Cingulate prediction of response to antidepressant and cognitive behavioral therapies for depression: Theory, meta-analysis, and empirical application

Objective In the interest of precision medicine, we sought to derive preclinical markers of neural mechanisms associated with treatment response in unipolar depression, separated by treatment type. Methods We conducted separate neuroimaging meta-analyses of neural predictors for response to Cognitive Behavioral Therapy (CBT) and Selective Serotonin Reuptake Inhibitors (SSRIs). We assessed whether reactivity of derived regions predicted clinical change in a preference trial of patients with major depressive disorder (MDD) who received CBT (n = 61) or SSRIs (n = 19). Results The meta-analyses yielded regions within the perigenual (pgACC) and subgenual anterior cingulate cortex (sgACC) associated with SSRI and CBT response, respectively. In our sample, reactivity of the sgACC region was prognostic for response to CBT, but neither cingulate region was prognostic for response to SSRIs using a linguistic task; most prognostic SSRI studies used images. An exploratory analysis revealed a pgACC region for which reactivity to images was prognostic for response to SSRIs. Conclusions Results suggest that neural reactivity of the sgACC and pgACC are associated with CBT and SSRI response for unipolar depression. Further research incorporating methodological considerations is necessary for translation. ### Competing Interest Statement The authors have declared no competing interest.