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
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DOI：
10.1038/s41386-019-0407-7
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发表时间：
2019-08-01
影响因子：
7.6
通讯作者：
Phan, K. Luan
中科院分区：
文献类型：
--
作者：
Gorka, Stephanie M.;Young, Christina B.;Phan, K. Luan
焦虑和抑郁成功治疗的机制和预测因素一直难以捉摸，这限制了现有治疗方法的有效性，阻碍了新干预措施的开发。在这项研究中，我们评估了三种广泛使用的情绪神经探测方法（体验、调节和感知）在预测症状改善以及与两种一线治疗方法——选择性5 - 羟色胺再摄取抑制剂（SSRIs）和认知行为疗法（CBT）治疗后的症状变化相关联方面的效用。55名寻求治疗的患有焦虑和/或抑郁的成年人被随机分配接受12周的SSRI或CBT治疗（临床试验注册号：NCT01903447）。功能性磁共振成像（fMRI）被用于检查在情绪体验、调节和感知过程中的额边缘脑功能，通过情绪调节任务（ERT；情绪体验和调节）以及情绪面孔评估任务（EFAT；情绪感知）进行探测。然后将脑功能与焦虑和抑郁症状变化相关联。结果显示，SSRI和CBT治疗在情绪感知过程中都同样减弱了脑岛和杏仁核的活动，并且脑岛和杏仁核活动与治疗相关的更大程度降低与焦虑症状的更大程度减轻相关。两种治疗在情绪体验过程中也都降低了杏仁核的活动，但脑变化与症状变化不相关。最后，在情绪感知过程中治疗前脑岛和杏仁核活动越强，预测焦虑和抑郁症状改善越明显。因此，SSRI和CBT治疗都会降低情绪感知过程中的边缘系统活动，并预测焦虑和抑郁症状的改善。关键的是，情绪感知过程中的神经反应性可能是一种非治疗特异性的症状改善机制。
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.