Abstract
Mechanisms and predictors for the successful treatment of anxiety and depression have been elusive, limiting the effectiveness of existing treatments and curtailing the development of new interventions. In this study, we evaluated the utility of three widely used neural probes of emotion (experience, regulation, and perception) in their ability to predict symptom improvement and correlate with symptom change following two first-line treatments—selective serotonin reuptake inhibitors (SSRIs) and cognitive-behavioral therapy (CBT). Fifty-five treatment-seeking adults with anxiety and/or depression were randomized to 12 weeks of SSRI or CBT treatment (ClinicalTrials.gov identifier: NCT01903447). Functional magnetic resonance imaging (fMRI) was used to examine frontolimbic brain function during emotion experience, regulation, and perception, as probed by the Emotion Regulation Task (ERT; emotion experience and regulation) and emotional face assessment task (EFAT; emotion perception). Brain function was then related to anxiety and depression symptom change. Results showed that both SSRI and CBT treatments similarly attenuated insula and amygdala activity during emotion perception, and greater treatment-related decrease in insula and amygdala activity was correlated with greater reduction in anxiety symptoms. Both treatments also reduced amygdala activity during emotion experience but brain change did not correlate with symptom change. Lastly, greater pre-treatment insula and amygdala activity during emotion perception predicted greater anxiety and depression symptom improvement. Thus, limbic activity during emotion perception is reduced by both SSRI and CBT treatments, and predicts anxiety and depression symptom improvement. Critically, neural reactivity during emotion perception may be a non-treatment-specific mechanism for symptom improvement.
Original language | English (US) |
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Pages (from-to) | 1639-1648 |
Number of pages | 10 |
Journal | Neuropsychopharmacology |
Volume | 44 |
Issue number | 9 |
DOIs | |
State | Published - Aug 1 2019 |
Funding
This study was funded by the National Institute of Mental Health of the National Institutes of Health grant R01MH101497 (to KLP) and the National Center for Advancing Translational Sciences, National Institutes of Health, through grant UL1TR002003. SMG is funded by the National Institute on Alcohol Abuse and Alcoholism grant K23AA025111. MBS has in the past 3 years been a consultant for Actelion, Aptinyx, Bionomics, Dart Neuroscience, Healthcare Management Technologies, Janssen, Neurocrine Biosciences, Oxeia Biopharmaceuticals, Pfizer, and Resilience Therapeutics. MBS owns founders shares and stock options in Resilience Therapeutics and has stock options in Oxeia Biopharmaceuticals. The remaining authors declare that they have no conflict of interest.
ASJC Scopus subject areas
- Psychiatry and Mental health
- Pharmacology