Midline and right frontal brain function as a physiologic biomarker of remission in major depression.
Prior investigations have reported that changes in the prefrontal electroencephalogram (EEG) precede symptom improvement from antidepressant medications, and could serve as a biomarker of treatment outcome in major depressive disorder (MDD). A new physiologically defined region of interest (ROI), overlying the midline and right frontal (MRF) cortical area, was examined here for a relationship between early decreases in theta-band cordance and remission. Subjects were 72 adults with unipolar MDD who had completed placebo-controlled antidepressant treatment trials, with 37 randomized to medication and 35 to placebo. We assessed changes in cordance and absolute and relative power in the MRF region at 48 h, 1 week, and 2 weeks after start of drug, as potential predictors of remission (final score on the 17-item Hamilton Depression Rating Scale of 5 or below. Out of 37 medication-treated subjects, 11 (30%) remitted versus 6 of 35 placebo subjects (17%). Change in MRF cordance 1 and 2 weeks after the beginning of treatment was significantly associated with remission in medication-treated subjects at 1 week, with receiver operating characteristic (ROC) analysis yielding 0.76 area under the curve. Decreases in MRF cordance at 1 week predicted remission with medication with 69% overall accuracy (90% sensitivity; 60% specificity). MRF cordance changes were not associated with remission with placebo. Absolute and relative power did not differentiate groups. These results suggest that remission may be predictable from physiologic measurements after 1 week of treatment, and that this region merits further investigation in the neurobiology of treatment response.
Cook
Ian A
IA
UCLA Depression Research & Clinic Program, Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles, CA, United States. icook@ucla.edu
Hunter
Aimee M
AM
Abrams
Michelle
M
Siegman
Barbara
B
Leuchter
Andrew F
AF
D000328:Adult; D000704:Analysis of Variance; D000928:Antidepressive Agents / Q000494:pharmacology / Q000627:therapeutic use; D015415:Biomarkers; D003865:Major Depressive Disorder / Q000175:diagnosis* / Q000188:drug therapy; D004311:Double-Blind Method; D004569:Electroencephalography / Q000379:methods; D005260:Female; D005625:Frontal Lobe / Q000187:drug effects / Q000473:pathology* / Q000503:physiopathology*; D007839:Functional Laterality / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales; D012372:ROC Curve; D012008:Recurrence; D012720:Severity of Illness Index; D013057:Spectrum Analysis; D013997:Time Factors; D016896:Treatment Outcome
D000928:Antidepressive Agents; D015415:Biomarkers