PDF herunterladen
Psychother Psychosom Med Psychol 2018; 68(06): 258-271
DOI: 10.1055/a-0598-4972
CME-Fortbildung
© Georg Thieme Verlag KG Stuttgart · New York

Psychotherapie depressiver Störungen als neurobiologischer Prozess – Erkenntnisse aus der Hirnbildgebung

Psychotherapy of Depression as Neurobiological Process – Evidence from Neuroimaging
Antonie Rubart
,
Fritz Hohagen
,
Bartosz Zurowski
Weitere Informationen

Publikationsverlauf

Publikationsdatum:
04. Juni 2018 (online)

Auch verfügbar auf
    Lizenzen und Reprints

Die Depression – eine der häufigsten psychischen Erkrankungen in Deutschland. Dieser Beitrag vermittelt Grundwissen über die Bildgebung in der Psychotherapieforschung und beschreibt Erklärungsmodelle für neurobiologische Prozesse mit der Möglichkeit der Vorhersage des Therapieerfolgs mittels bildgebender Verfahren.

Abstract

Research on neurobiological effects of psychotherapy in depression facilitates the improvement of treatment strategies. The cortico-limbic dysregulation model serves as a framework for numerous studies on neurobiological changes in depression. In this model, depression is described as hypoactivation of dorsal cortical brain regions in conjunction with hyperactivation of ventral paralimbic regions. This assumption has been supported by various studies of structural and functional brain abnormalities in depression. However, also regions not included in the original cortico-limbic dysregulation model, such as the dorsomedial prefrontal cortex, seem to play an important role in depression. Functional connectivity studies of depression have revealed an enhanced connectivity within the so-called default mode network which is involved in self-referential thinking. Studies also point to a normalization of limbic and cortical brain activity, especially in the anterior cingulate cortex, during psychotherapy. Some neurobiological markers like the activity of the anterior cingulate cortex, striatum and insula as well as hippocampal volume have been proposed to predict treatment response on a group-level. The activity of the anterior insula appears to be a candidate bio-marker for differential indication for psychotherapy or pharmacotherapy. The cortico-limbic dysregulation model and following research have inspired new forms of treatment for depression like deep brain stimulation of the subgenual anterior cingulate cortex, repetitive transcranial magnetic stimulation of the dorsolateral prefrontal cortex, neurofeedback and attention training.

Key words

depression - neurobiology - psychotherapy - pharmacotherapy - neuroimaging - limbic-cortical dysregulation

Schlüsselwörter

Depression - Neurobiologie - Psychotherapie - Pharmakotherapie - Neurobildgebung - kortikolimbische Dysregulation
 

  • Literatur

  • 1 Busch MA, Maske UE, Ryl L. et al. Prävalenz von depressiver Symptomatik und diagnostizierter Depression bei Erwachsenen in Deutschland. Ergebnisse der Studie zur Gesundheit Erwachsener in Deutschland (DEGS1). Bundesgesundheitsblatt 2013; 56: 733-739
    CrossrefPubMedGoogle Scholar
  • 2 Härter M, Klesse C, Bermejo I. et al. Evidenzbasierte Therapie der Depression. Die S3-Leitlinie unipolare Depression. Nervenarzt 2010; 81: 1049-1068
    CrossrefPubMedGoogle Scholar
  • 3 Huhn M, Tardy M, Spineli LM. et al. Efficacy of Pharmacotherapy and Psychotherapy for Adult Psychiatric Disorders. A Systematic Overview of Meta-Analysis. JAMA Psychiatry 2014; 71: 706-715
    CrossrefPubMedGoogle Scholar
  • 4 Cohen J. Statistical Power Analysis for the Behavioral Sciences. 2nd ed. Hillsdale NJ: Lawrence Erlbaum Associates; 1988
    Google Scholar
  • 5 Braun K, Bogerts B. Erfahrungsgesteuerte neuronale Plastizität. Bedeutung für Pathogenese und Therapie psychischer Erkrankungen. Nervenarzt 2001; 72: 3-10
    CrossrefPubMedGoogle Scholar
  • 6 Castrén E. Is mood chemistry?. Nat Rev Neurosci 2005; 6: 241-246
    CrossrefPubMedGoogle Scholar
  • 7 Berger T, Caspar F. Gewinnt die Psychotherapie durch die neurobiologische Erforschung ihrer Wirkmechanismen?. ZPPP 2009; 57: 77-85
    PubMedGoogle Scholar
  • 8 Mayberg HS. Limbic-Cortical Dysregulation: A Proposed Model of Depression. J Neuropsychiatr 1997; 9: 471-481
    PubMedGoogle Scholar
  • 9 Rive MM, van Rooijen G, Veltman DJ. et al. Neural correlates of dysfunctional emotion regulation in major depressive disorder. A systematic review of neuroimaging studies. Neurosci Biobehav Rev 2013; 37: 2529-2553
    CrossrefPubMedGoogle Scholar
  • 10 Lauterbur PC. Image formation by induced local interactions: examples employing nuclear magnetic resonance. Nature 1973; 242: 190-191
    CrossrefPubMedGoogle Scholar
  • 11 Ashburner J, Friston KJ. Voxel-Based Morphometry – The Methods. Neuroimage 2000; 11: 805-821
    CrossrefPubMedGoogle Scholar
  • 12 Fox PT, Mintun MA, Raichle ME. et al. Mapping human visual cortex with positron emission tomography. Nature 1986; 323: 806-809
    CrossrefPubMedGoogle Scholar
  • 13 Ogawa S, Tank DW, Menon R. et al. Intrinsic signal changes accompanying sensory stimulation: Functional brain mapping with magnetic resonance imaging. Proc Natl Acad Sci U S A 1992; 89: 5951-5955
    CrossrefPubMedGoogle Scholar
  • 14 Biswal BB, Mennes M, Zuo X. et al. Toward discovery science of human brain function. Proc Natl Acad Sci USA 2010; 107: 4734-4739
    CrossrefPubMedGoogle Scholar
  • 15 Palomero-Gallagher N, Vogt BA, Schleicher A. et al. Receptor architecture of human cingulate cortex: Evaluation of the four-region neurobiological model. Hum Brain Mapp 2009; 30: 2336-2355
    CrossrefPubMedGoogle Scholar
  • 16 Phan KL, Wager T, Taylor SF. et al. Functional Neuroanatomy of Emotion: A Meta-Analysis of Emotion Activation Studies in PET and fMRI. Neuroimage 2002; 16: 331-348
    CrossrefPubMedGoogle Scholar
  • 17 Sergerie K, Chochol C, Armony JL. The role of the amygdala in emotional processing: A quantitative meta-analysis of functional neuroimaging studies. Neurosci Biobehav Rev 2008; 32: 811-830
    CrossrefPubMedGoogle Scholar
  • 18 Kane MJ, Engle RW. The role of prefrontal cortex in working-memory capacity, executive attention, and general fluid intelligence: An individual-differences perspective. Psychon Bull Rev 2002; 9: 637-671
    CrossrefPubMedGoogle Scholar
  • 19 Buckner RL, Andrews-Hanna JR, Schacter DL. The Brain’s Default Network. Anatomy, Function, and Relevance to Disease. Ann NY Acad Sci 2008; 1124: 1-38
    CrossrefPubMedGoogle Scholar
  • 20 Eichenbaum H. A cortical-hippocampal system for declarative memory. Nat Rev Neurosci 2000; 1: 41-50
    CrossrefPubMedGoogle Scholar
  • 21 Scoville WB, Milner B. Loss of recent memory after bilateral hippocampal lesions. J Neurol Neurosurg Psychiatry 1957; 20: 11-21
    CrossrefPubMedGoogle Scholar
  • 22 Murphy FC, Nimmo-Smith I, Lawrence AD. Functional neuroanatomy of emotions: A meta-analysis. Cogn Affect Behav Neurosci 2003; 3: 207-233
    CrossrefPubMedGoogle Scholar
  • 23 Kurth F, Zilles K, Fox PT. et al. A link between the systems: functional differentiation and integration within the human insula revealed by meta-analysis. Brain Struct Funct 2010; 214: 519-534
    CrossrefPubMedGoogle Scholar
  • 24 Kringelbach ML. The human orbitofrontal cortex: linking reward to hedonic experience. Nat Rev Neurosci 2005; 6: 691-702
    CrossrefPubMedGoogle Scholar
  • 25 Leech R, Sharp DJ. The role of the posterior cingulate cortex in cognition and disease. Brain 2014; 137: 12-32
    CrossrefPubMedGoogle Scholar
  • 26 Zhang S, Li CR. Functional connectivity mapping of the human precuneus by resting state fMRI. Neuroimage 2012; 59: 3548-3562
    CrossrefPubMedGoogle Scholar
  • 27 Mayberg HS, Liotti M, Jerabek PA. et al. Induced sadness: A PET model of depression. Hum Brain Mapp 1995; 1 Suppl 396
    PubMedGoogle Scholar
  • 28 Seminowicz DA, Mayberg HS, McIntosh AR. et al. Limbic-frontal circuitry in major depression: a path modeling metanalysis. Neuroimage 2004; 22: 409-418
    CrossrefPubMedGoogle Scholar
  • 29 Anand A, Li Y, Wang Y. et al. Activity and Connectivity of Brain Mood Regulating Circuit in Depression: A Functional Magnetic Resonance Study. Biol Psychiatry 2005; 57: 1079-1088
    CrossrefPubMedGoogle Scholar
  • 30 Palmer SM, Crewther SG, Carey LM. et al. A meta-analysis of changes in brain activity in clinical depression. Front Hum Neurosci 2015; 8: 1045-1064
    PubMedGoogle Scholar
  • 31 Lueken U, Hahn T. Functional neuroimaging of psychotherapeutic processes in anxiety and depression: from mechanisms to predictions. Curr Opin Psychiatry 2016; 29: 25-31
    CrossrefPubMedGoogle Scholar
  • 32 Ramirez-Mahaluf JP, Roxin A, Mayberg HS. et al. A Computational Model of Major Depression: the Role of Glutamate Dysfunction on Cingulo-Frontal Network Dynamics. Cereb Cortex 2017; 27: 660-679
    PubMedGoogle Scholar
  • 33 Beck AT. The evolution of the cognitive model of depression and its neurobiological correlates. Am J Psychiatry 2008; 165: 969-977
    CrossrefPubMedGoogle Scholar
  • 34 Disner SG, Beevers CG, Haigh EA. et al. Neural mechanisms of the cognitive model of depression. Nat Rev Neurosci 2011; 12: 467-477
    CrossrefPubMedGoogle Scholar
  • 35 Bora E, Harrison BJ, Davey CG. et al. Meta-analysis of volumetric abnormalities in cortico-striatal-pallidal-thalamic circuits in major depressive disorder. Psychol Med 2012; 42: 671-681
    CrossrefPubMedGoogle Scholar
  • 36 Bora E, Fornito A, Pantelis C. et al. Gray matter abnormalities in Major Depressive Disorder: A meta-analysis of voxel based morphometry studies. J Affect Disord 2012; 138: 9-18
    CrossrefPubMedGoogle Scholar
  • 37 Schmaal L, Veltman DJ, van Erp TGM. et al. Subcortical brain alterations in major depressive disorder: Findings from the ENIGMA Major Depressive Disorder working group. Mol Psychiatry 2016; 21: 806-812
    CrossrefPubMedGoogle Scholar
  • 38 Schmaal L, Hibar DP, Sämann PG. et al. Cortical abnormalities in adults and adolescents with major depression based on brain scans from 20 cohorts worldwide in the ENIGMA Major Depressive Disorder Working Group. Mol Psychiatry 2017; 22: 900-909
    CrossrefPubMedGoogle Scholar
  • 39 Kaiser RH, Andrews-Hanna JR, Wagner TD. et al. Large-Scale Network Dysfunction in Major Depressive Disorder. A Meta-analysis of Resting-State Functional Connectivity. JAMA Psychiatry 2015; 72: 603-611
    CrossrefPubMedGoogle Scholar
  • 40 Franklin G, Carson AJ, Welch KA. Cognitive behavioural therapy for depression: systematic review of imaging studies. Acta Neuropsychiatr 2016; 28: 61-74
    CrossrefPubMedGoogle Scholar
  • 41 Joshi SH, Espinoza RT, Pirnia T. et al. Structural Plasticity of the Hippocampus and Amygdala Induced by Electroconvulsive Therapy in Major Depression. Biol Psychiatry 2016; 79: 282-292
    CrossrefPubMedGoogle Scholar
  • 42 Nordanskog P, Dahlstrand U, Larsson MR. et al. Increase in Hippocampal Volume After Electroconvulsive Therapy in Patients With Depression: A Volumetric Magnetic Resonance Imaging Study. J ECT 2010; 26: 62-67
    CrossrefPubMedGoogle Scholar
  • 43 Messina I, Sambin M, Palmieri A. et al. Neural Correlates of Psychotherapy in Anxiety and Depression: A Meta-Analysis. PloS ONE 2013; 8: e74657
    CrossrefPubMedGoogle Scholar
  • 44 Yoshimura S, Okamoto Y, Matsunaga M. et al. Cognitive behavioral therapy changes functional connectivity between medial prefrontal and anterior cingulate cortices. J Affect Disord 2017; 208: 610-614
    CrossrefPubMedGoogle Scholar
  • 45 Wiswede D, Taubner S, Buchheim A. et al. Tracking Functional Brain Changes in Patients with Depression under Psychodynamic Psychotherapy Using Individualized Stimuli. PloS One 2014; 9: e109037
    CrossrefPubMedGoogle Scholar
  • 46 Klein JP, Becker B, Hurlemann R. et al. Effect of specific psychotherapy for chronic depression on neural responses to emotional faces. J Affect Disord 2014; 166: 93-97
    CrossrefPubMedGoogle Scholar
  • 47 Buhle JT, Silvers JA, Wager TD. et al Cognitive Reappraisal of Emotion: A Meta-Analysis of Human Neuroimaging Studies. Cereb Cortex 2014; 24: 2981-2990
    CrossrefPubMedGoogle Scholar
  • 48 Zilverstand A, Parvaz MA, Goldstein RZ. Neuroimaging cognitive reappraisal in clinical populations to define neural targets for enhancing emotion regulation. A systematic review. Neuroimage 2017; 151: 105-116
    CrossrefPubMedGoogle Scholar
  • 49 Rubin-Falcone H, Weber J, Kishon R. et al. Longitudinal effects of cognitive behavioral therapy for depression on the neural correlates of emotion regulation. Psychiatry Res: Neuroimaging 2018; 271: 82-90 10.1016/j.pscychresns.2017.11.002
    CrossrefPubMedGoogle Scholar
  • 50 DeRubeis RJ, Siegle GJ, Hollon SD. Cognitive therapy versus medication for depression: treatment outcomes and neural mechanisms. Nat Rev Neurosci 2008; 9: 788-796
    CrossrefPubMedGoogle Scholar
  • 51 Hollon SD, DeRubeis RJ, Shelton RC. et al. Prevention of Relapse Following Cognitive Therapy vs. Medications in Moderate to Severe Depression. Arch Gen Psychiatry 2005; 62: 417-422
    CrossrefPubMedGoogle Scholar
  • 52 Kalsi N, Altavilla D, Tambelli R. et al. Neural Correlates of Outcome of the Psychotherapy Compared to Antidepressant Therapy in Anxiety and Depression Disorders: A Meta-Analysis. Front Psychol 2017; 8: 927
    CrossrefPubMedGoogle Scholar
  • 53 Fu CHY, Steiner H, Costafreda SG. Predictive neural biomarkers of clinical response in depression: A meta-analysis of functional and structural neuroimaging studies of pharmacological and psychological treatments. Neurobiol Dis 2013; 52: 75-83
    CrossrefPubMedGoogle Scholar
  • 54 Siegle GJ, Carter CS, Thase ME. Use of fMRI to Predict Recovery from Unipolar Depression with Cognitive Behavior Therapy. Am J Psychiatry 2006; 163: 735-738
    CrossrefPubMedGoogle Scholar
  • 55 Konarski JZ, Kennedy SH, Segal ZV. et al. Predictors of nonresponse to cognitive behavioural therapy or venlafaxine using glucose metabolism in major depressive disorder. J Psychiatry Neurosci 2009; 34: 175-180
    PubMedGoogle Scholar
  • 56 McGrath CL, Kelley ME, Holtzheimer PE. et al. Toward a Neuroimaging Treatment Selection Biomarker for Major Depressive Disorder. JAMA Psychiatry 2013; 70: 821-829
    CrossrefPubMedGoogle Scholar
  • 57 Dunlop BW, Mayberg HS. Neuroimaging-based biomarkers for treatment selection in major depressive disorder. Dialogues Clin Neurosci 2014; 16: 479-490
    PubMedGoogle Scholar
  • 58 Dunlop BW, Rajendra JK, Craighead WE. et al. Functional Connectivity of the Subcallosal Cingulate Cortex and Differential Outcomes to Treatment with Cognitive-Behavioral Therapy or Antidepressant Medication for Major Depressive Disorder. Am J Psychiatry 2017; 174: 533-545
    CrossrefPubMedGoogle Scholar
  • 59 Holtzheimer PE, Kelley ME, Gross RE. et al. Subcallosal Cingulate Deep Brain Stimulation for Treatment-Resistant Unipolar and Bipolar Depression. Arch Gen Psychiatry 2012; 69: 150-158
    CrossrefPubMedGoogle Scholar
  • 60 Lozano AM, Giacobbe P, Hamani C. et al. A multicenter pilot study of subcallosal cingulate area deep brain stimulation for treatment-resistant depression. J Neurosurg 2012; 116: 315-322
    CrossrefPubMedGoogle Scholar
  • 61 Puigdemont D, Pérez-Egea R, Portella MJ. et al. Deep brain stimulation of the subcallosal cingulate gyrus: further evidence in treatment-resistant major depression. Int J Neuropsychopharmacol 2012; 15: 121-133
    CrossrefPubMedGoogle Scholar
  • 62 Bergfeld IO, Mantione M, Hoogendoorn MLC. et al. Deep Brain Stimulation of the Ventral Anterior Limb of the Internal Capsule for Treatment-Resistant Depression. A Randomized Clinical Trial. JAMA Psychiatry 2016; 73: 456-464
    PubMedGoogle Scholar
  • 63 Dougherty DD, Rezai AR, Carpenter LL. et al. A Randomized Sham-Controlled Trial of Deep Brain Stimulation of the Ventral Capsule/Ventral Striatum for Chronic Treatment-Resistant Depression. Biol Psychiatry 2015; 78: 218-219
    CrossrefPubMedGoogle Scholar
  • 64 Puigdemont D, Portella MJ, Pérez-Egea R. et al. A randomized double-blind crossover trial of deep brain stimulation of the subcallosal cingulate gyrus in patients with treatment-resistant depression: A pilot study of relapse prevention. J Psychiatry Neurosci 2015; 40: 224-231
    CrossrefPubMedGoogle Scholar
  • 65 De Raedt R, Vanderhasselt MA, Baeken C. Neurostimulation as an intervention for treatment resistant depression: From research on mechanisms towards targeted neurocognitive strategies. Clin Psychol Rev 2015; 41: 61-69
    CrossrefPubMedGoogle Scholar
  • 66 Brunoni AR, Chaimani A, Moffa AH. et al. Repetitive Transcranial Magnetic Stimulation for the Acute Treatment of Major Depressive Episodes. A Systematic Review with Network Meta-analysis. JAMA Psychiatry 2017; 74: 143-153
    CrossrefPubMedGoogle Scholar
  • 67 Siegle GJ, Ghinassi F, Thase ME. Neurobehavioral Therapies in the 21st Century: Summary of an Emerging Field and an Extended Example of Cognitive Control Training for Depression. Cognit Ther Res 2007; 31: 235-262
    CrossrefPubMedGoogle Scholar
  • 68 Knowles MM, Foden P, El-Deredy W. et al. A Systematic Review of Efficacy of the Attention Training Technique in Clinical and Nonclinical Samples. J Clin Psychol 2016; 72: 999-1025
    CrossrefPubMedGoogle Scholar