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Neural effects of antidepressant medication and psychological treatments: a quantitative synthesis across three meta-analyses.

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Feldman Barrett, Lisa 
Lindquist, Kirsten 
Ma, Yina 
Marwood, Lindsey 


Background: Influential theories predict that antidepressant medication (ADM) and psychological therapies (PT) evoke distinct neural changes. Aims: We tested the convergence and divergence of ADM- and PT-evoked neural changes, and their overlap with the brain’s affect network. Method: We employ a quantitative synthesis of three meta-analyses (n=4206). First, we assessed the common and distinct neural changes evoked by ADM and PT, by contrasting two comparable meta-analyses reporting the neural effects of ADM and PT. Both meta-analyses included patients with affective disorders, including major depressive disorder, generalised anxiety disorder, and panic disorder. The majority were assessed using negative valence tasks during neuroimaging. Next, we assessed whether the neural changes evoked by ADM and PT overlapped with the brain’s affect network, using data from a third meta-analysis of affect-based neural activation. Results: We find that neural changes from PT and ADM do not significantly converge on any region. ADM evokes neural changes in the amygdala, while PT evokes anatomically-distinct changes in medial prefrontal cortex. Contrasts with the third affect network meta-analysis revealed that both PT and ADM changes separately converge on regions of the affect network. Conclusions: This supports the notion of treatment-specific brain effects of ADM and PT. Both ADM and PT induce changes in the affect network, but our results suggest the effects of ADM and PT on emotion processing occur via distinct proximal neurocognitive mechanisms of action.



Antidepressants, anxiety disorders, cognitive–behavioural therapies, depressive disorders, imaging, Antidepressive Agents, Anxiety Disorders, Depressive Disorder, Major, Humans, Mood Disorders, Psychotherapy

Journal Title

British Journal of Psychiatry

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Royal College of Psychiatrists


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MRC (unknown)
Medical Research Council (MC_UU_00005/4)

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