“It was very strange: There was a very large downward spike, and then … nothing,” Hunter says. “But the suicidal worsening isn’t happening at 48 hours–it’s happening at some later point over the next eight weeks.” She was seeing what appeared to be a harbinger of future response.
“They’re onto something important,” says Barry Lebowitz, a professor of psychiatry at the University of California at San Diego, who was not involved with the research. “This is clearly a first step in trying to personalize antidepressant treatment.”
Lebowitz, who has worked with the UCLA group on prior projects, notes that other techniques that could potentially predict a patient’s response to antidepressants are incredibly expensive, and not practical for widespread use. “But the kind of physiological measure this group is talking about is something people can use. An EEG machine is something that every doctor could have in the office for relatively small amounts of money.”
The results may also prove helpful in determining underlying physiology, says Ira Lesser, a professor of psychiatry at the Harbor-UCLA Medical Center who was not involved in the current work. “It begins to let people think neurochemically about what might be involved in the genesis of suicidal thinking. Heuristically, it could lead to whole other areas of study.”
Dan Iosifescu, who directs the translational neuroscience program at Boston’s Massachusetts General Hospital, performed similar QEEG experiments with similar results in 2008. “I think it’s interesting, but it’s too early to tell whether [the effect] is real or whether it’s an artifact,” he says. “Worsening of suicidal ideation is not a frequent event, and it happens in less than 10 percent of people. So you typically need very large data sets to study it adequately.”
Hunter’s next step is to determine whether a similar effect can be seen using abbreviated EEG monitors, which require far fewer electrodes and can be completed in just 10 minutes (as opposed to the hour required with the full electrode array), and she’ll be examining this using a much larger group of patients. “Further development needs to be done, but we’re hoping this would allow us to provide a tool that could make antidepressant use happen in a safer way,” she says.