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Randomized Controlled Trial
. 2009 May;34(3):175-80.

Predictors of nonresponse to cognitive behavioural therapy or venlafaxine using glucose metabolism in major depressive disorder

Jakub Z Konarski  1 , Sidney H Kennedy, Zindel V Segal, Mark A Lau, Peter J Bieling, Roger S McIntyre, Helen S Mayberg
Affiliations
Randomized Controlled Trial

Predictors of nonresponse to cognitive behavioural therapy or venlafaxine using glucose metabolism in major depressive disorder

Jakub Z Konarski et al. J Psychiatry Neurosci. 2009 May.

Abstract
in English, French

Background: Longitudinal neuroimaging investigations of antidepressant treatment offer the opportunity to identify potential baseline biomarkers associated with poor outcome.

Methods: To explore the neural correlates of nonresponse to cognitive behavioural therapy (CBT) or venlafaxine (VEN), we compared pretreatment (18)F-fluoro-2-deoxy-d-glucose positron emission tomography scans of participants with major depressive disorder responding to either 16 weeks of CBT (n = 7) or VEN treatment (n = 9) with treatment nonresponders (n = 8).

Results: Nonresponders to CBT or VEN, in contrast to responders, exhibited pretreatment hypermetabolism at the interface of the pregenual and subgenual cingulate cortices.

Limitations: Limitations of our study include the small sample sizes and the absence of both arterial sampling to determine absolute glucose metabolism and high-resolution structural magnetic resonance imaging coregistration for region-of-interest analyses.

Conclusion: Our current findings are consistent with those reported in previous studies of relative hyperactivity in the ventral anterior cingulate cortex in treatment-resistant populations.

Contexte: Les études de neuro-imagerie longitudinales pendant le traitement antidépresseur offrent la possibilité de repérer certains biomarqueurs de base susceptibles d’être associés à une évolution moins favorable.

Méthodes: Pour explorer les corrélats neuraux propres au phénomène de résistance à la thérapie cognitivo-comportementale (TCC) ou au traitement par venlafaxine (VEN), nous avons comparé les tomographies par émission de positrons au (18)F-fluoro-2-désoxy-d-glucose préthérapeutiques de participants atteints de troubles dépressifs majeurs qui ont répondu soit à 16 semaines de TCC (n = 7), soit à un traitement par VEN (n = 9), à celles de participants n’ayant pas répondu au traitement (n = 8).

Résultats: Comparativement aux participants ayant répondu au traitement, ceux qui n’ont répondu ni à la TCC ni à la VEN présentaient en prétraitement un hypermétabolisme au niveau de l’interface du cortex cingulaire ventro-antérieur du genou du corps calleux.

Limites: Les limites de notre étude sont notamment la petite taille des échantillons et l’absence à la fois de prélèvements artériels pour déterminer le métabolisme absolu du glucose et d’enregistrements simultanés d’imagerie par résonance magnétique structurelle de haute résolution à des fins d’analyse des régions concernées.

Conclusion: Nos résultats actuels concordent avec ceux d’études antérieures sur l’hyperactivité relative du cortex cingulaire ventro-antérieur dans le traitement des populations réfractaires au traitement.

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Figures

Fig. 1
Fig. 1
Ventral anterior cingulate cortex (Montreal Neurological Institute coordinates −10, 40, −04) hypermetabolism in non-responders to either treatment (pooled nonresponders, n = 8 > pooled responders, n = 16, p < 0.01 uncorrected, k > 74).
Fig. 2
Fig. 2
Hypermetabolism in nonresponders to either treatment (p > 0.01 uncorrected, k > 74).
See this image and copyright information in PMC

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