Brain changes associated with depression treatment: a meta-analysis

A meta-analysis of 18 experiments with 302 depressed patients found that effective depression treatment—whether pharmacology, psychotherapy, electroconvulsive therapy, psilocybin, or ketamine—consistently changes brain activity in the right amygdala. Across studies, activity in this region decreased after treatment. The finding suggests that the right amygdala is a key brain area for tracking depression treatment effects with fMRI, offering a target for future biomarker research.

Study at a glance

Abstract

BACKGROUND: Understanding changes in brain activity following treatment is critical to advancing the use of neuroimaging in psychiatric research. Previous work has focused on defining abnormalities (biomarkers) between patients and healthy controls but there has been less investigation of brain changes in depression patients following treatment. To boost sample size and explore the possibility of common treatment mechanisms, we considered results from standard and emerging forms of treatment. In order to investigate and synthesize findings of brain changes, we conducted a coordinate based meta-analysis of depression treatment studies reporting pre- and post-treatment task-based neuroimaging data to determine if there were common brain regions that changed with effective depression treatment across treatment types. METHODS: Activation likelihood estimation was performed to synthesize the imaging results. The meta-analysis included data from 302 depressed subjects yielding 87 foci across 18 experiments. The studies examined various depression treatments including pharmacology, psychotherapy, electroconvulsive therapy, psilocybin, and ketamine with brain activity measures in response to emotion tasks in the scanner. RESULTS: Across studies, the right amygdala (peak MNI coordinates [30, 2, -22]) was a region of convergence, reflecting a consistent change in activity following depression treatment. Follow-up analyses suggested that this finding was driven by right amygdala activity decreasing with treatment. CONCLUSIONS: Our result, focusing on within-patient changes associated with treatment, highlights the right amygdala as a brain area especially relevant to depression treatment measured with fMRI. This finding provides a lens to focus depression biomarker research based on imaging measures that track depression treatment effects.