Regional Brain Volume in Depression and Anxiety Disorders

Department of Psychiatry, Leiden University Medical Center, the Netherlands.
Archives of general psychiatry (Impact Factor: 14.48). 10/2010; 67(10):1002-11. DOI: 10.1001/archgenpsychiatry.2010.121
Source: PubMed


Major depressive disorder (MDD), panic disorder, and social anxiety disorder are among the most prevalent and frequently co-occurring psychiatric disorders in adults and may have, at least in part, a common etiology.
To identify the unique and shared neuroanatomical profile of depression and anxiety, controlling for illness severity, medication use, sex, age of onset, and recurrence.
Cross-sectional study.
Netherlands Study of Depression and Anxiety.
Outpatients with MDD (n = 68), comorbid MDD and anxiety (n = 88), panic disorder, and/or social anxiety disorder without comorbid MDD (n = 68) and healthy controls (n = 65).
Volumetric magnetic resonance imaging was conducted for voxel-based morphometry analyses. We tested voxelwise for the effects of diagnosis, age at onset, and recurrence on gray matter density. Post hoc, we studied the effects of use of medication, illness severity, and sex.
We demonstrated lower gray matter volumes of the rostral anterior cingulate gyrus extending into the dorsal anterior cingulate gyrus in MDD, comorbid MDD and anxiety, and anxiety disorders without comorbid MDD, independent of illness severity, sex, and medication use. Furthermore, we demonstrated reduced right lateral inferior frontal volumes in MDD and reduced left middle/superior temporal volume in anxiety disorders without comorbid MDD. Also, patients with onset of depression before 18 years of age showed lower volumes of the subgenual prefrontal cortex.
Our findings indicate that reduced volume of the rostral-dorsal anterior cingulate gyrus is a generic effect in depression and anxiety disorders, independent of illness severity, medication use, and sex. This generic effect supports the notion of a shared etiology and may reflect a common symptom dimension related to altered emotion processing. Specific involvement of the inferior frontal cortex in MDD and lateral temporal cortex in anxiety disorders without comorbid MDD, on the other hand, may reflect disorder-specific symptom clusters. Early onset of depression is associated with a distinct neuroanatomical profile that may represent a vulnerability marker of depressive disorder.


Available from: Marie-José van Tol
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    • "Third, we did not find altered cingulate thickness in MDD. However, reduced ACC volume is consistently reported in depressed patients (Bora et al, 2012; Koolschijn et al, 2009; Lai, 2013; van Tol et al, 2010). Moreover, greater ACC volume is associated with better clinical outcome (Chen et al, 2007; Frodl et al, 2008), suggesting that individual differences in the ACC structure may contribute to our ReHo and FC findings (Kuhn et al, 2012 "
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    ABSTRACT: Major depressive disorder (MDD) is associated with structural and functional alterations in the prefrontal cortex (PFC) and anterior cingulate cortex (ACC). Enhanced ACC activity at rest (measured using various imaging methodologies) is found in treatment-responsive patients and is hypothesized to bolster treatment response by fostering adaptive rumination. However, whether structural changes influence functional coupling between fronto-cingulate regions and ACC regional homogeneity (ReHo) and, whether these functional changes are related to levels of adaptive rumination and treatment response is still unclear. Cortical thickness and ReHo maps were calculated in twenty one unmedicated depressed patients and thirty five healthy controls. Regions with reduced cortical thickness defined the seeds for the subsequent functional connectivity (FC) analyses. Patients completed the Response Style Questionnaire, which provided a measure of adaptive rumination associated with better response to psychotherapy. Compared with controls, depressed patients showed thinning of the right anterior PFC, increased prefrontal connectivity with the supragenual ACC (suACC) and higher ReHo in the suACC. The suACC clusters of increased ReHo and FC spatially overlapped. In depressed patients, suACC ReHo scores positively correlated with PFC thickness and with FC strength. Moreover, stronger fronto-cingulate connectivity was related to higher levels of adaptive rumination. Greater suACC ReHo and connectivity with the right anterior PFC seem to foster adaptive forms of self-referential processing associated with better response to psychotherapy, whereas prefrontal thinning impairs the ability of depressed patients to engage the suACC during a major depressive episode. Bolstering the function of the suACC may represent a potential target for treatment.Neuropsychopharmacology accepted article preview online, 19 January 2015. doi:10.1038/npp.2015.8.
    Neuropsychopharmacology: official publication of the American College of Neuropsychopharmacology 01/2015; 40(7). DOI:10.1038/npp.2015.8 · 7.05 Impact Factor
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    • "Participants with MDD and no comorbid anxiety had increased activation in the dorsal anterior cingulate cortex during reward anticipation compared to the other two groups, which did not differ. Two studies in adults have specifically examined neurostructural differences in patients with anxious depression (Inkster et al., 2011; van Tol et al., 2010). The first of these studies compared three patient groups: adults with MDD plus anxiety (defined as having a current episode of MDD plus a diagnosis of panic disorder, social anxiety disorder, or generalized anxiety disorder), adults with MDD only, and adults with anxiety only (van Tol et al., 2010). "
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    ABSTRACT: Depressive and anxiety disorders are among the most frequently occurring psychiatric conditions in children and adolescents and commonly present occur together. Co-occurring depression and anxiety is associated with increased functional impairment and suicidality compared to depression alone. Despite this, little is known regarding the neurostructural differences between anxiety disorders and major depressive disorder (MDD). Moreover, the neurophysiologic impact of the presence of anxiety in adolescents with MDD is unknown.
    Journal of Affective Disorders 01/2015; 171:54-59. DOI:10.1016/j.jad.2014.09.004 · 3.38 Impact Factor
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    • "A summary of the main findings from these studies are shown in Table 1. However, hundreds of case control studies to date have identified morphometric reductions in candidate regions in the medial systems of the prefrontal cortex (eg, orbitofrontal cortex, ventromedial prefrontal cortex, and anterior cingulate cortex),6–10 as well as lateral prefrontal systems (eg, ventrolateral prefrontal cortex and dorsolateral prefrontal cortex).7,8,11,12 Although recent meta-analyses have supported the view that frontal gray matter differences in these regions are important in MDD,13,14 it should be noted that there is some inconsistency in results, with several null findings in these areas.15–18 "
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    ABSTRACT: A growing number of studies have used neuroimaging to further our understanding of how brain structure and function are altered in major depression. More recently, these techniques have begun to show promise for the diagnosis and treatment of depression, both as aids to conventional methods and as methods in their own right. In this review, we describe recent neuroimaging findings in the field that might aid diagnosis and improve treatment accuracy. Overall, major depression is associated with numerous structural and functional differences in neural systems involved in emotion processing and mood regulation. Furthermore, several studies have shown that the structure and function of these systems is changed by pharmacological and psychological treatments of the condition and that these changes in candidate brain regions might predict clinical response. More recently, "machine learning" methods have used neuroimaging data to categorize individual patients according to their diagnostic status and predict treatment response. Despite being mostly limited to group-level comparisons at present, with the introduction of new methods and more naturalistic studies, neuroimaging has the potential to become part of the clinical armamentarium and may improve diagnostic accuracy and inform treatment choice at the patient level.
    Neuropsychiatric Disease and Treatment 08/2014; 10:1509-22. DOI:10.2147/NDT.S50156 · 1.74 Impact Factor
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