Clinical Trial Summary
Depression is a debilitating illness with a risk of developing a treatment resistant form.
Currently, diagnosis is purely clinical with little features available to identify
potentially adverse developments. Clinical features such as early onset age, prolonged
episodes, anxiety, somatic symptoms and apathy are all arguments raising fears the onset of
resistance to conventional treatments. According to neuroimaging knowledge about the
pathophysiological mechanisms, involving front-limbic functional networks supporting the
functions of emotional regulation and reward system, recent work has focused on the
identification of neuroimaging biomarkers predicting therapeutic response. Among the regions
of interest identified, the anterior cingulate cortex, amygdala, hippocampus, and regions
participating in the Default Mode Network Training (Medial prefrontal cortex, posterior
cingulate cortex, inferior parietal lobe) are most frequently areas associated with the
prediction of therapeutic response. Limitations most reported in these studies are the
heterogeneity of experimental paradigms (resting state, cognitive or emotional functional
tasks), imaging (PET scan, MRI) the heterogeneity of clinical resistance criteria forms
studied, different techniques (as that we consider remission (threshold score) or response
(50% decrease from baseline score), and the sample size. Knowing that MRI into daily clinical
practice in the SHU of Adult Psychiatry, as the balance sheet of the disease, monitoring its
evolution, as in assumption rTMS (repetitive Transcranial Magnetic Stimulation) (pretreatment
assessment and neuro), the identification of neuroimaging biomarkers in a population of
patients with clinical criteria of Mood Depressive Episode, with an acquisition of identical
and reproducible image daily routine methodology appears to be a reliable way to correct the
heterogeneity of conventionally published studies on the topic. This study aim to identify,
in routine care, predictive clinical and neuroimaging markers of poor outcome in major
depressive disorder.
The main objective is to assess neuroimaging biomarkers like cortical thickness predictive of
poor outcome in major depressive disorder.
Secondary objectives are :
- Identifying neuroimaging biomarker like Cerebral Blood Flow (CBF) predictive of poor
outcome in major depressive disorder;
- Identifying morphological biomarker like volumetric abnormalities (Voxel Based
Morphometry - VBM), other than the cortical thickness, predictive of poor outcome in
major depressive disorder;
- Identifying clinical features (sociodemographic, clinical dimensions such as apathy or
anxiety) predictive of poor outcome of depression.
This study expect to assess on a large population of patients:
- Clinical and neuroimaging markers (morphological and perfusion) predictive of poor
outcome in major depressive disorder, allowing early identification of patients at risk
of poor therapeutic response. These markers should allow a better stratification of
patients;
- A better characterization of pathophysiological processes involved in major depressive
disorder at different stages of the illness;
- Development of innovative technologies such as treatment with repetitive transcranial
magnetic stimulation, or neurofeedback using real time fMRI, on both aspects of
evaluation of the effectiveness and optimization of procedures.
Such a study would open up on thinking in terms of therapeutic management. Indeed, recurrent
and potentially resistant forms and screened using such predictive neuroimaging biomarkers
could serve more specific therapeutic approaches in a preventive approach.
