The role of subgenual frontal connectivity in predicting response to serotonergic medications

There is an urgent need to develop imaging biomarkers of response to antidepressant medications in major depressive disorder (MDD). This serves the development of individualised treatment algorithms. We have recently shown that subgenual frontal (SF) functional connectivity alterations predict subsequent recurrence in MDD patients whose symptoms were remitted. Dunlop et al., (2017) have shown that resting state SF fMRI connectivity accurately predicts non-response to antidepressant medications in treatment-naïve patients. This demonstrates the high potential of SF connectivity as a biomarker of response to antidepressant treatment and recurrence risk in MDD. It is unknown, however, whether these findings generalise to patients with early treatment resistance as seen in UK primary care. Furthermore, the function of the SF cortex and its connectivity is still disputed. To address these questions, during year 1 & 2, the student will acquire resting state fMRI and cognitive data in 24 patients independently recruited for an NIHR-funded trial of a novel computerised decision support algorithm for antidepressant medications in primary care. We expect about 50% of patients to respond to treatment with serotonergic drugs. This will allow us to compare baseline MRI scans of treatment responders with non-responders. Year 3 and 4 will be devoted to completing analysis and write-up of journal manuscripts investigating 1) whether SF connectivity predicts subsequent response to treatment and 2) whether it is associated with individual differences on novel cognitive tests of blame attribution in social interactions.Training in clinical assessment, as well as fMRI data acquisition and analysis, will be provided.