Kim Nayoung, Bloom Paul A, Rosellini Anthony J, Webb Christian A, Pizzagalli Diego A, Auerbach Randy P
Department of Psychiatry, Columbia University, New York, New York; Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, New York, New York.
Department of Psychological, Boston and Brain Sciences, Boston University, Boston, Massachusetts; Department of Epidemiology, School of Public Health, Boston University, Boston, Massachusetts.
Biol Psychiatry Cogn Neurosci Neuroimaging. 2025 May;10(5):485-494. doi: 10.1016/j.bpsc.2024.10.010. Epub 2024 Nov 2.
Cognitive behavioral therapy (CBT) is a gold-standard approach for treating major depressive disorder in adolescents. However, nearly half of adolescents receiving CBT do not improve. To personalize treatment, it is essential to identify objective markers that predict treatment responsiveness. To address this aim, we investigated neurophysiological processes related to self-referential processing that predicted CBT response among female adolescents with depression.
At baseline, female adolescents ages 13 to 18 years (N = 80) completed a comprehensive clinical assessment, and a self-referential encoding task was administered while electroencephalographic data were recorded. Baseline electroencephalographic data were utilized to identify oscillatory differences between healthy adolescents (n = 42) and adolescents with depression (n = 38). Following the baseline assessment, adolescents with depression received up to 12 weeks of CBT. Baseline differences in electroencephalographic oscillations between healthy adolescents and those with depression were used to guide CBT prediction analysis. Cluster-based event-related spectral perturbation analysis was used to probe theta and alpha event-related synchronization (ERS)/event-related desynchronization (ERD) response to negative and positive words.
Baseline analyses showed that, relative to the healthy adolescents, adolescents with depression exhibited higher levels of frontal theta ERS and greater posterior alpha ERD. Multilevel modeling identified primary neural pretreatment predictors of treatment response: greater theta ERS in the right prefrontal cortex after the onset of negative words and lower alpha ERD in both the right prefrontal cortex and posterior cingulate cortex. ERS and ERD associations with treatment response remained significant, with baseline depressive and anxiety symptoms included as covariates in all analyses.
Consistent with prior research, results highlighted that relative to healthy adolescents, adolescents with depression are characterized by prominent theta synchronization and alpha desynchronization over the prefrontal cortex and posterior cingulate cortex, respectively. Cluster-based event-related spectral perturbation analysis also identified key mechanisms underlying depression-related self-referential processing that predicted improved symptoms during the course of CBT. Ultimately, a better characterization of the neural underpinnings of adolescent depression and its treatment may lead to more personalized interventions.
认知行为疗法（CBT）是治疗青少年重度抑郁症的金标准方法。然而，近一半接受CBT治疗的青少年并无改善。为了实现个性化治疗，识别预测治疗反应性的客观标志物至关重要。为实现这一目标，我们研究了与自我参照加工相关的神经生理过程，这些过程可预测患有抑郁症的女性青少年的CBT反应。
在基线时，13至18岁的女性青少年（N = 80）完成了全面的临床评估，并在记录脑电图数据的同时进行了自我参照编码任务。利用基线脑电图数据识别健康青少年（n = 42）和抑郁症青少年（n = 38）之间的振荡差异。在基线评估之后，患有抑郁症的青少年接受了长达12周的CBT治疗。健康青少年与抑郁症青少年之间脑电图振荡的基线差异被用于指导CBT预测分析。基于簇的事件相关频谱微扰分析用于探究θ波和α波对消极和积极词汇的事件相关同步化（ERS）/事件相关去同步化（ERD）反应。
基线分析表明，与健康青少年相比，抑郁症青少年表现出更高水平的额叶θ波ERS和更大程度的后部α波ERD。多层次建模确定了治疗反应的主要神经预处理预测指标：消极词汇出现后右侧前额叶皮质中更大的θ波ERS，以及右侧前额叶皮质和后扣带回皮质中较低的α波ERD。在所有分析中，将基线抑郁和焦虑症状作为协变量纳入后，ERS和ERD与治疗反应的关联仍然显著。
与先前的研究一致，结果突出表明，与健康青少年相比，抑郁症青少年的特征分别是前额叶皮质和后扣带回皮质上明显的θ波同步化和α波去同步化。基于簇的事件相关频谱微扰分析还确定了与抑郁症相关的自我参照加工的关键机制，这些机制可预测CBT过程中症状的改善。最终，对青少年抑郁症及其治疗的神经基础进行更好的表征可能会带来更个性化的干预措施。
