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Editorial
May 2018

A Promising Future Role for Neuroimaging in Tracking and Predicting Relapse in Major Depressive Disorder

Author Affiliations
  • 1Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania
JAMA Psychiatry. 2018;75(5):424-426. doi:10.1001/jamapsychiatry.2018.0405

Major depressive disorder (MDD) is the second leading cause of disability worldwide.1 Important problems that contribute to the high level of disability associated with this illness are the low rate of remission after first treatment2 and the high relapse rate.3 Understanding the pathophysiological processes that predispose people to MDD is clearly a step toward identifying objective neural markers that may guide treatment choice and novel intervention developments that can be translated into personalized interventions. For this reason, identifying neural mechanisms underlying MDD and the MDD illness course has been central to an increasing number of neuroimaging studies of the illness in recent years.4 Yet there has been little focus on understanding neural mechanisms that predispose individuals to relapse. Such studies can help identify early objective markers of relapse to aid development of interventions to halt or even prevent relapse in those individuals most at risk for this illness course. Perhaps a reason for the dearth of such studies is the fact that they are inherently difficult to conduct, because they require not only a longitudinal design with 2 or more neuroimaging assessments but also a series of controls to ensure that the focus is on the comparison of different types of illness courses during the follow-up period, while controlling for illness severity, medication use, and demographic factors at baseline and follow-up.

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