Changes in Prefrontal-Limbic Function in Major Depression after 15 Months of Long-Term Psychotherapy

Abstract

Neuroimaging studies of depression have demonstrated treatment-specific changes involving the limbic system and regulatory regions in the prefrontal cortex. While these studies have examined the effect of short-term, interpersonal or cognitive-behavioural psychotherapy, the effect of long-term, psychodynamic intervention has never been assessed. Here, we investigated recurrently depressed (DSM-IV) unmedicated outpatients (N = 16) and control participants matched for sex, age, and education (N = 17) before and after 15 months of psychodynamic psychotherapy. Participants were scanned at two time points, during which presentations of attachment-related scenes with neutral descriptions alternated with descriptions containing personal core sentences previously extracted from an attachment interview. Outcome measure was the interaction of the signal difference between personal and neutral presentations with group and time, and its association with symptom improvement during therapy. Signal associated with processing personalized attachment material varied in patients from baseline to endpoint, but not in healthy controls. Patients showed a higher activation in the left anterior hippocampus/amygdala, subgenual cingulate, and medial prefrontal cortex before treatment and a reduction in these areas after 15 months. This reduction was associated with improvement in depressiveness specifically, and in the medial prefrontal cortex with symptom improvement more generally. This is the first study documenting neurobiological changes in circuits implicated in emotional reactivity and control after long-term psychodynamic psychotherapy.

The Effects of Psychotherapy on Brain Function — Major Depressive Disorder

“…The activation of the subgenual cingulate cortex has been known to decrease in depression patients after PDT, compared to healthy people [100], and this neural mechanism of PDT in relieving the symptoms of depression was proven through neuroimaging. Depression is believed to be a pathological state of the activity level of the brain circuit, and PDT is believed to normalize the brain circuit.…”

“…[101] However, the difference in the methodologies of the studies makes their comparison difficult. For example, Buchheim suggested that PDT was very effective in patients with subgenual ACC overactive depression [100], whereas CBT did not show any relevance. [102,103] It was not completely understood if such result was because the neurobiological mechanisms of PDT and CBT were different, or if their study methodology was different due to their significantly different therapy methods.…”

“…The study examining the effect of psychotherapy on brain function in patients with depression was conducted to investigate the effect of long-term psychodynamic intervention (Buchheim et al, 2012). [100] Sixteen, un-medicated outpatients with depression who underwent 15 months of psychodynamic therapy were scanned twice, before and after treatment, during the presentation of attachment-related scenes with neutral descriptions alternated with descriptions containing personal sentences previously extracted from an attachment interview.…”

“…[100] Sixteen, un-medicated outpatients with depression who underwent 15 months of psychodynamic therapy were scanned twice, before and after treatment, during the presentation of attachment-related scenes with neutral descriptions alternated with descriptions containing personal sentences previously extracted from an attachment interview. The results showed increased activation in the left anterior hippocampus/amygdala, subgenual cingulate, and medial prefrontal cortex in patients compared to healthy controls before treatment, and a reduction in the same areas after treatment.…”

La depresión como un diagnóstico complejo: Implicancias para el desarrollo de recomendaciones clínicas

“…Las hipótesis en las que se basan las clasificaciones actuales serán mejoradas cuando se integre el conocimiento que la genética y las neuroimá-genes están aportando a la comprensión no sólo de la etiopatogenia de las enfermedades mentales sino también de la forma en que actúan las intervenciones terapéuticas desde los fármacos a la psicoterapia 69 . En ese sentido, la búsqueda de marcadores biológicos específicos podrá ayudar no sólo a definir la presencia y severidad de los sín-tomas sino también a delimitar subtipos clínicos, predecir la respuesta al tratamiento y establecer un pronóstico.…”