Amygdala rtfMRI Neurofeedback for Treatment Resistant Depression

杏仁核 rtfMRI 神经反馈治疗难治性抑郁症

• 批准号: 10634725
• 负责人: Kym Young
• 金额: $ 57.31万
• 依托单位: UNIVERSITY OF PITTSBURGH AT PITTSBURGH
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-08-01 至 2025-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10634725
• 关键词: Affect; Amygdaloid structure; Antidepressive Agents; Autobiography; Brain; Characteristics; Clinical; Clinical Trials; Cognitive; Control Groups; Development; Diagnosis; Disease; Disease remission; Dose; Double-Blind Method; Educational Intervention; Emotional; Ensure; Evaluation; Functional Magnetic Resonance Imaging; Functional disorder; Goals; Individual; Intervention; Left; Major Depressive Disorder; Memory; Mood Disorders; Moods; Outcome; Parietal; Participant; Patients; Pharmaceutical Preparations; Phase; Pilot Projects; Population; Randomized; Recovery; Research; Resistance; Sampling; Specificity; Stimulus; Symptoms; Time; Training; Treatment Efficacy; Work; behavioral response; clinical effect; clinical efficacy; clinically relevant; daily functioning; depressive symptoms; hemodynamics; improved; indexing; insight; intervention refinement; memory recall; neurofeedback; pharmacologic; psychologic; public health relevance; randomized, clinical trials; research clinical testing; response; success; therapy development; therapy resistant; treatment response; treatment-resistant depression

Abstract Up to two-thirds of patients diagnosed with major depressive disorder (MDD) will not respond to standard pharmacological and psychological interventions and will be considered treatment resistant (TR-MDD). Decreased reactivity to positive stimuli, indexed by low amygdala reactivity to positive autobiographical memory recall, may be a causal mechanism interfering with recovery from TR-MDD. Previous work in our lab suggests that individuals who do respond to antidepressant medications show increased amygdala activity that is indistinguishable from controls relative to baseline, while TR-MDD individuals fail to show this increase in amygdala activity. Furthermore, we have found that MDD participants (more generally, not specifically TR- MDD) are indeed able to increase their amygdala response during positive memory recall via real-time fMRI neurofeedback (rtfMRI-nf) training, and that this increase is associated with large and rapid reductions in depressive symptoms. Here, we propose to evaluate whether rtfMRI-nf training to increase the amygdala response to positive memories may serve as an intervention for TR-MDD. The R61 period will involve intervention refinement and evaluation of mechanism; N=40 TR-MDD individuals will undergo five amygdala rtfMRI-nf training sessions and we will assess changes in amygdala activity with the goal of confirming that patients with TR-MDD are able to increase the amygdala response to positive memories, and to determine the minimal number of training sessions required for sufficient target engagement/amygdala asymptote to be reached. The R33 phase will involve a mechanistic comparison to a control intervention and evaluation of clinical change (including duration of effects). N=60 TR-MDD individuals will be randomly assigned under double-blind conditions to the amygdala rtfMRI-nf intervention or to a control rtfMRI-nf intervention where they are trained to regulate a parietal region putatively not involved in emotional processing or MDD. Success will suggest a new non-pharmacological, non-invasive intervention for a traditionally treatment-resistant population of MDD individuals.

抽象的 多达三分之二的被诊断为重度抑郁症（MDD）的患者不会对标准做出反应 药理和心理干预措施，将被视为耐药性（TR-MDD）。 对正刺激的反应性降低，由低杏仁核对阳性自传的反应性索引 记忆召回，可能是一种因果机制，会干扰从TR-MDD恢复。以前在我们的实验室工作 表明确实对抗抑郁药反应的人表明，杏仁核活动增加了 与基线相对于控件没有区别，而TR-MDD个人无法显示这种增加 杏仁核活性。此外，我们发现MDD参与者（更一般地，不是特定的 MDD的确能够通过实时fMRI在积极记忆期间增加其杏仁核反应 神经反馈（RTFMRI-NF）训练，并且这种增加与大量和快速减少有关 抑郁症状。在这里，我们建议评估RTFMRI-NF培训是否增加杏仁核 对积极记忆的反应可以作为TR-MDD的干预。 R61时期将涉及 干预和评估机制； n = 40个TR-MDD个人将经历五个杏仁核 RTFMRI-NF培训课程，我们将评估杏仁核活动的变化，以确认该课程 TR-MDD患者能够增加杏仁核对阳性记忆的反应，并确定 足够目标参与所需的培训数量最少/杏仁核渐近线 到达。 R33阶段将涉及与控制干预和评估的机械比较 临床变化（包括影响持续时间）。 n = 60 tr-mdd个人将被随机分配 杏仁核RTFMRI-NF干预或控制RTFMRI-NF干预的双盲条件 受过训练，以规范一个不参与情感处理或MDD的顶叶区域。成功将 为传统的耐药人群提出新的非药理，非侵入性干预措施 MDD个人。