Regional brain volume in depression and anxiety disorders.
ABSTRACT 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.
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.
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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 01/2014; 10:1509-22. · 2.00 Impact Factor
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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. · 3.71 Impact Factor
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ABSTRACT: The anterior cingulate cortex (ACC) plays an important role in the neuropathology of major depressive disorder (MDD). So far, the effect of local cortical alteration on metabolites in multiple subdivisions of ACC has not been studied. We aimed to investigate structural and biochemical changes and their relationship in the pregenual ACC (pgACC), dorsal ACC (dACC) in MDD.Journal of Affective Disorders 08/2014; 169C:91-100. · 3.71 Impact Factor
APPENDIX: DSM-IV CRITERIA
LIST OF ABBREVIATIONS
DUTCH SUMMARY/NL SAMENVATTING
LIST OF PUBLICATIONS
168 | Appendix: DSM-IV criteria
APPENDIX: DSM-IV CRITERIA
MAJOR DEPRESSIVE DISORDER
A Major Depressive Episode (MDE) is characterized by 1) depressed/low mood
and/or 2) loss of interest or pleasure in daily activities during most of the day,
nearly every day, for at least two weeks. Next to these core symptoms of
depressed mood or loss of the capacity to experience pleasure (also know as
‘anhedonia’), an MDE is characterized by at least three (or four when only one
of the first two criteria are met) of the following symptoms that are present
nearly every day:
• weight loss or weight gain when not dieting;
• insomnia or hypersomnia (loss of sleep or excessive sleeping);
• psychomotor agitation or retardation (restlessness or slowing of daily
• fatigue or loss of energy;
• feelings of worthlessness or excessive or inappropriate guilt;
• attentional problems or indicisiveness;
• recurrents thoughts of death or recurrent suicidal ideation without a
specific plan or a suicide attempt or plans for committing suicide.
Symptoms are not better accounted for by bereavement or a diagnosis of mania
or personality disorder. Social, occupational, educational or other important
functioning should be impaired to fullfil the criteria for a diagnosis of MDD.
SOCIAL ANXIETY DISORDER
Social Anxiety Disorder (SAD), also know as ‘social phobia’ is characterized by
a persistent fear of one or more social or performance situation in which the
person is exposed to unfamiliar people or to possible scrutiny by others and the
individual fears that he or she will act in a way (or show anxiety symptoms) that
will be embarrassing and humiliating. A diagnosis is made when:
• exposure to the feared situation almost invariably provokes anxiety, which
may take the form of a situationally bound or situationally pre-disposed
panic attack (see Panic Disorder);
• the person recognizes that this fear is unreasonable or excessive;
• the feared situations are avoided or else are endured with intense anxiety
The avoidance, anxious anticipation, or distress in the feared social or
performance situation(s) interferes significantly with the person's normal
routine, occupational/educational functioning, or social activities or
relationships, or there is marked distress about having the phobia. Also, the
fear or avoidance is not due to direct physiological effects of a substance (e.g.,
drugs, medications) or a general medical condition and is not better accounted
for by another mental disorder.
Panic Disorder (PD) is characterized by recurrent unexpected Panic Attacks (see
below), and at least one of the attacks has been followed by 1 month (or more)
of one (or more) of the following:
• persistent concern about having additional attacks;
• worry about the implications of the attack or its consequences (e.g., losing
control, having a heart attack, "going crazy");
• a significant change in behavior related to the attacks;
The Panic Attacks are not due to the direct physiological effects of a substance
(e.g., drugs, medications) or a general medical condition (e.g., hyperthyroidism)
and are not better accounted for by another mental disorder.
A panic attack is a discrete period of intense fear or discomfort, in which four
(or more) of the following symptoms developed abruptly and reached a peak
within 10 minutes:
• palpitations, pounding heart, or accelerated heart rate;
• trembling or shaking;
• sensations of shortness of breath or smothering;
• feeling of choking;
• chest pain or discomfort;
• nausea or abdominal distress;
• feeling dizzy, unsteady, lightheaded, or faint;
• derealization (feelings of unreality) or depersonalization (being detached
• fear of losing control or going crazy;
• fear of dying;
• paresthesias (i.e, numbness or tingling sensations);
• chills or hot flushes.
A diagnosis of PD is further specified as PD with agoraphobia or without
agoraphobia. Agoraphobia is the anxiety about being in places or situations
from which escape might be difficult (or embarrassing) or in which help may
170 | Appendix: DSM-IV criteria
not be available in the event of having an unexpected or situationally
predisposed Panic Attack or panic-like symptoms. Agoraphobic fears typically
involve characteristic clusters of situations that include being outside the home
alone; being in a crowd, or standing in a line; being on a bridge; and traveling in
a bus, train, or automobile. As a result, the situations are avoided (e.g., travel
is restricted) or else are endured with marked distress or with anxiety about
having a Panic Attack or panic-like symptoms, or require the presence of a
GENERALIZED ANXIETY DISORDER
Criteria for the diagnosis of a Generalized Anxiety Disorder (GAD) are met when
a person experiences at least six months of excessive anxiety and worry about
a variety of events and situations and there is significant difficulty in controlling
the anxiety and worry. Also, three or more of the following symptoms should be
present for most days over the previous six months:
• feeling wound-up, tense, or restless;
• easily becoming fatigued or worn-out;
• concentration problems;
• significant tension in muscles;
• difficulty with sleep.
The symptoms cause significant distress or problems in daily life functioning,
but are not due to the direct physiological effects of a substance (e.g., a drugs,
medications) or a general medical condition and are not better accounted for
by another mental disorder.
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