Functional Neuroanatomy of Recovery from Depression

描述（由申请人提供）：本申请旨在检测复发性单极抑郁症患者与认知治疗（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，严重抑郁症的治疗通常很困难。对消极话题的沉思或不自觉的阐述是与抑郁症的严重程度和持续时间相关的一个显著症状。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（如前额皮质）对自动处理情绪信息的大脑区域的抑制减少所致。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检验。该提案要求资金用于检查在情绪信息处理任务中增加和持续的边缘和腹内侧前额叶皮层活动以及在认知任务中减少的背外侧前额叶皮层活动是否与CT显示的单极抑郁症的恢复有关。对于那些在治疗前显示出这些功能中断的个体，CT的恢复预计是最强的，这是CT的目标。因此，CT进一步有望降低边缘反应性，改善执行控制。在12-14周的CT前后，60名抑郁症患者将在需要认知和情绪信息处理的任务中使用功能性磁共振成像进行评估；21名健康人还将接受两次扫描，以了解与康复无关的大脑活动随时间的预期变化。积极的结果可以帮助了解哪些个体可能在CT中康复，这种有效的干预导致抑郁症个体康复的机制，抑郁症的认知和生理方面与康复的关系，以及对拟议的CT作用机制的验证。阴性结果表明，CT可能依赖于不同的作用机制，而不是认知神经科学界所提出的。该项目将与一项正在进行的临床试验一起执行，通过该试验将提供干预措施。

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.