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Lemke H, Klute H, Skupski J, Thiel K, Waltemate L, Winter A, Breuer F, Meinert S, Klug M, Enneking V, Winter NR, Grotegerd D, Leehr EJ, Repple J, Dohm K, Opel N, Stein F, Meller T, Brosch K, Ringwald KG, Pfarr JK, Thomas-Odenthal F, Hahn T, Krug A, Jansen A, Heindel W, Nenadić I, Kircher T, Dannlowski U. Brain structural correlates of recurrence following the first episode in patients with major depressive disorder. Transl Psychiatry 2022; 12:349. [PMID: 36030219 PMCID: PMC9420111 DOI: 10.1038/s41398-022-02113-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 08/09/2022] [Accepted: 08/11/2022] [Indexed: 11/11/2022] Open
Abstract
Former prospective studies showed that the occurrence of relapse in Major Depressive Disorder (MDD) is associated with volume loss in the insula, hippocampus and dorsolateral prefrontal cortex (DLPFC). However, these studies were confounded by the patient's lifetime disease history, as the number of previous episodes predict future recurrence. In order to analyze neural correlates of recurrence irrespective of prior disease course, this study prospectively examined changes in brain structure in patients with first-episode depression (FED) over 2 years. N = 63 FED patients and n = 63 healthy controls (HC) underwent structural magnetic resonance imaging at baseline and after 2 years. According to their disease course during the follow-up interval, patients were grouped into n = 21 FED patients with recurrence (FEDrec) during follow-up and n = 42 FED patients with stable remission (FEDrem). Gray matter volume changes were analysed using group by time interaction analyses of covariance for the DLPFC, hippocampus and insula. Significant group by time interactions in the DLPFC and insula emerged. Pairwise comparisons showed that FEDrec had greater volume decline in the DLPFC and insula from baseline to follow-up compared with FEDrem and HC. No group by time interactions in the hippocampus were found. Cross-sectional analyses at baseline and follow-up revealed no differences between groups. This longitudinal study provides evidence for neural alterations in the DLPFC and insula related to a detrimental course in MDD. These effects of recurrence are already detectable at initial stages of MDD and seem to occur without any prior disease history, emphasizing the importance of early interventions preventing depressive recurrence.
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Affiliation(s)
- Hannah Lemke
- grid.5949.10000 0001 2172 9288Institute for Translational Psychiatry, University of Münster, Münster, Germany
| | - Hannah Klute
- grid.5949.10000 0001 2172 9288Institute for Translational Psychiatry, University of Münster, Münster, Germany
| | - Jennifer Skupski
- grid.5949.10000 0001 2172 9288Institute for Translational Psychiatry, University of Münster, Münster, Germany
| | - Katharina Thiel
- grid.5949.10000 0001 2172 9288Institute for Translational Psychiatry, University of Münster, Münster, Germany
| | - Lena Waltemate
- grid.5949.10000 0001 2172 9288Institute for Translational Psychiatry, University of Münster, Münster, Germany
| | - Alexandra Winter
- grid.5949.10000 0001 2172 9288Institute for Translational Psychiatry, University of Münster, Münster, Germany
| | - Fabian Breuer
- grid.5949.10000 0001 2172 9288Institute for Translational Psychiatry, University of Münster, Münster, Germany
| | - Susanne Meinert
- grid.5949.10000 0001 2172 9288Institute for Translational Psychiatry, University of Münster, Münster, Germany ,grid.5949.10000 0001 2172 9288Institute for Translational Neuroscience, University of Münster, Münster, Germany
| | - Melissa Klug
- grid.5949.10000 0001 2172 9288Institute for Translational Psychiatry, University of Münster, Münster, Germany
| | - Verena Enneking
- grid.5949.10000 0001 2172 9288Institute for Translational Psychiatry, University of Münster, Münster, Germany
| | - Nils R. Winter
- grid.5949.10000 0001 2172 9288Institute for Translational Psychiatry, University of Münster, Münster, Germany
| | - Dominik Grotegerd
- grid.5949.10000 0001 2172 9288Institute for Translational Psychiatry, University of Münster, Münster, Germany
| | - Elisabeth J. Leehr
- grid.5949.10000 0001 2172 9288Institute for Translational Psychiatry, University of Münster, Münster, Germany
| | - Jonathan Repple
- grid.5949.10000 0001 2172 9288Institute for Translational Psychiatry, University of Münster, Münster, Germany
| | - Katharina Dohm
- grid.5949.10000 0001 2172 9288Institute for Translational Psychiatry, University of Münster, Münster, Germany
| | - Nils Opel
- grid.5949.10000 0001 2172 9288Institute for Translational Psychiatry, University of Münster, Münster, Germany
| | - Frederike Stein
- grid.10253.350000 0004 1936 9756Department of Psychiatry and Psychotherapy, University of Marburg, Marburg, Germany
| | - Tina Meller
- grid.10253.350000 0004 1936 9756Department of Psychiatry and Psychotherapy, University of Marburg, Marburg, Germany
| | - Katharina Brosch
- grid.10253.350000 0004 1936 9756Department of Psychiatry and Psychotherapy, University of Marburg, Marburg, Germany
| | - Kai G. Ringwald
- grid.10253.350000 0004 1936 9756Department of Psychiatry and Psychotherapy, University of Marburg, Marburg, Germany
| | - Julia-Katharina Pfarr
- grid.10253.350000 0004 1936 9756Department of Psychiatry and Psychotherapy, University of Marburg, Marburg, Germany
| | - Florian Thomas-Odenthal
- grid.10253.350000 0004 1936 9756Department of Psychiatry and Psychotherapy, University of Marburg, Marburg, Germany
| | - Tim Hahn
- grid.5949.10000 0001 2172 9288Institute for Translational Psychiatry, University of Münster, Münster, Germany
| | - Axel Krug
- grid.10253.350000 0004 1936 9756Department of Psychiatry and Psychotherapy, University of Marburg, Marburg, Germany ,grid.10388.320000 0001 2240 3300Department of Psychiatry and Psychotherapy, University of Bonn, Bonn, Germany
| | - Andreas Jansen
- grid.10253.350000 0004 1936 9756Department of Psychiatry and Psychotherapy, University of Marburg, Marburg, Germany
| | - Walter Heindel
- grid.5949.10000 0001 2172 9288University Clinic for Radiology, University of Münster, Münster, Germany
| | - Igor Nenadić
- grid.10253.350000 0004 1936 9756Department of Psychiatry and Psychotherapy, University of Marburg, Marburg, Germany
| | - Tilo Kircher
- grid.10253.350000 0004 1936 9756Department of Psychiatry and Psychotherapy, University of Marburg, Marburg, Germany
| | - Udo Dannlowski
- Institute for Translational Psychiatry, University of Münster, Münster, Germany.
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Saberi A, Mohammadi E, Zarei M, Eickhoff SB, Tahmasian M. Structural and functional neuroimaging of late-life depression: a coordinate-based meta-analysis. Brain Imaging Behav 2021; 16:518-531. [PMID: 34331655 DOI: 10.1007/s11682-021-00494-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 06/28/2021] [Indexed: 10/20/2022]
Abstract
Several neuroimaging studies have investigated localized aberrations in brain structure, function or connectivity in late-life depression, but the ensuing results are equivocal and often conflicting. Here, we provide a quantitative consolidation of neuroimaging in late-life depression using coordinate-based meta-analysis by searching multiple databases up to March 2020. Our search revealed 3252 unique records, among which we identified 32 eligible whole-brain neuroimaging publications comparing 674 patients with 568 controls. The peak coordinates of group comparisons between the patients and the controls were extracted and then analyzed using activation likelihood estimation method. Our sufficiently powered analysis on all the experiments, and more homogenous subsections of the data (patients > controls, controls > patients, and functional imaging experiments) revealed no significant convergent regional abnormality in late-life depression. This inconsistency might be due to clinical and biological heterogeneity of LLD, as well as experimental (e.g., choice of tasks, image modalities) and analytic flexibility (e.g., preprocessing and analytic parameters), and distributed patterns of neural abnormalities. Our findings highlight the importance of clinical/biological heterogeneity of late-life depression, in addition to the need for more reproducible research by using pre-registered and standardized protocols on more homogenous populations to identify potential consistent brain abnormalities in late-life depression.
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Affiliation(s)
- Amin Saberi
- Institute of Medical Science and Technology, Shahid Beheshti University, Tehran, Iran
| | - Esmaeil Mohammadi
- Institute of Medical Science and Technology, Shahid Beheshti University, Tehran, Iran.,Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mojtaba Zarei
- Institute of Medical Science and Technology, Shahid Beheshti University, Tehran, Iran
| | - Simon B Eickhoff
- Institute of Neuroscience and Medicine (INM-7: Brain and Behaviour), Research Centre Jülich, Jülich, Germany.,Institute of Systems Neuroscience, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Masoud Tahmasian
- Institute of Medical Science and Technology, Shahid Beheshti University, Tehran, Iran.
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Binnewies J, Nawijn L, van Tol MJ, van der Wee NJA, Veltman DJ, Penninx BWJH. Associations between depression, lifestyle and brain structure: A longitudinal MRI study. Neuroimage 2021; 231:117834. [PMID: 33549761 DOI: 10.1016/j.neuroimage.2021.117834] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 01/14/2021] [Accepted: 01/27/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Depression has been associated with decreased regional grey matter volume, which might partly be explained by an unhealthier lifestyle in depressed individuals which has been ignored by most earlier studies. Also, the longitudinal nature of depression, lifestyle and brain structure associations is largely unknown. This study investigates the relationship of depression and lifestyle with brain structure cross-sectionally and longitudinally over up to 9 years. METHODS We used longitudinal structural MRI data of persons with depression and/or anxiety disorders and controls (Nunique participants = 347, Nobservations = 609). Cortical thickness of medial orbitofrontal cortex (mOFC), rostral anterior cingulate cortex (rACC) and hippocampal volume were derived using FreeSurfer. Using Generalized Estimating Equations, we investigated associations of depression and lifestyle (Body mass index (BMI), smoking, alcohol consumption, physical activity and sleep duration) with brain structure and change in brain structure over 2 (n = 179) and 9 years (n = 82). RESULTS Depression status (B = -.053, p = .002) and severity (B = -.002, p = .002) were negatively associated with rACC thickness. mOFC thickness was negatively associated with BMI (B = -.004, p < .001) and positively with moderate alcohol consumption (B = .030, p = .009). All associations were independent of each other. No associations were observed between (change in) depression, disease burden or lifestyle factors with brain change over time. CONCLUSIONS Depressive symptoms and diagnosis were independently associated with thinner rACC, BMI with thinner mOFC, and moderate alcohol consumption with thicker mOFC. No longitudinal associations were observed, suggesting that regional grey matter alterations are a long-term consequence or vulnerability indicator for depression but not dynamically or progressively related to depression course trajectory.
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Affiliation(s)
- Julia Binnewies
- Department of Psychiatry, Amsterdam Neuroscience, Amsterdam UMC, Amsterdam, Vrije Universiteit Amsterdam, The Netherlands.
| | - Laura Nawijn
- Department of Psychiatry, Amsterdam Neuroscience, Amsterdam UMC, Amsterdam, Vrije Universiteit Amsterdam, The Netherlands.
| | - Marie-José van Tol
- Department of Neuroscience, University Medical Center Groningen, Groningen, The Netherlands.
| | - Nic J A van der Wee
- Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands.
| | - Dick J Veltman
- Department of Psychiatry, Amsterdam Neuroscience, Amsterdam UMC, Amsterdam, Vrije Universiteit Amsterdam, The Netherlands.
| | - Brenda W J H Penninx
- Department of Psychiatry, Amsterdam Neuroscience, Amsterdam UMC, Amsterdam, Vrije Universiteit Amsterdam, The Netherlands.
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Rashidi-Ranjbar N, Rajji TK, Kumar S, Herrmann N, Mah L, Flint AJ, Fischer CE, Butters MA, Pollock BG, Dickie EW, Anderson JAE, Mulsant BH, Voineskos AN. Frontal-executive and corticolimbic structural brain circuitry in older people with remitted depression, mild cognitive impairment, Alzheimer's dementia, and normal cognition. Neuropsychopharmacology 2020; 45:1567-1578. [PMID: 32422643 PMCID: PMC7360554 DOI: 10.1038/s41386-020-0715-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 04/15/2020] [Accepted: 05/11/2020] [Indexed: 12/11/2022]
Abstract
A history of depression is a risk factor for dementia. Despite strong epidemiologic evidence, the pathways linking depression and dementia remain unclear. We assessed structural brain alterations in white and gray matter of frontal-executive and corticolimbic circuitries in five groups of older adults putatively at-risk for developing dementia- remitted depression (MDD), non-amnestic MCI (naMCI), MDD+naMCI, amnestic MCI (aMCI), and MDD+aMCI. We also examined two other groups: non-psychiatric ("healthy") controls (HC) and individuals with Alzheimer's dementia (AD). Magnetic resonance imaging (MRI) data were acquired on the same 3T scanner. Following quality control in these seven groups, from diffusion-weighted imaging (n = 300), we compared white matter fractional anisotropy (FA), mean diffusivity (MD), and from T1-weighted imaging (n = 333), subcortical volumes and cortical thickness in frontal-executive and corticolimbic regions of interest (ROIs). We also used exploratory graph theory analysis to compare topological properties of structural covariance networks and hub regions. We found main effects for diagnostic group in FA, MD, subcortical volume, and cortical thickness. These differences were largely due to greater deficits in the AD group and to a lesser extent aMCI compared with other groups. Graph theory analysis revealed differences in several global measures among several groups. Older individuals with remitted MDD and naMCI did not have the same white or gray matter changes in the frontal-executive and corticolimbic circuitries as those with aMCI or AD, suggesting distinct neural mechanisms in these disorders. Structural covariance global metrics suggested a potential difference in brain reserve among groups.
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Affiliation(s)
- Neda Rashidi-Ranjbar
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Tarek K Rajji
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Sanjeev Kumar
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Nathan Herrmann
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Sunnybrook Health Sciences Centre, Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Linda Mah
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Baycrest Health Sciences, Rotman Research Institute, Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Alastair J Flint
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- University Health Network, Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Corinne E Fischer
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Keenan Research Centre for Biomedical Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
| | - Meryl A Butters
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Bruce G Pollock
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Erin W Dickie
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - John A E Anderson
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Benoit H Mulsant
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Aristotle N Voineskos
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada.
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada.
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
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5
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Rashidi-Ranjbar N, Miranda D, Butters MA, Mulsant BH, Voineskos AN. Evidence for Structural and Functional Alterations of Frontal-Executive and Corticolimbic Circuits in Late-Life Depression and Relationship to Mild Cognitive Impairment and Dementia: A Systematic Review. Front Neurosci 2020; 14:253. [PMID: 32362808 PMCID: PMC7182055 DOI: 10.3389/fnins.2020.00253] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 03/06/2020] [Indexed: 01/12/2023] Open
Abstract
Depression is a risk factor for developing Alzheimer's disease and Related Dementia (ADRD). We conducted a systematic review between 2008 and October 2018, to evaluate the evidence for a conceptual mechanistic model linking depression and ADRD, focusing on frontal-executive and corticolimbic circuits. We focused on two neuroimaging modalities: diffusion-weighted imaging measuring white matter tract disruptions and resting-state functional MRI measuring alterations in network dynamics in late-life depression (LLD), mild cognitive impairment (MCI), and LLD+MCI vs. healthy control (HC) individuals. Our data synthesis revealed that in some but not all studies, impairment of both frontal-executive and corticolimbic circuits, as well as impairment of global brain topology was present in LLD, MCI, and LLD+MCI vs. HC groups. Further, posterior midline regions (posterior cingulate cortex and precuneus) appeared to have the most structural and functional alterations in all patient groups. Future cohort and longitudinal studies are required to address the heterogeneity of findings, and to clarify which subgroups of people with LLD are at highest risk for developing MCI and ADRD.
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Affiliation(s)
- Neda Rashidi-Ranjbar
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada.,Campbell Family Mental Health Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Dayton Miranda
- Campbell Family Mental Health Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Meryl A Butters
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Benoit H Mulsant
- Campbell Family Mental Health Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Aristotle N Voineskos
- Campbell Family Mental Health Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
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Jamieson A, Goodwill AM, Termine M, Campbell S, Szoeke C. Depression related cerebral pathology and its relationship with cognitive functioning: A systematic review. J Affect Disord 2019; 250:410-418. [PMID: 30878653 DOI: 10.1016/j.jad.2019.03.042] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 02/26/2019] [Accepted: 03/04/2019] [Indexed: 01/29/2023]
Abstract
BACKGROUND Depression's relationship with cerebral abnormalities and cognitive decline is temporally dynamic. Despite clear clinical utility, understanding depression's effect on cerebral structures, cognitive impairment and the interaction between these symptoms has had limited consideration. METHODS This review summarised studies examining a clinical depression diagnosis or validated scales measuring depressive symptoms, data concerning amyloid-beta (Aβ) levels, brain structure and function focusing on hippocampal alterations, or white matter hyperintensities (WMH), and at least one validated neuropsychological test. Online database searches of: PsycINFO, EMBASE, MEDLINE, and Scopus were conducted to identify potential articles. RESULTS While depression was consistently associated with cross-sectionally cognitive decline across multiple domains, the neuropathological basis of this dysfunction remained unclear. Hippocampal, frontal, and limbic dysfunction as well as cortical thinning, WMH, and Aβ burden all provide inconsistent findings, likely due to depression subtypes. The consistency of these findings additionally decreases when examining this relationship longitudinally, as these results are further confounded by pre-dementia states. The therapeutic interventions examined were more efficacious in the younger compared with the older samples, who were characterised by greater WMH and Aβ burden. LIMITATIONS The limited number of longitudinal and interventional studies in addition to the heterogeneity of the samples restricts their generalisability. CONCLUSIONS Symptomatological differences between early-onset and late-onset depression (EOD and LOD) appear crucial in understanding whether late-life depression is the primary or secondary source of cerebral pathology. Though severe cognitive impairments and clearer neuropathological underpinnings are more characteristic of LOD than EOD, the inconsistency of valid biomarkers remains problematic.
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Affiliation(s)
- Alec Jamieson
- Centre for Medical Research, Royal Melbourne Hospital, Faculty of Medicine Dentistry and Health Sciences, University of Melbourne, Parkville, Victoria, Australia
| | - Alicia M Goodwill
- Centre for Medical Research, Royal Melbourne Hospital, Faculty of Medicine Dentistry and Health Sciences, University of Melbourne, Parkville, Victoria, Australia; Healthy Brain Initiative, Faculty of Health Sciences, Australian Catholic University, Melbourne, Victoria, Australia
| | - Mario Termine
- Centre for Medical Research, Royal Melbourne Hospital, Faculty of Medicine Dentistry and Health Sciences, University of Melbourne, Parkville, Victoria, Australia
| | - Stephen Campbell
- Australian Healthy Ageing Organisation (AHAO), Parkville, Victoria, Australia
| | - Cassandra Szoeke
- Centre for Medical Research, Royal Melbourne Hospital, Faculty of Medicine Dentistry and Health Sciences, University of Melbourne, Parkville, Victoria, Australia; Healthy Brain Initiative, Faculty of Health Sciences, Australian Catholic University, Melbourne, Victoria, Australia; Australian Healthy Ageing Organisation (AHAO), Parkville, Victoria, Australia.
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7
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Zaremba D, Dohm K, Redlich R, Grotegerd D, Strojny R, Meinert S, Bürger C, Enneking V, Förster K, Repple J, Opel N, Baune BT, Zwitserlood P, Heindel W, Arolt V, Kugel H, Dannlowski U. Association of Brain Cortical Changes With Relapse in Patients With Major Depressive Disorder. JAMA Psychiatry 2018; 75:484-492. [PMID: 29590315 PMCID: PMC5875383 DOI: 10.1001/jamapsychiatry.2018.0123] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
IMPORTANCE More than half of all patients with major depressive disorder (MDD) experience a relapse within 2 years after recovery. It is unclear how relapse affects brain morphologic features during the course of MDD. OBJECTIVE To use structural magnetic resonance imaging to identify morphologic brain changes associated with relapse in MDD. DESIGN, SETTING, AND PARTICIPANTS In this longitudinal case-control study, patients with acute MDD at baseline and healthy controls were recruited from the University of Münster Department of Psychiatry from March 21, 2010, to November 14, 2014, and were reassessed from November 11, 2012, to October 28, 2016. Depending on patients' course of illness during follow-up, they were subdivided into groups of patients with and without relapse. Whole-brain gray matter volume and cortical thickness of the anterior cingulate cortex, orbitofrontal cortex, middle frontal gyrus, and insula were assessed via 3-T magnetic resonance imaging at baseline and 2 years later. MAIN OUTCOMES AND MEASURES Gray matter was analyzed via group (no relapse, relapse, and healthy controls) by time (baseline and follow-up) analysis of covariance, controlling for age and total intracranial volume. Confounding factors of medication and depression severity were assessed. RESULTS This study included 37 patients with MDD and a relapse (19 women and 18 men; mean [SD] age, 37.0 [12.7] years), 23 patients with MDD and without relapse (13 women and 10 men; mean [SD] age, 32.5 [10.5] years), and 54 age- and sex-matched healthy controls (24 women and 30 men; mean [SD] age, 37.5 [8.7] years). A significant group-by-time interaction controlling for age and total intracranial volume revealed that patients with relapse showed a significant decline of insular volume (difference, -0.032; 95% CI, -0.063 to -0.002; P = .04) and dorsolateral prefrontal volume (difference, -0.079; 95% CI, -0.113 to -0.045; P < .001) from baseline to follow-up. In patients without relapse, gray matter volume in these regions did not change significantly (insula: difference, 0.027; 95% CI, -0.012 to 0.066; P = .17; and dorsolateral prefrontal volume: difference, 0.023; 95% CI, -0.020 to 0.066; P = .30). Volume changes were not correlated with psychiatric medication or with severity of depression at follow-up. Additional analysis of cortical thickness showed an increase in the anterior cingulate cortex (difference, 0.073 mm; 95% CI, 0.023-0.123 mm; P = .005) and orbitofrontal cortex (difference, 0.089 mm; 95% CI, 0.032-0.147 mm; P = .003) from baseline to follow-up in patients without relapse. CONCLUSION AND RELEVANCE A distinct association of relapse in MDD with brain morphologic features was revealed using a longitudinal design. Relapse is associated with brain structures that are crucial for regulation of emotions and thus needs to be prevented. This study might be a step to guide future prognosis and maintenance treatment in patients with recurrent MDD.
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Affiliation(s)
- Dario Zaremba
- Department of Psychiatry, University of Münster, Münster, Germany
| | - Katharina Dohm
- Department of Psychiatry, University of Münster, Münster, Germany
| | - Ronny Redlich
- Department of Psychiatry, University of Münster, Münster, Germany
| | | | - Robert Strojny
- Department of Psychiatry, University of Münster, Münster, Germany
| | - Susanne Meinert
- Department of Psychiatry, University of Münster, Münster, Germany
| | - Christian Bürger
- Department of Psychiatry, University of Münster, Münster, Germany
| | - Verena Enneking
- Department of Psychiatry, University of Münster, Münster, Germany
| | | | - Jonathan Repple
- Department of Psychiatry, University of Münster, Münster, Germany
| | - Nils Opel
- Department of Psychiatry, University of Münster, Münster, Germany
| | - Bernhard T. Baune
- Discipline of Psychiatry, University of Adelaide, Adelaide, South Australia
| | | | - Walter Heindel
- Department of Clinical Radiology, University of Münster, Münster, Germany
| | - Volker Arolt
- Department of Psychiatry, University of Münster, Münster, Germany
| | - Harald Kugel
- Department of Clinical Radiology, University of Münster, Münster, Germany
| | - Udo Dannlowski
- Department of Psychiatry, University of Münster, Münster, Germany
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8
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Dohm K, Redlich R, Zwitserlood P, Dannlowski U. Trajectories of major depression disorders: A systematic review of longitudinal neuroimaging findings. Aust N Z J Psychiatry 2017; 51:441-454. [PMID: 27539592 DOI: 10.1177/0004867416661426] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Structural and functional brain alterations in major depression disorder (MDD) are well studied in cross-sectional designs, but little is known about the causality between onset and course of depression on the one hand, and neurobiological changes over time on the other. To explore the direction of causality, longitudinal studies with a long time window (preferably years) are needed, but only few have been undertaken so far. This article reviews all prospective neuroimaging studies in MDD patients currently available and provides a critical discussion of methodological challenges involved in the investigation of the causal relationship between brain alterations and the course of MDD. METHOD We conducted a systematic review of studies published before September 2015, to identify structural magnetic resonance imaging (MRI) studies that assess the relation between neuronal alterations and MDD in longitudinal (⩾1 year) designs. RESULTS Only 15 studies meeting minimal standards were identified. An analysis of these longitudinal data showed a large heterogeneity between studies regarding design, samples, imaging methods, spatial restrictions and, consequently, results. There was a strong relationship between brain-volume outcomes and the current mood state, whereas longitudinal studies failed to clarify the influence of pre-existing brain changes on depressive outcome. CONCLUSION So far, available longitudinal studies cannot resolve the causality between the course of depression and neurobiological changes over time. Future studies should combine high methodological standards with large sample sizes. Cooperation in multi-center studies is indispensable to attain sufficient sample sizes, and should allow careful assessment of possible confounders.
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Affiliation(s)
- Katharina Dohm
- 1 Department of Psychiatry, University of Münster, Münster, Germany
| | - Ronny Redlich
- 1 Department of Psychiatry, University of Münster, Münster, Germany
| | | | - Udo Dannlowski
- 1 Department of Psychiatry, University of Münster, Münster, Germany.,3 Department of Psychiatry, University of Marburg, Marburg, Germany
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9
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Yang J, Yin P, Wei D, Wang K, Li Y, Qiu J. Effects of parental emotional warmth on the relationship between regional gray matter volume and depression-related personality traits. Soc Neurosci 2016; 12:337-348. [PMID: 27079866 DOI: 10.1080/17470919.2016.1174150] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The depression-related personality trait is associated with the severity of patients' current depressive symptoms and with the vulnerability to depression within the nonclinical groups. However, little is known about the anatomical structure associated with the depression-related personality traits within the nonclinical sample. Parenting behavior is associated with the depression symptoms; however, whether or not parenting behavior influence the neural basis of the depression-related personality traits is unclear. Thus in current study, first, we used voxel-based morphometry to identify the brain regions underlying individual differences in depression-related personality traits, as measured by the revised Neuroticism-Extraversion-Openness Personality Inventory, in a large sample of young healthy adults. Second, we use mediation analysis to investigate the relationship between parenting behavior and neural basis of depression-related personality traits. The results revealed that depression-related personality traits were positively correlated with gray matter volume mainly in medial frontal gyrus (MFG) that is implicated in the self-referential processing and emotional regulation. Furthermore, parental emotional warmth acted as a mediational mechanism underlying the association between the MFG volume and the depression-related personality trait. Together, our findings suggested that the family environment might play an important role in the acquisition and process of the depression-related personality traits.
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Affiliation(s)
- Junyi Yang
- a Key Laboratory of Cognition and Personality (SWU) , Ministry of Education , Chongqing , China.,b Department of Psychology , Southwest University , Chongqing , China
| | - Ping Yin
- c Department of Radiology , The First Affiliated Hospital of Chongqing Medical University , Chongqing , China
| | - Dongtao Wei
- a Key Laboratory of Cognition and Personality (SWU) , Ministry of Education , Chongqing , China.,b Department of Psychology , Southwest University , Chongqing , China
| | - Kangcheng Wang
- a Key Laboratory of Cognition and Personality (SWU) , Ministry of Education , Chongqing , China.,b Department of Psychology , Southwest University , Chongqing , China
| | - Yongmei Li
- c Department of Radiology , The First Affiliated Hospital of Chongqing Medical University , Chongqing , China
| | - Jiang Qiu
- a Key Laboratory of Cognition and Personality (SWU) , Ministry of Education , Chongqing , China.,b Department of Psychology , Southwest University , Chongqing , China
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10
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Jellinger KA. Organic bases of late-life depression: a critical update. J Neural Transm (Vienna) 2013; 120:1109-25. [PMID: 23355089 DOI: 10.1007/s00702-012-0945-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2012] [Accepted: 11/30/2012] [Indexed: 02/07/2023]
Abstract
Late-life depression (LLD) is frequently associated with cognitive impairment and increases the risk of subsequent dementia. Cerebrovascular disease, deep white matter lesions, Alzheimer disease (AD) and dementia with Lewy bodies (DLB) have all been hypothesized to contribute to this increased risk, and a host of studies have looked at the interplay between cerebrovascular disease and LLD. This has resulted in new concepts of LLD, such as "vascular depression", but despite multiple magnetic resonance imaging (MRI) studies in this field, the relationship between structural changes in human brain and LLD is still controversial. While pathological findings of suicide in some elderly persons revealed multiple lacunes, small vessel cerebrovascular disease, AD-related lesions or multiple neurodegenerative pathologies, recent autopsy data challenged the role of subcortical lacunes and white matter lesions as major morphological substrates of depressive symptoms as well as poorer executive function and memory. Several neuropathological studies, including a personal clinico-pathological study in a small cohort of elderly persons with LLD and age-matched controls confirmed that lacunes, periventricular and deep white matter demyelination as well as AD-related lesions are usually unrelated to the occurrence of LLD. In the same line, neuropathological data show that early-onset depression is not associated with an acceleration of age-related neurodegenerative changes. Very recent data on the critical role of glia-modulating neuronal dysfunction and degeneration in depression are discussed.
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Affiliation(s)
- Kurt A Jellinger
- Institute of Clinical Neurobiology, Kenyongasse 18, 1070 Vienna, Austria.
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11
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Neuropathological substrates and structural changes in late-life depression: the impact of vascular burden. Acta Neuropathol 2012; 124:453-64. [PMID: 22836715 DOI: 10.1007/s00401-012-1021-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2012] [Revised: 07/13/2012] [Accepted: 07/17/2012] [Indexed: 01/01/2023]
Abstract
A first episode of depression after 65 years of age has long been associated with both severe macrovascular and small microvascular pathology. Among the three more frequent forms of depression in old age, post-stroke depression has been associated with an abrupt damage of cortical circuits involved in monoamine production and mood regulation. Late-onset depression (LOD) in the absence of stroke has been related to lacunes and white matter lesions that invade both the neocortex and subcortical nuclei. Recurrent late-life depression is thought to induce neuronal loss in the hippocampal formation and white matter lesions that affect limbic pathways. Despite an impressive number of magnetic resonance imaging (MRI) studies in this field, the presence of a causal relationship between structural changes in the human brain and LOD is still controversial. The present article provides a critical overview of the contribution of neuropathology in post-stroke, late-onset, and late-life recurrent depression. Recent autopsy findings challenge the role of stroke location in the occurrence of post-stroke depression by pointing to the deleterious effect of subcortical lacunes. Despite the lines of evidences supporting the association between MRI-assessed white matter changes and mood dysregulation, lacunes, periventricular and deep white matter demyelination are all unrelated to the occurrence of LOD. In the same line, neuropathological data show that early-onset depression is not associated with an acceleration of aging-related neurodegenerative changes in the human brain. However, they also provide data in favor of the neurotoxic theory of depression by showing that neuronal loss occurs in the hippocampus of chronically depressed patients. These three paradigms are discussed in the light of the complex relationships between psychosocial determinants and biological vulnerability in affective disorders.
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