Fisher Patrick M, Ozenne Brice, Ganz Melanie, Frokjaer Vibe G, Dam Vibeke Nh, Penninx Brenda Wjh, Sankar Anajli, Miskowiak Kamilla, Jensen Peter S, Knudsen Gitte M, Jorgensen Martin B
Neurobiology Research Unit, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.
NeuroPharm, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.
J Psychopharmacol. 2022 May;36(5):626-636. doi: 10.1177/02698811221089035. Epub 2022 May 13.
Major depressive disorder (MDD) is a prevalent neuropsychiatric illness for which it is important to resolve underlying brain mechanisms. Current treatments are often unsuccessful, precipitating a need to identify predictive markers.
We evaluated (1) alterations in brain responses to an emotional faces functional magnetic resonance imaging (fMRI) paradigm in individuals with MDD, compared to controls, (2) whether pretreatment brain responses predicted antidepressant treatment response, and (3) pre-post change in brain responses following treatment.
Eighty-nine medication-free, depressed individuals and 115 healthy controls completed the fMRI paradigm. Depressed individuals completed a nonrandomized, open-label, 8-week treatment with escitalopram, including the option to switch to duloxetine after 4 weeks. We examined patient-control group differences in regional fMRI responses at baseline, whether baseline fMRI responses predicted treatment response at 8 weeks, including early life stress moderating effects, and change in fMRI responses in 36 depressed individuals rescanned following 8 weeks of treatment.
Task reaction time was 5% slower in patients. Multiple brain regions showed significant task-related responses, but we observed no statistically significant patient-control group differences (Cohen's < 0.35). Patient pretreatment brain responses did not predict antidepressant treatment response (area under the curve of the receiver operator characteristic (AUC-ROC) < 0.6) and brain responses were not statistically significantly changed after treatment (Cohen's < 0.33).
This represents the largest prediction study to date examining emotional faces fMRI features as predictors of antidepressant treatment response. Brain response to this fMRI emotional faces paradigm did not distinguish depressed individuals from healthy controls, nor was it predictive of antidepressant treatment response.: Site: https://clinicaltrials.gov, Trial Number: NCT02869035, Trial Title: Treatment Outcome in Major Depressive Disorder.
重度抑郁症（MDD）是一种常见的神经精神疾病，了解其潜在的脑机制很重要。目前的治疗方法常常不成功，因此需要确定预测指标。
我们评估了（1）与对照组相比，MDD患者对情绪面孔功能磁共振成像（fMRI）范式的脑反应变化；（2）治疗前的脑反应是否能预测抗抑郁治疗反应；（3）治疗后脑反应的前后变化。
89名未服用药物的抑郁症患者和115名健康对照完成了fMRI范式。抑郁症患者完成了为期8周的艾司西酞普兰非随机、开放标签治疗，包括在4周后可换用度洛西汀的选择。我们研究了基线时患者与对照组在fMRI区域反应上的差异，基线fMRI反应是否能预测8周时的治疗反应，包括早期生活压力的调节作用，以及36名抑郁症患者在8周治疗后重新扫描时fMRI反应的变化。
患者的任务反应时间慢5%。多个脑区显示出显著的任务相关反应，但我们未观察到患者与对照组之间有统计学显著差异（科恩d值<0.35）。患者治疗前的脑反应不能预测抗抑郁治疗反应（受试者操作特征曲线下面积（AUC-ROC）<0.6），且治疗后脑反应无统计学显著变化（科恩d值<0.33）。
这是迄今为止最大的一项预测研究，考察情绪面孔fMRI特征作为抗抑郁治疗反应的预测指标。对该fMRI情绪面孔范式的脑反应未能区分抑郁症患者与健康对照，也不能预测抗抑郁治疗反应。：网站：https://clinicaltrials.gov，试验编号：NCT02869035，试验标题：重度抑郁症的治疗结果
