Resting-state MRI may predict psychotherapy response

By Larry Hand

NEW YORK (Reuters Health) - Resting-state functional brain connectivity, imaged by magnetic resonance imaging (MRI), may predict how a patient with unipolar major depressive disorder (MDD) will respond to psychotherapy, a new study suggests.

"Deciding that a particular kind of treatment is not working for a patient as soon as possible and then switching to another empirically validated treatment approach is a powerful way to help patients feel relief sooner," co-principal investigator (PI) Gabriel S. Dichter, of the University of North Carolina, Chapel Hill, told Reuters Health by email.

Dichter and colleagues, including co-PI Moria J. Smoski of Duke University, investigated whether resting-state functional connectivity (rs-fcMRI) scans could predict responses to talk therapy in 23 MDD patients and 20 nondepressed controls.

All participants underwent rs-fcMRI, after which the MDD patients received an average of 12 weekly talk therapy sessions, formally called Behavioral Activation Treatment for Depression (BATD), which is designed to increase engagement and decrease avoidance behavior.

The researchers analyzed the neuroimaging data to evaluate functional connectivity for four resting-state brain networks: the default mode, the dorsal attention, the executive control, and the salience networks. They used hierarchical linear modeling to determine response to therapy, according to a report online February 4 in Neuropsychopharmacology.

They found that, for the MDD group, response was predicted "by pretreatment connectivity of the right insula with the right middle temporal gyrus and the left intraparietal sulcus with the orbital frontal cortex."

"One take-away from this study is that people are 'hard-wired' to respond better to different forms of treatment for depression," Dichter said. "Although this study only considered a form of talk therapy, we know this to be true for a range of antidepressant treatments, including talk therapy, medication, and brain stimulation treatments."

He continued, "Clinicians should tell patients that there are a lot of excellent treatments available to treat depression, but we have no way to know which one is best for each patient. Even the best treatments delivered under optimal circumstances will not help every single patient."

"Patience is needed to try a number of treatments, and perhaps some treatments in combination, until the best one is found. If patients and their care providers are willing to try up to three of four different treatment modalities, nearly every patient will be able to achieve remission of clinical depression," he said.

His group is seeking funding to expand this research to multiple treatments.

In their paper, the researchers conclude, "The present study adds to the nascent but growing body of evidence linking pretreatment neuroimaging endophenotypes to antidepressant treatment outcomes. This line of research has the ultimate goal of improved response rates to currently available antidepressants through matching patients to specific, empirically validated treatment options."

The National Institute of Mental Health supported this research, along with the University of North Carolina.

SOURCE: http://bit.ly/1FqCdN8

Neuropsychopharmacol 2015.

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