A neurocognitive model for understanding treatment action in depression

Abstract

One contribution of 15 to a theme issue 'Controlling brain activity to alter perception, behaviour and society'. The way in which emotion is represented and processed in the human brain is an expanding area of research and has key implications for how we understand and potentially treat affective disorders such as depression. Characterizing the effects of pharmacological manipulations of key neurotransmitter systems can also help reveal the neurochemical underpinnings of emotional processing and how common antidepressant drugs may work in the treatment of depression and anxiety. This approach has revealed that depression is associated with both neural and behavioural biases towards negative over positive stimuli. Evidence from pharmacological challenge studies suggests that antidepressant treatment acts to normalize these biases early on in treatment, resulting in patients experiencing the world in a more positive way, improving their mood over time. This model is supported by evidence from both pharmacological and non-pharmacological interventions. The unique perspective on antidepressant treatment offered by this approach provides some insights into individual response to treatment, as well as novel approaches to drug development.

Attentional Bias Modification is associated with fMRI Response towards Negative Stimuli in Residual Depression: A Randomized Controlled Trial

“…targeting the same mechanism as when applying an ABM procedure. [56][57][58] Similarly, the moderation of awareness towards negative stimuli via ABM (the mechanism of change) may alter automatic emotional vigilance and arousal towards negative stimuli. These moderations may lead to altered parasympathetic responses via circuitry involving the amygdala and ACC.…”

Changes in causal attributions and relationship representations: Are they specific or common mechanisms in the treatment of depression?

“…Furthermore, psychodynamic techniques may alter brain functioning (Buchheim et al, 2012; Karlsson, 2011; Loughead et al, 2010;; Roffman et al, 2014), and symptom change may occur through changes in neurotransmitter processes. Some theorists have proposed that serotonin changes resulting from antidepressant medication may directly alter cognitive biases and relationships as well through alterations in emotion processing in the brain (Warren et al, 2015). The role of neurochemical and brain pathways remains an important subject in the study of depression treatment mechanisms.…”

Biased Facial-Emotion Perception in Mental Health Disorders: A Possible Target for Psychological Intervention?

“…These changes in biases are rapidly observable -even in response to a single dose of SSRI (Warren, Pringle & Harmer, 2015, for a review). Crucially, these changes in emotional perception occur before improvement in patients' symptoms, and their magnitude predicts recovery.…”

“…So, while CBM targets early stage, basic, automatic biases, conventional psychotherapies may act at later stages, challenging perceptual biases using a topdown approach, (Hallion & Ruscio, 2011). Analogously, while SSRIs successfully reduce the salience of negative emotional signals in the environment (Warren, Pringle, & Harmer, 2015), emotion recognition training focuses on instilling positive biases. Preliminary evidence from the secondary outcomes in (Peters et al, 2017, January 30) indicates that CBM may have some effects on anhedonia.…”