Magazine article Clinical Psychiatry News

Pupillometry Could Lead to MDD Treatment

Magazine article Clinical Psychiatry News

Pupillometry Could Lead to MDD Treatment

Article excerpt

ISTANBUL, TURKEY -- Neuroimaging studies of brain mechanisms uniquely engaged by cognitive-behavioral therapy or antidepressant medication might eventually permit individualized treatment selection--and better outcomes for patients with major depression.

"Ideally, we're approaching what could be a treatment algorithm--not for use today, but perhaps in the future--where if you have decreased pretreatment reactivity in the subgenual cingulate cortex along with increased reactivity in the amygdala to a task involving emotional stimuli, you may be a particularly good candidate for cognitive-behavioral therapy," Greg J. Siegle, Ph.D., explained at the annual congress of the European College of Neuropsychopharmacology.

That's what his whole-brain functional magnetic resonance imaging (fMRI) studies suggest, as do positron-emission tomography studies by other investigators. It might be impractical to perform pretreatment fMRIs on each of the estimated 13-14 million American adults affected by major depressive disorder each year, but pupillometry might be a low-cost potential alternative.

The pupils are innervated by most areas of the brain involved in depression. And studies suggest that pupil dilation as measured using a commercially available hand-held pupillometer might provide a good peripheral physiologic correlate of activity going on in the brain structures of therapeutic interest, said Dr. Siegle, director of the Program in Cognitive Affective Neuroscience at the University of Pittsburgh.

His studies indicate that responders to cognitive-behavioral therapy (CBT) have less pupil dilation than normal controls in response to a pretreatment task sensitive to emotional-information processing--for example, consideration of a negative word or a picture of an unhappy face--while CBT nonresponders have greater pupil dilation, compared with controls. …

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