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Use of FMRI to predict recovery from unipolar depression with cognitive behavior therapy.

OBJECTIVE
In controlled treatment trials, 40%-60% of unmedicated depressed individuals respond to cognitive behavior therapy (CBT). The authors examined whether pretreatment neural reactivity to emotional stimuli accounted for this variation.


METHOD
Unmedicated depressed individuals (N=14) and never depressed comparison subjects (N=21) underwent fMRI during performance of a task sensitive to sustained emotional information processing. Afterward, depressed participants completed 16 sessions of CBT.


RESULTS
Participants whose sustained reactivity to emotional stimuli was low in the subgenual cingulate cortex (Brodmann's area 25) and high in the amygdala displayed the strongest improvement with CBT.


CONCLUSIONS
The presence of emotion regulation disruptions, which are targeted in CBT, may be the key to recovery with this intervention.