This Cognitive Biotype May Respond Poorly To Antidepressants, Study Finds

Managing depression often requires a combination of therapies, treatments, and lifestyle changes that varies from person to person. And while medication may be helpful and life-changing for some people, it can be counterproductive for others. 

The new research study led by Stanford Medicine published on JAMA Network1 suggests that a certain "cognitive biotype" of depression may respond poorly to standard antidepressants. 

Hold on: What's a biotype? According to the American Psychological Association, a biotype refers to a group of individuals with a similar genetic makeup. In this case, biotype refers to people who share similar neuronal patterns when it comes to learning and processing information and regulating mood.

The research focused on those with a cognitive biotype that made them have more difficulty with planning ahead, holding concentration, and exercising self-control (as shown by brain imaging scans that measure activity in certain brain regions). The typical symptoms of depression, including trouble with executive functioning, decision-making, memory, concentration, and the ability to suppress negative emotions in favor of positive behavior, are all more pronounced in this cognitive biotype.

In the study, researchers took 1,008 adults with previously unmedicated major depressive disorder and randomly assigned each person one of three common antidepressants: escitalopram (also known as Lexapro), sertraline (Zoloft), and venlafaxine-XR (Effexor). A total of 712 participants completed the eight-week prescription.

Both before and after the antidepressant treatment, the participants' depressive symptoms were measured using two surveys (one administered by a clinician and the other self-reported) and a cognitive assessment. 

After the antidepressant treatment, researchers found that the absence of depression symptoms was 38.8% for those with the biotype, and 47.7% for those without it. 

The largest difference in treatment outcomes was with the group given sertraline (Zoloft)—where only 35.9% of those with the biotype saw improvement, while 50% of those without the biotype did.

"We find that 27% of people actually have this biotype and the people who have this are less likely to respond to the typical antidepressants that they might get like Zoloft or Prozac," board-certified psychiatrist Sue Varma, M.D., P.C., DFAPA, explains in a segment on her Instagram.

This research further proves that there is no one-size-fits-all treatment for depression. While medication may be helpful for some, other methods may be better for those with certain brain makeups.

One therapy being studied for treatment within this cognitive biotype is transcranial magnetic stimulation (TMS)—a noninvasive, FDA-approved procedure that uses magnetic fields to stimulate nerve cells in the brain to improve symptoms of depression and obsessive-compulsive disorder (OCD). However, Varma notes that more research is needed to confirm the efficacy rates of this treatment. 

She describes cognitive behavioral therapy (CBT) as the "gold standard" when it comes to treating symptoms of depression, including in people with this biotype. Beyond medication and therapy, prioritizing positive habits like exercise, a healthy diet, and high-quality sleep can make a noticeable difference for some people.

Again, not every treatment will work for everybody, and research on how this particular biotype can find relief is still ongoing.