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Remission prognosis for cognitive therapy for recurrent depression using the pupil: utility and neural correlates. | LitMetric

AI Article Synopsis

  • - The study explores how pupillary responses to negative emotional information can predict which patients with major depressive disorder are likely to benefit from cognitive therapy (CT) by assessing their responses before treatment.
  • - Results showed that remission from depression was linked to low initial severity or a mix of high severity and low sustained pupillary responses, achieving high accuracy in predicting remitters versus nonremitters.
  • - The findings suggest that disruptions in brain regions related to executive control and emotion regulation, indicated by pupillary responses, may be crucial factors in achieving remission through CT, highlighting the potential of simple, cost-effective assessments in clinical settings.

Article Abstract

Background: Although up to 60% of people with major depressive disorder respond to cognitive therapy (CT) in controlled trials, clinicians do not routinely use standardized assessments to inform which patients should receive this treatment. Inexpensive, noninvasive prognostic indicators could aid in matching patients with appropriate treatments. Pupillary response to emotional information is an excellent candidate, reflecting limbic reactivity and executive control. This study examined 1) whether pretreatment assessment of pupillary responses to negative information were associated with remission in CT and 2) their associated brain mechanisms.

Methods: We examined whether pretreatment pupillary responses to emotional stimuli were prognostic for remission in an inception cohort of 32 unipolar depressed adults to 16 to 20 sessions of CT. Twenty patients were then assessed on the same task using functional magnetic resonance imaging. Pupillary responses were assessed in 51 never-depressed controls for reference.

Results: Remission was associated with either low initial severity or the combination of higher initial severity and low sustained pupillary responses to negative words (87% correct classification of remitters and nonremitters, 93% sensitivity, 80% specificity; 88% correct classification of high-severity participants, p < .01, 90% sensitivity, 92% specificity). Increased pupillary responses were associated with increased activity in dorsolateral prefrontal regions associated with executive control and emotion regulation.

Conclusions: For patients with higher severity, disruptions of executive control mechanisms responsible for initiating emotion regulation, which are indexed by low sustained pupil responses and targeted in therapy, may be key to remitting in this intervention. These mechanisms can be measured using inexpensive noninvasive psychophysiological assessments.

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Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3951934PMC
http://dx.doi.org/10.1016/j.biopsych.2010.12.041DOI Listing

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