Neural correlates of emotional processing in depression: Changes with cognitive behavioral therapy and predictors of treatment response

Abstract

a b s t r a c tMajor depressive disorder (MDD) is characterized by the presence of disturbances in emotional processing. However, the neural correlates of these alterations, and how they may be affected by therapeutic interventions, remain unclear. The present study addressed these issues in a preliminary investigation using functional magnetic resonance imaging (fMRI) to examine neural responses to positive, negative, and neutral pictures in unmedicated MDD patients (N ¼ 22) versus controls (N ¼ 14). After this initial scan, MDD patients were treated with cognitive behavioral therapy (CBT) and scanned again after treatment. Within regions that showed pre-treatment differences between patients and controls, we tested the association between pre-treatment activity and subsequent treatment response as well as activity changes from pre-to post-treatment. This study yielded three main findings. First, prior to treatment and relative to controls, patients exhibited overall reduced activity in the ventromedial prefrontal cortex (PFC), diminished discrimination between emotional and neutral items in the amygdala, caudate, and hippocampus, and enhanced responses to negative versus positive stimuli in the left anterior temporal lobe (ATL) and right dorsolateral PFC. Second, CBT-related symptom improvement in MDD patients was predicted by increased activity at baseline in ventromedial PFC as well as the valence effects in the ATL and dorsolateral PFC. Third, from pre-to post-treatment, MDD patients exhibited overall increases in ventromedial PFC activation, enhanced arousal responses in the amygdala, caudate, and hippocampus, and a reversal of valence effects in the ATL. The study was limited by the relatively small sample that was able to complete both scan sessions, as well as an inability to determine the influence of comorbid disorders within the current sample. Nevertheless, components of the neural networks corresponding to emotion processing disturbances in MDD appear to resolve following treatment and are predictive of treatment response, possibly reflecting improvements in emotion regulation processes in response to CBT.

Cognitive behavioural therapy for depression: systematic review of imaging studies

“…Two fMRI studies reported post-CBT increases in superior frontal gyrus/DMPFC (BA8) activity when processing emotional stimuli, though Yoshimura et al found it increased on judging whether positive emotional trait words applied to them and Fu et al increased on processing sad facial expressions (23,28 (23,28,29).…”

Depression: A change of mind

“…"The imaging data have been really encouraging, " says Timothy Strauman, a psychologist at Duke University in Durham, North Carolina, who has generated similar results 7 . "We do find evidence for the kinds of changes that you would expect.…”

Brain Activation During Emotional Memory Processing Associated with Subsequent Course of Depression

“…However, it is currently unclear which patients will show a favorable or unfavorable course. Studies on treatment response have indicated the importance of structure and functioning of the lateral prefrontal cortex (PFC) (Heller et al, 2013;Langenecker et al, 2007;Ritchey et al, 2011), medial PFC (Ritchey et al, 2011), anterior cingulate cortex (ACC) (Fu et al, 2013;Kemp et al, 2008;Pizzagalli, 2010), insula (Fu et al, 2013;Langenecker et al, 2007;McGrath et al, 2013), amygdala (Langenecker et al, 2007), and hippocampus (Frodl et al, 2004;Fu et al, 2013) for predicting remission following treatment. However, treatment-response markers are not necessarily markers of a naturalistic course of depression.…”