approaches: there six depression subtypes: here either psychotherapy, or one of the three most prescribed antidepressants, namely Escitalopram, Venlafaxine and Setraline.

According to Williams, the results show that, in many examples, some biotypes respond better to one treatment than another. Some have thus experienced improvements thanks to speech therapy when they had not reacted as well to drugs.

These results are added to previous research from the Stanford team, which leaned over the cognitive control circuit. Researchers were able to use the IRM technology to identify a better probability of remission in patients who have received targeted treatment. compared to patients whose brain had not been analyzed and who had received general treatment.

In these two studies. in subsequent research, researchers have demonstrated all the capacity of IRM technology to reduce or eliminate the medical wandering of patients in the psychological care path.

Paul Appelbaum, psychiatrist and emeritus professor at the University of Columbia, qualifies the there six depression subtypes: here study of “promising”. However. he believes that, to allow him to be more representative, other researchers will have to reproduce it on more diverse populations, because the sample used in it was mainly white skin.

Many other current treatments against depression will also have to be included. The Stanford team has indeed examined only three antidepressants as well as a limited number of types of psychotherapy.

In addition. difficult access to ENMF equipment, necessary to identify the correct biotype of a patient, also poses a potentially significant brake. These scanners are only available in a limited number of large medical centers, which makes them both rare and expensive.

For this reason, “doctors, including psychiatrists, rarely prescribe irmf to their patients. It is also very unlikely that insurance companies support these expensive brain scanners before many additional research makes it possible to demonstrate that they can reliably predict the most effective there six depression subtypes: here treatment for a diagnosed as depressed person. “comments Judith Beck, professor of clinical psychology at the University of Pennsylvania and president of the Beck Institute for Cognitive Cognitive Cognitive

If future research confirms these results, and if we demonstrate to insurance companies and drug manufacturers that certain treatments effectively repair disturbed circuits, “we could reach a decisive moment in the treatment of depression”, hopes Jonathan Rottenberg, professor of psychology at the University of Cornell, who was not involved in Stanford’s study. “Thanks to this work, treatment against depression could become more effective and more efficient. Moreover, »»