Differences in Brain Glucose Metabolism Between Responders to CBT and Venlafaxine in a 16-Week Randomized Controlled Trial
Abstract
Objective: Neuroimaging investigations reveal changes in glucose metabolism (fluorine-18-fluorodeoxyglucose positron emission tomography [PET]) associated with response to disparate antidepressant treatment modalities, including cognitive behavior therapy (CBT), antidepressant pharmacotherapies, and deep brain stimulation. Using a nonrandomized design, the authors previously compared changes following CBT or paroxetine in depressed patients. In this study, the authors report changes in fluorine-18-fluorodeoxyglucose PET in responders to CBT or venlafaxine during a randomized controlled trial. Methods Subjects meeting DSM-IV-TR criteria for a major depressive episode and a diagnosis of a major depressive disorder received a fluorine-18-fluorodeoxyglucose PET scan before randomization and after 16 weeks of antidepressant treatment with either CBT (N=12) or venlafaxine (N=12). Modality-specific and modality-independent regional brain metabolic changes associated with response status were analyzed. Results: Response rates were comparable between the CBT (7/12) and venlafaxine (9/12) groups. Response to either treatment modality was associated with decreased glucose metabolism bilaterally in the orbitofrontal cortex and left medial prefrontal cortex, along with increased metabolism in the right occipital-temporal cortex. Changes in metabolism in the anterior and posterior parts of the subgenual cingulate cortex and the caudate differentiated CBT and venlafaxine responders. Conclusions: Responders to either treatment modality demonstrated reduced metabolism in several prefrontal regions. Consistent with earlier reports, response to CBT was associated with a reciprocal modulation of cortical-limbic connectivity, while venlafaxine engaged additional cortical and striatal regions previously unreported in neuroimaging investigations.
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MDD patients who respond to cognitive-behavioral therapy tend to show increased subgenual activity after CBT treatment.
“Kennedy et al. (105) found that MDD patients who are responsive to cognitive-behavioral therapy (CBT) tend to exhibit increased subgenual activity following CBT treatment”
From Functional anatomy of ventromedial prefrontal cortex: implications for mood and anxiety disorders (2012) · cites this paper as [105]
Successful treatment of mood disorder results in a relative normalization of these activity patterns.
“Successful treatment of mood disorder results in a relative normalization of these activity patterns (Mayberg et al. 1999, 2005; Goldapple et al. 2004; Kennedy et al. 2007).”
From Anatomical connectivity of the subgenual cingulate region targeted with deep brain stimulation for treatment-resistant depression (2008) · cites this paper as Kennedy et al. 2007
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“As a learning-based intervention, practice of CBT skills improves symptoms and is associated with changes in brain metabolism.(14) 15 CBT is the standard of care for many psychiatric disorders including depression, anxiety disorders, eating disorders, addiction, chronic pain and sleeping disturbance (insomnia) across…”
- Authors
- Kennedy, S. H., Konarski, J. Z., Segal, Z. V., Lau, M. A., Bieling, P. J., McIntyre, R. S., & Mayberg, H. S.
- Affiliations
- University Health Network (CA)
- Venue
- American Journal of Psychiatry
- Published
- 2007-05
- Volume
- 164
- Issue
- 5
- Pages
- 778-788
- ISSN
- 0002-953X (ISSN-L)
- 1535-7228
- OpenAlex
- W2150215146
- Cited by
- 420
- References
- 67
- Citations by year
- 2026: 11 · 2025: 6 · 2024: 5 · 2023: 11 · 2022: 10 · 2021: 34 · 2020: 21 · 2019: 13 · 2018: 19 · 2017: 25 · 2016: 16 · 2015: 27 · 2014: 36 · 2013: 43 · 2012: 25
- FWCI
- 20.16
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- American Journal of Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Life Sciences › Neuroscience › Cellular and Molecular Neuroscience › Neurotransmitter Receptor Influence on Behavior
- Keywords
- brain glucose metabolism, cognitive behavioral therapy, venlafaxine, major depressive disorder, treatment response, orbitofrontal cortex, medial prefrontal cortex, subgenual anterior cingulate cortex, caudate nucleus, antidepressant treatment
- MeSH terms
- Venlafaxine Hydrochloride, Adult, Brain, Cerebral Cortex, Combined Modality Therapy, Cyclohexanols, Major Depressive Disorder, Female, Glucose, Humans, Functional Laterality, Limbic System, Male, Middle Aged, Cognitive Behavioral Therapy, Treatment Outcome, Selective Serotonin Reuptake Inhibitors, Fluorodeoxyglucose F18, Positron-Emission Tomography
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