Does the Loudness Dependence of Auditory Evoked Potential Predict Response to Selective Serotonin Reuptake Inhibitors?: A Meta-analysis

Basic stimulus processing alterations from top-down cognitive control in depression drive independent temporal components of multi-echo naturalistic fMRI data

Perceptual changes in major depressive disorder (MDD) may extend beyond emotional content and include the processing of basic stimulus features. These alterations may ultimately contribute to perceptual bias and anhedonia. To characterize blood oxygen level-dependent (BOLD) signal of perceptual processing, we investigated temporally independent fMRI signal components related to naturalistic stimulus processing in 39 patients with MDD and 36 healthy subjects. Leveraging the capability of multi-echo data to detect BOLD activity changes, we extracted physiologically meaningful group temporal components. For each component that exhibited a significant correlation with the movie content, we localized its underlying brain network and assessed MDD-associated alterations. Two components exhibited significant group differences; one was associated with auditory features (sound pressure level) and one with visual features (temporal contrast of intensity). Notably, these deficits in MDD localized primarily to higher-order processing areas, such as the dorsal prefrontal cortex and insula, rather than primary sensory cortices. For the visual feature component, additional group differences emerged in non-visual primary sensory cortices (auditory and somatosensory) as well as major hubs of the motor system. Our findings support the hypothesis that basic sensory processing deficits represent an inherent feature of MDD which may contribute to anhedonia and negative perceptual bias. These deficits are primarily confined to higher-order processing units, as well as cross-modal primary sensory cortices indicating predominant dysfunction of top-down control and multisensory integration. Therapeutic effects of interventions targeting the prefrontal cortex may be partially mediated by restoring prefrontal control not only over emotional but also sensory processing hubs.

Loudness dependent auditory evoked potentials and suicidality in depression - A meta-analysis with replication in unmedicated patients

OBJECTIVE

Major Depressive Disorder (MDD) is a risk factor for suicide. Loudness-Dependent Auditory Evoked Potentials (LDAEP) is an electroencephalographic biomarker of central serotonergic activity associated with MDD and suicidality. Yet, studies on the matter are conflicting. We therefore: 1) Conducted a meta-analysis to clarify the relation between LDAEP, past suicide attempts and current suicidality in MDD, and 2) replicated the findings in independent data of unmedicated patients with MDD.

METHODOLOGY

1) 10 studies were included in the meta-analysis. The difference in scalp LDAEP between patients with and without past suicide attempts was estimated using Hedge's g. The correlation between scalp LDAEP and suicidality was estimated using Fisher's Zr. The Newcastle-Ottawa Scale was used to assess methodological differences. The review was preregistered (PROSPERO). 2) We examined the associations above within an independent cohort of 88 unmedicated patients with MDD. The analyses were preregistered (AsPredicted.org) and used to update the meta-analysis.

RESULTS

In the initial meta-analysis, scalp LDAEP was not associated with past suicide attempts (g = 0.11 [-0.23, 0.46], p = 0.53) or correlated with suicidality (Zr = 0.06 [-0.15, 0.27], p = 0.60). In the independent cohort, scalp LDAEP was also not associated with past suicide attempts (g = 0.05 [-0.56, 0.65] t(86) = 0.15, p = 0.88) or correlated with suicidality (Zr = 0.11 [-0.1, 0.33] r = 0.11 [-0.10, 0.32], p = 0.30). In the updated meta-analysis, scalp LDAEP continued not to be associated with suicide attempts (g = 0.10 [-0.19, 0.39], p = 0.51) or suicidality (Zr = 0.06 [-0.12, 0.24], p = 0.50).

CONCLUSION

LDAEP is not associated with past suicide attempts or suicidality in MDD, and LDAEP's usefulness in suicide prevention seems limited.

Loudness dependence of the auditory evoked potential: temporal stability, associations to sociodemographic variables, and functional significance-implications for clinical research

Introduction

The loudness dependence of the auditory evoked potential (LDAEP) has been suggested as a biomarker for central serotonergic function, and as such a proxy for serotonin related psychiatric symptomatology and intervention outcome, particularly in depression. This study aims to explore LDAEP characteristics in a large healthy population by assessing its test-retest reliability and examining associations with sociodemographic variables, psychological distress, and performance-based cognitive function.

Methods

Our sample included 100 healthy adults whose LDAEP was measured and correlated with age, sex, self-reported psychological distress, and cognitive performance.

Results

Participants examined twice (n = 38) showed high test-retest reliability with intraclass correlations (ICCs) between 0.67 and 0.89 over a 2-to-3-month interval. Furthermore, the magnitude of the LDAEP was significantly higher in women than men, and female hormonal contraceptive users exhibited higher LDAEP than non-users. In females, age was inversely correlated with LDAEP. However, no significant associations were found between LDAEP and measures of psychological distress, including depressive symptoms, nor with cognitive test performance.

Discussion

These results underline LDAEP's reliability as a biomarker over time, but also highlight age, sex and hormonal contraceptive use as significant factors influencing the LDAEP. Future research in clinical population should take these results into account, with an emphasis on providing the necessary sample sizes for relevant sub-group analyses.

Intensity dependence of auditory evoked potentials distinguish participants with unmedicated depression from non-depressed controls

Depression is a heterogeneous syndrome that impacts an individual's emotional, social, cognitive and bodily functioning. Depression is associated with biases in emotional processing, but alterations in basic sensory processing have received less attention in depression research. Here, we measured event-related potentials (ERPs) in response to changes in the intensity of auditory stimuli and the location of somatosensory stimuli in participants with depression and in non-depressed control participants. We tested whether auditory mismatch negativity, P3a or N1 intensity dependence response or somatosensory mismatch response, P3a, P50 or N80 can dissociate depressed participants and non-depressed controls, and we also analysed the effects of depression medication and age in this sample. N1 intensity dependence response was increased in unmedicated depressed participants relative to non-depressed controls. When age was controlled for in the analysis, the effect of depression was only at a trend level. N1 intensity dependence response correlated with depression severity at the whole sample level. We did not observe any depression-related alterations in auditory mismatch negativity or P3a or somatosensory ERPs. Our results may reflect an association between the N1 intensity dependence response and altered neurotransmitter activity in depression, but this should be confirmed in future studies.

Affective disorders and the loudness dependence of the auditory evoked potential: Serotonin and beyond

Identifying additional noninvasive biomarkers for affective disorders, such as unipolar major depressive disorder (MDD) and bipolar disorder (BD), could aid in the diagnosis and treatment of these prevalent and debilitating neuropsychiatric conditions. One such candidate biomarker is the loudness dependence of the auditory evoked potential (LDAEP), an event-related potential that measures responsiveness of the auditory cortex to different intensities of sound. The LDAEP has been associated with MDD and BD, including therapeutic response to particular classes of antidepressant drugs, while also correlating with several other neuropsychiatric disorders. It has been suggested that increased values of the LDAEP indicate low central serotonergic neurotransmission, further implicating this EEG measure in depression. Here, we briefly review the literature on the LDAEP in affective disorders, including its association with serotonergic signaling, as well as with that of other neurotransmitters such as dopamine. We summarize key findings on the LDAEP and the genetics of these neurotransmitters, as well as prediction of response to particular classes of antidepressants in MDD, including SSRIs versus noradrenergic agents. The possible relationship between this EEG measure and suicidality is addressed. We also briefly analyze acute pharmacologic studies of serotonin and/or dopamine precursor depletion and the LDAEP. In conclusion, the existing literature suggests that serotonin and norepinephrine may modulate the LDAEP in an opposing manner, and that this event-related marker may be of use in predicting response to chronic treatment with particular pharmacologic agents in the context of affective disorders, such as MDD and BD, including in the presence of suicidality.

Technical and clinical considerations for electroencephalography-based biomarkers for major depressive disorder

Major depressive disorder (MDD) is a prevalent and debilitating psychiatric disease that leads to substantial loss of quality of life. There has been little progress in developing new MDD therapeutics due to a poor understanding of disease heterogeneity and individuals' responses to treatments. Electroencephalography (EEG) is poised to improve this, owing to the ease of large-scale data collection and the advancement of computational methods to address artifacts. This review summarizes the viability of EEG for developing brain-based biomarkers in MDD. We examine the properties of well-established EEG preprocessing pipelines and consider factors leading to the discovery of sensitive and reliable biomarkers.

Relationships between fear of flying, loudness dependence of auditory evoked potentials and frontal alpha asymmetry

Previous research has suggested that fear of flying, which is defined as a situational, specific phobia, could overlap with depressive and anxiety disorders. Whether the neuronal dysfunctions including altered serotonergic activity in the brain and altered neural oscillations observed for depressive and anxiety disorders also overlap with alterations in fear of flying is unclear. Here, thirty-six participants with self-reported fear of flying (FF) and forty-one unaffected participants (NFF) were recruited. The participants completed the Beck Depression Inventory (BDI-II), the State-trait Anxiety Inventory (STAI) and the Fear of Flying Scale (FFS). EEG-recording was conducted during resting-state and during presentation of auditory stimuli with varying loudness levels for analysis of the Loudness Dependence of Auditory Evoked Potentials (LDAEP), which is suggested to be inversely related to central serotonergic activity. Participants with fear of flying did not differ from the control group with regard to BDI-II and STAI data. The LDAEP was higher over F4 electrode in the FF group compared to controls, whereas exploratory analysis suggest that differences between groups were conveyed by female participants. Moreover, the FF group showed relatively higher right frontal alpha activity compared to the control group, whereas no difference in frequency power (alpha, beta and theta) was observed. Thus, this study brought the first hint for reduced serotonergic activity in individuals with fear of flying and relatively higher right frontal activity. Thus, based on the preliminary findings, future research should aim to examine the boundaries with anxiety and depressive disorders and to clarify the distinct neural mechanisms.

Association between the loudness dependence of auditory evoked potential, serotonergic neurotransmission and treatment outcome in patients with depression

Previous studies have suggested that the loudness dependence of auditory evoked potential (LDAEP) is associated with the effectiveness of antidepressant treatment in patients with major depressive disorders (MDD). Furthermore, both LDAEP and the cerebral serotonin 4 receptor (5-HT₄R) density is inversely related to brain serotonin levels. We included 84 patients with MDD and 22 healthy controls to examined the association between LDAEP and treatment response and its association with cerebral 5-HT₄R density. Participants underwent both EEG and 5-HT₄R neuroimaging with [¹¹C]SB207145 PET. Thirty-nine patients with MDD were re-examined after 8 weeks of treatment with selective serotonin reuptake inhibitors/serotonin noradrenaline reuptake inhibitor (SSRI/SNRI). We found that the cortical source of LDAEP was higher in untreated patients with MDD compared to healthy controls (p=0.03). Prior to SSRI/SNRI treatment, subsequent treatment responders had a negative association between LDAEP and depressive symptoms and a positive association between scalp LDAEP and symptom improvement at week 8. This was not found in source LDAEP. In healthy controls, we found a positive correlation between both scalp and source LDAEP and cerebral 5-HT₄R binding but that was not observed in patients with MDD. We did not see any changes in scalp and source LDAEP in response to SSRI/SNRI treatment. These results support a theoretical framework where both LDAEP and cerebral 5-HT₄R are indices of cerebral 5-HT levels in healthy individuals while this association seems to be disrupted in MDD. The combination of the two biomarkers may be useful for stratifying patients with MDD. Clinical Trials Registration:https://clinicaltrials.gov/ct2/show/NCT02869035?draw=1Registration number: NCT0286903.

Relationship of loudness-dependent auditory evoked potentials with change-related cortical responses

Previous studies have suggested that change-related cortical responses are phenomena similar to the onset response and could be applied to the loudness dependence of auditory evoked potential (LDAEP) paradigm. In the present study, we examined the relationship between LDAEP and the change-related response using electroencephalography findings in 50 healthy subjects. There were five conditions (55, 65, 75, 85, and 95 dB) for LDAEP and five similar conditions (abrupt sound pressure increase from 70 to 75, 80, 85, 90, and 95 dB) for the change-related response. Both the onset and abrupt sound pressure increase evoked a triphasic response with peaks at approximately 50 (P50), 100 (N100), and 200 (P200) ms. We calculated the peak-to-peak amplitudes for P50/N100 and N100/P200. Medians and slopes for P50/N100 and N100/P200 amplitudes were calculated and compared between the two measures. Results revealed a significant correlation for both the slope and median for P50/N100 (r = 0.36, 0.37, p = 1.0 × 10⁻², 7.9 × 10⁻³), N100/P200 (r = 0.40, 0.34, p = 4.0 × 10⁻³, 1.6 × 10⁻²), and P50/N100/P200 (r = 0.36, 0.35, p = 1.0 × 10⁻², 1.3 × 10⁻²). These results suggested that the change-related response and LDAEP shared generation mechanisms at least partially.

Auditory event-related potentials in separating patients with depressive disorders and non-depressed controls: A narrative review

This narrative review brings together the findings regarding the differences in the auditory event-related potentials (ERPs) between patients with depressive disorder and non-depressed control subjects. These studies' results can inform us of the possible alterations in sensory-cognitive processing in depressive disorders and the potential of using these ERPs in clinical applications. Auditory P3, mismatch negativity (MMN) and loudness dependence of auditory evoked potentials (LDAEP) were the subjects of the investigation. A search in PubMed yielded 84 studies. The findings of the reviewed studies were not highly consistent, but some patterns could be identified. For auditory P3b, the common findings were attenuated amplitude and prolonged latency among depressed patients. Regarding auditory MMN, especially the amplitude of duration deviance MMN was commonly attenuated, and the amplitude of frequency deviance MMN was increased in depressed patients. In LDAEP studies, generally, no differences between depressed patients and non-depressed controls were reported, although some group differences concerning specific depression subtypes were found. This review posits that future research should investigate whether certain stimulus conditions are particularly efficient at separating depressed and non-depressed participant groups. Future studies should contrast responses in different subpopulations of depressed patients, as well as different clinical groups (e.g., depressive disorder and anxiety disorder patients), to investigate the specificity of the auditory ERP alterations for depressive disorders.