Opposing and emotion-specific frontal alterations during facial emotion processing in generalized anxiety and depression

Abstract

Background: Major depression (MDD) and generalized anxiety disorder (GAD) have become one of the leading global causes of disability and both are characterized by marked interpersonal and social impairments. However, despite a high comorbidity and overlapping social-emotional deficits it remains unclear whether MDD and GAD share a common neural basis during interpersonal processing. Methods: This study combined an emotional face processing paradigm with fMRI and dimensional and categorical analyses in a sample of unmedicated MDD and GAD patients (N = 72) as well as healthy controls (N = 35). Results: No group differences were found in categorical analyses. However, the dimensional analyses revealed that dorsolateral prefrontal cortex (dlPFC) reactivity to sad facial expressions was positively associated with depressive, yet negatively associated with GAD symptom load in the entire sample. On the network level depression symptom load was positively associated with functional connectivity between the bilateral amygdala and a widespread network including the anterior cingulate and insular cortex. Limitations: Sex differences were not examined in the present study and some patients exhibited depression-GAD comorbidity. Conclusions: Together, these findings suggest that the dlPFC - engaged in cognitive and emotional processing - exhibits symptom- and emotion-specific alteration during interpersonal processing. Dysregulated communication between amygdala and core regions of the salience network may represent MDD-specific neural dysregulations.