Jonathan Silver, MD reviewing Goldstein-Piekarski AN et al. Proc Natl Acad Sci U S A 2016 Oct 18.

Early life stress combined with amygdala responsivity on imaging was sensitive and specific in predicting therapeutic response.

Early life stress (ELS) and the response of the amygdala to stressful stimuli may be mechanisms for the development of depression. To evaluate whether the interaction of baseline amygdala responsivity and history of ELS has a relationship to antidepressant response, researchers analyzed data from the industry-funded International Study to Predict Optimized Treatment in Depression (iSPOT-D). ELS was determined on a rating scale, and amygdala responsivity to happy or fearful faces compared with neutral faces was measured on functional magnetic resonance imaging (fMRI).

The analyzed sample consisted of 70 individuals with depression, divided by ELS history and functional remission status. Patients had been randomized to escitalopram (mean dose, 10.2 mg), sertraline (mean dose, 59.5 mg), or venlafaxine (mean dose, 90.0 mg). There was no relationship between response and antidepressant or dose. Prediction models were amygdala reactivity to happy faces × ELS, reactivity to fearful faces × ELS, and a model combining ELS with both reactivity measures. The combined model had a sensitivity of 89% and specificity of 88% in determining response to antidepressant therapy. Low ELS and amygdala hyporeactivity to happy and fearful faces or high ELS and response to happy faces (social reward) were associated with better response to antidepressants.

CITATION(S):

Goldstein-Piekarski AN et al. Human amygdala engagement moderated by early life stress exposure is a biobehavioral target for predicting recovery on antidepressants. Proc Natl Acad Sci U S A 2016 Oct 18; 113:11955.

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