Abstract
Introduction: The prediction of antidepressant treatment response may improve outcome. Functional magnetic resonance imaging (fMRI) of emotion processing in major depressive disorder (MDD) may reveal regional brain function serving as predictors of response to treatment with selective serotonin reuptake inhibitor (SSRI).Methods: We examined the association between pre-treatment neural activity by means of fMRI during the perception of emotional stimuli in 22 patients with MDD and the treatment outcome after 6 weeks' medication with an SSRI. A whole brain correlation analysis with Beck Depression Inventory (BDI) change between pre- to post-treatment was conducted to identify neural regions associated with treatment response.Results: During the perception of positive stimuli, responders were characterized by more activation in posterior cingulate cortex (PCC), medial prefrontal cortex, and thalamus as well as middle temporal gyrus. During perception of negative stimuli, PCC, and pregenual anterior cingulate cortex showed the highest correlation with treatment response. Furthermore, responders exhibited higher activation to emotional stimuli than to neutral stimuli in all the above-mentioned regions, while non-responders demonstrated an attenuated neural response to emotional compared to neutral stimuli.Conclusion: Our data suggest that the activity of distinct brain regions is correlated with SSRI treatment outcome and may serve as treatment response predictor. While some regions, in which activity was correlated with treatment response, can be assigned to networks that have been implied in the pathophysiology of depression, most of our regions of interest could also be matched to the default mode network (DMN). Higher DMN activity has been associated with increased rumination as well as negative self-referential processing in previous studies. This may suggest our responders to SSRI to be characterized by such dysregulations and that SSRIs might modify the function associated with this network.
Highlights
The prediction of antidepressant treatment response may improve outcome
We hypothesized a difference in information processing when perceiving/expecting emotional stimuli in major depressive disorder (MDD) depending on improvement by treatment with a selective serotonin reuptake inhibitor (SSRI) for 6 weeks
We examined whether neurobiological markers revealed from Functional magnetic resonance imaging (fMRI) during emotion perception are associated with treatment response in depression in order to determine potential treatment response predictors
Summary
The prediction of antidepressant treatment response may improve outcome. Functional magnetic resonance imaging (fMRI) of emotion processing in major depressive disorder (MDD) may reveal regional brain function serving as predictors of response to treatment with selective serotonin reuptake inhibitor (SSRI). In a newer model of antidepressant drug action, they have been suggested to remediate negative affective biases by changing the processing of emotionally valenced information [22] Such negative biases have been studied by our research group, with [23] showing a neural correlate of a pessimistic attitude in healthy participants during expectation of unpleasant stimuli and stimuli of unknown valence. A similar setup in depressed patients identified distinct regions potentially corresponding to a negative cognitive bias in MDD [24, 25] Based on these results, we hypothesized a difference in information processing when perceiving/expecting emotional stimuli in MDD depending on improvement by treatment with a selective serotonin reuptake inhibitor (SSRI) for 6 weeks
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