Young Kymberly D, Siegle Greg J, Zotev Vadim, Phillips Raquel, Misaki Masaya, Yuan Han, Drevets Wayne C, Bodurka Jerzy
From the Laureate Institute for Brain Research, Tulsa, Okla.; the Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh; the Stephenson School of Biomedical Engineering, University of Oklahoma, Norman; Janssen Research and Development, New Brunswick, N.J.; and the Biomedical Engineering Center, University of Oklahoma College of Engineering, Norman.
Am J Psychiatry. 2017 Aug 1;174(8):748-755. doi: 10.1176/appi.ajp.2017.16060637. Epub 2017 Apr 14.
Patients with depression show blunted amygdala hemodynamic activity to positive stimuli, including autobiographical memories. The authors examined the therapeutic efficacy of real-time functional MRI neurofeedback (rtfMRI-nf) training aimed at increasing the amygdala's hemodynamic response to positive memories in patients with depression.
In a double-blind, placebo-controlled, randomized clinical trial, unmedicated adults with depression (N=36) were randomly assigned to receive two sessions of rtfMRI-nf either from the amygdala (N=19) or from a parietal control region not involved in emotional processing (N=17). Clinical scores and autobiographical memory performance were assessed at baseline and 1 week after the final rtfMRI-nf session. The primary outcome measure was change in score on the Montgomery-Åsberg Depression Rating Scale (MADRS), and the main analytic approach consisted of a linear mixed-model analysis.
In participants in the experimental group, the hemodynamic response in the amygdala increased relative to their own baseline and to the control group. Twelve participants in the amygdala rtfMRI-nf group, compared with only two in the control group, had a >50% decrease in MADRS score. Six participants in the experimental group, compared with one in the control group, met conventional criteria for remission at study end, resulting in a number needed to treat of 4. In participants receiving amygdala rtfMRI-nf, the percent of positive specific memories recalled increased relative to baseline and to the control group.
rtfMRI-nf training to increase the amygdala hemodynamic response to positive memories significantly decreased depressive symptoms and increased the percent of specific memories recalled on an autobiographical memory test. These data support a role of the amygdala in recovery from depression.
抑郁症患者对包括自传体记忆在内的积极刺激表现出杏仁核血流动力学活动减弱。作者研究了实时功能磁共振成像神经反馈（rtfMRI-nf）训练的治疗效果，该训练旨在增强抑郁症患者杏仁核对积极记忆的血流动力学反应。
在一项双盲、安慰剂对照、随机临床试验中，未服用药物的成年抑郁症患者（N = 36）被随机分配接受来自杏仁核（N = 19）或来自不参与情绪处理的顶叶对照区域（N = 17）的两阶段rtfMRI-nf训练。在基线和最后一次rtfMRI-nf训练后1周评估临床评分和自传体记忆表现。主要结局指标是蒙哥马利-Åsberg抑郁评定量表（MADRS）得分的变化，主要分析方法包括线性混合模型分析。
在实验组参与者中，杏仁核的血流动力学反应相对于其自身基线和对照组有所增加。杏仁核rtfMRI-nf组的12名参与者，与对照组的仅2名参与者相比，MADRS得分降低了50%以上。实验组的6名参与者，与对照组的1名参与者相比，在研究结束时达到了传统的缓解标准，治疗所需人数为4。在接受杏仁核rtfMRI-nf训练的参与者中，回忆起的积极特定记忆的百分比相对于基线和对照组有所增加。
rtfMRI-nf训练以增强杏仁核对积极记忆的血流动力学反应，显著减轻了抑郁症状，并增加了自传体记忆测试中回忆起的特定记忆的百分比。这些数据支持了杏仁核在抑郁症康复中的作用。
