Journal
ARCHIVES OF GENERAL PSYCHIATRY
Volume 69, Issue 9, Pages 913-924Publisher
AMER MEDICAL ASSOC
DOI: 10.1001/archgenpsychiatry.2012.65
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Funding
- Agency for Healthcare Research and Quality
- Eli Lilly and Company
- GlaxoSmithKline
- National Institute of Mental Health
- Otsuka Inc
- Pfizer Inc
- Pharmaneuroboost
- Roche, Inc.
- Aspect Medical Systems
- Indevus
- AstraZeneca
- Bristol-Myers Squibb
- Pfizer
- anofi-aventis
- Wyeth-Ayerst
- Cyberonics
- Novartis
- NorthStar/St Jude Medical
- Medtronics
- Respironics
- National Institutes of Health [MH074807, MH082998, MH58356, MH58397, MH69618]
- Pittsburgh Foundation
- Emmerling Fund
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Context: Among depressed individuals not receiving medication in controlled trials, 40% to 60% respond to cognitive therapy (CT). Multiple previous studies suggest that activity in the subgenual anterior cingulate cortex (sgACC; Brodmann area 25) predicts outcome in CT for depression, but these results have not been prospectively replicated. Objective: To examine whether sgACC activity is a reliable and robust prognostic outcome marker of CT for depression and whether sgACC activity changes in treatment. Design: Two inception cohorts underwent assessment with functional magnetic resonance imaging using different scanners on a task sensitive to sustained emotional information processing before and after 16 to 20 sessions of CT, along with a sample of control participants who underwent testing at comparable intervals. Setting: A hospital outpatient clinic. Patients: Forty-nine unmedicated depressed adults and 35 healthy controls. Main Outcome Measures: Pretreatment sgACC activity in an a priori region in response to negative words was correlated with residual severity and used to classify response and remission. Results: As expected, in both samples, participants with the lowest pretreatment sustained sgACC reactivity in response to negative words displayed the most improvement after CT (R-2 = 0.29, > 75% correct classification of response, > 70% correct classification of remission). Other a priori regions explained additional variance. Response/remission in cohort 2 was predicted based on thresholds from cohort 1. Subgenual anterior cingulate activity remained low for patients in remission after treatment. Conclusions: Neuroimaging provides a quick, valid, and clinically applicable way of assessing neural systems associated with treatment response/remission. Subgenual anterior cingulate activity, in particular, may reflect processes that interfere with treatment (eg, emotion generation) in addition to its putative regulatory role; alternately, its absence may facilitate treatment response.
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