Brain Activation Predicts Quetiapine Response in Adolescent Bipolar Depression
Investigators examined neurofunctional effects of quetiapine using a functional MRI in adolescents with bipolar depression.
Quetiapine may be more effective in treating adolescents with bipolar depression depending on the context of specific brain activation patterns identified at baseline and which patterns are used to predict improvement in depressive symptoms, according to a study published in Journal of Child and Adolescent Psychopharmacology.
The study sample included 16 adolescents (9 girls, 7 boys,) aged 12 to 18 years with a current depressive episode associated with bipolar I or II disorder. The participants were randomly assigned to quetiapine monotherapy (n=10) or placebo treatment (n=6) for 8 weeks, and underwent functional magnetic resonance imaging scans at baseline and at the end of study, during which the patients rated negative and neutral pictures while being monitored for specific prefrontal activation changes. Depressive symptoms were scored using the Children's Depression Rating Scale-Revised.
The study results showed that at baseline higher activation in the left ventrolateral prefrontal cortex (P=.024) and lower activation in the left dorsolateral prefrontal cortex (P<.005) predicted greater improvement in depressive symptoms scores in the quetiapine group at follow-up. In fact, all of the participants that responded positively to either quetiapine or placebo showed inversely correlated activation of left dorsolateral and left ventrolateral regions.
The results suggest that the activity of dorsal and ventral prefrontal subregions may be used as biological indicators for treatment response in bipolar depression. Limitations of the study included a small sample size with fewer participants receiving placebo.
Baseline activation patterns identified in the specific dorsal and ventral regions of the prefrontal cortex were significant in predicting the ability of the patients to regulate emotional response. The study investigators advocate that certain medications, such as quetiapine, may be more effective in the context of specific prefrontal activation patterns identified at baseline.
This study was supported by AstraZeneca. Please refer to reference for a complete list of authors' disclosures.
Chang K, DelBello M, Garrett A, et al. Neurofunctional correlates of response to quetiapine in adolescents with bipolar depression [published online May 30, 2018]. J Child Adolesc Psychopharmacol. doi: 10.1089/cap.2017.0030