EPA-1086 - Dorsomedial and precuneus activation during self referential processing predict long term remission to agomelatine in major depression

Abstract

Less than half of depressed patients achieve remission. Identification of biological markers may help clinicians to predict remission and improve patient's treatment. To identify brain regions whose activity during self-referential processing at baseline could predict long-term remission among patients with Major Depressive Disorder (MDD) and to investigate the brain effects of Agomelatine. Nineteen acutely depressed patients and fourteen healthy controls performed self-referential judgments on emotional pictures during two fMRI sessions: before treatment and after 6 to 7 weeks of Agomelatine in patients or one week of placebo in controls. Patients were treated during 6 months and remission was assessed (HAM-D≤7). Activation in dorsomedial prefrontal cortex (dmPFC) and precuneus, during self-referential processing at baseline, was lower in future remitters than in non-remitters and remained stable after 6/7 weeks of treatment in both groups of patients. Pre-treatment activation of dmPFC and precuneus predicted clinical remission at 6 months with a sensitivity of 100% and a specificity of 71.6%. After 6–7 weeks of Agomelatine, the brain activation of MDD patients during self-referential processing was normalized i.e. decrease in the excessive activation of the dorsolateral prefrontal cortex and increase in the ventral anterior cingulate cortex activation. Pre-treatment activation of precuneus and dmPFC during self-referential processing appears to be a valid predictor of clinical remission. Such results are consistent with the idea that cortical midline structures activity may play a major role in treatment outcome of MDD and may help developing biomarkers-based treatment of MDD.