Abstract
Several previous functional magnetic resonance imaging (fMRI) studies have demonstrated the predictive value of brain activity during emotion processing for antidepressant response, with a focus on clinical outcome after 6–8 weeks. However, longitudinal studies emphasize the paramount importance of early symptom improvement for the course of disease in major depressive disorder (MDD). We therefore aimed to assess whether neural activity during the emotion discrimination task (EDT) predicts early antidepressant effects, and how these predictive measures relate to more sustained response. Twenty-three MDD patients were investigated once with ultrahigh-field 7T fMRI and the EDT. Following fMRI, patients received Escitalopram in a flexible dose schema and were assessed with the Hamilton Depression Rating Scale (HAMD) before, and after 2 and 4 weeks of treatment. Deactivation of the precuneus and posterior cingulate cortex (PCC) during the EDT predicted change in HAMD scores after 2 weeks of treatment. Baseline EDT activity was not predictive of HAMD change after 4 weeks of treatment. The precuneus and PCC are integral components of the default mode network (DMN). We show that patients who exhibit stronger DMN suppression during emotion processing are more likely to show antidepressant response after 2 weeks. This is, to our knowledge, the first study to show that DMN activity predicts early antidepressant effects. However, DMN deactivation did not predict response at 4 weeks, suggesting that our finding is representative of early, likely treatment-related, yet unspecific symptom improvement. Regardless, early effects may be harnessed for optimization of treatment regimens and patient care.
Highlights
First-line antidepressant treatment leads to response rates of ~ 50%, resulting in a large population of patients that does not respond to initial antidepressant treatment.[1]
We aimed to assess whether neural activity during the emotion discrimination task (EDT) predicts early antidepressant effects, and how these predictive measures relate to more sustained response
The study at hand aimed to investigate whether functional magnetic resonance imaging (fMRI) task activity related to emotion processing allows for prediction of early antidepressant response
Summary
First-line antidepressant treatment leads to response rates of ~ 50%, resulting in a large population of patients that does not respond to initial antidepressant treatment.[1] On the other hand, depression is associated with detrimental personal, social and economic costs. Neuroimaging biomarker studies have focused on strategies that allow for prediction of treatment response and selection of effective treatment for individual patients in order to optimize clinical routine and patient experience.[2]. A meta-analysis of 41 studies showed that symptom reduction at 2 weeks predicted stable response and remission with 81% and 87% sensitivity, respectively.[3] such observations have led some authors to suggest shortening the recommended time during which antidepressant effects are assessed and after which antidepressant medication should be adapted, to 2–4 weeks.[4] As early response serves as an indicator of later outcome, elucidation of early responders before treatment begin may allow for prediction of general treatment results
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