Cortical Thickness Predicts Response Following 2 Weeks of SSRI Regimen in First-Episode, Drug-Naive Major Depressive Disorder: An MRI Study
Authors: Wu Peiyi , Zhang Aixia , Sun Ning , Lei Lei , Liu Penghong , Wang Yikun , Li Hejun , Yang Chunxia , Zhang Kerang 
Published: February 2022

Objective

Major depression disorder (MDD) is a harmful disorder, and the pathological mechanism remains unclear. The primary pharmacotherapy regimen for MDD is selective serotonin reuptake inhibitors (SSRIs), but fewer than 40% of patients with MDD are in remission following initial treatment. Neuroimaging biomarkers of treatment efficacy can be used to guide personalized treatment in MDD. This study aims to determine if cortical thickness can be used as a predictor for SSRIs.

Methods

A total of 126 first-episode, drug-naive MDD patients (MDDs) and 71 healthy controls (HCs) were enrolled in our study. Demographic data were collected according to the self-made case report form (CRF) at the baseline of all subjects. Magnetic resonance imaging (MRI) scanning was performed for all the participants at baseline, and all imaging was processed using the DPABISurf software. All MDDs were treated with SSRIs, and symptoms were assessed at both the baseline and 2 weeks using the 17-item Hamilton Rating Scale (HAMD-17). According to HAMD-17 total score improvement from baseline to the end of 2 weeks, the MDDs were divided into the non-responder group (defined as ≤ 20% HAMD-17 reduction) and responder group (defined as ≥50% HAMD-17 reduction). The receiver operating characteristic (ROC) curve was used to analyze the diagnostic value of MDDs' and HCs' cortical thickness for MDD. Correlation analysis was performed for the responder group and the non-responder group separately to identify the relationship between cortical thickness and SSRI treatment efficacy. To analyze whether cortical thickness was sufficient to differentiate responders and non-responders at baseline, we used ROC curve analysis.

Results

Significant decreases were found in the cortical thickness of the right supplementary motor area (SMA) in MDDs at the baseline (corrected by the Monte Carlo permutation correction, cluster-wise significant threshold at p &lt; 0.025 and vertex-wise threshold at p = 0.001), area under the curve (AUC) = 0.732 [95% confidence interval (CI) = 0.233–0.399]. In the responder group, the cortical thickness of the right SMA was significantly thinner than in the non-responder group at baseline. There was a negative correlation (r = −0.373, p = 0.044) between the cortical thickness of SMA (0 weeks) and HAMD-17 reductive rate (2 weeks) in the responder group. The results of ROC curve analyses of the responder and non-responder groups were AUC = 0.885 (95% CI = 0.803–0.968), sensitivity = 73.5%, and specificity = 96.6%, and the cutoff value was 0.701.

Conclusion

Lower cortical thickness of the right SMA in MDD patients at the baseline may be a neuroimaging biomarker for MDD diagnosis, and a greater extent of thinner cortical thickness in the right SMA at baseline may predict improved SSRI treatment response. Our study shows the potential of cortical thickness as a possible biomarker that predicts a patient's clinical treatment response to SSRIs in MDD.