Neural markers of symptomatic improvement during antidepressant therapy in severe depression: subgenual cingulate and visual cortical responses to sad, but not happy, facial stimuli are correlated with changes in symptom score

• Published in: Journal of psychopharmacology (Oxford) 2009-09, Vol.23 (7), p.775-788
• Main Authors: Keedwell, P, Drapier, D, Surguladze, S, Giampietro, V, Brammer, M, Phillips, M
• Format: Article
• Language: English
• Subjects: Adult and adolescent clinical studies; Affect; Antidepressants; Antidepressive Agents - therapeutic use; Biological and medical sciences; Biomarkers - blood; Brain - metabolism; Cohort Studies; Depression; Depressive Disorder, Major - blood; Depressive Disorder, Major - diagnosis; Depressive Disorder, Major - drug therapy; Facial Expression; Female; Functional magnetic resonance imaging; Gyrus Cinguli - metabolism; Humans; Investigative techniques, diagnostic techniques (general aspects); Magnetic Resonance Imaging; Male; Medical sciences; Mental depression; Middle Aged; Mood disorders; Nervous system; Neuroimaging; Neuropharmacology; Oxygen - blood; Oxygenation; Pharmacology. Drug treatments; Psychoanaleptics: cns stimulant, antidepressant agent, nootropic agent, mood stabilizer; Psychoanaleptics: cns stimulant, antidepressant agent, nootropic agent, mood stabilizer..., (alzheimer disease); Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Psychopharmacology; Radiodiagnosis. Nmr imagery. Nmr spectrometry; Temporal cortex; Time Factors; Visual cortex; Visual Cortex - metabolism; Visual stimuli
• ISSN: 0269-8811; 1461-7285
• DOI: 10.1177/0269881108093589

Abstract Resting state activity in the ventral cingulate may be an important neural marker of symptomatic improvement in depression. The number of task related functional magnetic resonance imaging (fMRI) studies correlating blood oxygenation level dependent (BOLD) response with symptomatic improvement is limited and methodologies are still evolving. We measured BOLD responses to sad and happy facial stimuli in 12 severely depressed individuals in the early stages of antidepressant treatment (Time 1) and 12 weeks later (Time 2) using event-related fMRI. We calculated correlations between temporal changes in BOLD response and changes in symptom scores. Most subjects improved markedly by Time 2. At Time 1, depression severity correlated positively with responses to sad stimuli in the right visual cortex, subgenual cingulate, anterior temporal pole and hippocampus and correlated negatively with responses to happy stimuli in left visual cortex and right caudate. Decreases in individual effect sizes of right subgenual cingulate and right visual cortical responses to sad, but not happy, facial stimuli were correlated with decreases in symptom scores. There are contrasting cortical and subcortical responses to sad and happy stimuli in severe depression. Responses to sad stimuli show the strongest correlates of clinical improvement, particularly in the subgenual cingulate.