Cited by 342Functional Brain Connectivity StudiesTreatment of Major DepressionAnxiety, Depression, Psychometrics, Treatment, Cognitive Processes

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Functional connectivity of the subcallosal cingulate cortex and differential outcomes to treatment with cognitive- behavioral therapy or antidepressant medication for major depressive disorder

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Dunlop, Boadie W., Rajendra, Justin K., Craighead, W. Edward, Kelley, Mary E., McGrath, Callie L., Choi, Ki Sueng, Kinkead, Becky, Nemeroff, Charles B., Mayberg, Helen S.·2017·American Journal of Psychiatry

DOI 10.1176/appi.ajp.2016.16050518PMC PMC5453828

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Abstract

OBJECTIVE: The purpose of this article was to inform the first-line treatment choice between cognitive-behavioral therapy (CBT) or an antidepressant medication for treatment-naive adults with major depressive disorder by defining a neuroimaging biomarker that differentially identifies the outcomes of remission and treatment failure to these interventions. METHOD: Functional MRI resting-state functional connectivity analyses using a bilateral subcallosal cingulate cortex (SCC) seed was applied to 122 patients from the Prediction of Remission to Individual and Combined Treatments (PReDICT) study who completed 12 weeks of randomized treatment with CBT or antidepressant medication. Of the 122 participants, 58 achieved remission (Hamilton Depression Rating Scale [HAM-D] score ≤7 at weeks 10 and 12), and 24 had treatment failure (<30% decrease from baseline in HAM-D score). A 2×2 analysis of variance using voxel-wise subsampling permutation tests compared the interaction of treatment and outcome. Receiver operating characteristic curves constructed using brain connectivity measures were used to determine possible classification rates for differential treatment outcomes. RESULTS: The resting-state functional connectivity of the following three regions with the SCC was differentially associated with outcomes of remission and treatment failure to CBT and antidepressant medication and survived application of the subsample permutation tests: the left anterior ventrolateral prefrontal cortex/insula, the dorsal midbrain, and the left ventromedial prefrontal cortex. Using the summed SCC functional connectivity scores for these three regions, overall classification rates of 72%-78% for remission and 75%-89% for treatment failure was demonstrated. Positive summed functional connectivity was associated with remission with CBT and treatment failure with medication, whereas negative summed functional connectivity scores were associated with remission to medication and treatment failure with CBT. CONCLUSIONS: Imaging-based depression subtypes defined using resting-state functional connectivity differentially identified an individual's probability of remission or treatment failure with first-line treatment options for major depression. This biomarker should be explored in future research through prospective testing and as a component of multivariate treatment prediction models.

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“These findings are consistent with the hypothesis that frontopolar cortical dysfunction plays a key role in the hopelessness that manifests in patients with MDD. Non-standard abbreviations MDD Major depressive disorder BA10 Brodmann area [BA] 10 GRID-HAMD GRID-Hamilton Depression Rating Scale BDI-II Beck Depression In…”
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Multilayer brain network combined with deep convolutional neural network for detecting major depressive disorder
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Autonomic arousal elicited by subcallosal cingulate stimulation is explained by white matter connectivity
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“In keeping with this, one study of patients undergoing either pharmacotherapy with fluoxetine or CBT found that clinical remission to pharmacotherapy was predicted by greater GM volume density in the right rostral ACC, left PCC, whereas no prediction was found for CBT (68).”
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Hippocampal and parahippocampal volume and function predict antidepressant response in patients with major depression: A multimodal neuroimaging study
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Background
Prediction of remission among patients with a major depressive disorder based on the resting-state functional connectivity of emotion regulation networks
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Anterior cingulate gyrus acts as a moderator of the relationship between problematic mobile phone use and depressive symptoms in college students
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“In addition, ACC was regarded as a promising predictor for antidepression response from several studies (Dunlop et al., 2017; Godlewska et al., 2018; Wolke et al., 2019).”
Result

Authors: Dunlop, B. W., Rajendra, J. K., Craighead, W. E., Kelley, M. E., McGrath, C. L., Choi, K. S., Kinkead, B., Nemeroff, C. B., & Mayberg, H. S.
Affiliations: Harvard University (US)
ORCID: Dunlop, Boadie W.
Rajendra, Justin K.
Craighead, W. Edward
Kelley, Mary E.
Choi, Ki Sueng
Kinkead, Becky
Nemeroff, Charles B.
Mayberg, Helen S.
Venue: American Journal of Psychiatry
Publisher: American Psychiatric Association Publishing
Published: 2017-06-01
Volume: 174
Issue: 6
Pages: 533-545
ISSN: 0002-953X (ISSN-L)
1535-7228
DOI: 10.1176/appi.ajp.2016.16050518
PMC: PMC5453828
OpenAlex: W2600118519
Cited by: 342
References: 80
Citations by year: 2026: 20 · 2025: 32 · 2024: 30 · 2023: 30 · 2022: 31 · 2021: 47 · 2020: 55 · 2019: 50 · 2018: 28 · 2017: 19
FWCI: 23.85
Type: journal article
Language: en
Open access: green
www.ncbi.nlm.nih.gov
Locations: American Journal of Psychiatry (publishedVersion)
PubMed (publishedVersion)
Europe PMC (PubMed Central) (acceptedVersion)
PubMed Central (acceptedVersion)
Funders: National Institutes of Health (5r01mh080880-05, UL1TR000454)
National Institute of Mental Health (K23MH086690, R01-MH080880, P50MH077083)
National Center for Research Resources (UL1RR025008, M01RR000039)
National Center for Advancing Translational Sciences
Topics: Life Sciences › Neuroscience › Cognitive Neuroscience › Functional Brain Connectivity Studies
Health Sciences › Medicine › Pharmacology (medical) › Treatment of Major Depression
Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
Keywords: major depressive disorder, resting-state functional connectivity, cognitive behavioral therapy, antidepressants, treatment response prediction, remission, treatment failure, neuroimaging biomarkers, ventromedial prefrontal cortex, dorsal midbrain, anterior insula, ventrolateral prefrontal cortex, individualized treatment selection
MeSH terms: Duloxetine Hydrochloride, Adolescent, Adult, Aged, Antidepressive Agents, Depressive Disorder, Major, Major Depressive Disorder, Dominance, Cerebral, Female, Gyrus Cinguli, Humans, Image Interpretation, Computer-Assisted, Magnetic Resonance Imaging, Male, Middle Aged, Nerve Net, Psychiatric Status Rating Scales, Citalopram, Cognitive Behavioral Therapy, Outcome Assessment, Health Care, Prefrontal Cortex, Young Adult

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Functional connectivity of the subcallosal cingulate cortex and differential outcomes to treatment with cognitive- behavioral therapy or antidepressant medication for major depressive disorder

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