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Berwian IM, Tröndle M, de Miquel C, Ziogas A, Stefanics G, Walter H, Stephan KE, Huys QJM. Emotion-Induced Frontal Alpha Asymmetry as a Candidate Predictor of Relapse After Discontinuation of Antidepressant Medication. BIOLOGICAL PSYCHIATRY. COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2024; 9:809-818. [PMID: 38735534 DOI: 10.1016/j.bpsc.2024.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 02/13/2024] [Accepted: 05/03/2024] [Indexed: 05/14/2024]
Abstract
BACKGROUND One in 3 patients relapse after antidepressant discontinuation. Thus, the prevention of relapse after achieving remission is an important component in the long-term management of major depressive disorder. However, no clinical or other predictors are established. Frontal reactivity to sad mood as measured by functional magnetic resonance imaging has been reported to relate to relapse independently of antidepressant discontinuation and is an interesting candidate predictor. METHODS Patients (n = 56) who had remitted from a depressive episode while taking antidepressants underwent electroencephalography (EEG) recording during a sad mood induction procedure prior to gradually discontinuing their medication. Relapse was assessed over a 6-month follow-up period. Thirty five healthy control participants were also tested. Current source density of the EEG power in the alpha band (8-13 Hz) was extracted and alpha asymmetry was computed by comparing the power across 2 hemispheres at frontal electrodes (F5 and F6). RESULTS Sad mood induction was robust across all groups. Reactivity of alpha asymmetry to sad mood did not distinguish healthy control participants from patients with remitted major depressive disorder on medication. However, the 14 (25%) patients who relapsed during the follow-up period after discontinuing medication showed significantly reduced reactivity in alpha asymmetry compared with patients who remained well. This EEG signal provided predictive power (69% out-of-sample balanced accuracy and a positive predictive value of 0.75). CONCLUSIONS A simple EEG-based measure of emotional reactivity may have potential to contribute to clinical prediction models of antidepressant discontinuation. Given the very small sample size, this finding must be interpreted with caution and requires replication in a larger study.
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Affiliation(s)
- Isabel M Berwian
- Princeton Neuroscience Institute & Psychology Department, Princeton University, Princeton, New Jersey; Translational Neuromodeling Unit, Institute for Biomedical Engineering, University of Zurich and ETH Zürich, Zurich, Switzerland.
| | - Marius Tröndle
- Methods of Plasticity Research, Department of Psychology, University of Zurich, Zurich, Switzerland
| | - Carlota de Miquel
- Research Innovation and Teaching Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain; Centro de Investigación Biomédica en Red de Salud Mental, Madrid, Spain
| | - Anastasios Ziogas
- Faculty of Psychology, University Distance Suisse, Brig, Switzerland
| | - Gabor Stefanics
- Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary
| | - Henrik Walter
- Charité-Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Psychiatry and Psychotherapy, Berlin, Germany
| | - Klaas E Stephan
- Translational Neuromodeling Unit, Institute for Biomedical Engineering, University of Zurich and ETH Zürich, Zurich, Switzerland; Max Planck Institute for Metabolism Research, Cologne, Germany
| | - Quentin J M Huys
- Translational Neuromodeling Unit, Institute for Biomedical Engineering, University of Zurich and ETH Zürich, Zurich, Switzerland; Department of Psychiatry, Psychotherapy and Psychosomatics, Hospital of Psychiatry, University of Zurich, Zurich, Switzerland; Applied Computational Psychiatry Lab, Mental Health Neuroscience Department, Division of Psychiatry and Max Planck Centre for Computational Psychiatry and Ageing Research, Queen Square Institute of Neurology, University College London, London, United Kingdom; Camden and Islington NHS Foundation Trust, London, United Kingdom
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Price CJ, Sevinc G, Farb NAS. Within-Person Modulation of Neural Networks following Interoceptive Awareness Training through Mindful Awareness in Body-Oriented Therapy (MABT): A Pilot Study. Brain Sci 2023; 13:1396. [PMID: 37891765 PMCID: PMC10605589 DOI: 10.3390/brainsci13101396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 09/19/2023] [Accepted: 09/26/2023] [Indexed: 10/29/2023] Open
Abstract
Interoception, the representation of the body's internal state, is increasingly recognized for informing subjective wellbeing and promoting regulatory behavior. However, few empirical reports characterize interoceptive neural networks, and fewer demonstrate changes to these networks in response to an efficacious intervention. Using a two-group randomized controlled trial, this pilot study explored within-participant neural plasticity in interoceptive networks following Mindful Awareness in Body-oriented Therapy (MABT). Participants (N = 22) were assigned to either 8 weeks of MABT or to a no-treatment control and completed baseline and post-intervention assessments that included subjective interoceptive awareness (MAIA) and neuroimaging of an interoceptive awareness task. MABT was uniquely associated with insula deactivation, increased functional connectivity between the dorsal attention network and the somatomotor cortex, and connectivity changes correlated positively with changes in subjective interoception. Within the MABT group, changes in subjective interoception interacted with changes in a predefined anterior cingulate seed region to predict changes in right middle insula activity, a putative primary interoceptive representation region. While the small sample size requires the replication of findings, results suggest that interoceptive training enhances sensory-prefrontal connectivity, and that such changes are commensurate with enhanced interoceptive awareness.
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Affiliation(s)
| | - Gunes Sevinc
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA;
- Ardea Outcomes, Halifax, NS, Canada
| | - Norman A. S. Farb
- Department of Psychology, University of Toronto Mississauga, Mississauga, ON, Canada;
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Liu C, Belleau EL, Dong D, Sun X, Xiong G, Pizzagalli DA, Auerbach RP, Wang X, Yao S. Trait- and state-like co-activation pattern dynamics in current and remitted major depressive disorder. J Affect Disord 2023; 337:159-168. [PMID: 37245549 PMCID: PMC10897955 DOI: 10.1016/j.jad.2023.05.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 05/02/2023] [Accepted: 05/21/2023] [Indexed: 05/30/2023]
Abstract
BACKGROUND Distinguishing between trait- and state-like neural alternations in major depressive disorder (MDD) may advance our understanding of this recurring disorder. We aimed to investigate dynamic functional connectivity alternations in unmedicated individuals with current or past MDD using co-activation pattern analyses. METHODS Resting-state functional magnetic resonance imaging data were acquired from individuals with first-episode current MDD (cMDD, n = 50), remitted MDD (rMDD, n = 44), and healthy controls (HCs, n = 64). Using a data-driven consensus clustering technique, four whole-brain states of spatial co-activation were identified and associated metrics (dominance, entries, transition frequency) were analyzed with respect to clinical characteristics. RESULTS Relative to rMDD and HC, cMDD showed increased dominance and entries of state 1 (primarily involving default mode network (DMN)), and decreased dominance of state 4 (mostly involving frontal-parietal network (FPN)). Among cMDD, state 1 entries correlated positively with trait rumination. Conversely, relative to cMDD and HC, individuals with rMDD were characterized by increased state 4 entries. Relative to HC, both MDD groups showed increased state 4-to-1 (FPN to DMN) transition frequency but reduction in state 3 (spanning visual attention, somatosensory, limbic networks), with the former metric specifically related to trait rumination. LIMITATIONS Further confirmation with longitudinal studies are required. CONCLUSIONS Regardless of symptoms, MDD was characterized by increased FPN-to-DMN transitions and reduced dominance of a hybrid network. State-related effect emerged in regions critically implicated in repetitive introspection and cognitive control. Asymptomatic individuals with past MDD were uniquely linked to increased FPN entries. Our findings identify trait-like brain network dynamics that might increase vulnerability to future MDD.
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Affiliation(s)
- Chengwen Liu
- Medical Psychological Center, The Second Xiangya Hospital of Central South University, Changsha, Hunan, PR China; China National Clinical Research Center for Mental Disorders (Xiangya), Changsha, Hunan, PR China
| | - Emily L Belleau
- Center for Depression, Anxiety and Stress Research, McLean Hospital, Belmont, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Daifeng Dong
- Medical Psychological Center, The Second Xiangya Hospital of Central South University, Changsha, Hunan, PR China; China National Clinical Research Center for Mental Disorders (Xiangya), Changsha, Hunan, PR China
| | - Xiaoqiang Sun
- Medical Psychological Center, The Second Xiangya Hospital of Central South University, Changsha, Hunan, PR China; China National Clinical Research Center for Mental Disorders (Xiangya), Changsha, Hunan, PR China
| | - Ge Xiong
- Medical Psychological Center, The Second Xiangya Hospital of Central South University, Changsha, Hunan, PR China; China National Clinical Research Center for Mental Disorders (Xiangya), Changsha, Hunan, PR China
| | - Diego A Pizzagalli
- Center for Depression, Anxiety and Stress Research, McLean Hospital, Belmont, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Randy P Auerbach
- Department of Psychiatry, Columbia University, New York, NY, USA
| | - Xiang Wang
- Medical Psychological Center, The Second Xiangya Hospital of Central South University, Changsha, Hunan, PR China; China National Clinical Research Center for Mental Disorders (Xiangya), Changsha, Hunan, PR China.
| | - Shuqiao Yao
- Medical Psychological Center, The Second Xiangya Hospital of Central South University, Changsha, Hunan, PR China; China National Clinical Research Center for Mental Disorders (Xiangya), Changsha, Hunan, PR China.
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Farb NAS, Zuo Z, Price CJ. Interoceptive Awareness of the Breath Preserves Attention and Language Networks amidst Widespread Cortical Deactivation: A Within-Participant Neuroimaging Study. eNeuro 2023; 10:ENEURO.0088-23.2023. [PMID: 37316296 PMCID: PMC10295813 DOI: 10.1523/eneuro.0088-23.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 05/26/2023] [Accepted: 06/06/2023] [Indexed: 06/16/2023] Open
Abstract
Interoception, the representation of the body's internal state, serves as a foundation for emotion, motivation, and wellbeing. Yet despite its centrality in human experience, the neural mechanisms of interoceptive attention are poorly understood. The Interoceptive/Exteroceptive Attention Task (IEAT) is a novel neuroimaging paradigm that compares behavioral tracking of the respiratory cycle (Active Interoception) to tracking of a visual stimulus (Active Exteroception). Twenty-two healthy participants completed the IEAT during two separate scanning sessions (N = 44) as part of a randomized control trial of mindful awareness in body-oriented therapy (MABT). Compared with Active Exteroception, Active Interoception deactivated somatomotor and prefrontal regions. Greater self-reported interoceptive sensibility (MAIA scale) predicted sparing from deactivation within the anterior cingulate cortex (ACC) and left-lateralized language regions. The right insula, typically described as a primary interoceptive cortex, was only specifically implicated by its deactivation during an exogenously paced respiration condition (Active Matching) relative to self-paced Active Interoception. Psychophysiological interaction (PPI) analysis characterized Active Interoception as promoting greater ACC connectivity with lateral prefrontal and parietal regions commonly referred to as the dorsal attention network (DAN). In contrast to evidence relating accurate detection of liminal interoceptive signals such as the heartbeat to anterior insula activity, interoceptive attention toward salient signals such as the respiratory cycle may involve reduced cortical activity but greater ACC-DAN connectivity, with greater sensibility linked to reduced deactivation within the ACC and language-processing regions.
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Affiliation(s)
- Norman A S Farb
- Department of Psychology, University of Toronto Mississauga, Mississauga, Ontario L5L 1C6, Canada
- Department of Psychological Clinical Sciences, University of Toronto Scarborough, Scarborough, Ontario M1C 1A4, Canada
| | - Zoey Zuo
- Department of Psychological Clinical Sciences, University of Toronto Scarborough, Scarborough, Ontario M1C 1A4, Canada
| | - Cynthia J Price
- Department of Biobehavioral Nursing and Health Informatics, University of Washington, Seattle, WA 98195
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