Functional Neuroanatomy of Recovery from Depression

描述（由申请人提供）：本申请旨在检查与复发性单相抑郁症的认知治疗（CT）反应相关的脑功能。抑郁症是一种常见的，使人衰弱的疾病，严重抑郁症的治疗往往很困难。对消极话题的沉思或无意识的阐述是与抑郁严重程度和持续时间相关的突出症状。来自认知和情感神经科学的证据表明，这种持续的情绪信息处理可能是由于负责执行控制的大脑区域（如前额叶皮层）对自动处理情绪信息的大脑区域的抑制减少。最初的数据表明，抑郁症患者的杏仁核增加，前额叶活动减少，CT可能针对这些机制。然而，这些联系尚未得到直接测试。这项提案要求资金，以检查是否增加和持续的边缘系统和腹内侧前额叶活动在情绪信息处理任务和减少背外侧前额叶皮层活动在认知任务与CT单相抑郁症的恢复。CT的恢复预计是最强的个人谁显示治疗前中断这些功能，这是CT的目标。因此，进一步预期CT降低边缘系统反应性并改善执行控制。60名抑郁症患者将在CT治疗前后12-14周进行认知和情感信息处理任务时使用功能性磁共振成像进行评估; 21名健康个体也将进行两次扫描，以了解与恢复无关的大脑活动随时间的预期变化。积极的结果可能有助于了解哪些人可能在CT中恢复，这种有效的干预导致抑郁症患者恢复的机制，抑郁症的认知和生理方面如何与恢复相关，以及验证CT的拟议作用机制。阴性结果表明，CT可能依赖于不同的作用机制，而不是由认知神经科学界提出的。本项目将与正在进行的临床试验一起执行，通过该临床试验将提供干预。

DESCRIPTION (provided by applicant): This application proposes to examine brain function associated with response to cognitive therapy (CT) for recurrent unipolar depression. Depression is a common, debilitating disorder and treatment of severe depression is often difficult. Rumination or involuntary elaboration on negative topics is a salient symptom linked to depressive severity and duration. Evidence from cognitive and affective neuroscience suggests that such sustained emotional information processing could result from decreased inhibition of brain areas that automatically process emotional information by brain areas responsible for executive control such as the prefrontal cortex. Initial data suggests that depressed individuals suffer from increased amygdala and decreased prefrontal activity, and that CT is likely to target these mechanisms. Yet, these links have not been tested directly. This proposal requests funds to examine whether increased and sustained limbic and ventromedial prefrontal activity during emotional information processing tasks and decreased dorso-lateral prefrontal cortex activity during cognitive tasks are associated with recovery from unipolar depression in CT. Recovery in CT is expected to be strongest for individuals who display pre-treatment disruptions in these functions, which are targeted by CT. Thus, CT is further expected to decrease limbic reactivity and improve executive control. 60 depressed individuals will be assessed using functional magnetic resonance imaging during tasks requiring cognitive and emotional information processing before and after 12-14 weeks of CT; 21 healthy individuals will also be scanned twice to understand expected changes in brain activity overtime that are unrelated to recovery. Positive results could help to understand which individuals are likely to recover in CT, the mechanisms by which this efficacious intervention leads to recovery in depressed individuals, how cognitive and physiological aspects of depression are related to recovery, and validation for the proposed mechanisms of action for CT. Negative results would suggest that CT may depend on different mechanisms of action than have been proposed by the cognitive neuroscience community. This project will be executed in conjunction with an ongoing clinical trial through which the intervention will be provided.