Functional Connectivity of the Subcallosal Cingulate Cortex And Differential Outcomes to Treatment With Cognitive-Behavioral Therapy or Antidepressant Medication for Major Depressive Disorder

Autor: Boadie W. Dunlop, Mary E. Kelley, W. Edward Craighead, Ki Sueng Choi, Charles B. Nemeroff, Helen S. Mayberg, Becky Kinkead, Callie L. McGrath, Justin K. Rajendra
Rok vydání: 2017
Předmět:
Adult
Male
Cingulate cortex
medicine.medical_specialty
Adolescent
medicine.medical_treatment
Prefrontal Cortex
Citalopram
Duloxetine Hydrochloride
Gyrus Cinguli
Young Adult
03 medical and health sciences
0302 clinical medicine
Neuroimaging
Rating scale
Internal medicine
Image Interpretation
Computer-Assisted

Outcome Assessment
Health Care

medicine
Humans
Dominance
Cerebral

Depression (differential diagnoses)
Aged
Psychiatric Status Rating Scales
Depressive Disorder
Major

Cognitive Behavioral Therapy
Middle Aged
medicine.disease
Magnetic Resonance Imaging
Antidepressive Agents
030227 psychiatry
Cognitive behavioral therapy
Psychiatry and Mental health
Cognitive therapy
Major depressive disorder
Female
Analysis of variance
Nerve Net
Psychology
030217 neurology & neurosurgery
Clinical psychology
Zdroj: American Journal of Psychiatry. 174:533-545
ISSN: 1535-7228
0002-953X
DOI: 10.1176/appi.ajp.2016.16050518
Popis: The purpose of this article was to inform the first-line treatment choice between cognitive-behavioral therapy (CBT) or an antidepressant medication for treatment-naive adults with major depressive disorder by defining a neuroimaging biomarker that differentially identifies the outcomes of remission and treatment failure to these interventions.Functional MRI resting-state functional connectivity analyses using a bilateral subcallosal cingulate cortex (SCC) seed was applied to 122 patients from the Prediction of Remission to Individual and Combined Treatments (PReDICT) study who completed 12 weeks of randomized treatment with CBT or antidepressant medication. Of the 122 participants, 58 achieved remission (Hamilton Depression Rating Scale [HAM-D] score ≤7 at weeks 10 and 12), and 24 had treatment failure (30% decrease from baseline in HAM-D score). A 2×2 analysis of variance using voxel-wise subsampling permutation tests compared the interaction of treatment and outcome. Receiver operating characteristic curves constructed using brain connectivity measures were used to determine possible classification rates for differential treatment outcomes.The resting-state functional connectivity of the following three regions with the SCC was differentially associated with outcomes of remission and treatment failure to CBT and antidepressant medication and survived application of the subsample permutation tests: the left anterior ventrolateral prefrontal cortex/insula, the dorsal midbrain, and the left ventromedial prefrontal cortex. Using the summed SCC functional connectivity scores for these three regions, overall classification rates of 72%-78% for remission and 75%-89% for treatment failure was demonstrated. Positive summed functional connectivity was associated with remission with CBT and treatment failure with medication, whereas negative summed functional connectivity scores were associated with remission to medication and treatment failure with CBT.Imaging-based depression subtypes defined using resting-state functional connectivity differentially identified an individual's probability of remission or treatment failure with first-line treatment options for major depression. This biomarker should be explored in future research through prospective testing and as a component of multivariate treatment prediction models.
Databáze: OpenAIRE