Fifteen people with MDD were scanned before and after therapy while they performed a task requiring cognitive control in both sad and neutral contexts. Before BATD, the participants recruited prefrontal cortical areas (right orbital frontal cortex [BA 47], right frontal pole [BA 10], and paracingulate Inhibitors,research,lifescience,medical gyrus [BA 9]) to a greater extent to cognitive control stimuli
presented in sad contexts than in neutral contexts. Following BATD, decreased activation in response to cognitive control stimuli presented within a sad context was noted in these prefrontal structures. Of note, the magnitude of pretreatment activation Inhibitors,research,lifescience,medical in the part of the paracingulate gyrus cluster responsive to treatment predicted the magnitude of depressive symptom change after BATD. The effect of a long-term, psychodynamic intervention has been recently assessed in recurrently depressed unmedicated individuals (n=16).9 Scans were Angiogenesis inhibitor conducted before and after 15 months of therapy. During scanning, descriptions containing personal core sentences Inhibitors,research,lifescience,medical previously extracted from an attachment interview alternated with presentations of attachment-related scenes with neutral descriptions. Compared with control
participants, MDD participants displayed a greater activation in the subgenual cingulate cortex [BA 25], medial PFC [BA 8 and 9], and left anterior hippocampus/amygdala before treatment, and a reduction in these brain regions after long-term psychodynamic therapy. This reduction was correlated with symptom improvement. Putative neural mechanisms of change Inhibitors,research,lifescience,medical in psychotherapy for MDD A limbic-cortical-striatal-pallidal-thalamic circuit has been proposed to play a pivotal role in the pathogenesis and maintenance of the MDD.5 This Inhibitors,research,lifescience,medical circuit has connections to several cortical areas including the medial PFC, the dorsomedial/dorsal anterolateral PFC, the mid and posterior cingulate cortex, the
anterior superior temporal gyrus, and the entorhinal and posterior parahippocampal heptaminol cortices.10 Several studies exploring the brain metabolic correlates of MDD have reported, during resting state, metabolic abnormalities in these structures, including the dorsolateral prefrontal areas (known to be involved in cognitive control and working memory) and (para) limbic regions (presumably implicated in ruminative thoughts and negative emotional states). It seems likely that distinct psychotherapies, such as IPT and CBT, exert differing effects on the brain at cellular and molecular levels.11 Unfortunately, we know very little regarding this basic issue.