Neural Responsiveness to Reward as an Index of Depressive Symptom Change Following Cognitive-Behavioral Therapy and SSRI Treatment

Burkhouse, Katie L.; Gorka, Stephanie M.; Klumpp, Heide; Kennedy, Amy E.; Karich, Shannon R; Francis, Jennifer; Ajilore, Olusola; Craske, Michelle G.; Langenecker, Scott A.; Shankman, Stewart A.; Hajcak, Greg; Phan, K. Luan

doi:10.4088/jcp.17m11836

Cited by 44 publications

(39 citation statements)

References 42 publications

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“…Participants were randomized to either 12 weeks of SSRI or CBT treatment, as previously detailed [25,26]. SSRI and CBT treatment details are described in Supplementary Materials.…”

Section: Treatment Proceduresmentioning

confidence: 99%

Emotion-based brain mechanisms and predictors for SSRI and CBT treatment of anxiety and depression: a randomized trial

Gorka

Young

Klumpp

et al. 2019

Neuropsychopharmacol.

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Mechanisms and predictors for the successful treatment of anxiety and depression have been elusive, limiting the effectiveness of existing treatments and curtailing the development of new interventions. In this study, we evaluated the utility of three widely used neural probes of emotion (experience, regulation, and perception) in their ability to predict symptom improvement and correlate with symptom change following two first-line treatments-selective serotonin reuptake inhibitors (SSRIs) and cognitive-behavioral therapy (CBT). Fifty-five treatment-seeking adults with anxiety and/or depression were randomized to 12 weeks of SSRI or CBT treatment (ClinicalTrials.gov identifier: NCT01903447). Functional magnetic resonance imaging (fMRI) was used to examine frontolimbic brain function during emotion experience, regulation, and perception, as probed by the Emotion Regulation Task (ERT; emotion experience and regulation) and emotional face assessment task (EFAT; emotion perception). Brain function was then related to anxiety and depression symptom change. Results showed that both SSRI and CBT treatments similarly attenuated insula and amygdala activity during emotion perception, and greater treatment-related decrease in insula and amygdala activity was correlated with greater reduction in anxiety symptoms. Both treatments also reduced amygdala activity during emotion experience but brain change did not correlate with symptom change. Lastly, greater pre-treatment insula and amygdala activity during emotion perception predicted greater anxiety and depression symptom improvement. Thus, limbic activity during emotion perception is reduced by both SSRI and CBT treatments, and predicts anxiety and depression symptom improvement. Critically, neural reactivity during emotion perception may be a non-treatment-specific mechanism for symptom improvement.

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“…Participants were randomized to either 12 weeks of SSRI or CBT treatment, as previously detailed [25,26]. SSRI and CBT treatment details are described in Supplementary Materials.…”

Section: Treatment Proceduresmentioning

confidence: 99%

Emotion-based brain mechanisms and predictors for SSRI and CBT treatment of anxiety and depression: a randomized trial

Gorka

Young

Klumpp

et al. 2019

Neuropsychopharmacol.

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“…Reduced reward responsiveness, as measured by RewP, has consistently been shown to predict the emergence of depressive symptoms in adolescence (for a review, Kujawa and Burkhouse 2017). There is also some evidence that RewP may predict CBT or SSRI response among adults with internalizing disorders (Burkhouse et al 2016(Burkhouse et al , 2018, but these methods have yet to be extended to pediatric treatment studies.…”

Section: Introductionmentioning

confidence: 99%

Reduced Reward Responsiveness Predicts Change in Depressive Symptoms in Anxious Children and Adolescents Following Treatment

Kujawa

Burkhouse

Karich

et al. 2019

Journal of Child and Adolescent Psychopharmacology

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Objectives: Reduced reward responsiveness, as measured by the event-related potential (ERP) component, the reward positivity (RewP), has been shown to play a role in the development of internalizing disorders, but implications for treatment remain unclear. In adult patients with anxiety and/or depression, reduced RewP has emerged as a predictor of greater change in symptoms following cognitive behavior therapy (CBT) or selective serotonin reuptake inhibitor (SSRI) treatment. The objectives of this preliminary study were to extend these findings to children and adolescents with anxiety disorders by evaluating RewP to reward as a predictor of change in anxiety severity or depressive symptoms following treatment with CBT or SSRI and to explore whether RewP differentially predicts response to one type of treatment. Methods: Patients (7-19 years old) with social and/or generalized anxiety disorder (N = 27) completed baseline measures of anxiety severity and depressive symptoms, as well as an ERP monetary reward anticipation and feedback task. RewP was measured in response to reward and breaking even feedback. Patients were then randomly assigned to CBT or SSRI treatment, and completed measures of anxiety and depressive symptom severity at the last treatment session. Results: Reduced reward responsiveness, as measured by RewP to rewards, predicted greater change in depressive symptoms following treatment, adjusting for baseline symptoms, age, and RewP to breaking even. RewP was not a significant predictor of change in anxiety symptoms. Although preliminary, exploratory analyses suggested that among anxious youth, RewP specifically predicted change in depressive symptoms following CBT, rather than SSRI. Conclusion: Results provide preliminary support for the utility of ERP measures of reward responsiveness in predicting treatment response in youth. With further research and standardization, ERP assessments could potentially be implemented in clinical settings to inform prognosis and treatment planning for youth with internalizing disorders.

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“…Only two studies provided cross-validated metrics for prediction accuracy (Table S1). There were four studies that referenced pre-registration (19,20,35,63), but none of these had in depth descriptions of analytical approaches.…”

Section: Effect Of Measurement Error On Observed Correlationsmentioning

confidence: 99%

“…Statistically, this amounts to a mediation. Many interventions can perturb the reward system (80-89) and some have even shown that changes in this system correlate to changes in depressive symptoms (20,63,(90)(91)(92)(93). One study did find a significant mediation (20), so they provide some evidence for the manipulability of depression symptoms via manipulations of the reward processing system.…”

Section: Manipulabilitymentioning

confidence: 99%

Great Expectations: A Critical Review of and Recommendations for the study of Reward Processing as a Cause and Predictor of Depression

Nielson

Keren

O’Callaghan

et al. 2020

Preprint

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Both human and animal studies support the relationship between depression and reward processing abnormalities, giving rise to the expectation that neural signals of these processes may serve as biomarkers or mechanistic treatment targets. Given the great promise of this research line, we scrutinize those findings and the theoretical claims that underlie them. To achieve this, we apply the framework provided by classical work on causality as well as contemporary approaches to prediction. We identify a number of conceptual, practical, and analytical challenges to this line of research, and use a pre-registered meta-analysis to quantify the longitudinal associations between reward processing aberrations and depression. We also investigate the impact of measurement error on reported data. We find that reward processing abnormalities do not reach levels that would be useful for clinical prediction, yet the evidence thus far does not exclude their possible causal role in depression.

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Neural Responsiveness to Reward as an Index of Depressive Symptom Change Following Cognitive-Behavioral Therapy and SSRI Treatment

Abstract: ClinicalTrials.gov identifier: NCT01903447.

Cited by 44 publications

References 42 publications

Emotion-based brain mechanisms and predictors for SSRI and CBT treatment of anxiety and depression: a randomized trial

Emotion-based brain mechanisms and predictors for SSRI and CBT treatment of anxiety and depression: a randomized trial

Reduced Reward Responsiveness Predicts Change in Depressive Symptoms in Anxious Children and Adolescents Following Treatment

Great Expectations: A Critical Review of and Recommendations for the study of Reward Processing as a Cause and Predictor of Depression

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