Antidepressants for people with depression and ritalin for ADHD patients. It is the usual medical treatments for such disorders. But the medication is not always effective for all patients. PhD student Martijn Arns conducted research into predicting the correct treatment method for depression and ADHD. According to him, EEG research offers a solution: “In the future, after a simple EEG examination, the patient could receive personalized treatment.” Arns will be awarded a PhD by Utrecht University on December 23.

Treatments in psychiatry are often determined based on the behavior of the patient. For example, if hyperactivity and attention problems are observed in a patient, ADHD is diagnosed, after which the patient is prescribed the drug ritalin. However, the medication does not always appear to have the desired effect. According to PhD student Arns, that is hardly surprising: “Both depression and ADHD have different subtypes. Medication works for one variant, but not for the other.”

Electrodes on the head

To see if a treatment method has a chance of success, PhD student Arns subjected his patients to an EEG. With an EEG the patient gets electrodes placed on the head so that the brain activity can be measured. After this EEG patients were prescribed one of the following three treatments: treatment with medication, with magnetic brain stimulation (rTMS) in depression or with neurofeedback in ADHD. After treatment, Arns examined whether there had been improvement in the patient and whether there was a relationship between the success of the treatment method and the EEG prior to treatment.

Ritalin positive for only one subgroup

Arns writes in his dissertation that he has distinguished three subgroups of ADHD patients. One of those subgroups is characterized by responding well to the drug ritalin. “For example, this group exhibited increased theta activity in the EEG: an activity that is associated with a lowered alertness level and reduced sustained attention.” In depression, this increased theta activity was found to be associated with non-responding to antidepressants and rTMS. Possibly this subgroup of patients responds better to, for example, ritalin. Another important measure, the so-called slow alpha peak frequency, appeared to be a predictor for the general failure to respond to treatments for both ADHD and depression. “Future research must therefore focus on the development of new treatments for this substantial subgroup,” says Arns.

Brain activity instead of behavior

In his dissertation, the Utrecht researcher argues for more use of personalized treatments in psychiatry. Thereby the behavior should no longer be taken as a starting point for a diagnosis and therefore for a treatment, but the measured brain activity. “A simple EEG examination would be a welcome tool for the psychiatrist.”

Follow-up investigation

For a large-scale follow-up study in this area, patients with depression or ADHD are still looking for who are considering taking medication. For more information see also: iSPOT.

More information

You can download the thesis ‘Personalized Medicine in ADHD and Depression: A quest for EEG treatment predictors’ here.