Finding neuro-biomarkers for clinical response to CBT in depression
07 April 2009
Cognitive behavioural therapy (CBT) is an effective, short-term psychotherapy treatment for depression. CBT focuses on the thoughts and behaviours which underlie and perpetuate the depressive episode. However, currently there are no neurobiological markers that are used in clinical practice which can help to predict how well an individual with depression will respond to CBT.
Dr. Cynthia Fu, Senior Clinical Lecturer at the Institute of Psychiatry, and colleagues examined the brain responses in individuals suffering from depression while they looked at different facial expressions. Viewing facial expressions engages implicit processing of socially relevant, emotional cues. The researchers investigated whether the pattern of brain activity to sad faces in an individual patient predicted his or her clinical response to CBT. In particular, a subset of patients was initially excluded and reintroduced as novel participants to test how well the pattern of brain activity predicted clinical response in a new, previously unseen patient.
The brain responses to sad faces identified those patients while they were acutely depressed, before they began CBT, who would go on to have a full clinical response to CBT (sensitivity 71%) and those patients who would have some ongoing symptoms of depression following CBT (specificity 86%) (P = 0.029). The brain responses to sad faces may be a more sensitive marker of clinical response to CBT than to antidepressant medication as an earlier study found a lower predictive potential for antidepressant medication.
The development of biomarkers which can help to diagnose and to predict clinical response will help clinicians and individuals with clinical decisions and to choose the best treatments.
The paper authors are: Sergi G. Costafreda, Akash Khanna, Janaina Mourao-Miranda and Cynthia H.Y. Fu. Neural correlates of sad faces predict clinical remission to cognitive behavioural therapy in depression.
NeuroReport. 2009 Mar 31: http://journals.lww.com/neuroreport/Abstract/publishahead/Neural_correlates_of_sad_faces_predict_clinical.99850.aspx.