SYMPOSIUM
132. Structural and Connectomic Brain Features of Treatment Resistant Depression and Antidepressant Response to Ketamine

https://doi.org/10.1016/j.biopsych.2019.03.146Get rights and content

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Background

Treatment-resistant depression (TRD), characterizing patients with major depressive disorder (MDD) who do not benefit from conventional antidepressant treatments, is a major public health problem. Ketamine has been reported to be beneficial for patients with TRD, however few studies have investigated brain structural and connectomic patterns specific to TRD and antidepressant response to ketamine.

Methods

Subjects (N=102) underwent structural and resting state functional neuroimaging with MRI at 3T and depression severity was measured using the Montgomery-Asberg Depression Rating Scale (MADRS). We examined the relationship between whole-brain gray matter voxel-based morphometry (VBM) and level of treatment-resistance defined using the Maudsley Staging Model (MSM) in unmedicated patients with MDD (N=61) and healthy controls (N=41). A subset of patients (N=27) received a single IV infusion of

Results

MDD was associated with decreased gray matter volume (GMV) in the left dorsolateral prefrontal cortex (p<0.0005), adjusting for TRD status, age and sex. TRD (MSM score >2) was uniquely associated with decreased GMV in the right retrosplenial cortex and precuneus (p<0.0001). Response to ketamine was associated with decreased connectivity between retroplenial cortex and the ventromedial prefrontal cortex (vmPFC, p<0.005).

Conclusions

We found that TRD was associated with reduced GMV within posterior midline cortical structures, important components of the default mode network. Reduced connectivity within this circuit positively predicted antidepressant response to ketamine.

Supported By

K23 NIMH (Murrough)

Keywords

Depression, Multimodal Neuroimaging, Treatment Resistant Depression, Ketamine, Voxel Based Morphometry

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