Resting State Functional Connectivity and Outcomes of Psychotherapies for Late-Life Depression

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Highlights

  • What is the primary question addressed by this study? The study investigated whether there is an association between resting state functional connectivity (rsFC) of the reward and default mode network (DMN) and outcomes of problem solving therapy (PST) and “Engage” psychotherapy for late life depression.

  • What is the main finding of this study? We found that in both PST and “Engage,” higher rsFC between DMN nodes at baseline was associated with greater improvement in depression severity. Additionally, in “Engage” treated participants, lower rsFC between the dorsal anterior cingulate cortex and dorsomedial prefrontal cortex at baseline was associated with depression improvement. Finally, in “Engage” only, early increase between NAcc and superior parietal cortex was associated with increased behavioral activation.

  • What is the meaning of the finding? Depressed older adults who present with higher functional connectivity between DMN nodes may benefit from behavioral psychotherapies. Additionally, “Engage,” a reward-exposure based therapy, may facilitate increase in rsFC of the reward system, and lead to increase in behavioral activation.

ABSTRACT

Background

Problem solving therapy (PST) and “Engage,” a reward-exposure” based therapy, are important treatment options for late-life depression, given modest efficacy of antidepressants in this disorder. Abnormal function of the reward and default mode networks has been observed during depressive episodes. This study examined whether resting state functional connectivity (rsFC) of reward and DMN 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.” We assessed rsFC at baseline and week 6. We placed seeds in three a priori regions of interest: subgenual anterior cingulate cortex (sgACC), dorsal anterior cingulate cortex (dACC), and nucleus accumbens (NAcc). Outcome measures included the Hamilton Depression Rating Scale (HAMD) 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 (HAMD). Preliminary findings suggested that in “Engage” treated participants, lower rsFC between the dACC and dorsomedial prefrontal cortex at baseline was associated with HAMD improvement. Finally, in Engage only, increased rsFC from baseline to week 6 between NAcc and Superior Parietal Cortex was associated with increased BADS scores.

Conclusion

The results suggest that patients who present with higher rsFC between the sgACC and a structure within the DMN may benefit from behavioral psychotherapies for late life depression. “Engage” may lead to increased rsFC within the reward system reflecting a reconditioning of the reward systems by reward exposure

Key Words

Depressed individuals often have abnormalities in the reward systems and the default mode network (DMN),

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  • Sheline YI
  • Barch DM
  • Price JL
  • et al.
The default mode network and self-referential processes in depression.