title: Brain activation predicts treatment improvement in patients with major depressive disorder.
abstract: Major depressive disorder (MDD) is associated with alterations in brain function that might be useful for therapy evaluation. The current study aimed to identify predictors for therapy improvement and to track functional brain changes during therapy. Twenty-one drug-free patients with MDD underwent functional MRI twice during performance of an emotional perception task: once before and once after 4 weeks of antidepressant treatment (mirtazapine or venlafaxine). Twelve healthy controls were investigated once with the same methods. A significant difference between groups was a relative greater activation of the right dorsolateral prefrontal cortex (dlPFC) in the patients vs. controls. Before treatment, patients responding better to pharmacological treatment showed greater activation in the dorsomedial PFC (dmPFC), posterior cingulate cortex (pCC) and superior frontal gyrus (SFG) when viewing of negative emotional pictures was compared with the resting condition. Activations in the caudate nucleus and insula contrasted for emotional compared to neutral stimuli were also associated with successful treatment. Responders had also significantly higher levels of activation, compared to non-responders, in a range of other brain regions. Brain activation related to treatment success might be related to altered self-referential processes and a differential response to external emotional stimuli, suggesting differences in the processing of emotionally salient stimuli between those who are likely to respond to pharmacological treatment and those who will not. The present investigation suggests the pCC, dmPFC, SFG, caudate nucleus and insula may have a key role as a biological marker for treatment response and predictor for therapeutic success.
authors.affiliation: Department of Psychiatry, School of Medicine & Trinity College Institute of Neuroscience, Integrated Neuroimaging, The Adelaide and Meath Hospital incorporating the National Children's Hospital (AMNCH), & St. James's Hospital, Trinity College, Dublin, Ireland. andrea.samson@stanford.edu
authors.forename: Andrea C
authors.initials: AC
authors.lastname: Samson
authors.forename: Eva
authors.initials: E
authors.lastname: Meisenzahl
authors.forename: Johanna
authors.initials: J
authors.lastname: Scheuerecker
authors.forename: Emma
authors.initials: E
authors.lastname: Rose
authors.forename: Veronika
authors.initials: V
authors.lastname: Schoepf
authors.forename: Martin
authors.initials: M
authors.lastname: Wiesmann
authors.forename: Thomas
authors.initials: T
authors.lastname: Frodl
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D000928:Antidepressive Agents / Q000494:pharmacology / Q000627:therapeutic use; D001921:Brain / Q000098:blood supply / Q000187:drug effects / Q000503:physiopathology*; D001931:Brain Mapping; D003865:Major Depressive Disorder / Q000188:drug therapy / Q000473:pathology*; D004644:Emotions / Q000187:drug effects / Q000502:physiology*; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D010100:Oxygen / Q000097:blood; D010364:Pattern Recognition, Visual / Q000187:drug effects; D010775:Photic Stimulation / Q000379:methods; D011237:Predictive Value of Tests; D011930:Reaction Time / Q000187:drug effects / Q000502:physiology
chemical_list: D000928:Antidepressive Agents; D010100:Oxygen