Lindsay W Victoria1, George S Alexopoulos2, Irena Ilieva2, Aliza T Stein3, Matthew J Hoptman4, Naib Chowdhury2, Matteo Respino2, Sarah Shizuko Morimoto5, Dora Kanellopoulos2, Jimmy N Avari2, Faith M Gunning2. 1. Weill Cornell Institute of Geriatric Psychiatry, Department of Psychiatry, Weill Cornell Medicine, 21 Bloomingdale Road, White Plains, NY, United States. Electronic address: liv3002@med.cornell.edu. 2. Weill Cornell Institute of Geriatric Psychiatry, Department of Psychiatry, Weill Cornell Medicine, 21 Bloomingdale Road, White Plains, NY, United States. 3. Department of Psychology, University of Texas at Austin, Austin, TX, United States. 4. Schizophrenia Research Division, Nathan S. Kline Institute for Psychiatric Research, Orangeburg, NY, United States; Department of Psychiatry, New York University School of Medicine, New York, NY, United States. 5. Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, UT, United States.
Abstract
BACKGROUND: Negative self-referential thinking is a common symptom of depression associated with poor treatment response. In late-life depression, white matter abnormalities may contribute to negative self-referential thoughts following antidepressant treatment. We investigated the association of fractional anisotropy (FA) in select regions of the negative valence system (NVS) with residual negative self-referential thoughts following treatment with escitalopram for late-life depression. METHODS: The participants were older adults with major depression and psychiatrically normal controls. Depressed participants received 12 weeks of treatment with escitalopram. To assess self-referential thinking, participants completed a Trait Adjective Task at baseline and at week 12. Baseline MRI scans included a diffusion imaging sequence for FA analyses. RESULTS: Participants with late-life depression differed from controls on all performance measures of the Trait Adjective Task at baseline and at 12 weeks. Depressed participants endorsed fewer negative personality traits and more positive personality traits at week 12 compared to baseline. Lower FA in the dorsal anterior cingulate and in the uncinate fasciculus in depressed participants was correlated with residual negative self-referential thinking (e.g., more endorsed negative adjectives, fewer rejected negative adjectives) at treatment end. LIMITATIONS: The sample size is modest so the findings are preliminary. FA analyses were restricted to predetermined regions. CONCLUSIONS: Negative self-referential thinking improved in depressed older adults following 12 weeks of treatment with escitalopram. Baseline FA in select white matter regions of the NVS was associated with residual negative self-referential thinking. These findings may help identify treatment targets for residual negative self-referential thoughts.
BACKGROUND: Negative self-referential thinking is a common symptom of depression associated with poor treatment response. In late-life depression, white matter abnormalities may contribute to negative self-referential thoughts following antidepressant treatment. We investigated the association of fractional anisotropy (FA) in select regions of the negative valence system (NVS) with residual negative self-referential thoughts following treatment with escitalopram for late-life depression. METHODS: The participants were older adults with major depression and psychiatrically normal controls. Depressedparticipants received 12 weeks of treatment with escitalopram. To assess self-referential thinking, participants completed a Trait Adjective Task at baseline and at week 12. Baseline MRI scans included a diffusion imaging sequence for FA analyses. RESULTS:Participants with late-life depression differed from controls on all performance measures of the Trait Adjective Task at baseline and at 12 weeks. Depressedparticipants endorsed fewer negative personality traits and more positive personality traits at week 12 compared to baseline. Lower FA in the dorsal anterior cingulate and in the uncinate fasciculus in depressedparticipants was correlated with residual negative self-referential thinking (e.g., more endorsed negative adjectives, fewer rejected negative adjectives) at treatment end. LIMITATIONS: The sample size is modest so the findings are preliminary. FA analyses were restricted to predetermined regions. CONCLUSIONS: Negative self-referential thinking improved in depressed older adults following 12 weeks of treatment with escitalopram. Baseline FA in select white matter regions of the NVS was associated with residual negative self-referential thinking. These findings may help identify treatment targets for residual negative self-referential thoughts.
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