Predicting Treatment Response in Depression: The Role of Anterior Cingulate Cortex

Abstract

BackgroundIdentification of biomarkers predicting therapeutic outcome of antidepressant treatment is one of the most important tasks in current research because it may transform the lengthy process of finding the right treatment for a given individual with depression. In the current study, we explored the potential of pretreatment pregenual anterior cingulate cortex activity as a putative biomarker of treatment response.MethodsThirty-two medication-free patients with depression were treated for 6 weeks with a selective serotonin reuptake inhibitor, escitalopram. Before treatment began, patients underwent an fMRI scan testing response to brief, masked, presentations of facial expression depicting sadness and happiness.ResultsAfter 6 weeks of treatment, there were 20 selective serotonin reuptake inhibitor responders and 12 nonresponders. Increased pretreatment pregenual anterior cingulate cortex activity to sad vs happy faces was observed in responders relative to nonresponders. A leave-one-out analysis suggested that activity in the anterior cingulate cortex was able to predict response status at the level of the individual participant.ConclusionsThe study supports the notion of pregenual anterior cingulate cortex as a promising predictor of antidepressant response.

Predicting escitalopram monotherapy response in depression: The role of anterior cingulate cortex

“…Beata and others (Godlewska et al, 2018) have also shown that pretreatment pgACC activity is predictive of response to escitalopram after 6 weeks. FC of subcallosal cingulate cortex could identify individuals' treatment outcome to cognitive behavioral therapy (CBT) and antidepressant medicine .…”

“…This potentially suggested that lower DMN related connectivity is a feasible predictor of effective antidepressant medications (Ma et al, ). Beata and others (Godlewska et al, ) have also shown that pretreatment pgACC activity is predictive of response to escitalopram after 6 weeks. FC of subcallosal cingulate cortex could identify individuals' treatment outcome to cognitive behavioral therapy (CBT) and antidepressant medicine (Dunlop et al, ).…”

Neuroimaging as a Tool for Individualized Treatment Choice in Depression: the Past, the Present and the Future

“…In order to address the question of why only some people respond to medications, pre-treatment differences in brain function and structure between future responders and non-responders, as well as correlations between baseline brain activity and a change in depression severity over treatment, were explored (e.g. [7,8,9,10]). These studies have provided valuable information on the mechanisms of action of AD treatments and the factors that determine response to individual drugs [11].…”

“…At this point, probably the best supported candidate for a neuroimaging response biomarker is pgACC, with its increased activity being a predictor of good clinical response consistently shown over the past 20 years (e.g. [10,22,23]) and supported by meta-analyses and systematic reviews [19, 20••]. PgACC plays a crucial role in the development of depressive symptoms and antidepressant response due to its central position between the circuits responsible for a quick automatic response to emotionally salient stimuli and prefrontal regions exerting cognitive control over them.…”

Toward clinical digital phenotyping: a timely opportunity to consider purpose, quality, and safety

“…Separately, an important potential opportunity in the clinical management of depression is predicting treatment response. 20 Only 50% of individuals respond to the first treatment they are offered, 21 and lengthy trial-and-error approaches incur significant patient and health-service costs. Digital phenotyping using voice analysis 22 provides a proof of concept for new methods to predict treatment response but improvements in prediction accuracy are now needed to enable clinical uses.…”