Insights into brain connectivity could help clinicians choose between talk therapy and drugs for depression

Researchers at Emory University used two long-term NIH-funded studies to predict how well three first-line treatments would work for adults diagnosed with major depressive disorder (MDD). We continue to develop a deeper understanding of the factors that help.

The primary objective of this study, called Predictors of Remission in Depression to Individual and Combined Treatments (PReDICT), was to test clinically naïve individuals on one of two antidepressant medications (ADM) or cognitive-behavioral therapy. Talk therapy known as (CBT).New results highlight changes in brain circuit connections associated with changes in depressive symptoms online It is also published in the March issue of the American Journal of Psychiatry.

This study provided insight into brain connectivity in patients who significantly improved after receiving CBT or ADM treatment. Overall, they found changes in the way different parts of the brain communicated with each other, and while some of these changes were common to all patients who improved, others were associated with the treatment they received. It was peculiar to the species.

“Clinical depression is the leading cause of disability and loss of enjoyment in life among mental illnesses. , based on trial and error and the preferences of the treating mental health professional.” W. Edward Craighead, PhD, J. Rex Fuqua Professor of Psychiatry and Behavioral Sciences, Emory University School of Medicine. “PReDICT will help us better understand how different areas of the brain relate to and respond to different therapies. We can develop a much-needed method for

Craighead co-led the PReDICT research with Helen S. Mayberg, MD, a former Emory colleague and now professor at the Icahn School of Medicine, Mount Sinai. Bodie W. DunlopMD, Emory Professor of Psychiatry and Director of the Emory Mood and Anxiety Disorders Program.

The primary aim of this study was to identify shared, intrinsic alterations in brain resting state functional connectivity (RSFC) between CBT and ADM-improved major depressive disorder (MDD) patients. . RSFC is a type of brain imaging that uses functional magnetic resonance imaging (fMRI) to measure connections between different areas of the brain, allowing individuals to rest and experience specific cognitive, emotional, or motor activity. not running the task.

PReDICT randomly assigned 344 adult study participants with MDD aged 18 to 65 years to receive 12 weeks of treatment with CBT or one of two ADMs, escitalopram or duloxetine. Treatment in this study lasted for two years or until participants chose to stop working with a mental health professional. To investigate, we evaluated the efficacy of treatments and their relative effectiveness.

Although there was no difference in relative clinical outcomes among the three frontline treatments for treatment-naïve participants with depression, the level of remission (~47%) was higher than that of previous depression. It was slightly higher than studies that included patients (remission ~30%). Overall, PReDICT found that approximately 25–30% of participants did not respond to either or both treatments and may need to seek alternative biological or psychological interventions.

Mayberg found that both the CBT and ADM groups of participants showed decreased functional connectivity between key emotional processing centers (the subcorpus callosum cingulate cortex) and parts of the primary motor cortex, irrespective of treatment. , the general change in movement initiation and ability. Elsewhere, CBT was associated with an increase in his RSFC, whereas ADM treatment was associated with a decrease in her RSFC.

According to Dunlop, one of the study’s key findings showed that CBT greatly increased the way different parts of the brain communicate with each other. Specifically, this study showed an increase in RSFC between two key parts of the brain known as the executive control network and the dorsal attention network. Craighead also said the findings are important and promising for individuals suffering from depression, as they suggest that CBT may have more profound effects on the brain than previously recognized. He said it could be a treatment option.

Although the patient sample in this study was fairly large and relatively diverse, the principal investigators noted that it is still unclear whether these connectivity changes are seen in other depressed patient groups or in different regions of the world. , pointed out that further research is needed. Check out these findings.

The PReDICT team concludes: They may want to consider psychotherapy or alternatives to ADM, and may need to seek another biological or psychological intervention if they do not respond to either or both treatments. yeah. ”

This research is supported by the following NIH grant: P50 MH077083. RO1MH080880; UL1 RR025008; M01 RR0039; K23 MH086690, and the Fuqua Family Foundation.