Major Depressive Disorder Is Associated with Impaired Interoceptive Accuracy: A Systematic Review

Abstract

Interoception is the sense of the physiological condition of the entire body. Impaired interoception has been associated with aberrant activity of the insula in major depressive disorder (MDD) during heartbeat perception tasks. Despite clinical relevance, studies investigating interoceptive impairments in MDD have never been reviewed systematically according to the guidelines of the PRISMA protocol, and therefore we collated studies that assessed accuracy in detecting heartbeat sensations (interoceptive accuracy, IAc) in MDD (databases: PubMed/Medline, PsycINFO, and PsycARTICLES). Out of 389 records, six studies met the inclusion criteria. The main findings suggest that (i) moderately depressed samples exhibit the largest interoceptive deficits as compared with healthy adults. (ii) difficulties in decision making and low affect intensity are correlated with low IAc, and (iii) IAc seems to normalize in severely depressed subjects. These associations may be confounded by sex, anxiety or panic disorder, and intake of selective serotonin reuptake inhibitors. Our findings have implications for the development of interoceptive treatments that might relieve MDD-related symptoms or prevent relapse in recurrent depression by targeting the interoceptive nervous system.

Dissociations between interoceptive accuracy and attention: evidence from the interoceptive attention scale

“…Parallel to this renewed interest in the relationship between interoception and cognition, individual differences in interoceptive abilities have increasingly been linked to mental health (see Khalsa et al, 2018;Murphy, Brewer, Catmur, & Bird, 2017). Indeed, a body of literature suggests the presence of atypical interoceptive abilities across a number of mental health conditions, including anxiety, depression, obsessive compulsive disorder, anorexia nervosa, schizophrenia, borderline personality disorder and substance use disorders (Ardizzi et al, 2016;Eggart, Lange, Binser, Queri, & Müller-Oerlinghausen, 2019;Löffler, Foell, & Bekrater-Bodmann, 2018;Paulus & Stein, 2010;Schultchen, Zaudig, Krauseneck, Berberich, & Pollatos, 2019;Sönmez, Kahyacı Kılıç, Ateş Çöl, Görgülü, & Köse Çınar, 2017). Despite these considerable efforts to develop our understanding of interoception, and determine its relevance for health and cognition, empirical progress has been impeded by difficulties with the measurement of interoceptive abilities.…”

Effects of Psychoactive Massage in Outpatients with Depressive Disorders: A Randomized Controlled Mixed-Methods Study

“…However, even if this feeling of relaxation is a significant part of the overall effect, there must be other factors involved, otherwise the superiority of massage over a standardized relaxation method would hardly make sense. In modern theories of depression, the concept of interoception has been given increasing attention [ 47 , 48 ]. Interoception, i.e., the perception of the processes of the body’s interior, distinguishes between proprioception (perception of body position and movement in space) and visceroception (perception of the inner organs’ activity).…”

Trauma or Drama: A Predictive Processing Perspective on the Continuum of Stress

“…Depressed patients show decreased activity in the insula during an interoceptive task ( Avery et al, 2014 ). The impaired interoceptive accuracy in depression has been documented in a recent comprehensive review ( Eggart et al, 2019 ). The cumulative findings show a correlation between low affectivity and low interoceptive accuracy.…”