Brain imaging predictors and the international study to predict optimized treatment for depression: study protocol for a randomized controlled trial
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BACKGROUND: Approximately 50% of patients with major depressive disorder (MDD) do not respond optimally to antidepressant treatments. Given this is a large proportion of the patient population, pretreatment tests that predict which patients will respond to which types of treatment could save time, money and patient burden. Brain imaging offers a means to identify treatment predictors that are grounded in the neurobiology of the treatment and the pathophysiology of MDD. METHODS/DESIGN: The international Study to Predict Optimized Treatment in Depression is a multi-center, parallel model, randomized clinical trial with an embedded imaging sub-study to identify such predictors. We focus on brain circuits implicated in major depressive disorder and its treatment. In the full trial, depressed participants are randomized to receive escitalopram, sertraline or venlafaxine-XR (open-label). They are assessed using standardized multiple clinical, cognitive-emotional behavioral, electroencephalographic and genetic measures at baseline and at eight weeks post-treatment. Overall, 2,016 depressed participants (18 to 65 years old) will enter the study, of whom a target of 10% will be recruited into the brain imaging sub-study (approximately 67 participants in each treatment arm) and 67 controls. The imaging sub-study is conducted at the University of Sydney and at Stanford University. Structural studies include high-resolution three-dimensional T1-weighted, diffusion tensor and T2/Proton Density scans. Functional studies include standardized functional magnetic resonance imaging (MRI) with three cognitive tasks (auditory oddball, a continuous performance task, and Go-NoGo) and two emotion tasks (unmasked conscious and masked non-conscious emotion processing tasks). After eight weeks of treatment, the functional MRI is repeated with the above tasks. We will establish the methods in the first 30 patients. Then we will identify predictors in the first half (n=102), test the findings in the second half, and then extend the analyses to the total sample. TRIAL REGISTRATION: International Study to Predict Optimized Treatment--in Depression (iSPOT-D). ClinicalTrials.gov, NCT00693849.
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Previous data from this study support the concept that functional and white matter DTI structural deficits underlie the fronto-limbic dysfunction observed in MDD.
“We have recently presented data from this study supporting the concept that functional and white matter Diffusion Tensor Imaging (DTI) structural deficits underlie the fronto-limbic dysfunction observed in MDD (Grieve et al., 2013; Korgaonkar et al., 2011, 2012).”
From Widespread reductions in gray matter volume in depression (2013) · cites this paper as Grieve et al., 2013
Strong abnormal fMRI measures affecting the amygdala were observed in the current cohort, but the associated GM volume changes in the amygdala were weak and may not be as robust to observe for assessments made at the whole brain level.
“Although, we observe strong abnormal fMRI measures affecting the amygdala in the current cohort, the associated GM volume changes in the amygdala were weak (Grieve et al., 2013) and may not be as robust to observe for assessments made at the whole brain level.”
From Widespread reductions in gray matter volume in depression (2013) · cites this paper as Grieve et al., 2013
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Widespread reductions in gray matter volume in depression
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- Authors
- Grieve, S. M., Korgaonkar, M. S., Etkin, A., Harris, A., Koslow, S. H., Wisniewski, S., Schatzberg, A. F., Nemeroff, C. B., Gordon, E., & Williams, L. M.
- Affiliations
- The University of Sydney (AU)
- VA Palo Alto Health Care System (US)
- University of Miami (US)
- Stanford University (US)
- Corresponding author
- Grieve, Stuart M
- ORCID
- Venue
- Trials
- Published
- 2013
- Volume
- 14
- Issue
- 1
- Pages
- 224
- ISSN
- 1745-6215 (ISSN-L)
- PMC
- PMC3729660
- OpenAlex
- W2099704444
- Cited by
- 44
- References
- 63
- Citations by year
- 2025: 2 · 2024: 4 · 2023: 1 · 2022: 2 · 2021: 2 · 2020: 2 · 2019: 9 · 2018: 2 · 2017: 2 · 2016: 2 · 2015: 6 · 2014: 8 · 2013: 2
- FWCI
- 4.41
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- Trials (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
- Life Sciences › Neuroscience › Cognitive Neuroscience › Neural and Behavioral Psychology Studies
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- major depressive disorder, treatment response prediction, antidepressant treatment, neuroimaging, escitalopram, sertraline, venlafaxine, structural MRI, diffusion tensor imaging, functional MRI, emotional processing, cognitive tasks, EEG, genetic markers, treatment-resistant depression
- MeSH terms
- Venlafaxine Hydrochloride, Adolescent, Adult, Aged, Antidepressive Agents, Brain, California, Clinical Protocols, Cognition, Cyclohexanols, Depressive Disorder, Major, Major Depressive Disorder, Emotions, Female, Humans, Magnetic Resonance Imaging, Male, Middle Aged, Neuropsychological Tests, New South Wales, Predictive Value of Tests, Prospective Studies, Psychiatric Status Rating Scales, Research Design, Citalopram, Treatment Outcome, Sertraline, Young Adult, Diffusion Tensor Imaging
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