Original ArticleA Functional Magnetic Resonance Imaging Predictor of Treatment Response to Venlafaxine in Generalized Anxiety Disorder
Section snippets
Participants
Thirty subjects (24 female subjects) shown to be right-handed (26) were studied. Fifteen of these subjects (12 female subjects) answered a local newspaper advertisement seeking individuals with GAD for a venlafaxine treatment study (mean age 27 ± 7 [SD] years; range 19–52). The 15 control subjects who were also recruited via newspaper advertisement (mean age 33 ± 11 [SD] years; range 20–51) did not differ significantly in age [t(28) = 1.79, p > .05] or in years of education [t(28) = .58, p >
fMRI Predictor of Treatment Response in Subjects with GAD: Reported Anxiety
Table 1 presents pretreatment and posttreatment HAM-A scores for all subjects. Individual differences in decrease in HAM-A scores were then correlated with pretreatment amygdala and rACC responsivity of subjects with GAD to fearful faces. Figure 1A depicts a significant positive correlation between drop in HAM-A scores (y axis) and pretreatment rACC (x = −12, y = 32, z = 22) responsivity (x axis) to fearful faces when compared with neutral faces (r = .61, p = .016). Figure 1B shows a
Discussion
Pretreatment fMRI responsivity during presentation of biologically relevant stimuli associated with threat (i.e., fearful faces) predicted treatment response to venlafaxine in subjects with GAD. Specifically, greater rACC and lesser amygdala responsivity to fearful faces predicted greater decreases in anxiety after 8 weeks of treatment. This effect was specific to fearful faces, as no such effect was observed to either happy or neutral faces when directly contrasted (Figure 1E and F).
Given the
References (46)
- et al.
For better or for worse: Neural systems supporting the cognitive down- and up-regulation of negative emotion
Neuroimage
(2004) - et al.
Extinction learning in humans: Role of the amygdala and vmPFC
Neuron
(2004) - et al.
Trauma modulates amygdala and medial prefrontal responses to consciously attended fear
Neuroimage
(2006) - et al.
Exaggerated amygdala response to masked facial stimuli in posttraumatic stress disorder: A functional MRI study
Biol Psychiatry
(2000) - et al.
Increased amygdala response to masked emotional faces in depressed subjects resolves with antidepressant treatment: An fMRI study
Biol Psychiatry
(2001) - et al.
Association between amygdala hyperactivity to harsh faces and severity of social anxiety in generalized social phobia
Biol Psychiatry
(2006) The assessment and analysis of handedness: The Edinburgh Inventory
Neuropsychologia
(1971)- et al.
Development and validation of the Penn State worry questionnaire
Behav Res Ther
(1990) - et al.
Stability of amygdala BOLD response to fearful faces over multiple scan sessions
Neuroimage
(2005) - et al.
Selection of voxel size and slice orientation for fMRI in the presence of susceptibility field gradients: Application to imaging of the amygdala
Neuroimage
(2003)
AFNI: Software for analysis and visualization of functional magnetic resonance neuroimages
Comput Biomed Res
Sequence of information processing for emotions based on the anatomic dialogue between prefrontal cortex and amygdala
Neuroimage
Well-being and life satisfaction in generalized anxiety disorder: Comparison to major depressive disorder in a community sample
J Affect Disord
Amygdala and insular responses to emotionally valenced human faces in small animal specific phobia
Biol Psychiatry
FMRI of fearful facial affect recognition in panic disorder: The cingulate gyrus-amygdala connection
J Affect Disord
Vascular dynamics and BOLD fMRI: CBF level effects and analysis considerations
Neuroimage
The Emotional Brain
The amygdala: Vigilance and emotion
Mol Psychiatry
Fear, vigilance and ambiguity: Initial neuroimaging studies of the human amygdala
Curr Dir Psychol Sci
Efferent connections of the cingulate gyrus in the rhesus monkey
Exp Brain Res
Anatomical organization of the primate amygdaloid complex
Inverse amygdala and medial prefrontal cortex responses to surprised faces
Neuroreport
Contextual modulation of amygdala responsivity to surprised faces
J Cogn Neurosci
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