A quantitative electroencephalography (QEEG)-based psychiatric registry led to improved treatment outcomes in patients with depressive disorders, according to new research reported in Neuropsychiatric Disease and Treatment.1
Depression affects an estimated 6.7% of the general adult US population, and rates may be twice as high among military personnel, 15% of whom have reported depressive symptoms.2,3 Despite the availability of a range of pharmacological and psychotherapeutic options for addressing depressive disorders, treatment is often based on a trial-and-error approach, and up to 30% of patients are unresponsive or only partially responsive to treatment.4 The use of an QEEG-based treatment registry may lead to a more targeted approach.
The Psychiatric Electroencephalography Evaluation Registry (PEER) Interactive is based on a registry pertaining to the treatment of childhood cancers–introduced in the 1970s and still in use today–that has significantly increased rates of survival in the target population. The origins of the PEER registry trace back to researchers who began recording EEGs on patient in the 1990s and treating them per standard care protocols, then noting their outcomes with the aim of facilitating correlation between EEG features and treatment efficacy.5 Many subsequent studies have expanded on the approach and found support for its utility in improving patient outcomes, including some showing strong links between QEEG results and treatment response.
Video news update: Dr. Patricia Deldin of the Michigan Depression Center speaks about depression. Watch now.
Presently, the “entire process, including receipt of the raw EEG data, correlation with known outcomes, and delivery of the findings to the referring physician and collection of patient outcomes,” is housed on the secure, online PEER Interactive system that is accessible to clinicians worldwide, according to the new study. The registry contains more than 10 000 EEGs and 38 000 pharmacological outcomes. The software “compares the z scores of a given patient to its registry of physician outcomes, generating a probability statement for the likelihood of a positive outcome with the most commonly used medication classes and agents,” the authors explained. The treating clinician can easily compare the probability that a patient will respond to various medications and potentially avoid those associated with a low probability of treatment response.
In the current paper, researchers presented an interim analysis of the early findings of a prospective, randomized, double-blind, multi-site trial assessing the effectiveness of PEER-guided pharmacotherapy. Patients (n=150) with depressive disorders from 2 military hospitals were randomly assigned to either treatment-as-usual or to a group whose treating physicians received a PEER report. The latter group was further divided into participants whose doctors based their recommendations on the PEER report and those whose doctors did not follow PEER recommendations. The main outcome was patients’ scores on the Quick Inventory of Depressive Symptomatology, Self-Report (QIDS-SR16).
Consistent with previous findings, the results show that compared to patients who were not treated based on the PEER report, those treated according to PEER recommendations had significantly greater improvement in depression (P<0.03), as well as decreased suicidal ideation (P<0.002) and post-traumatic stress disorder (PTSD) symptoms (P<0.04). These results indicate that the PEER Interactive may prove to be a valuable prescribing tool that could help guide clinicians toward more effective, personalized treatments for patients with depressive disorders.
1. Iosifescu DV, Neborsky RJ, Valuck RJ. The use of the Psychiatric Electroencephalography Evaluation Registry (PEER) to personalize pharmacotherapy. Neuropsychiatr Dis Treat. 2016; 12: 2131–2142.
2. National Institutes of Health: National Institute of Mental Health. Major depression in adults. Retrieved 9/12/16 from http://www.nimh.nih.gov/health/statistics/prevalence/major-depression-among-adults.shtml
3. Department of Veterans Affairs/Department of Defense. VA/DoD clinical practice guideline for the management of major depressive disorder–patient guide. Retrieved 9/12/16 from http://www.healthquality.va.gov/guidelines/MH/mdd/MDDCPGPatientSummaryFINAL41816.pdf
4. Al-Harbi KS. Treatment-resistant depression: therapeutic trends, challenges, and future directions. Patient Prefer Adherence. 2012; 6: 369-388.
5. Suffin SC, Emory WH. Neurometric subgroups in attentional and affective disorders and their association with pharmacotherapeutic outcome. Clin Electroencephalogr. 1995; 26(2):76–83.