Imaging Predictors of Treatment Response in Depression
Status:
Completed
Trial end date:
2013-07-01
Target enrollment:
Participant gender:
Summary
While there are many effective options for treating a major depressive episode, there are no
clinical markers that predict the likelihood of remission with an initial trial of either an
antidepressant medication or psychotherapy. More critically, there are also no reliable
predictors that might anticipate failure to such standard treatments either alone or in
combination. This project will characterize imaging-based brain subtypes that distinguish
groups of depressed patients who later remit or not to SSRI pharmacotherapy or cognitive
behavior therapy (CBT), respectively. To define these subtypes, a prospectively-treated
cohort of 100 patients will be randomized to receive either escitalopram (s-CIT) or CBT for
the first 12 weeks, with non-remitters to either first treatment crossed over to receive an
additional 12 weeks of treatment with combined treatment. Non-remitters to both treatments
will thus define a relatively treatment resistant third subgroup. Resting-state
18F-fluoro-deoxyglucose (FDG) positron emission tomography (PET) scans will be acquired prior
to initiating antidepressant therapy, with pre-treatment scan patterns associated with three
possible outcomes (CBT remission, s-CIT remission, and non-remission to both) assessed using
multivariate analytic methods. A second PET scan, acquired early in the treatment course,
will be used to assess the likelihood of response to the specific treatment first assigned.
The proposed studies are a first step towards defining brain-based biomarkers predictive of
differential treatment outcome in major depression; most critically, patterns distinguishing
patients at risk for treatment resistance. Identification of such biomarkers has additional
implications for future testing of novel therapies in patients with distinct brain
signatures, including development of evidence-based treatment algorithms for individual
patients.