The use of referenced-EEG (rEEG) in assisting medication selection for the treatment of depression.
OBJECTIVE
To evaluate the efficacy of rEEG(®)-guided pharmacotherapy for the treatment of depression in those circumstances where rEEG and STAR*D provided different recommendations.


METHODS
This was a randomized, single-blind, parallel group, 12 center, US study of rEEG-guided pharmacotherapy vs. the most effective treatment regimens reported in the NIH sponsored STAR*D study. Relatively treatment-resistant subjects ≥18 years who failed one or more antidepressants were required to have a QIDS-16-SR score ≥13 and a MADRS score ≥26 at baseline. All subjects underwent a washout of all current medications (with some protocol-specified exceptions) for at least five half-lives before receiving a QEEG and rEEG report. Subjects randomized to rEEG were assigned a regimen based on the rEEG report. Control subjects who had failed only SSRI's in their current episode were randomized to receive venlafaxine XR. Control subjects who had failed antidepressants from ≥2 classes of antidepressants were randomized to receive a regimen from Steps 2-4 of the STAR*D study. Treatment lasted 12 weeks. The primary outcome measures were change from baseline for self-rated QIDS-SR16 and Q-LES-Q-SF.


RESULTS
A total of 114 subjects were randomized and 89 subjects were evaluable. rEEG-guided pharmacotherapy exhibited significantly greater improvement for both primary endpoints, QIDS-SR16 (-6.8 vs. -4.5, p<0.0002) and Q-LES-Q-SF (18.0 vs. 8.9, p<0.0002) compared to control, respectively, as well as statistical superiority in 9 out of 12 secondary endpoints.


CONCLUSIONS
These results warrant additional studies to determine the role of rEEG-guided psychopharmacology in the treatment of depression. If these results were confirmed, rEEG-guided pharmacotherapy would represent an easy, relatively inexpensive, predictive, objective office procedure that builds upon clinical judgment to guide antidepressant medication choice.
DeBattista
Charles
C
Stanford University School of Medicine, Department of Psychiatry and Behavioral Sciences, 401 Quarry Road, Stanford, CA 94305, USA. debattista@stanford.edu
Kinrys
Gustavo
G
Hoffman
Daniel
D
Goldstein
Corey
C
Zajecka
John
J
Kocsis
James
J
Teicher
Martin
M
Potkin
Steven
S
Preda
Adrian
A
Multani
Gurmeet
G
Brandt
Len
L
Schiller
Mark
M
Iosifescu
Dan
D
Fava
Maurizio
M
D000293:Adolescent; D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D000928:Antidepressive Agents / Q000627:therapeutic use; D002755:Choice Behavior / Q000502:physiology*; D003863:Depression / Q000175:diagnosis* / Q000188:drug therapy* / Q000503:physiopathology; D004569:Electroencephalography / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use; D016037:Single-Blind Method; D013997:Time Factors; D014481:United States; D055815:Young Adult
D000928:Antidepressive Agents; D017367:Selective Serotonin Reuptake Inhibitors