Resting State Functional Connectivity of the Reward System and Outcomes in Psychotherapies for Late-Life Depression

https://doi.org/10.1016/j.biopsych.2020.02.1118Get rights and content

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Background

Problem solving therapy (PST) and “Engage”, a reward-exposure” based therapy, are important treatment options for late-life depression (LLD), given modest efficacy of antidepressants in this disorder. Abnormal function of reward networks has been observed during depressive episodes. This study examined whether resting state functional connectivity (rsFC) of reward circuitries is associated with treatment outcomes.

Methods

Thirty-two older adults with major depression (mean age = 72.7) were randomized to 9-weeks of either PST or “Engage,” a novel reward exposure-based psychotherapy. We assessed rsFC at baseline and Week 6. We placed seeds in three a priori regions of interest: subgenual cingulate (sgACC), dorsal anterior cingulate cortex (dACC), and nucleus accumbens (NAcc). Outcome measures included the Hamilton Depression Rating Scale (HAM-D) and the Behavioral Activation for Depression Scale (BADS).

Results

In both PST and “Engage”, higher rsFC between the sgACC and middle temporal gyrus at baseline was associated with greater improvement in depression severity (HAM-D). In “Engage” treated participants, lower rsFC between the dACC and DMPFC at baseline was associated with HAM-D improvement. Finally, in Engage only, increased rsFC from baseline to Week 6 between NAcc and Superior Parietal Cortex was associated with increased BADS scores.

Conclusions

Higher rsFC of the sgACC with cortical structures predicted favorable response to behavioral psychotherapies. Low rsFC within cognitive control and reward network circuitry (dACC-DMPFC) at baseline predicted favorable response to “Engage” but not to PST. Increased rsFC of a central node of the reward network (NAcc) during “Engage” was correlated with behavioral activation.

Supported By

T32 MH019132; P50 MH113838; R01 MH102252

Keywords

Psychotherapy, Late Life Depression, Reward Network, Brain Magnetic Resonance Imaging (MRI), Efficacy

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