Elsevier

Journal of Affective Disorders

Volume 174, 15 March 2015, Pages 397-399
Journal of Affective Disorders

Preliminary communication
Anterior cingulate volume predicts response to cognitive behavioral therapy in major depressive disorder

https://doi.org/10.1016/j.jad.2014.12.009Get rights and content

Abstract

Background

Cognitive behavioral therapy (CBT) is widely used to treat major depressive disorder (MDD). Although improved response prediction could facilitate the development of individualized treatment plans, few studies have investigated whether underlying brain structure is related to CBT response in MDD.

Methods

Ten MDD patients who received individual CBT were studied in this study. We investigated the relationship between the regional gray matter (GM) volume and subsequent responses to CBT using voxel-based morphometry.

Results

The degree of improvement in depressive symptoms was positively correlated with GM volume in the caudal portion of the anterior cingulate cortex.

Limitations

The sample size was small, and the effects of medication on the results could not be excluded.

Conclusions

Our results, although preliminary, suggest that the anterior cingulate cortex is a key structure whose volume can be used to predict responses to CBT and is thus a potential prognostic marker in MDD.

Introduction

Cognitive behavioral therapy (CBT) is reported to be effective for about half of people with major depressive disorder (MDD) (Hollon et al., 2002, Siegle et al., 2006). Detecting patients who are likely to benefit from CBT could increase the success rate and reduce the burden on patients. Thus, improving prediction accuracy for responses to CBT is an important goal of MDD research, and in this regard, neuroimaging data may provide useful information. Indeed, several functional neuroimaging studies indicate that CBT response is associated with activation levels in the anterior cingulate cortex (ACC) (Costafreda et al., 2009, Fu et al., 2008, Siegle et al., 2006, Ritchey et al., 2011), although localization within the ACC was mixed. For example, one study showed that CBT was more effective in MDD patients whose sustained responses to emotional stimuli were low in the subgenual ACC (Siegle et al., 2006). Additionally, another study reported that dorsal ACC activity during emotion processing of sad faces showed a significant inverse relationship with subsequent clinical response (Fu et al., 2008).

Although a number of functional imaging studies have examined the relationship between brain activation and subsequent CBT response, few studies have investigated whether underlying brain structure is related to CBT response in MDD. Here, we investigated whether there was a relationship between gray matter (GM) volume and subsequent CBT response in the disorder using voxel-based morphometry (VBM). Based on the results of previous functional imaging studies, we hypothesized that the volume of ACC would be correlated with subsequent CBT responses.

Section snippets

Participants

Fourteen consecutive MDD outpatients who participated in the CBT program in Kyoto University were recruited for the study. Patients had experienced at least one major depressive episode according to the Structured Clinical Interview for DSM-IV Axis I Disorders. Two patients had current comorbid axis I diagnoses; one met the criteria for panic disorder and the other for social anxiety disorder. None had a previous history of psychosis or mania. In addition, none had a history of head trauma, any

Results

The patients varied in the degree of depressive symptom change assessed by BDI-II, but on average the depressive symptoms were improved during CBT (pre-treatment BDI-II: 21.3±8.7, post-treatment BDI-II: 15.2±9.5; p=0.04 [paired t-test, analyzed with spss 21]).

Whole-brain VBM analyses showed that one cluster including the caudal portion of the ACC (peak MNI coordinates: −2, −3, 34 [Broadman area 24], T-score=6.92, k=153 voxels) was positively correlated with the rate of BDI-II improvement (Fig. 1

Discussion

In this study, we investigated whether there was a relationship between GM volume and subsequent CBT responses in MDD patients. We found a significant correlation between GM volume in the caudal portion of the ACC and improvements in depressive symptoms during CBT. Our results suggest that the volume in the region can predict CBT responses.

Identifying predictors of treatment efficacy is an essential goal of MDD research. Previous functional imaging studies related to emotional processing showed

Conflict of interest

All authors declare that they have no conflicts of interest.

Role of funding source

This work was supported by Grants-in-Aid for Young Scientists B (23791326) from the Japan Society for the Promotion of Science; SENSHIN Medical Research Foundation; Grants-in-Aid for scientific research S (22220003), scientific research A (24243061), and on Innovative Areas (23118004, 23120009), from the Ministry of Education, Culture, Sports, Science and Technology of Japan; Health and Labour Science Research Grant for Comprehensive Research on Disability Health and Welfare

Acknowledgements

The authors wish to extend their gratitude to Ryosaku Kawada, Yusuke Tanaka, Manabu Kubota, Akihiko Sasamoto, Shiho Ubukata, Yukiko Matsumoto, Masanori Isobe, Shuraku Son, Kousuke Tsurumi, Kimito Hirose, Yasuo Mori, Naoto Yokoyama, Miki Ono, Naho Saito, Tomomi Noda, Hideaki Takeuchi, Ema Murao and Takuro Murao for their assistance in data acquisition and processing, and, most of all, to the patients and volunteers for participating in the study.

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