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Predicting Response to the Antidepressant Bupropion using Pretreatment fMRI.
Predict Intell Med (2019) 2019; 11843:53-62PI

Abstract

Major depressive disorder is a primary cause of disability in adults with a lifetime prevalence of 6-21% worldwide. While medical treatment may provide symptomatic relief, response to any given antidepressant is unpredictable and patient-specific. The standard of care requires a patient to sequentially test different antidepressants for 3 months each until an optimal treatment has been identified. For 30-40% of patients, no effective treatment is found after more than one year of this trial-and-error process, during which a patient may suffer loss of employment or marriage, undertreated symptoms, and suicidal ideation. This work develops a predictive model that may be used to expedite the treatment selection process by identifying for individual patients whether the patient will respond favorably to bupropion, a widely prescribed antidepressant, using only pretreatment imaging data. This is the first model to do so for individuals for bupropion. Specifically, a deep learning predictor is trained to estimate the 8-week change in Hamilton Rating Scale for Depression (HAMD) score from pretreatment task-based functional magnetic resonance imaging (fMRI) obtained in a randomized controlled antidepressant trial. An unbiased neural architecture search is conducted over 800 distinct model architecture and brain parcellation combinations, and patterns of model hyperparameters yielding the highest prediction accuracy are revealed. The winning model identifies bupropion-treated subjects who will experience remission with the number of subjects needed-to-treat (NNT) to lower morbidity of only 3.2 subjects. It attains a substantially high neuroimaging study effect size explaining 26% of the variance (R 2 = 0.26) and the model predicts post-treatment change in the 52-point HAMD score with an RMSE of 4.71. These results support the continued development of fMRI and deep learning-based predictors of response for additional depression treatments.

Authors+Show Affiliations

University of Texas Southwestern Medical Center.University of Texas Southwestern Medical Center.University of Texas Southwestern Medical Center.University of Texas Southwestern Medical Center.University of Texas Southwestern Medical Center.University of Texas Southwestern Medical Center.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31709423

Citation

Nguyen, Kevin P., et al. "Predicting Response to the Antidepressant Bupropion Using Pretreatment FMRI." Predictive Intelligence in Medicine : Second International Workshop, PRIME 2019, Held in Conjunction With MICCAI 2019, Shenzhen, China, October 13, 2019, Proceedings. PRIME (Workshop) (2nd : 2019 : Shenzhen Shi, China), vol. 11843, 2019, pp. 53-62.
Nguyen KP, Fatt CC, Treacher A, et al. Predicting Response to the Antidepressant Bupropion using Pretreatment fMRI. Predict Intell Med (2019). 2019;11843:53-62.
Nguyen, K. P., Fatt, C. C., Treacher, A., Mellema, C., Trivedi, M. H., & Montillo, A. (2019). Predicting Response to the Antidepressant Bupropion using Pretreatment fMRI. Predictive Intelligence in Medicine : Second International Workshop, PRIME 2019, Held in Conjunction With MICCAI 2019, Shenzhen, China, October 13, 2019, Proceedings. PRIME (Workshop) (2nd : 2019 : Shenzhen Shi, China), 11843, pp. 53-62. doi:10.1007/978-3-030-32281-6_6.
Nguyen KP, et al. Predicting Response to the Antidepressant Bupropion Using Pretreatment FMRI. Predict Intell Med (2019). 2019;11843:53-62. PubMed PMID: 31709423.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Predicting Response to the Antidepressant Bupropion using Pretreatment fMRI. AU - Nguyen,Kevin P, AU - Fatt,Cherise Chin, AU - Treacher,Alex, AU - Mellema,Cooper, AU - Trivedi,Madhukar H, AU - Montillo,Albert, Y1 - 2019/10/10/ PY - 2019/11/12/entrez PY - 2019/11/12/pubmed PY - 2019/11/12/medline KW - deep learning KW - depression KW - fMRI KW - neural architecture search KW - neuroimaging KW - treatment response SP - 53 EP - 62 JF - Predictive intelligence in medicine : second International Workshop, PRIME 2019, held in Conjunction with MICCAI 2019, Shenzhen, China, October 13, 2019, Proceedings. PRIME (Workshop) (2nd : 2019 : Shenzhen Shi, China) JO - Predict Intell Med (2019) VL - 11843 N2 - Major depressive disorder is a primary cause of disability in adults with a lifetime prevalence of 6-21% worldwide. While medical treatment may provide symptomatic relief, response to any given antidepressant is unpredictable and patient-specific. The standard of care requires a patient to sequentially test different antidepressants for 3 months each until an optimal treatment has been identified. For 30-40% of patients, no effective treatment is found after more than one year of this trial-and-error process, during which a patient may suffer loss of employment or marriage, undertreated symptoms, and suicidal ideation. This work develops a predictive model that may be used to expedite the treatment selection process by identifying for individual patients whether the patient will respond favorably to bupropion, a widely prescribed antidepressant, using only pretreatment imaging data. This is the first model to do so for individuals for bupropion. Specifically, a deep learning predictor is trained to estimate the 8-week change in Hamilton Rating Scale for Depression (HAMD) score from pretreatment task-based functional magnetic resonance imaging (fMRI) obtained in a randomized controlled antidepressant trial. An unbiased neural architecture search is conducted over 800 distinct model architecture and brain parcellation combinations, and patterns of model hyperparameters yielding the highest prediction accuracy are revealed. The winning model identifies bupropion-treated subjects who will experience remission with the number of subjects needed-to-treat (NNT) to lower morbidity of only 3.2 subjects. It attains a substantially high neuroimaging study effect size explaining 26% of the variance (R 2 = 0.26) and the model predicts post-treatment change in the 52-point HAMD score with an RMSE of 4.71. These results support the continued development of fMRI and deep learning-based predictors of response for additional depression treatments. UR - https://www.unboundmedicine.com/medline/citation/31709423/Predicting_Response_to_the_Antidepressant_Bupropion_using_Pretreatment_fMRI DB - PRIME DP - Unbound Medicine ER -