Abstract
This pilot randomized control trial was designed to examine whether Rumination-Focused Cognitive Behavior Therapy (RFCBT) reduces rumination and residual depressive symptoms among adolescents with a history of Major Depressive Disorder (MDD) who are at risk for relapse. We also examined whether these changes in symptoms were associated with changes in functional connectivity of the posterior cingulate cortex (PCC), a key node in the default mode network (DMN). Thirty-three adolescents (ages 12–18) were randomized to eight weeks of RFCBT or an assessment only (AO) control. Twenty two adolescents successfully completed fMRI scans pre- and post-intervention. Adolescents were recruited from the clinic and community and met criteria for at least one previous episode of MDD and were currently in full or partial remission. An Independent Evaluator interviewed parent and child before and after the eight-week intervention. The left PCC (-5, -50, 36) seed was used to probe resting state functional connectivity of the DMN. Adolescents who received RFCBT demonstrated reduced rumination (F = -2.76, df = 112, p < .01, 95% CI [-4.72,-0.80]) and self-report depression across eight weeks (F = -2.58, df = 113, p < .01, 95% CI [-4.21, -0.94]). Youth who received RFCBT also demonstrated significant decreases in connectivity between the left PCC and the right inferior frontal gyrus (IFG) and bilateral inferior temporal gyri (ITG). Degree of change in connectivity was correlated with changes in self-report depression and rumination. These data suggest that rumination can be reduced over eight weeks and that this reduction is associated with parallel decreases in residual depressive symptoms and decreased functional connectivity of the left PCC with cognitive control nodes. These changes may enhance the ability of vulnerable youth to stay well during the transition to adulthood.Trial Registration: ClinicalTrials.gov NCT01905267
Highlights
Major Depressive Disorder (MDD) with early onset can set youth on a trajectory towards lifelong illness and disability [1,2]
We found that Rumination-Focused Cognitive Behavior Therapy (RFCBT) reduced rumination which was associated with protection from increases in depressive symptoms over the course of eight weeks
Our finding that connectivity between the left posterior cingulate cortex (PCC) and the right inferior frontal gyrus (IFG) was reduced with RFCBT suggests that the default mode network (DMN) and CCN may begin to function more independently as skills for reducing rumination are learned
Summary
Major Depressive Disorder (MDD) with early onset can set youth on a trajectory towards lifelong illness and disability [1,2]. Only 10% of those who received RFCBT relapsed over the course of six months compared to 53% of those in TAU, indicating that rumination is a modifiable mechanism even in the context of recurrent MDD Despite these promising results, the potential efficacy of intervening earlier, before the onset of “treatment refractory” depression, has not yet been examined. Including the inferior frontal gyrus (IFG) and medial frontal gyrus (MFG) We examined these relations among remitted young adults with a history of adolescent-onset MDD and found that rumination was inversely correlated with connectivity between the PCC and the right superior and the middle frontal gyri [23]. Given the exploratory nature of the study, a data-driven approach was taken and connectivity of the PCC with the whole brain was examined
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