Brain dynamics predictive of response to psilocybin for treatment-resistant depression

Abstract

Psilocybin therapy for depression has started to show promise, yet the underlying causal mechanisms are not currently known. Here, we leveraged the differential outcome in responders and non-responders to psilocybin (10 and 25 mg, 7 days apart) therapy for depression-to gain new insights into regions and networks implicated in the restoration of healthy brain dynamics. We used large-scale brain modelling to fit the spatiotemporal brain dynamics at rest in both responders and non-responders before treatment. Dynamic sensitivity analysis of systematic perturbation of these models enabled us to identify specific brain regions implicated in a transition from a depressive brain state to a healthy one. Binarizing the sample into treatment responders (>50% reduction in depressive symptoms) versus non-responders enabled us to identify a subset of regions implicated in this change. Interestingly, these regions correlate with in vivo density maps of serotonin receptors 5-hydroxytryptamine 2a and 5-hydroxytryptamine 1a, which psilocin, the active metabolite of psilocybin, has an appreciable affinity for, and where it acts as a full-to-partial agonist. Serotonergic transmission has long been associated with depression, and our findings provide causal mechanistic evidence for the role of brain regions in the recovery from depression via psilocybin.

J.V. is supported by the EU H2020 Future and Emerging Technologies (FET) Proactive project Neurotwin grant agreement no. 101017716. M.L.K. is supported by the European Research Council Consolidator Grant: CAREGIVING (615539), Pettit Foundation, Carlsberg Foundation and Center for Music in the Brain, funded by the Danish National Research Foundation (DNRF117). J.C. is supported by the Portuguese Foundation for Science and Technology CEECIND/03325/2017, UIDB/50026/2020 and UIDP/50026/2020, Portugal. G.D. is supported by the Spanish Research Project PSI2016-75688-P (Agencia Estatal de Investigación/Fondo Europeo de Desarrollo Regional, European Union); by the European Union's Horizon 2020 Research and Innovation Programme under Grant Agreements 720270 (Human Brain Project [HBP] SGA1) and 785907 (HBP SGA2); and by the Catalan Agency for Management of University and Research Grants Programme 2017 SGR 1545.