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Corticolimbic Brain Reactivity to Social Signals of Threat Before and After Sertraline Treatment in Generalized Social Phobia

  • K. Luan Phan
    Correspondence
    Address correspondence to K. Luan Phan, M.D., Department of Psychiatry, University of Illinois at Chicago, 1747 W. Roosevelt Road, IJR/WROB Room 244, Chicago, IL 60608
    Affiliations
    Department of Psychiatry, University of Illinois at Chicago, and Mental Health Service Line, Jesse Brown VA Medical Center, Chicago, Illinois

    Department of Psychiatry, University of Michigan, Ann Arbor, Michigan
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  • Emil F. Coccaro
    Affiliations
    Department of Psychiatry and Behavioral Neurosciences, University of Chicago, Chicago, Illinois
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  • Mike Angstadt
    Affiliations
    Department of Psychiatry, University of Illinois at Chicago, and Mental Health Service Line, Jesse Brown VA Medical Center, Chicago, Illinois

    Department of Psychiatry, University of Michigan, Ann Arbor, Michigan
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  • K. Jane Kreger
    Affiliations
    Department of Psychiatry, University of Illinois at Chicago, and Mental Health Service Line, Jesse Brown VA Medical Center, Chicago, Illinois

    Department of Psychiatry, University of Michigan, Ann Arbor, Michigan
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  • Helen S. Mayberg
    Affiliations
    Department of Psychiatry, Emory University, Atlanta, Georgia
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  • Israel Liberzon
    Affiliations
    Department of Psychiatry, University of Illinois at Chicago, and Mental Health Service Line, Jesse Brown VA Medical Center, Chicago, Illinois

    Department of Psychiatry, University of Michigan, Ann Arbor, Michigan
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  • Murray B. Stein
    Affiliations
    Department of Psychiatry, University of California, San Diego, California
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Published:November 19, 2012DOI:https://doi.org/10.1016/j.biopsych.2012.10.003

      Background

      Generalized social phobia (gSP), also known as generalized social anxiety disorder, is characterized by excessive fear of scrutiny by others and pervasive avoidance of social interactions. Pathophysiologic models of gSP implicate exaggerated reactivity of the amygdala and insula in response to social evaluative threat, making them plausible targets for treatment. Although selective serotonin reuptake inhibitor (SSRI) treatment is known to be an effective treatment, little is known about the mechanism through which these agents exert their anxiolytic effects at a brain level in gSP.

      Methods

      We acquired functional magnetic resonance imaging data of brain response to social signals of threat (fearful/angry faces) in 21 gSP patients before and after they completed 12 weeks of open-label treatment with the SSRI sertraline. For comparison, 19 healthy control (HC) subjects also underwent two functional magnetic resonance imaging scans, 12 weeks apart.

      Results

      Whole-brain voxelwise analysis of variance revealed significant Group×Time interactions in the amygdala and the ventral medial prefrontal cortex. Follow-up analyses showed that treatment in gSP subjects reduced amygdala reactivity to fearful faces (which was exaggerated relative to HCs before treatment) and enhanced ventral medial prefrontal cortex activation to angry faces (which was attenuated relative to HCs before treatment). However, these brain changes were not significantly related to social anxiety symptom improvement.

      Conclusions

      SSRI treatment response in gSP is associated with changes in a discrete limbic-paralimbic brain network, representing a neural mechanism through which SSRIs may exert their actions.

      Key Words

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