Neural Predictors of Treatment Response in Depression

Abstract

Depression is a leading cause of disability and treatment response is highly variable between patients. The current review focuses on recent findings from studies exploring neural predictors of treatment response to conventional antidepressant drugs, psychological treatment, and novel candidate interventions. Structural markers of response have revealed that decreased volume of key substrates such as the hippocampus and orbitofrontal cortex are predictive of poor response to antidepressant drug treatment, and diffusion tensor imaging offers potentially relevant information for future studies. Pretreatment measures of rostral anterior cingulate activity (from functional magnetic resonance imaging- and electroencephalogram-based approaches) have also been highlighted as a biomarker for antidepressant drug response. The relative utility of measurements taken at baseline versus early change for refining treatment in individual patients is considered. The response to novel treatments such as scopolamine, ketamine, and deep brain stimulation also offer promise for understanding targets of treatment and predictors for tailoring treatment. There is considerable overlap between neural biomarkers for different treatments although positron emission tomography metabolism in the anterior insula may offer a differential predictor of response to pharmacotherapy versus psychotherapy in depression. These insights provide important information about the potential targets and mechanisms underlying the prediction of treatment effects in depression. Future work needs to explore these different predictors between treatment arms in prospectively defined studies to evaluate whether these markers may have utility in the clinic.