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Cingulate prediction of response to antidepressant and cognitive behavioral therapies for depression: Meta-analysis and empirical application

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Abstract

We sought to identify baseline (pre-treatment) neural markers associated with treatment response in major depressive disorder (MDD), specific to treatment type, Cognitive Behavioral Therapy (CBT) or pharmacotherapy (selective serotonin reuptake inhibitors; SSRI). We conducted a meta-analysis of functional magnetic resonance imaging (fMRI) studies to identify neural prognostic indicators of response to CBT or SSRI. To verify the regions derived from literature, the meta-analytic regions were used to predict clinical change in a verification sample of participants with MDD who received either CBT (n = 60) or an SSRI (n = 19) as part of prior clinical trials. The meta-analysis consisted of 21 fMRI studies that used emotion-related tasks. It yielded prognostic regions of the perigenual (meta pgACC) and subgenual anterior cingulate cortex (meta sgACC), associated with SSRI and CBT response, respectively. When applying the meta-analytic regions to predict treatment response in the verification sample, reactivity of the meta pgACC was prognostic for SSRI response, yet the effect direction was opposite of most prior studies. Meta sgACC reactivity failed to be prognostic for CBT response. Results confirm the prognostic potential of neural reactivity of ACC subregions in MDD but further research is necessary for clinical translation.

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Data Availability (data transparency)

The data that support the findings of this study are available from the corresponding author on reasonable request.

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Funding

Supported by the National Institute of Mental Health MH082998, MH074807, MH58356, MH69618, and the Pittsburgh Foundation, Emmerling Fund M2007-0114.

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Authors and Affiliations

  1. Department of Psychiatry, University of Pittsburgh, Pittsburgh, United States

    Marlene V. Strege Ph.D., Greg J. Siegle Ph.D. & Kymberly Young Ph.D.

  2. Department of Psychology, Virginia Polytechnic Institute and State University, Blacksburg, United States

    John A. Richey Ph.D.

  3. University of Pittsburgh Medical Center, Pittsburgh, United States

    Rebecca A. Krawczak B.S.

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Author contributions included conception and study design (MVS, GJS, KY), data collection or acquisition (MVS, GJS), statistical analysis (MVS, GJS), interpretation of results (MVS, GJS, KY, JAR), drafting the manuscript work or revising it critically for important intellectual content (All authors) and approval of final version to be published and agreement to be accountable for the integrity and accuracy of all aspects of the work (All authors).

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Author GJS receives royalty payments on a patent regarding a novel depression intervention licensed to Apollo Neurosciences, which is not relevant to this article, and consults for Johnson and Johnson on novel pharmacology unrelated to this project. The other authors report nothing to disclose.

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Strege, M.V., Siegle, G.J., Richey, J.A. et al. Cingulate prediction of response to antidepressant and cognitive behavioral therapies for depression: Meta-analysis and empirical application. Brain Imaging and Behavior 17, 450–460 (2023). https://doi.org/10.1007/s11682-022-00756-0

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