Depression und moderne Bildgebung

Zusammenfassung

Die moderne Bildgebung in Form von PET, SPECT, MR-Volumetrie, funktioneller Kernspintomographie und MR-Spektroskopie hat die Erforschung der Ätiologie, Pathogenese und Therapiemöglichkeiten depressiver Störungen nachhaltig bereichert, wie nachfolgende Übersicht zum aktuellen Forschungsstand verdeutlichen soll. In Einklang mit den morphologischen Befunden, die auf eine relativ abgrenzbare Verteilung von Auffälligkeiten im Bereich emotional relevanter Regelkreise des Gehirns bei depressiven Störungen hinweisen, fokussieren auch die Ergebnisse funktioneller Studien auf Veränderungen der Basalganglien, des Frontalhirns sowie des limbischen Systems mit der Hippokampus-Amygdala-Formation. Wird die Verarbeitung emotional relevanter Reize betrachtet, zeigen depressive Patienten im Bereich des Frontallappens und der Amygdala ein abweichendes Aktivierungsverhalten. Auch unabhängig von der emotionalen Stimulusqualität konnten in eigener Untersuchung an einer Subgruppe Auffälligkeiten in der Reizverarbeitung bei depressiven Patienten aufgezeigt werden, insbesondere posterior-parietal und präfrontal. Affektive Modulation beim Gesunden korreliert mit der geordneten Interaktion ventral-limbischer und dorsal-neokortikaler Regionen des Gehirns, die bei depressiven Störungen in Dysbalance gelangen. Zukünftige viel versprechende Anwendungsgebiete der modernen Bildgebung zielen auf eine Identifikation valider neurofunktioneller Subgruppen der heterogenen affektiven Störungen mit der Ermöglichung entsprechend angepasster effizienter Behandlungsstrategien.

Abstract

Modern neuroimaging like PET, SPECT, MR-Volumetry, functional MRI and MR-Spectroscopy has effectively advanced research on aetiology, pathogenesis and therapy options of depressive disorders. This review highlights the status of current research on this topic. Consistent with morphological findings, which report alterations in regions of emotionally relevant networks of the brain in depressive disorders, findings of functional studies point to changes in the basal ganglia, the frontal cortex and the limbic system involving the hippocampus and the amygdala. During processing of emotional cues depressive patients show different activation patterns in the regions of the frontal lobe and the amygdala. In our study of a subgroup we were also able to show deficits in processing cues independently from the emotional quality of the stimulus - especially in posterior-parietal and prefrontal areas. In healthy subjects affective modulation correlates with an ordered interaction of ventral-limbic and dorsal-neocortical regions of the brain, which become unbalanced in depressive disorders. In the future, modern neuroimaging will open promising fields of research, which aim at the identification of valid neurofunctional subgroups of the heterogeneous affective disorders and the development of more adjusted and efficient therapy strategies.

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