Early changes in emotional processing as a marker of clinical response to SSRI treatment in depression.
Early changes in emotional processing as a marker of clinical response to SSRI treatment in depression.
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DOI：
10.1038/tp.2016.130
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发表时间：
2016-11-22
影响因子：
6.8
通讯作者：
Harmer CJ
中科院分区：
文献类型：
--
作者：
Godlewska BR;Browning M;Norbury R;Cowen PJ;Harmer CJ
抗抑郁治疗可减少治疗早期负面情绪偏见的行为和神经标志物，并已被提议作为抗抑郁药物作用的机制。在这里，我们通过评估早期情绪处理变化的神经标记是否可以预测抑郁症的后期临床反应，对这一假设进行了关键测试。 35 名未接受药物治疗的重度抑郁症患者服用选择性血清素再摄取抑制剂 (SSRI)、艾司西酞普兰 (10mg) 超过 6 周，根据治疗结束时症状至少减轻 50%，被分为有反应者（22 名患者）和无反应者（13 名患者）。使用功能磁共振成像在治疗前和治疗后 7 天评估神经对恐惧和快乐情绪面部表情的反应。使用艾司西酞普兰 7 天后，将患者对这些面部线索的神经反应的变化作为后来临床反应的函数进行比较。还评估了健康对照样本。在基线时，与对照组相比，抑郁症患者的岛叶和背侧前扣带回对恐惧和快乐面孔表现出更大的激活。继续对 SSRI 产生反应的抑郁症患者在使用艾司西酞普兰仅 7 天后，包括前扣带回、岛叶、杏仁核和丘脑在内的区域网络中恐惧面部表情与快乐面部表情的神经活动均大幅减少。中介分析证实，神经变化对症状反应的直接影响并不是由抑郁症状的初始变化介导的。这些结果支持这样的假设：抗抑郁治疗的早期情绪处理变化是后来临床改善的基础。因此，早期纠正负面偏差可能是抗抑郁药物作用的关键机制，也是治疗反应的潜在有用预测因子。
Antidepressant treatment reduces behavioural and neural markers of negative emotional bias early in treatment and has been proposed as a mechanism of antidepressant drug action. Here, we provide a critical test of this hypothesis by assessing whether neural markers of early emotional processing changes predict later clinical response in depression. Thirty-five unmedicated patients with major depression took the selective serotonin re-uptake inhibitor (SSRI), escitalopram (10 mg), over 6 weeks, and were classified as responders (22 patients) versus non-responders (13 patients), based on at least a 50% reduction in symptoms by the end of treatment. The neural response to fearful and happy emotional facial expressions was assessed before and after 7 days of treatment using functional magnetic resonance imaging. Changes in the neural response to these facial cues after 7 days of escitalopram were compared in patients as a function of later clinical response. A sample of healthy controls was also assessed. At baseline, depressed patients showed greater activation to fear versus happy faces than controls in the insula and dorsal anterior cingulate. Depressed patients who went on to respond to the SSRI had a greater reduction in neural activity to fearful versus happy facial expressions after just 7 days of escitalopram across a network of regions including the anterior cingulate, insula, amygdala and thalamus. Mediation analysis confirmed that the direct effect of neural change on symptom response was not mediated by initial changes in depressive symptoms. These results support the hypothesis that early changes in emotional processing with antidepressant treatment are the basis of later clinical improvement. As such, early correction of negative bias may be a key mechanism of antidepressant drug action and a potentially useful predictor of therapeutic response.