Study of Morphological and Perfusion Imaging Predictors of Pejorative Outcome in Major Depressive Disorder

The main objective is to assess neuroimaging biomarkers like cortical thickness predictive of poor outcome in major depressive disorder.

Secondary objectives are :

• Identifying neuroimaging biomarker like Cerebral Blood Flow (CBF) predictive of poor outcome in major depressive disorder;
• Identifying morphological biomarker like volumetric abnormalities (Voxel Based Morphometry - VBM), other than the cortical thickness, predictive of poor outcome in major depressive disorder;
• Identifying clinical features (sociodemographic, clinical dimensions such as apathy or anxiety) predictive of poor outcome of depression.

This study expect to assess on a large population of patients:

• Clinical and neuroimaging markers (morphological and perfusion) predictive of poor outcome in major depressive disorder, allowing early identification of patients at risk of poor therapeutic response. These markers should allow a better stratification of patients;
• A better characterization of pathophysiological processes involved in major depressive disorder at different stages of the illness;
• Development of innovative technologies such as treatment with repetitive transcranial magnetic stimulation, or neurofeedback using real time fMRI, on both aspects of evaluation of the effectiveness and optimization of procedures.

Such a study would open up on thinking in terms of therapeutic management. Indeed, recurrent and potentially resistant forms and screened using such predictive neuroimaging biomarkers could serve more specific therapeutic approaches in a preventive approach.

Inclusion criteria

• Men and women aged over 18 years;
• Patient with a diagnosis (according to DSM IV criteria measured at MINI) for Major Depressive Episode, and / or recurrent depressive disorder unipolar or bipolar , or chronic and resistant depression (according to the criteria of Thase and Rush);
• Patients will be stratified as the stages of classification and Thase Rush scale widely used to characterize the therapeutic resistance in depression;
• Intensity of EDM with a minimum score of 15 (MADRS);
• Patient in receiving information on the protocol;
• Patient who received information about the protocol and did not express opposition to participate.

Exclusion criteria

Related to MRI

• Pacemaker or implantable defibrillator;
• Neurosurgical clips;
• Cochlear implants;
• Metal intra orbital or encephalic foreign bodies;
• Stents placed for less than four weeks and osteosynthesis material posed for less than six weeks;
• Claustrophobia.

Other criteria

• Pregnant or lactating women;
• Hemodynamically unstable acute respiratory failure , a general poor condition or a need for monitoring incompatible with the constraints of MRI ;
• Legal protection ;
• Patients hospitalized without their consent.