Pretreatment Reward Sensitivity and Frontostriatal Resting-State Functional Connectivity Are Associated With Response to Bupropion After Sertraline Nonresponse.
Pretreatment Reward Sensitivity and Frontostriatal Resting-State Functional Connectivity Are Associated With Response to Bupropion After Sertraline Nonresponse.
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DOI：
10.1016/j.biopsych.2020.04.009
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发表时间：
2020-10-15
影响因子：
10.6
通讯作者：
Pizzagalli DA
中科院分区：
文献类型：
--
作者：
Ang YS;Kaiser R;Deckersbach T;Almeida J;Phillips ML;Chase HW;Webb CA;Parsey R;Fava M;McGrath P;Weissman M;Adams P;Deldin P;Oquendo MA;McInnis MG;Carmody T;Bruder G;Cooper CM;Chin Fatt CR;Trivedi MH;Pizzagalli DA
标准指南推荐选择性血清素再摄取抑制剂 (SSRI) 作为成人重度抑郁症 (MDD) 的一线抗抑郁药物，但成功率有限，未能受益的患者通常会改用非 SSRI 药物。这项研究调查了大脑和基于行为的奖励处理标记是否可能与舍曲林无反应后对安非他酮的反应有关。在一项两阶段、双盲临床试验（建立临床护理抗抑郁药反应的调节因素和生物特征）中，296 名参与者被随机分配在第一阶段接受 8 周的舍曲林或安慰剂治疗。有反应的个体在第二阶段继续接受另一个为期 8 周的相同干预疗程，而舍曲林和安慰剂无反应者分别交叉使用安非他酮和舍曲林。分析了 241 名参与者的数据。第二阶段样本包括 87 名更换药物的 MDD 患者和 38 名健康对照者。在第一阶段接受舍曲林治疗的 116 名 MDD 参与者作为独立的复制样本。在基线时进行概率奖励任务和静息态功能磁共振成像。较高的治疗前奖赏敏感性，以及双侧伏核和头端前扣带皮层之间较高的静息态功能连接，与安非他酮的阳性反应相关，但与舍曲林的阳性反应无关。第一阶段样本中重复了舍曲林的无效结果。治疗前奖励敏感性和额纹状体连接性可能会识别出 SSRI 失败后可能从安非他酮中获益的患者。结果呼吁基于这些生物标志物进行前瞻性复制，以推进临床护理。 ClinicalTrials.gov 标识符：NCT01407094
Standard guidelines recommend selective serotonin reuptake inhibitors (SSRIs) as first-line antidepressants for adults with Major Depressive Disorder (MDD), but success is limited and patients who fail to benefit are often switched to non-SSRI agents. This study investigated whether brain and behavior-based markers of reward processing might be associated with response to bupropion after sertraline nonresponse. In a two-stage, double-blinded clinical trial (Establishing Moderators and Biosignatures of Antidepressant Response for Clinical Care), 296 participants were randomized to receive 8 weeks of sertraline or placebo in Stage 1. Individuals who responded continued on another 8-week course of the same intervention in Stage 2, while sertraline and placebo non-responders crossed-over to bupropion and sertraline, respectively. Data from 241 participants were analyzed. The Stage 2 sample comprised 87 MDD patients who switched medication and 38 healthy controls. 116 MDD participants treated with sertraline in Stage 1 served as an independent replication sample. The probabilistic reward task and resting-state functional magnetic resonance imaging were administered at baseline. Greater pretreatment reward sensitivity, as well as higher resting-state functional connectivity between bilateral nucleus accumbens and rostral anterior cingulate cortex, were associated with positive response to bupropion, but not sertraline. Null findings for sertraline were replicated in the Stage 1 sample. Pretreatment reward sensitivity and frontostriatal connectivity may identify patients likely to benefit from bupropion following SSRI failures. Results call for a prospective replication based on these biomarkers to advance clinical care. clinicaltrials.gov Identifier: NCT01407094
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