Depression und Bildgebung

Zusammenfassung

Das Etablieren pathogenetischer Netzwerkmodelle für depressive Störungen wurde durch die moderne Bildgebung nachhaltig gefördert. Distinkte morphologische Befunde weisen bei depressiven Störungen auf eine relativ abgrenzbare Verteilung von Auffälligkeiten im Bereich emotional relevanter Regelkreise des Gehirns hin. Die funktionelle Bildgebung konzentriert sich auf neuronale Störungen im Bereich des Frontalhirns, des limbischen Systems mit der Hippokampus-Amygdala-Formation sowie der Basalganglien. Affektmodulation erfordert ein geordnetes Zusammenspiel ventral-limbischer mit dorsal-neokortikalen Hirnregionen, die bei depressiven Störungen in Dysbalance geraten, wobei dem rostralen anterioren Cingulum möglicherweise eine Schlüsselstellung dabei zukommt. Aufbauend auf diesem Modell zielt die bildgebende Forschung zukünftig auf die Identifikation valider neurofunktioneller Subgruppen unter Einbezug von Vulnerabilitätsgenen ab, auch um effizientere Behandlungsstrategien entwickeln zu können.

Summary

Modern neuroimaging has effectively advanced the implementation of network models into research of depressive disorders. Distinct morphological findings report alternations in brain regions, which are part of the emotional network. Functional neuroimaging points to disturbances of regions like frontal cortex, limbic system involving the hippocampus-amygdala-formation and finally the basal ganglia. Affective modulation depends on an ordered interaction of ventral-limbic and dorsal-neocortical regions of the brain, which become unbalanced in depressive disorders, whereas the rostral part of the anterior cingulate gyrus seems to be a key region. In the future neuroimaging research will focus on the identification of valid neurofunctional subgroups based on this model having regard to vulnerability genes. This will encourage the development of more efficient therapy strategies.

Key Words

affective disorders - neuroimaging - PET/Spect - MRI - MR-spectroscopy

Literatur

• 1 Abercrombie HC, Schaefer SM, Larson CL, Oakes TR, Lindgren KA, Holden JE, Perlman SB, Turski PA, Krahn DD, Benca RM, Davidson RJ. Metabolic rate in the right amygdala predicts negative affect in depressed patients.  Neuroreport. 1998;  9 3301-3307
• 2 Ahearn EP, Jamison KR, Steffens DC, Cassidy F, Provenzale JM, Lehman A, Weisler RH, Carroll BJ, Krishnan KR. MRI correlates of suicide attempt history in unipolar depression.  Biol Psychiatry. 2001;  50 266-270
• 3 Bremner JD, Innis RB, Salomon RM, Staib LH, Ng CK, Miller HL, Bronen RA, Krystal JH, Duncan J, Rich D, Price LH, Malison R, Dey H, Soufer R, Charney DS. Positron emission tomography measurement of cerebral metabolic correlates of tryptophan depletion-induced depressive relapse.  Arch Gen Psychiatry. 1997;  54 364-374
• 4 Caspi A, Sugden K, Moffitt TE, Taylor A, Craig IW, Harrington H, McClay J, Mill J, Martin J, Braithwaite A, Poulton R. Influence of life stress on depression: moderation by a polymorphism in the 5-HTT gene.  Science. 2003;  301 386-389
• 5 Davidson RJ, Irwin W, Anderle MJ, Kalin NH. The neural substrates of affective processing in depressed patients treated with venlafaxine.  Am J Psychiatry. 2003;  160 64-75
• 6 Drevets WC, Price JL, Simpson Jr. JR, Todd RD, Reich T, Vannier M, Raichle ME. Subgenual prefrontal cortex abnormalities in mood disorders.  Nature. 1997;  386 824-827
• 7 Elliott R, Rubinsztein JS, Sahakian BJ, Dolan RJ. The neural basis of mood-congruent processing biases in depression.  Arch Gen Psychiatry. 2002;  59 597-604
• 8 Ende G, Braus DF, Walter S, Weber-Fahr W, Henn FA. The hippocampus in patients treated with electroconvulsive therapy: a proton magnetic resonance spectroscopic imaging study.  Arch Gen Psychiatry. 2000;  57 937-943
• 9 Frodl T, Meisenzahl EM, Zill P, Baghai T, Rujescu D, Leinsinger G, Bottlender R, Schule C, Zwanzger P, Engel RR, Rupprecht R, Bondy B, Reiser M, Moller HJ. Reduced hippocampal volumes associated with the long variant of the serotonin transporter polymorphism in major depression.  Arch Gen Psychiatry. 2004;  61 177-183
• 10 Fu CH, Williams SC, Cleare AJ, Brammer MJ, Walsh ND, Kim J, Andrew CM, Pich EM, Williams PM, Reed LJ, Mitterschiffthaler MT, Suckling J, Bullmore ET. Attenuation of the neural response to sad faces in major depression by antidepressant treatment: a prospective, event-related functional magnetic resonance imaging study.  Arch Gen Psychiatry. 2004;  61 877-889
• 11 Heinz A, Braus DF, Smolka MN, Wrase J, Puls I, Hermann D, Klein S, Grusser SM, Flor H, Schumann G, Mann K, Buchel C. Amygdala-prefrontal coupling depends on a genetic variation of the serotonin transporter.  Nat Neurosci. 2005;  8 20-21
• 12 Holthoff VA, Beuthien-Baumann B, Zundorf G, Triemer A, Ludecke S, Winiecki P, Koch R, Fuchtner F, Herholz K. Changes in brain metabolism associated with remission in unipolar major depression.  Acta Psychiatr Scand. 2004;  110 184-194
• 13 Kaufman MJ, Henry ME, Frederick B, Hennen J, Villafuerte RA, Stoddard EP, Schmidt ME, Cohen BM, Renshaw PF. Selective serotonin reuptake inhibitor discontinuation syndrome is associated with a rostral anterior cingulate choline metabolite decrease: a proton magnetic resonance spectroscopic imaging study.  Biol Psychiatry. 2003;  54 534-539
• 14 Kegeles LS, Malone KM, Slifstein M, Ellis SP, Xanthopoulos E, Keilp JG, Campbell C, Oquendo M, Van Heertum RL, Mann JJ. Response of cortical metabolic deficits to serotonergic challenge in familial mood disorders.  Am J Psychiatry. 2003;  160 76-82
• 15 Kennedy SH, Evans KR, Kruger S, Mayberg HS, Meyer JH, McCann S, Arifuzzman AI, Houle S, Vaccarino FJ. Changes in regional brain glucose metabolism measured with positron emission tomography after paroxetine treatment of major depression.  Am J Psychiatry. 2001;  158 899-905
• 16 Lawrence NS, Williams AM, Surguladze S, Giampietro V, Brammer MJ, Andrew C, Frangou S, Ecker C, Phillips ML. Subcortical and ventral prefrontal cortical neural responses to facial expressions distinguish patients with bipolar disorder and major depression.  Biol Psychiatry. 2004;  55 578-587
• 17 Liotti M, Mayberg HS, Brannan SK, McGinnis S, Jerabek P, Fox PT. Differential limbic-cortical correlates of sadness and anxiety in healthy subjects: implications for affective disorders.  Biol Psychiatry. 2000;  48 30-42
• 18 Liotti M, Mayberg HS, McGinnis S, Brannan SL, Jerabek P. Unmasking disease-specific cerebral blood flow abnormalities: mood challenge in patients with remitted unipolar depression.  Am J Psychiatry. 2002;  159 1830-1840
• 19 Little JT, Ketter TA, Kimbrell TA, Dunn RT, Benson BE, Willis MW, Luckenbaugh DA, Post RM. Bupropion and venlafaxine responders differ in pretreatment regional cerebral metabolism in unipolar depression.  Biol Psychiatry. 2005;  57 220-228
• 20 Mayberg HS, Brannan SK, Tekell JL, Silva JA, Mahurin RK, McGinnis S, Jerabek PA. Regional metabolic effects of fluoxetine in major depression: serial changes and relationship to clinical response.  Biol Psychiatry. 2000;  48 830-843
• 21 Mayberg HS, Liotti M, Brannan SK, McGinnis S, Mahurin RK, Jerabek PA, Silva JA, Tekell JL, Martin CC, Lancaster JL, Fox PT. Reciprocal limbic-cortical function and negative mood: converging PET findings in depression and normal sadness.  Am J Psychiatry. 1999;  156 675-682
• 22 Obergriesser T, Ende G, Braus DF, Henn FA. Long-term follow-up of magnetic resonance-detectable choline signal changes in the hippocampus of patients treated with electroconvulsive therapy.  J Clin Psychiatry. 2003;  64 775-780
• 23 Okada G, Okamoto Y, Morinobu S, Yamawaki S, Yokota N. Attenuated left prefrontal activation during a verbal fluency task in patients with depression.  Neuropsychobiology. 2003;  47 21-26
• 24 Renshaw PF, Lafer B, Babb SM, Fava M, Stoll AL, Christensen JD, Moore CM, Yurgelun-Todd DA, Bonello CM, Pillay SS, Rothschild AJ, Nierenberg AA, Rosenbaum JF, Cohen BM. Basal ganglia choline levels in depression and response to fluoxetine treatment: an in vivo proton magnetic resonance spectroscopy study.  Biol Psychiatry. 1997;  41 837-843
• 25 Sheline YI, Barch DM, Donnelly JM, Ollinger JM, Snyder AZ, Mintun MA. Increased amygdala response to masked emotional faces in depressed subjects resolves with antidepressant treatment: an fMRI study.  Biol Psychiatry. 2001;  50 651-658
• 26 Siegle GJ, Steinhauer SR, Thase ME, Stenger VA, Carter CS. Can't shake that feeling: event-related fMRI assessment of sustained amygdala activity in response to emotional information in depressed individuals.  Biol Psychiatry. 2002;  51 693-707
• 27 Steingard R, Renshaw P, Hennen J, Lenox M, Cintron C, Young A, Connor D, Au T, Yurgelun-Todd D. Smaller frontal lobe white matter volumes in depressed adolescents.  Biol Psychiatry. 2002;  52 413
• 28 Surguladze S, Brammer MJ, Keedwell P, Giampietro V, Young AW, Travis MJ, Williams SC, Phillips ML. A differential pattern of neural response toward sad versus happy facial expressions in major depressive disorder.  Biol Psychiatry. 2005;  57 201-209
• 29 Thomas AJ, O'Brien JT, Davis S, Ballard C, Barber R, Kalaria RN, Perry RH. Ischemic basis for deep white matter hyperintensities in major depression: a neuropathological study.  Arch Gen Psychiatry. 2002;  59 785-792
• 30 Videbech P, Ravnkilde B, Pedersen TH, Hartvig H, Egander A, Clemmensen K, Rasmussen NA, Andersen F, Gjedde A, Rosenberg R. The Danish PET/depression project: clinical symptoms and cerebral blood flow. A regions-of-interest analysis.  Acta Psychiatr Scand. 2002;  106 35-44
• 31 Videbech P, Ravnkilde B. Hippocampal volume and depression: a meta-analysis of MRI studies.  Am J Psychiatry. 2004;  161 1957-1966
• 32 Vollmert C, Tost H, Brassen S, Jatzko A, Braus DF. Depression und moderne Bildgebung.  Fortschr Neurol Psychiatr. 2004;  72 435-445

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