Pretreatment brain states identify likely nonresponse to standard treatments for depression.
Pretreatment brain states identify likely nonresponse to standard treatments for depression.
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DOI：
10.1016/j.biopsych.2013.12.005
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发表时间：
2014-10-01
影响因子：
10.6
通讯作者：
Mayberg, Helen S.
中科院分区：
文献类型：
--
作者：
McGrath, Callie L.;Kelley, Mary E.;Dunlop, Boadie W.;Holtzheimer, Paul E., III;Craighead, W. Edward;Mayberg, Helen S.
关键词：
重度抑郁症（MDD）的治疗方法导致大约三分之一的患者在首次治疗后获得缓解。增加治疗通常可以提高缓解率，但大约三分之一的患者在多次治疗（顺序单药或联合治疗）后没有反应。预处理生物标志物可以帮助识别这些患者。胼胝体下扣带的过度活动与MDD治疗无反应有关，它是这样一个生物标志物的潜在候选者。82名目前未接受治疗的重度抑郁症患者参加了一项两期治疗研究。获得了氟脱氧葡萄糖正电子发射断层扫描。扫描后，患者被随机分配到12周的艾司西酞普兰或认知行为疗法（CBT）。在初始治疗12周后未达到缓解的患者接受额外12周的艾司西酞普兰加CBT治疗。比较1期或2期治疗无反应者和缓解者的胼胝体下扣带代谢。这个分析之后是一个全脑分析，做了同样的比较。经过两期治疗（24周），36例患者缓解，6例患者缓解，9例无反应。无反应者的胼胝体下扣带代谢明显高于缓解者。在随访的全脑分析中，颞上沟活动增加也与两次治疗无反应有关。与服用CBT、艾司西酞普兰或两者联合用药的患者相比，未能接受CBT或艾司西酞普兰治疗的抑郁症患者，其脑代谢模式明显不同。在clinicaltrials.gov注册（NCT00367341）
Treatment approaches for major depressive disorder (MDD) result in approximately one-third of patients achieving remission after a first treatment. Added treatment generally improves remission rates, but approximately one-third of all patients fail to respond after several treatments (sequential monotherapies or combined treatment). A pretreatment biomarker could help identify these patients. Over activity of the subcallosal cingulate has been associated with treatment non-response in MDD, and it is a potential candidate for such a biomarker. Eighty-two currently untreated MDD patients were enrolled in a two-phase treatment study. A flurodeoxyglucose positron emission tomography scan was acquired. Following scanning, patients were randomized to 12 weeks of either escitalopram or cognitive behavior therapy (CBT). Patients not achieving remission after 12 weeks of initial treatment were treated with an additional 12 weeks of escitalopram plus CBT. Subcallosal cingulate metabolism was compared between non-responders and remitters to either Phase 1 or Phase 2 treatment. This analysis was followed by a whole brain analysis making the same comparison. After two phases of treatment (24 weeks), 36 patients achieved remission, 6 patients achieved response, and 9 patients were non-responders. Subcallosal cingulate metabolism was significantly higher in non-responders than remitters. In the follow-up whole brain analysis, increased superior temporal sulcus activity was also associated with two-treatment non-response. Depressed patients who fail to remit to CBT or escitalopram, either alone or in combination, have a distinct brain metabolic pattern compared to patients who remit with CBT, escitalopram or their combination. Registered at clinicaltrials.gov (NCT00367341)
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影响因子：
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通讯作者：
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