Modulation of Cortical-Limbic Pathways in Major Depression

Goldapple, Kim; Segal, Zindel V.; Garson, Carol; Lau, Mark A.; Bieling, Peter; Kennedy, Sidney H.; Mayberg, Helen S.

doi:10.1001/archpsyc.61.1.34

Cited by 970 publications

(253 citation statements)

References 93 publications

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“…44,45 Moreover, a significant increase in glucose metabolism in the dACC was seen in responders to CBT for major depression. 46 Taken together with these prior findings, our results suggest that dACC activation might be a common mechanism of action required for response to CBT across disorders.…”

Section: Discussionsupporting

confidence: 82%

Rapid effects of brief intensive cognitive-behavioral therapy on brain glucose metabolism in obsessive-compulsive disorder

Saxena

Gorbis²,

O’Neill³

et al. 2008

Mol Psychiatry

124

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Brief intensive cognitive-behavioral therapy (CBT) using exposure and response prevention significantly improves obsessive-compulsive disorder (OCD) symptoms in as little as 4 weeks. However, it has been thought that much longer treatment was needed to produce the changes in brain function seen in neuroimaging studies of OCD. We sought to elucidate the brain mediation of response to brief intensive CBT for OCD and determine whether this treatment could induce functional brain changes previously seen after longer trials of pharmacotherapy or standard CBT. [ 18 F]-fluorodeoxyglucose positron emission tomography brain scans were obtained on 10 OCD patients before and after 4 weeks of intensive individual CBT. Twelve normal controls were scanned twice, several weeks apart, without treatment. Regional glucose metabolic changes were compared between groups. OCD symptoms, depression, anxiety and overall functioning improved robustly with treatment. Significant changes in normalized regional glucose metabolism were seen after brief intensive CBT (P = 0.04). Compared to controls, OCD patients showed significant bilateral decreases in normalized thalamic metabolism with intensive CBT but had a significant increase in right dorsal anterior cingulate cortex activity that correlated strongly with the degree of improvement in OCD symptoms (P = 0.02). The rapid response of OCD to intensive CBT is mediated by a distinct pattern of changes in regional brain function. Reduction of thalamic activity may be a final common pathway for improvement in OCD, but response to intensive CBT may require activation of dorsal anterior cingulate cortex, a region involved in reappraisal and suppression of negative emotions.

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Section: Discussionsupporting

confidence: 82%

Rapid effects of brief intensive cognitive-behavioral therapy on brain glucose metabolism in obsessive-compulsive disorder

Saxena

Gorbis²,

O’Neill³

et al. 2008

Mol Psychiatry

124

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“…Further, while hundreds of studies have shown that cognitive behavior therapy (CBT) can effectively change the thought processes and behaviors of adults with various types of psychopathology (Hofmann et al 2012), there is strong evidence to suggest that these cognitive and behavioral changes are associated with neurological changes when assessed with MRI and fMRI (Kandel 2006;Jokić-Begić 2010;Schwartz and Begley 2002;Goldapple et al 2004). Similarly, experiments have shown both mindfulness and compassion-focused meditation to be effective in reducing anxiety, depression, and anger while enhancing emotion regulation, empathy, and psychological well-being (e.g., Eberth and Sedlmeier 2012;Hofmann et al 2011).…”

Section: Anomalies That Challenged the Old View Of The Brainmentioning

confidence: 99%

Invited Address: “The Times They Are A-Changin’” Gene Expression, Neuroplasticity, and Developmental Research

Simons

Klopack

2014

J Youth Adolescence

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For good reason, social scientists have a long history of being suspicious of biological explanations of human behavior. Importantly, however, recent paradigmatic shifts in the life sciences have largely obviated these longstanding concerns. We highlight the changes that have occurred in genetics with its movement away from genetic determinism to an emphasis on epigenetics and in neuroscience with its switch from a fixed to a neuroplastic view of the brain. We describe these new developments noting the way they recognize, indeed place a premium upon, the role of the environment. The remainder of the paper focuses upon the challenges and opportunities for social scientists, especially those involved in developmental work, proffered by these paradigmatic shifts. The evidence clearly shows that nature and nurture are inextricably interlinked. Importantly, however, it also indicates that they are connected in a manner that honors the priority that the social sciences place upon the environment. We contend that incorporating biological processes into our developmental work will sharpen our theories and enhance their significance. We argue that such biologically integrated models will provide a clearer and more comprehensive understanding of how nurture influences behavior across the life course.

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“…39,114 Cognitive behavioral therapy (CBT) and interpersonal therapy (IPT), two forms of psychotherapy studied for efficacy in the treatment of depression, have effects on affective circuitry that are distinct from those of antidepressant medication. 37,115,116 A "top-down" mechanism has been postulated in which these therapies may enhance function of the orbital cortex/anterior insula and other cortical regions to more effectively attenuate dysregulated limbic activity. 12,116 These findings support the hypothesis that it is an imbalance within these circuits, rather than any specific directional disturbance in a sin- gle region, that provides a neural substrate for mood dysregulation.…”

Section: Presumptive Mood Disorder Circuitsmentioning

confidence: 99%

“…37,115,116 A "top-down" mechanism has been postulated in which these therapies may enhance function of the orbital cortex/anterior insula and other cortical regions to more effectively attenuate dysregulated limbic activity. 12,116 These findings support the hypothesis that it is an imbalance within these circuits, rather than any specific directional disturbance in a sin- gle region, that provides a neural substrate for mood dysregulation. Magnetic seizure therapy (MST), an experimental technique using a magnetic field to induce a seizure, is currently being investigated in the treatment of depression by Lisanby et al 117 They have reported some preliminary evidence that MST may have fewer cognitive side effects than ECT.…”

Section: Presumptive Mood Disorder Circuitsmentioning

confidence: 99%

Neural circuitry and neuroplasticity in mood disorders: Insights for novel therapeutic targets

Carlson¹,

Singh²,

Zarate³

et al. 2006

NeuroRX

135

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Summary:Major depressive disorder and bipolar disorder are severe mood disorders that affect the lives and functioning of millions each year. The majority of previous neurobiological research and standard pharmacotherapy regimens have approached these illnesses as purely neurochemical disorders, with particular focus on the monoaminergic neurotransmitter systems. Not altogether surprisingly, these treatments are inadequate for many individuals afflicted with these devastating illnesses. Recent advances in functional brain imaging have identified critical neural circuits involving the amygdala and other limbic structures, prefrontal cortical regions, thalamus, and basal ganglia that modulate emotional behavior and are disturbed in primary and secondary mood disorders. Growing evidence suggests that mechanisms of neural plasticity and cellular resilience, including impairments of neurotrophic signaling cascades as well as altered glutamatergic and glucocorticoid signaling, underlie the dysregulation in these circuits. The increasing ability to monitor and modulate activity in these circuits is beginning to yield greater insight into the neurobiological basis of mood disorders. Modulation of dysregulated activity in these affective circuits via pharmacological agents that enhance neuronal resilience and plasticity, and possibly via emerging nonpharmacologic, circuitry-based modalities (for example, deep brain stimulation, magnetic stimulation, or vagus nerve stimulation) offers promising targets for novel experimental therapeutics in the treatment of mood disorders.

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Modulation of Cortical-Limbic Pathways in Major Depression

Cited by 970 publications

References 93 publications

Rapid effects of brief intensive cognitive-behavioral therapy on brain glucose metabolism in obsessive-compulsive disorder

Rapid effects of brief intensive cognitive-behavioral therapy on brain glucose metabolism in obsessive-compulsive disorder

Invited Address: “The Times They Are A-Changin’” Gene Expression, Neuroplasticity, and Developmental Research

Neural circuitry and neuroplasticity in mood disorders: Insights for novel therapeutic targets

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