Initial white matter connectivity differences between remitters and non-remitters of patients with panic disorder after 6 months of pharmacotherapy

Long-term benefits of mindfulness on white matter tracts underlying the cortical midline structures in panic disorder: A 2-year longitudinal study

AIMS

We aimed to examine the long-term benefits of mindfulness-based cognitive therapy (MBCT) on white matter plasticity in the cortical midline structures (CMS) for a period of 2 years in patients with panic disorder and the relationships between white matter changes in the CMS and severity of state and trait symptoms.

METHODS

Seventy-one participants were enrolled and underwent diffusion tensor imaging at baseline and after 2 years (26 who received MBCT as an adjunct to pharmacotherapy [MBCT+PT], 20 treated with pharmacotherapy alone [PT-alone], and 25 healthy controls [HCs]). The severity of symptoms and fractional anisotropy (FA) in white matter regions underlying the CMS were assessed at baseline and 2-year follow-up.

RESULTS

The MBCT+PT group showed better outcomes after 2 years than the PT-alone group. The groups showed different FA changes: the MBCT+PT group showed decreased FA in the left anterior cingulate cortex (ACC); the PT-alone group showed increased FA in the bilateral dorsomedial prefrontal cortex, posterior cingulate cortex (PCC), and precuneus. Decreased white matter FA in the ACC, PCC, and precuneus was associated with improvements in the severity of state and trait symptoms in patients with panic disorder.

CONCLUSION

Alleviation of excessive white matter connectivity in the CMS after MBCT leads to improvements in clinical symptoms and trait vulnerability in patients with panic disorder. Our study provides new evidence for the long-term benefits of MBCT on white matter plasticity and its clinical applicability as a robust treatment for panic disorder.

Prediction of prognosis in patients with panic disorder using pre-treatment brain white matter features

BACKGROUND

The early identification of patients with panic disorder (PD) with a poor prognosis is important for improving treatment outcomes; however, it is challenging due to a lack of objective biomarkers. We investigated the reliability of characterizing structural white matter (WM) connectivity and its ability to predict PD prognosis after pharmacotherapy.

METHODS

A total of 138 patients (59 men) with PD and 153 healthy controls (HCs; 73 men) participated in this study. PD symptom severity was measured using the Panic Disorder Severity Scale (PDSS) at baseline and follow-up periods of 8 weeks, 6 months, and 1 year. The least absolute shrinkage and selection operator (Lasso) was utilized to identify prognosis-related WM regions on diffusion imaging features.

RESULTS

Lasso identified seven prognosis-related WM regions: the bilateral posterior corona radiata, bilateral posterior limb of the internal capsule, the left retrolenticular part of the internal capsule, the left sagittal stratum, and the right fornix/stria terminalis. Some of these regions showed lower mean fractional anisotropy (FA) values in patients with PD than in HCs. The predicted PDSS scores using FA from these regions consistently correlated with the actual prognosis in all periods.

LIMITATIONS

This study had limited ability to evaluate individual longitudinal changes in detail owing to the data acquisition time and brain atlas resolution.

CONCLUSIONS

Our findings suggest the possibility of using structural WM connectivity as a biomarker for the clinical characterization of PD. Our findings will expand our understanding of the neurobiology of PD and improve biomarker-based prognosis prediction in clinical practice.