The long-term objective of this Patient-Oriented Mentored Career Development Award (K23) is to support the career development of the candidate in functional neuroimaging and experimental therapeutics in mood disorders. This will be accomplished through a structured supervised research experience and formal instruction that will focus on the training areas of (1) Clinical Research Methodology, Biostatistics and Ethics;(2) Functional Neuroimaging Methodology;and (3) Affective and Cognitive Neuroscience. The specific objective of the proposed research strategy is to characterize the function of emotion-processing neural networks in vivo in patients with treatment-resistant depression (TRD), and to identify functional changes in these networks that are specific to rapid antidepressant response. Conventional antidepressant treatments are slow to result in therapeutic benefit, and 20-30% of patients with major depression fail to achieve an adequate therapeutic response (i.e., experience TRD). Recent findings of rapid and robust antidepressant effects of the anesthetic agent ketamine, a N-methyl-D-aspartate (NMDA) glutamate receptor antagonist, present a unique opportunity to test hypotheses regarding the mechanisms of rapid-acting therapeutic action. The proposed research will utilize advanced cognitive neuroscience techniques and functional magnetic resonance imaging (fMRI) to investigate the specific functional contributions of key neural systems supporting emotion generation/regulation, including the prefrontal cortex (PFC), anterior cingulate cortex (ACC) and associated subcortical structures, in TRD and rapid antidepressant response to ketamine. TRD subjects will undergo fMRI at baseline (in the depressed state) and then again 24 hours following a single IV infusion of ketamine or a control treatment. The fMRI strategy will utilize both a well-validated probe of negative emotion bias (sad facial expressions), and a probe of emotion regulation (cognitive reappraisal), which specifically recruits PFC/ACC structures implicated in mechanisms of antidepressant action. This research will test specific hypotheses regarding the role of emotion generation (e.g. subcortical) and regulation (e.g. PFC/ACC) neural systems in the depressed state in patients with TRD, and changes in the function of these systems associated with changes in depressive symptoms resulting from ketamine. The skills and data acquired and research methods developed during the K23 award period will provide the candidate with the tools required to achieve the long- term goal of becoming an independent investigator in clinical neuroscience research in mood disorders.

Public Health Relevance

Up to one-third of patients with major depression continue to suffer a high symptom burden despite an optimized treatment trial [e.g. they suffer treatment-resistant depression (TRD)], and symptom relief is slow even in patients who do respond. Therefore, rapidly acting, more effective treatments are urgently needed. The proposed research project aims to illuminate the functional brain mechanisms of rapid antidepressant response in patients with TRD, with the long-term goal of facilitating the identification of improved treatments for patients suffering from this disabling illness.

Agency
National Institute of Health (NIH)
Institute
National Institute of Mental Health (NIMH)
Type
Mentored Patient-Oriented Research Career Development Award (K23)
Project #
5K23MH094707-02
Application #
8301510
Study Section
Pathophysiological Basis of Mental Disorders and Addictions Study Section (PMDA)
Program Officer
Wynne, Debra K
Project Start
2011-07-15
Project End
2016-05-31
Budget Start
2012-06-01
Budget End
2013-05-31
Support Year
2
Fiscal Year
2012
Total Cost
$176,357
Indirect Cost
$12,508
Name
Icahn School of Medicine at Mount Sinai
Department
Psychiatry
Type
Schools of Medicine
DUNS #
078861598
City
New York
State
NY
Country
United States
Zip Code
10029
Abdallah, Chadi G; Averill, Lynnette A; Collins, Katherine A et al. (2016) Ketamine Treatment and Global Brain Connectivity in Major Depression. Neuropsychopharmacology :
Lener, Marc S; Kundu, Prantik; Wong, Edmund et al. (2016) Cortical abnormalities and association with symptom dimensions across the depressive spectrum. J Affect Disord 190:529-36
Murrough, James W; Abdallah, Chadi G; Anticevic, Alan et al. (2016) Reduced global functional connectivity of the medial prefrontal cortex in major depressive disorder. Hum Brain Mapp 37:3214-23
Murrough, James W; Burdick, Katherine E; Levitch, Cara F et al. (2015) Neurocognitive effects of ketamine and association with antidepressant response in individuals with treatment-resistant depression: a randomized controlled trial. Neuropsychopharmacology 40:1084-90
Costi, Sara; Van Dam, Nicholas T; Murrough, James W (2015) Current Status of Ketamine and Related Therapies for Mood and Anxiety Disorders. Curr Behav Neurosci Rep 2:216-225
Murrough, James W; Yaqubi, Sahab; Sayed, Sehrish et al. (2015) Emerging drugs for the treatment of anxiety. Expert Opin Emerg Drugs 20:393-406
Wan, Le-Ben; Levitch, Cara F; Perez, Andrew M et al. (2015) Ketamine safety and tolerability in clinical trials for treatment-resistant depression. J Clin Psychiatry 76:247-52
Murrough, J W; Collins, K A; Fields, J et al. (2015) Regulation of neural responses to emotion perception by ketamine in individuals with treatment-resistant major depressive disorder. Transl Psychiatry 5:e509
Soleimani, Laili; Welch, Alison; Murrough, James W (2015) ""Does Ketamine Have Rapid Anti-Suicidal Ideation Effects?"" Curr Treat Options Psychiatry 2:383-393
Murrough, James W (2015) Glutamate NMDA receptor modulators for the treatment of depression: trials and tribulations. Psychopharmacology (Berl) 232:1497-9

Showing the most recent 10 out of 25 publications