Amygdala rtfMRI Neurofeedback for Treatment Resistant Depression

杏仁核 rtfMRI 神经反馈治疗难治性抑郁症

• 批准号: 10611151
• 负责人: Kym Young
• 金额: $ 57.33万
• 依托单位: UNIVERSITY OF PITTSBURGH AT PITTSBURGH
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-08-01 至 2025-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10611151
• 关键词: Affect; Amygdaloid structure; Antidepressive Agents; Brain; Characteristics; Clinical; Clinical Trials; Cognitive; Control Groups; Development; Diagnosis; Disease; Disease remission; Dose; Double-Blind Method; Educational Intervention; Emotional; Ensure; Evaluation; Functional Magnetic Resonance Imaging; Functional disorder; Goals; Individual; Intervention; Left; Major Depressive Disorder; Memory; Mood Disorders; Moods; Outcome; Parietal; Participant; Patients; Pharmaceutical Preparations; Pharmacology; Phase; Pilot Projects; Population; Randomized; Randomized Clinical Trials; Recovery; Research; Resistance; Sampling; Specificity; Stimulus; Symptoms; Time; Training; Treatment Efficacy; Work; base; behavioral response; clinical effect; clinical efficacy; clinically relevant; daily functioning; depressive symptoms; hemodynamics; improved; indexing; insight; intervention refinement; memory recall; neurofeedback; psychologic; public health relevance; research clinical testing; response; success; therapy development; therapy resistant; treatment response; treatment-resistant depression

Abstract Up to two-thirds of patients diagnosed with major depressive disorder (MDD) will not respond to standard pharmacological and psychological interventions and will be considered treatment resistant (TR-MDD). Decreased reactivity to positive stimuli, indexed by low amygdala reactivity to positive autobiographical memory recall, may be a causal mechanism interfering with recovery from TR-MDD. Previous work in our lab suggests that individuals who do respond to antidepressant medications show increased amygdala activity that is indistinguishable from controls relative to baseline, while TR-MDD individuals fail to show this increase in amygdala activity. Furthermore, we have found that MDD participants (more generally, not specifically TR- MDD) are indeed able to increase their amygdala response during positive memory recall via real-time fMRI neurofeedback (rtfMRI-nf) training, and that this increase is associated with large and rapid reductions in depressive symptoms. Here, we propose to evaluate whether rtfMRI-nf training to increase the amygdala response to positive memories may serve as an intervention for TR-MDD. The R61 period will involve intervention refinement and evaluation of mechanism; N=40 TR-MDD individuals will undergo five amygdala rtfMRI-nf training sessions and we will assess changes in amygdala activity with the goal of confirming that patients with TR-MDD are able to increase the amygdala response to positive memories, and to determine the minimal number of training sessions required for sufficient target engagement/amygdala asymptote to be reached. The R33 phase will involve a mechanistic comparison to a control intervention and evaluation of clinical change (including duration of effects). N=60 TR-MDD individuals will be randomly assigned under double-blind conditions to the amygdala rtfMRI-nf intervention or to a control rtfMRI-nf intervention where they are trained to regulate a parietal region putatively not involved in emotional processing or MDD. Success will suggest a new non-pharmacological, non-invasive intervention for a traditionally treatment-resistant population of MDD individuals.

摘要 多达三分之二的诊断为重度抑郁症（MDD）的患者对标准治疗没有反应。 药物和心理干预，并将被视为治疗抵抗（TR-MDD）。 对积极刺激的反应性降低，以杏仁核对积极自传体的低反应性为指标 记忆回忆，可能是干扰TR-MDD恢复的因果机制。我们实验室以前的工作 研究表明，对抗抑郁药物有反应的个体表现出杏仁核活动的增加， 与对照组相比，相对于基线，TR-MDD个体没有表现出这种增加， 杏仁核活动此外，我们发现MDD参与者（更一般地说，不具体地说，TR- MDD）确实能够通过实时fMRI在积极记忆回忆期间增加他们的杏仁核反应 神经反馈（rtfMRI-nf）训练，这种增加与大而快速的减少有关， 抑郁症状。在这里，我们建议评估rtfMRI-NF训练是否增加杏仁核 对积极记忆的反应可以作为TR-MDD的干预。R61期间将涉及 干预细化和机制评估; N=40名TR-MDD个体将接受5个杏仁核 rtfMRI-nf训练课程，我们将评估杏仁核活动的变化，目的是确认 TR-MDD患者能够增加杏仁核对积极记忆的反应，并确定 足够的目标参与/杏仁核渐近线所需的最小训练次数 达到了R33阶段将涉及与对照干预的机制比较，并评估 临床变化（包括影响持续时间）。N=60名TR-MDD受试者将随机分配至 杏仁核rtfMRI-nf干预或对照rtfMRI-nf干预的双盲条件， 被训练来调节不参与情绪处理或MDD的顶叶区域。成功将 这为传统治疗抵抗人群提供了一种新的非药物性、非侵入性干预措施 MDD患者。