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Zhang X, Guo YM, Ning YP, Cao LP, Rao YH, Sun JQ, Qing MJ, Zheng W. Adjunctive vagus nerve stimulation for treatment-resistant depression: a preliminary study. Int J Psychiatry Clin Pract 2022; 26:337-342. [PMID: 35023429 DOI: 10.1080/13651501.2021.2019789] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND This study is the first to assess the safety and therapeutic efficacy of vagus nerve stimulation (VNS) as an adjunctive treatment for Chinese patients suffering from treatment-resistant depression (TRD). METHODS A total of seven patients with TRD underwent surgical implantation of a VNS device were followed over a 9-month period. The 24-item Hamilton Rating Scale for Depression (HAMD-24) and the 14-item Hamilton Anxiety Scale (HAMA) were used to assess depressive and anxiety symptoms, respectively. Neurocognitive function was measured with the Wechsler Adult Intelligence Scale (WAIS) and the Wechsler Memory Scale (WMS). RESULTS After 3 months of treatment with VNS, the antidepressant response and remission rates were 42.9% and 28.6%, respectively. After 9 months of treatment with VNS, the response and remission rates increased to 85.7% and 57.1%, respectively. Significant time main effects were identified for HAMD-24 scores, HAMA scores, the WMS memory quotient, and the full intelligence quotients measured with the WAIS (all ps < 0.05). The most frequent adverse effects of VNS treatment were voice alteration (100%) and cough frequency increase (71.4%). CONCLUSION This preliminary study indicated that adjunctive VNS was effective and safe in treating Chinese patients who were suffering from TRD, and its efficacy increased with time.Key pointsThere is positive evidence to support the role of VNS as an adjunctive treatment in Chinese patients with TRD.The antidepressant efficacy of adjunctive VNS for Chinese patients with TRD increased with time.The most frequent adverse effects of VNS treatment were voice alteration and cough frequency increase.
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Affiliation(s)
- Xun Zhang
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Yan-Mei Guo
- The Third Affiliated of Guangzhou Medical University, Guangzhou, China
| | - Yu-Ping Ning
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Li-Ping Cao
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Ying-Hua Rao
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Jia-Qi Sun
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Ming-Jun Qing
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Wei Zheng
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
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Smart Device-Driven Corticolimbic Plasticity in Cognitive–Emotional Restructuring of Space-Related Neuropsychiatric Disease and Injury. Life (Basel) 2022; 12:life12020236. [PMID: 35207523 PMCID: PMC8875345 DOI: 10.3390/life12020236] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 01/27/2022] [Accepted: 02/01/2022] [Indexed: 11/16/2022] Open
Abstract
Escalating government and commercial efforts to plan and deploy viable manned near-to-deep solar system exploration and habitation over the coming decades now drives next-generation space medicine innovations. The application of cutting-edge precision medicine, such as brain stimulation techniques, provides powerful clinical and field/flight situation methods to selectively control vagal tone and neuroendocrine-modulated corticolimbic plasticity, which is affected by prolonged cosmic radiation exposure, social isolation or crowding, and weightlessness in constricted operational non-terran locales. Earth-based clinical research demonstrates that brain stimulation approaches may be combined with novel psychotherapeutic integrated memory structure rationales for the corrective reconsolidation of arousing or emotional experiences, autobiographical memories, semantic schema, and other cognitive structures to enhance neuropsychiatric patient outcomes. Such smart cotherapies or countermeasures, which exploit natural, pharmaceutical, and minimally invasive neuroprosthesis-driven nervous system activity, may optimize the cognitive-emotional restructuring of astronauts suffering from space-related neuropsychiatric disease and injury, including mood, affect, and anxiety symptoms of any potential severity and pathophysiology. An appreciation of improved neuropsychiatric healthcare through the merging of new or rediscovered smart theragnostic medical technologies, capable of rendering personalized neuroplasticity training and managed psychotherapeutic treatment protocols, will reveal deeper insights into the illness states experienced by astronauts. Future work in this area should emphasize the ethical role of telemedicine and/or digital clinicians to advance the (semi)autonomous, technology-assisted medical prophylaxis, diagnosis, treatment, monitoring, and compliance of astronauts for elevated health, safety, and performance in remote extreme space and extraterrestrial environments.
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Sun J, Ma Y, Du Z, Wang Z, Guo C, Luo Y, Chen L, Gao D, Li X, Xu K, Hong Y, Xu F, Yu X, Xiao X, Fang J, Hou X. Immediate Modulation of Transcutaneous Auricular Vagus Nerve Stimulation in Patients With Treatment-Resistant Depression: A Resting-State Functional Magnetic Resonance Imaging Study. Front Psychiatry 2022; 13:923783. [PMID: 35845466 PMCID: PMC9284008 DOI: 10.3389/fpsyt.2022.923783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 05/05/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Previous studies found that transcutaneous auricular vagus nerve stimulation (taVNS) was clinically effective in treating a case of treatment-resistant depression (TRD). However, the brain neural mechanisms underlying the immediate effects of taVNS treatment for TRD have not been elucidated. MATERIALS AND METHODS Differences in the amplitude of low-frequency fluctuations (ALFF) between TRD and healthy control (HC) groups were observed. The TRD group was treated with taVNS for 30 min, and changes in ALFF in the TRD group before and after immediate treatment were observed. The ALFF brain regions altered by taVNS induction were used as regions of interest to analyze whole-brain functional connectivity (FC) changes in the TRD group. RESULTS A total of 44 TRD patients and 44 HCs completed the study and were included in the data analysis. Compared with the HC group, the TRD group had increased ALFF in the left orbital area of the middle frontal gyrus. After taVNS treatment, ALFF in the left orbital area of the middle frontal gyrus and right middle frontal gyrus decreased in the TRD group, while ALFF in the right orbital area of the superior frontal gyrus increased. The FC in the left orbital area of the middle frontal gyrus with left middle frontal gyrus and the right inferior occipital gyrus was significantly increased. CONCLUSION Transcutaneous auricular vagus nerve stimulation demonstrates immediate modulation of functional activity in the emotional network, cognitive control network, and visual processing cortex, and may be a potential brain imaging biomarker for the treatment of TRD.
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Affiliation(s)
- Jifei Sun
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China.,Graduate School of China Academy of Chinese Medical Sciences, Beijing, China
| | - Yue Ma
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China.,Graduate School of China Academy of Chinese Medical Sciences, Beijing, China
| | - Zhongming Du
- Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Zhi Wang
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China.,Graduate School of China Academy of Chinese Medical Sciences, Beijing, China
| | - Chunlei Guo
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China.,Graduate School of China Academy of Chinese Medical Sciences, Beijing, China
| | - Yi Luo
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China.,Graduate School of China Academy of Chinese Medical Sciences, Beijing, China
| | - Limei Chen
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China.,Graduate School of China Academy of Chinese Medical Sciences, Beijing, China
| | - Deqiang Gao
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Xiaojiao Li
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Ke Xu
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Yang Hong
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Fengquan Xu
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Xue Yu
- Beijing First Hospital of Integrated Chinese and Western Medicine, Beijing, China
| | - Xue Xiao
- Beijing First Hospital of Integrated Chinese and Western Medicine, Beijing, China
| | - Jiliang Fang
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Xiaobing Hou
- Beijing First Hospital of Integrated Chinese and Western Medicine, Beijing, China
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Leitzke M, Stefanovic D, Meyer JJ, Schimpf S, Schönknecht P. Autonomic balance determines the severity of COVID-19 courses. Bioelectron Med 2020; 6:22. [PMID: 33292846 PMCID: PMC7683278 DOI: 10.1186/s42234-020-00058-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 10/26/2020] [Indexed: 12/15/2022] Open
Abstract
COVID-19 has left mankind desperately seeking how to manage dramatically rising infection rates associated with severe disease progressions. COVID-19 courses range from mild symptoms up to multiple organ failure and death, triggered by excessively high serum cytokine levels (IL 1β, IL 6, TNF α, IL 8). The vagally driven cholinergic anti-inflammatory pathway (CAP) stops the action of nuclear factor κB (NF-κB), the transcriptional factor of pro-inflammatory cytokines. Thus, well-balanced cytokine release depends on adequate vagal signaling. Coronaviruses replicate using NF-κB transcriptional factor as well. By degrading the cytoplasmatic inhibitor of NF-κB subunits (IκB), coronaviruses induce unrestricted NF-κB expression accelerating both, virus replication and cytokine transcription.We hypothesize that CAP detriment due to depressed vagal tone critically determines the severity of COVID-19.
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Affiliation(s)
- M Leitzke
- Department of Anesthesiology, Helios Clinics, Colditzer Straße 48, 04703, Leisnig, Germany.
| | - D Stefanovic
- Department of Anesthesiology, Helios Clinics, Colditzer Straße 48, 04703, Leisnig, Germany
| | - J-J Meyer
- Department of Anesthesiology, Helios Clinics, Colditzer Straße 48, 04703, Leisnig, Germany
| | - S Schimpf
- Drägerwerk AG & Co. KGaA, Moislinger Allee 53-55, 23558, Lübeck, Germany
| | - P Schönknecht
- Medical faculty of Leipzig University, Saxon Hospital, Hufelandstraße 15, Sächsisches Krankenhaus, 01477, Arnsdorf, Germany
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Abstract
Vagus nerve stimulation (VNS) has been increasingly studied in treating treatment-resistant depression (TRD), but the findings have been mixed. This updated meta-analysis was conducted to examine the efficacy and safety of adjunctive VNS for TRD. Controlled studies reporting on the efficacy and safety of adjunctive VNS for TRD were screened, identified and analyzed. Standardized mean difference (SMD), risk ratio (RR) and their 95% confidence intervals (CIs) were analyzed using RevMan version 5.3. Three controlled studies with a total of 1048 patients with TRD compared VNS (n = 622) with control (n = 426) groups. Only one study was rated as 'high quality' using the Jadad scale. Adjunctive VNS was significantly superior to the control group regarding study-defined response [SMD:1.96 (95%CI:1.60, 2.40), P < 0.00001, I2 = 0%]. Patient-reported voice alteration occurred more frequently with adjunctive VNS for patients with TRD. No significant group differences were found regarding discontinuation due to any reason [RR:0.50 (95%CI:0.12, 2.09), P = 0.34, I2 = 85%]. Adjunctive VNS appeared to be effective and relatively safe treatment for TRD. Further randomized controlled trials are needed to confirm the efficacy and safety of VNS for TRD.
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Computerized Exposure Therapy for Spider Phobia: Effects of Cardiac Timing and Interoceptive Ability on Subjective and Behavioral Outcomes. Psychosom Med 2019; 81:90-99. [PMID: 30300237 DOI: 10.1097/psy.0000000000000646] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE Spider phobia is a common form of anxiety disorder for which exposure therapy is an effective first-line treatment. Motivated by the observed modulation of threat processing by afferent cardiac signals, we tested the hypothesis that interoceptive information concerning cardiovascular arousal can influence the outcomes of computerized exposure therapy for spider phobia. METHOD Fifty-three normal healthy participants with high spider phobia scores underwent one of the following three modified computerized exposure protocols, defined by the timing of exposure to brief spider stimuli within the cardiac cycle: systole (during afferent baroreceptor firing); diastole (during baroreceptor-quiescent interbeat interval); random (noncontingent on cardiac cycle). Outcomes were judged on phobic and anxiety measures and physiological data (skin conductance). Individuals were also rated on interoceptive accuracy. RESULTS MANCOVA analysis showed that timing group affected the outcome measures (F(10,80) = 2.405, p = .015) and there was a group interaction with interoception ability (F(15,110) = 1.808, p = .045). Subjective symptom reduction was greatest in the systolic group relative to the other two groups (diastolic (t = 3.115, ptukey = .009); random (t = 2.438, ptukey = .048)), with greatest reductions in those participants with lower interoceptive accuracy. Behavioral aversion reduced more in cardiac-contingent groups than the noncontingent (random) group (diastolic (t = 3.295, ptukey = .005); systolic (t = 2.602, ptukey = .032)). Physiological (skin conductance response) responses remained strongest for spider stimuli presented at cardiac systole. CONCLUSIONS Interoceptive information influences exposure benefit. The reduction in the subjective expression of fear/phobia is facilitated by "bottom-up" afferent signals, whereas improvement in the behavioral expression is further dependent on "top-down" representation of self-related physiology (heart rhythm). Individual interoceptive differences moderate these effects, suggesting means to personalize therapy.
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Dalenberg JR, Weitkamp L, Renken RJ, ter Horst GJ. Valence processing differs across stimulus modalities. Neuroimage 2018; 183:734-744. [DOI: 10.1016/j.neuroimage.2018.08.059] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Revised: 08/06/2018] [Accepted: 08/24/2018] [Indexed: 12/15/2022] Open
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Makovac E, Garfinkel S, Bassi A, Basile B, Macaluso E, Cercignani M, Calcagnini G, Mattei E, Mancini M, Agalliu D, Cortelli P, Caltagirone C, Critchley H, Bozzali M. Fear processing is differentially affected by lateralized stimulation of carotid baroreceptors. Cortex 2018; 99:200-212. [DOI: 10.1016/j.cortex.2017.07.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Revised: 03/21/2017] [Accepted: 07/05/2017] [Indexed: 10/19/2022]
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9
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Doleys DM, Dolce JJ. Psychological Issues and Evaluation for Patients Undergoing Implantable Technology. Neuromodulation 2018. [DOI: 10.1016/b978-0-12-805353-9.00002-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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10
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Miskowiak KW, Macoveanu J, Jørgensen MB, Støttrup MM, Ott CV, Jensen HM, Jørgensen A, Harmer J, Paulson OB, Kessing LV, Siebner HR. Neural Response After a Single ECT Session During Retrieval of Emotional Self-Referent Words in Depression: A Randomized, Sham-Controlled fMRI Study. Int J Neuropsychopharmacol 2017; 21:226-235. [PMID: 29718333 PMCID: PMC5838818 DOI: 10.1093/ijnp/pyx091] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Accepted: 09/29/2017] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Negative neurocognitive bias is a core feature of depression that is reversed by antidepressant drug treatment. However, it is unclear whether modulation of neurocognitive bias is a common mechanism of distinct biological treatments. This randomized controlled functional magnetic resonance imaging study explored the effects of a single electroconvulsive therapy session on self-referent emotional processing. METHODS Twenty-nine patients with treatment-resistant major depressive disorder were randomized to one active or sham electroconvulsive therapy session at the beginning of their electroconvulsive therapy course in a double-blind, between-groups design. The following day, patients were given a self-referential emotional word categorization test and a free recall test. This was followed by an incidental word recognition task during whole-brain functional magnetic resonance imaging at 3T. Mood was assessed at baseline, on the functional magnetic resonance imaging day, and after 6 electroconvulsive therapy sessions. Data were complete and analyzed for 25 patients (electroconvulsive therapy: n = 14, sham: n = 11). The functional magnetic resonance imaging data were analyzed using the FMRIB Software Library randomize algorithm, and the Threshold-Free Cluster Enhancement method was used to identify significant clusters (corrected at P < .05). RESULTS A single electroconvulsive therapy session had no effect on hippocampal activity during retrieval of emotional words. However, electroconvulsive therapy reduced the retrieval-specific neural response for positive words in the left frontopolar cortex. This effect occurred in the absence of differences between groups in behavioral performance or mood symptoms. CONCLUSIONS The observed effect of electroconvulsive therapy on prefrontal response may reflect early facilitation of memory for positive self-referent information, which could contribute to improvements in depressive symptoms including feelings of self-worth with repeated treatments.
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Affiliation(s)
- Kamilla W Miskowiak
- Psychiatric Centre Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark,Department of Psychology, University of Copenhagen, Copenhagen, Denmark,Correspondence: Kamilla W. Miskowiak, DPhil, Psychiatric Centre Copenhagen, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen, Denmark ()
| | - Julian Macoveanu
- Psychiatric Centre Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark,Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital, Hvidovre, Denmark,Center for Integrated Molecular Brain Imaging, Rigshospitalet, Copenhagen
| | - Martin B Jørgensen
- Psychiatric Centre Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark
| | - Mette M Støttrup
- Psychiatric Centre Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark
| | - Caroline V Ott
- Psychiatric Centre Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Anders Jørgensen
- Psychiatric Centre Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark
| | - J Harmer
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Olaf B Paulson
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital, Hvidovre, Denmark,Center for Integrated Molecular Brain Imaging, Rigshospitalet, Copenhagen,Neurobiology Research Unit, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Lars V Kessing
- Psychiatric Centre Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark
| | - Hartwig R Siebner
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital, Hvidovre, Denmark,Center for Integrated Molecular Brain Imaging, Rigshospitalet, Copenhagen,Department of Neurology, Copenhagen University Hospital, Bispebjerg, Denmark
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Frangos E, Komisaruk BR. Access to Vagal Projections via Cutaneous Electrical Stimulation of the Neck: fMRI Evidence in Healthy Humans. Brain Stimul 2017; 10:19-27. [DOI: 10.1016/j.brs.2016.10.008] [Citation(s) in RCA: 127] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2016] [Revised: 09/13/2016] [Accepted: 10/16/2016] [Indexed: 01/30/2023] Open
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12
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Pringle A, Harmer CJ. The effects of drugs on human models of emotional processing: an account of antidepressant drug treatment. DIALOGUES IN CLINICAL NEUROSCIENCE 2016. [PMID: 26869848 PMCID: PMC4734885 DOI: 10.31887/dcns.2015.17.4/apringle] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Human models of emotional processing suggest that the direct effect of successful antidepressant drug treatment may be to modify biases in the processing of emotional information. Negative biases in emotional processing are documented in depression, and single or short-term dosing with conventional antidepressant drugs reverses these biases in depressed patients prior to any subjective change in mood. Antidepressant drug treatments also modulate emotional processing in healthy volunteers, which allows the consideration of the psychological effects of these drugs without the confound of changes in mood. As such, human models of emotional processing may prove to be useful for testing the efficacy of novel treatments and for matching treatments to individual patients or subgroups of patients.
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Akhtar H, Bukhari F, Nazir M, Anwar MN, Shahzad A. Therapeutic Efficacy of Neurostimulation for Depression: Techniques, Current Modalities, and Future Challenges. Neurosci Bull 2016; 32:115-26. [PMID: 26781880 PMCID: PMC5563754 DOI: 10.1007/s12264-015-0009-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Accepted: 10/20/2015] [Indexed: 01/30/2023] Open
Abstract
Depression is the most prevalent debilitating mental illness; it is characterized as a disorder of mood, cognitive function, and neurovegetative function. About one in ten individuals experience depression at some stage of their lives. Antidepressant drugs are used to reduce the symptoms but relapse occurs in ~20% of patients. However, alternate therapies like brain stimulation techniques have shown promising results in this regard. This review covers the brain stimulation techniques electroconvulsive therapy, transcranial direct current stimulation, repetitive transcranial magnetic stimulation, vagus nerve stimulation, and deep brain stimulation, which are used as alternatives to antidepressant drugs, and elucidates their research and clinical outcomes.
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Affiliation(s)
- Hafsah Akhtar
- Human Systems Lab, Department of Biomedical Engineering and Sciences, School of Mechanical and Manufacturing Engineering, National University of Sciences and Technology (NUST), Sector H-12, Islamabad, 44000, Pakistan
| | - Faiza Bukhari
- Human Systems Lab, Department of Biomedical Engineering and Sciences, School of Mechanical and Manufacturing Engineering, National University of Sciences and Technology (NUST), Sector H-12, Islamabad, 44000, Pakistan
| | - Misbah Nazir
- Human Systems Lab, Department of Biomedical Engineering and Sciences, School of Mechanical and Manufacturing Engineering, National University of Sciences and Technology (NUST), Sector H-12, Islamabad, 44000, Pakistan
| | - Muhammad Nabeel Anwar
- Human Systems Lab, Department of Biomedical Engineering and Sciences, School of Mechanical and Manufacturing Engineering, National University of Sciences and Technology (NUST), Sector H-12, Islamabad, 44000, Pakistan.
| | - Adeeb Shahzad
- Human Systems Lab, Department of Biomedical Engineering and Sciences, School of Mechanical and Manufacturing Engineering, National University of Sciences and Technology (NUST), Sector H-12, Islamabad, 44000, Pakistan
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Garfinkel SN, Critchley HD. Threat and the Body: How the Heart Supports Fear Processing. Trends Cogn Sci 2015; 20:34-46. [PMID: 26628111 DOI: 10.1016/j.tics.2015.10.005] [Citation(s) in RCA: 136] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Revised: 10/01/2015] [Accepted: 10/12/2015] [Indexed: 12/16/2022]
Abstract
Mental processes depend upon a dynamic integration of brain and body. Emotions encompass internal physiological changes which, through interoception (sensing bodily states), underpin emotional feelings, for example, cardiovascular arousal can intensify feelings of fear and anxiety. The brain is informed about how quickly and strongly the heart is beating by signals from arterial baroreceptors. These fire in bursts after each heartbeat, and are quiet between heartbeats. The processing of fear stimuli is selectively enhanced by these phasic signals, and these inhibit the processing of other types of stimuli including physical pain. Behavioural and neuroimaging studies detail this differential impact of heart signals on the processing of salient stimuli, and add to knowledge linking rhythmic activity in brain and body to perceptual consciousness.
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Affiliation(s)
- Sarah N Garfinkel
- Division of Psychiatry, Brighton and Sussex Medical School, University of Sussex, Falmer, Brighton BN1 9RR, UK; Sackler Centre for Consciousness Science, University of Sussex, Falmer Brighton, BN1 9RH, UK.
| | - Hugo D Critchley
- Division of Psychiatry, Brighton and Sussex Medical School, University of Sussex, Falmer, Brighton BN1 9RR, UK; Sackler Centre for Consciousness Science, University of Sussex, Falmer Brighton, BN1 9RH, UK; Sussex Partnership National Health Service (NHS) Foundation Trust, Sussex, UK
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Harshaw C. Interoceptive dysfunction: toward an integrated framework for understanding somatic and affective disturbance in depression. Psychol Bull 2015; 141:311-363. [PMID: 25365763 PMCID: PMC4346391 DOI: 10.1037/a0038101] [Citation(s) in RCA: 170] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Depression is characterized by disturbed sleep and eating, a variety of other nonspecific somatic symptoms, and significant somatic comorbidities. Why there is such close association between cognitive and somatic dysfunction in depression is nonetheless poorly understood. An explosion of research in the area of interoception-the perception and interpretation of bodily signals-over the last decade nonetheless holds promise for illuminating what have until now been obscure links between the social, cognitive-affective, and somatic features of depression. This article reviews rapidly accumulating evidence that both somatic signaling and interoception are frequently altered in depression. This includes comparative studies showing vagus-mediated effects on depression-like behaviors in rodent models as well as studies in humans indicating both dysfunction in the neural substrates for interoception (e.g., vagus, insula, anterior cingulate cortex) and reduced sensitivity to bodily stimuli in depression. An integrative framework for organizing and interpreting this evidence is put forward which incorporates (a) multiple potential pathways to interoceptive dysfunction; (b) interaction with individual, gender, and cultural differences in interoception; and (c) a developmental psychobiological systems perspective, emphasizing likely differential susceptibility to somatic and interoceptive dysfunction across the lifespan. Combined with current theory and evidence, it is suggested that core symptoms of depression (e.g., anhedonia, social deficits) may be products of disturbed interoceptive-exteroceptive integration. More research is nonetheless needed to fully elucidate the relationship between mind, body, and social context in depression.
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Heartfelt imitation: High interoceptive awareness is linked to greater automatic imitation. Neuropsychologia 2014; 60:21-8. [DOI: 10.1016/j.neuropsychologia.2014.05.010] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Revised: 04/23/2014] [Accepted: 05/16/2014] [Indexed: 12/30/2022]
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Botelho de Oliveira S, Flórez RNS, Caballero DAV. [Consistent Declarative Memory with Depressive Symptomatology]. ACTA ACUST UNITED AC 2014; 41:881-99. [PMID: 26572272 DOI: 10.1016/s0034-7450(14)60053-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2012] [Accepted: 08/06/2012] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Some studies have suggested that potentiated remembrance of negative events on people with depressive disorders seems to be an important factor in the etiology, course and maintenance of depression. OBJECTIVE Evaluate the emotional memory in people with and without depressive symptomatology by means of an audio-visual test. METHODOLOGY 73 university students were evaluated, male and female, between 18 and 40 years old, distributed in two groups: with depressive symptomatology (32) and without depressive symptomatology (40), using the Scale from the Center of Epidemiologic Studies for Depression (CES-D, English Abbreviation) and a cutting point of 20. RESULTS There were not meaningful differences between free and voluntary recalls, with and without depressive symptomatology, in spite of the fact that both groups had granted a higher emotional value to the audio-visual test and that they had associated it with emotional sadness. CONCLUSION People with depressive symptomatology did not exhibit the effect of mnemonic potentiation generally associated to the content of the emotional version of the test; therefore, the hypothesis of emotional consistency was not validated.
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Affiliation(s)
- Silvia Botelho de Oliveira
- Psicóloga, Universidade Estadual Paulista São Paulo, Brasil. Magíster y PhD en Psicobiología de la Universidade de São Paulo, São Paulo, Brasil. Docente titular de la Facultad de Psicología de la Universidad Pontificia Bolivariana Seccional Bucaramanga, Bucaramanga, Colombia. Directora del Laboratorio de Neurociencias y Comportamiento, Universidad Pontificia Bolivariana Seccional Bucaramanga, Bucaramanga, Colombia.
| | - Ruth Natalia Suárez Flórez
- Psicólogos, Universidad Pontificia Bolivariana. Grupo Neurociencias y Comportamiento (NYC), Universidad Industrial de Santander y Universidad Pontificia Bolivariana, Bucaramanga, Colombia
| | - Diego Andrés Vásquez Caballero
- Psicólogos, Universidad Pontificia Bolivariana. Grupo Neurociencias y Comportamiento (NYC), Universidad Industrial de Santander y Universidad Pontificia Bolivariana, Bucaramanga, Colombia
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18
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Abstract
Mental processes and their neural substrates are intimately linked to the homeostatic control of internal bodily state. There are a set of distinct interoceptive pathways that directly and indirectly influence brain functions. The anatomical organization of these pathways and the psychological/behavioral expressions of their influence appear along discrete, evolutionarily conserved dimensions that are tractable to a mechanistic understanding. Here, we review the role of these pathways as sources of biases to perception, cognition, emotion, and behavior and arguably the dynamic basis to the concept of self.
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Affiliation(s)
- Hugo D Critchley
- Psychiatry, Brighton and Sussex Medical School, Brighton BN1 9RR, UK.
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Garfinkel SN, Barrett AB, Minati L, Dolan RJ, Seth AK, Critchley HD. What the heart forgets: Cardiac timing influences memory for words and is modulated by metacognition and interoceptive sensitivity. Psychophysiology 2013; 50:505-12. [PMID: 23521494 DOI: 10.1111/psyp.12039] [Citation(s) in RCA: 108] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2012] [Accepted: 01/07/2013] [Indexed: 11/30/2022]
Abstract
Mental functions are influenced by states of physiological arousal. Afferent neural activity from arterial baroreceptors at systole conveys the strength and timing of individual heartbeats to the brain. We presented words under limited attentional resources time-locked to different phases of the cardiac cycle, to test a hypothesis that natural baroreceptor stimulation influences detection and subsequent memory of words. We show memory for words presented around systole was decreased relative to words at diastole. The deleterious memory effect of systole was greater for words detected with low confidence and amplified in individuals with low interoceptive sensitivity, as indexed using a heartbeat counting task. Our observations highlight an important cardiovascular channel through which autonomic arousal impacts a cognitive function, an effect mitigated by metacognition (perceptual confidence) and interoceptive sensitivity.
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Affiliation(s)
- Sarah N Garfinkel
- Department of Psychiatry, Brighton and Sussex Medical School, University of Sussex, Falmer, UK.
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20
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Interaction between cognition, emotion, and the autonomic nervous system. HANDBOOK OF CLINICAL NEUROLOGY 2013; 117:59-77. [PMID: 24095116 DOI: 10.1016/b978-0-444-53491-0.00006-7] [Citation(s) in RCA: 139] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The mind and body are intrinsically and dynamically coupled. Perceptions, thoughts and feelings change, and respond to, the state of the body. This chapter describes the integration of cognitive and affective processes with the autonomic control of bodily arousal, focusing on reciprocal effects of autonomic responses on decision making, error detection, memory and emotions. Neuroimaging techniques are beginning to detail the neuronal substrates mediating these interactions between mental and physiological states, implicating cortical regions (specifically insular and cingulate cortices) alongside subcortical (amygdala) and brainstem (notably dorsal pons) in these mechanisms. The extent to which bodily states influence mental processes is determined in part by "interoceptive sensitivity," an index of individual differences in the ability to detect one's own bodily sensations. Moreover, the misidentification or misattribution of interoceptive responses is implicated in a number of pathologies such as depersonalization, schizophrenia, and anxiety. Increasing knowledge of the mechanisms of body-mind interactions has wide ranging implications, from decision making to empathy, and may serve elucidate potential avenues of intervention for stress-sensitive conditions in which psychological, cognitive, and emotional factors impact on the expression of physical symptoms.
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21
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The Role of Biomaterials in Stimulating Bioelectrodes. Biomater Sci 2013. [DOI: 10.1016/b978-0-08-087780-8.00084-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
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22
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Pringle A, Parsons E, Cowen LG, McTavish SF, Cowen PJ, Harmer CJ. Using an experimental medicine model to understand the antidepressant potential of the N-Methyl-D-aspartic acid (NMDA) receptor antagonist memantine. J Psychopharmacol 2012; 26:1417-23. [PMID: 22596208 PMCID: PMC3546643 DOI: 10.1177/0269881112446535] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
There is growing interest in the role of the glutamatergic system both in depression and as a novel target for treatments. Preclinical studies suggested that the non-competitive N-Methyl-D-aspartic acid (NMDA) receptor antagonist memantine might have antidepressant properties, but a randomised controlled trial failed to support this. A healthy volunteer model of emotional processing was used to assess the neuropsychological profile of action of memantine. Healthy volunteers (n=32) were randomised to receive a single dose of memantine (10 mg) or placebo, and subsequently completed a battery of tasks measuring emotional processing, including facial expression recognition, emotional memory, dot-probe and emotion-potentiated startle tasks, as well as working and verbal memory. Memantine treated volunteers showed an increased emotion-potentiated startle, and a reduced bias for negative items in emotional recognition memory. There were no effects of the drug on any other aspect of emotional or non-emotional information processing. These results suggest that a single dose of memantine produces an early anxiogenic response in the emotion-potentiated startle similar to that seen following a single dose of the selective serotonin reuptake inhibitor, citalopram. However, the overall profile of effects is more limited than that which might be expected in response to a conventional antidepressant.
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Affiliation(s)
- A Pringle
- Department of Psychiatry, University of Oxford, Oxford, UK.
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23
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Harmer CJ, Charles M, McTavish S, Favaron E, Cowen PJ. Negative ion treatment increases positive emotional processing in seasonal affective disorder. Psychol Med 2012; 42:1605-1612. [PMID: 22152099 DOI: 10.1017/s0033291711002820] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Antidepressant drug treatments increase the processing of positive compared to negative affective information early in treatment. Such effects have been hypothesized to play a key role in the development of later therapeutic responses to treatment. However, it is unknown whether these effects are a common mechanism of action for different treatment modalities. High-density negative ion (HDNI) treatment is an environmental manipulation that has efficacy in randomized clinical trials in seasonal affective disorder (SAD). METHOD The current study investigated whether a single session of HDNI treatment could reverse negative affective biases seen in seasonal depression using a battery of emotional processing tasks in a double-blind, placebo-controlled randomized study. RESULTS Under placebo conditions, participants with seasonal mood disturbance showed reduced recognition of happy facial expressions, increased recognition memory for negative personality characteristics and increased vigilance to masked presentation of negative words in a dot-probe task compared to matched healthy controls. Negative ion treatment increased the recognition of positive compared to negative facial expression and improved vigilance to unmasked stimuli across participants with seasonal depression and healthy controls. Negative ion treatment also improved recognition memory for positive information in the SAD group alone. These effects were seen in the absence of changes in subjective state or mood. CONCLUSIONS These results are consistent with the hypothesis that early change in emotional processing may be an important mechanism for treatment action in depression and suggest that these effects are also apparent with negative ion treatment in seasonal depression.
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Affiliation(s)
- C J Harmer
- University Department of Psychiatry, Warneford Hospital, Oxford, UK.
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24
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Abstract
Negative affective schema and associated biases in information processing have long been associated with clinical depression. Such an approach has guided the development of successful psychological therapies for this and other emotional disorders. However, until quite recently, there has been a large chasm between the practitioners and scientists working with this approach and those working on the neurobiological basis of depression and its treatment. Recent research, however, has started to bridge this gap and our understanding of the neural processes underpinning these cognitive processes has progressed markedly over the past decade. Moreover, rather than representing separate targets for psychological and biological treatments, novel findings suggest that pharmacological interventions for depression also modify these psychological maintaining factors early in treatment and may be involved in the later emergence of clinically relevant change. Such findings offer the possibility of greater integration between psychological and pharmacological conceptualisations of psychiatric illness and provide an experimental medicine model to generate and test specific predictions. Such a model could be applied to improve treatment development, stratification and combination approaches for patients with depression and provide a framework for considering and overcoming treatment nonresponse.
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Affiliation(s)
- Catherine J Harmer
- Warneford Hospital, University Department of Psychiatry, Headington, Oxford, OX3 7JX, UK.
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25
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Abstract
Current antidepressant agents are similar in efficacy to the original drugs discovered in the 1950s. The development of new treatments for depression is, however, limited by the absence of validated human biomarker models to predict efficacy, clinical profile and dosing. Such models need to meet key criteria for biomarkers including sensitivity, specificity and relevance to depression. Here we review studies exploring whether early changes in emotional processing with antidepressant drug administration meet these criteria. A large body of evidence suggests that changes in emotional memory are particularly relevant to depression and to antidepressant drug action whereas changes in attentional processing are sensitive to anxiolytic drugs. These tasks are not consistently affected by agents which have failed in clinical trials in depression, but do show changes in the predicted direction with agents associated either with amelioration or induction of symptoms. Hence, early assessment of novel drugs on emotional processing may predict likely clinical effects and dosing prior to randomized controlled trials. Greater validation is required to assess whether these effects are an obligatory component of effective treatment of depression and whether use of these models can improve the accuracy of go/no-go decisions in drug development.
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Affiliation(s)
- Catherine J Harmer
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford OX3 7JX, UK.
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26
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Pringle A, Browning M, Cowen PJ, Harmer CJ. A cognitive neuropsychological model of antidepressant drug action. Prog Neuropsychopharmacol Biol Psychiatry 2011; 35:1586-92. [PMID: 20673783 DOI: 10.1016/j.pnpbp.2010.07.022] [Citation(s) in RCA: 92] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2010] [Revised: 07/19/2010] [Accepted: 07/20/2010] [Indexed: 12/24/2022]
Abstract
The psychological mechanisms by which antidepressant drugs act to improve mood remain underspecified. In this paper we consider the evidence to suggest that early changes in emotional processing underlie subsequent mood improvement following antidepressant treatment. Negative biases in information processing are consistently found in depression, and we argue that primary mode of action of antidepressant drugs may be to remediate these biases providing a more positive social environment in which the patient can relearn emotional associations fostering later improvement in mood. Evidence from behavioural and functional magnetic resonance imaging studies supports this hypothesis. Experimental medicine models developed under this premise have the potential to screen for new treatments, to predict individual treatment response and to consider the effects of pharmacological vs psychological treatments.
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Affiliation(s)
- A Pringle
- Department of Psychiatry, University of Oxford, Neurosciences Building, University Department of Psychiatry, Warneford Hospital, Oxford, OX3 7JX, United Kingdom
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27
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Pringle A, McTavish SF, Williams C, Smith R, Cowen PJ, Harmer CJ. Short-term NK1 receptor antagonism and emotional processing in healthy volunteers. Psychopharmacology (Berl) 2011; 215:239-46. [PMID: 21161182 DOI: 10.1007/s00213-010-2133-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2010] [Accepted: 11/29/2010] [Indexed: 10/18/2022]
Abstract
BACKGROUND Despite early promise in phase II, the performance of the NK1 receptor antagonist aprepitant in subsequent clinical trials has been disappointing. Healthy volunteer models of emotional processing offer a potential means by which novel drugs can be screened prior to clinical trials. Here, we consider the effect of 7 days of treatment with aprepitant in such a model. METHOD Healthy volunteers (n = 32) were randomised to receive 7-day treatment with aprepitant (125 mg) or placebo. On the seventh day, participants completed a battery of tasks measuring emotional processing previously demonstrated to be sensitive to conventional antidepressant drugs. The tasks included facial expression recognition, emotional categorisation and memory, attentional dot-probe and emotion potentiated startle task. RESULTS Aprepitant abolished the emotionally potentiated startle effect and increased recognition memory for emotionally positive versus negative stimuli. In addition, the drug decreased attention to negative relative to positive emotional stimuli on the masked version of the dot-probe task. These effects were seen in the absence of any change in subjective mood. There were no effects on emotional categorisation, recall or on facial expression recognition. CONCLUSION These results suggest that NK1 receptor antagonism does affect some aspects of emotional processing and, in particular, that it has anxiolytic-like effects. The profile of effects reported here is, however, more limited than that found in response to conventional antidepressant treatment, and this may explain disappointing results at clinical trial. Healthy volunteer models of emotional processing may be useful in closing the gap between preclinical and clinical trials.
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Affiliation(s)
- Abbie Pringle
- Department of Psychiatry, University of Oxford, Oxford, UK.
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28
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Critchley HD, Nagai Y, Gray MA, Mathias CJ. Dissecting axes of autonomic control in humans: Insights from neuroimaging. Auton Neurosci 2011; 161:34-42. [DOI: 10.1016/j.autneu.2010.09.005] [Citation(s) in RCA: 119] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2010] [Revised: 09/08/2010] [Accepted: 09/09/2010] [Indexed: 12/30/2022]
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29
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Liu H, Liu Y, Yu J, Lai M, Zhu H, Sun A, Chen W, Zhou W. Vagus nerve stimulation inhibits heroin-seeking behavior induced by heroin priming or heroin-associated cues in rats. Neurosci Lett 2011; 494:70-4. [DOI: 10.1016/j.neulet.2011.02.059] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2011] [Revised: 02/18/2011] [Accepted: 02/18/2011] [Indexed: 10/18/2022]
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30
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Elliott R, Zahn R, Deakin JFW, Anderson IM. Affective cognition and its disruption in mood disorders. Neuropsychopharmacology 2011; 36:153-82. [PMID: 20571485 PMCID: PMC3055516 DOI: 10.1038/npp.2010.77] [Citation(s) in RCA: 202] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2010] [Revised: 04/23/2010] [Accepted: 05/03/2010] [Indexed: 01/13/2023]
Abstract
In this review, we consider affective cognition, responses to emotional stimuli occurring in the context of cognitive evaluation. In particular, we discuss emotion categorization, biasing of memory and attention, as well as social/moral emotion. We discuss limited neuropsychological evidence suggesting that affective cognition depends critically on the amygdala, ventromedial frontal cortex, and the connections between them. We then consider neuroimaging studies of affective cognition in healthy volunteers, which have led to the development of more sophisticated neural models of these processes. Disturbances of affective cognition are a core and specific feature of mood disorders, and we discuss the evidence supporting this claim, both from behavioral and neuroimaging perspectives. Serotonin is considered to be a key neurotransmitter involved in depression, and there is a considerable body of research exploring whether serotonin may mediate disturbances of affective cognition. The final section presents an overview of this literature and considers implications for understanding the pathophysiology of mood disorder as well as developing and evaluating new treatment strategies.
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Affiliation(s)
- Rebecca Elliott
- Neuroscience and Psychiatry Unit, School of Community-Based Medicine, University of Manchester, Manchester, UK.
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31
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Chandra P, Hafizi S, Massey-Chase RM, Goodwin GM, Cowen PJ, Harmer CJ. NK1 receptor antagonism and emotional processing in healthy volunteers. J Psychopharmacol 2010; 24:481-7. [PMID: 19351798 DOI: 10.1177/0269881109103101] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The neurokinin-1 (NK(1)) receptor antagonist, aprepitant, showed activity in several animal models of depression; however, its efficacy in clinical trials was disappointing. There is little knowledge of the role of NK(1) receptors in human emotional behaviour to help explain this discrepancy. The aim of the current study was to assess the effects of a single oral dose of aprepitant (125 mg) on models of emotional processing sensitive to conventional antidepressant drug administration in 38 healthy volunteers, randomly allocated to receive aprepitant or placebo in a between groups double blind design. Performance on measures of facial expression recognition, emotional categorisation, memory and attentional visual-probe were assessed following the drug absorption. Relative to placebo, aprepitant improved recognition of happy facial expressions and increased vigilance to emotional information in the unmasked condition of the visual probe task. In contrast, aprepitant impaired emotional memory and slowed responses in the facial expression recognition task suggesting possible deleterious effects on cognition. These results suggest that while antagonism of NK(1) receptors does affect emotional processing in humans, its effects are more restricted and less consistent across tasks than those of conventional antidepressants. Human models of emotional processing may provide a useful means of assessing the likely therapeutic potential of new treatments for depression.
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Affiliation(s)
- P Chandra
- University Department of Psychiatry, Warneford Hospital, Oxford, UK
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32
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Abstract
Treatment-resistant depression (TRD) presents major challenges for both patients and clinicians. There is no universally accepted definition of TRD, but results from the US National Institute of Mental Health's (NIMH) STAR*D (Sequenced Treatment Alternatives to Relieve Depression) programme indicate that after the failure of two treatment trials, the chances of remission decrease significantly. Several pharmacological and nonpharmacological treatments for TRD may be considered when optimized (adequate dose and duration) therapy has not produced a successful outcome and a patient is classified as resistant to treatment. Nonpharmacological strategies include psychotherapy (often in conjunction with pharmacotherapy), electroconvulsive therapy and vagus nerve stimulation. The US FDA recently approved vagus nerve stimulation as adjunctive therapy (after four prior treatment failures); however, its benefits are seen only after prolonged (up to 1 year) use. Other nonpharmacological options, such as repetitive transcranial stimulation, deep brain stimulation or psychosurgery, remain experimental and are not widely available. Pharmacological treatments of TRD can be grouped in two main categories: 'switching' or 'combining'. In the first, treatment is switched within and between classes of compounds. The benefits of switching include avoidance of polypharmacy, a narrower range of treatment-emergent adverse events and lower costs. An inherent disadvantage of any switching strategy is that partial treatment responses resulting from the initial treatment might be lost by its discontinuation in favour of another medication trial. Monotherapy switches have also been shown to have limited effectiveness in achieving remission. The advantage of combination strategies is the potential to build upon achieved improvements; they are generally recommended if partial response was achieved with the current treatment trial. Various non-antidepressant augmenting agents, such as lithium and thyroid hormones, are well studied, although not commonly used. There is also evidence of efficacy and increasing use of atypical antipsychotics in combination with antidepressants, for example, olanzapine in combination with fluoxetine (OFC) or augmentation with aripiprazole. The disadvantages of a combination strategy include multiple medications, a broader range of treatment-emergent adverse events and higher costs. Several experimental pharmaceutical treatment alternatives for TRD are also being explored in combination with antidepressants or as monotherapy. These less studied alternative compounds include pindolol, inositol, CNS stimulants, hormones, herbal supplements, omega-3 fatty acids, S-adenosyl-L-methionine, folic acid, lamotrigine, modafinil, riluzole and topiramate. In summary, despite an increasing variety of choices for the treatment of TRD, this condition remains universally undefined and represents an area of unmet medical need. There are few known approved pharmacological agents for TRD (aripiprazole and OFC) and overall outcomes remain poor. This might be an indication that depression itself is a heterogeneous condition with a great diversity of pathologies, highlighting the need for careful evaluation of individuals with depressive symptoms who are unresponsive to treatment. Clearly, more research is needed to provide clinicians with better guidance in making those treatment decisions--especially in light of accumulating evidence that the longer patients are unsuccessfully treated, the worse their long-term prognosis tends to be.
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Affiliation(s)
- Richard C Shelton
- Department of Psychiatry, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
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33
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Critchley HD. Psychophysiology of neural, cognitive and affective integration: fMRI and autonomic indicants. Int J Psychophysiol 2009; 73:88-94. [PMID: 19414044 PMCID: PMC2722714 DOI: 10.1016/j.ijpsycho.2009.01.012] [Citation(s) in RCA: 211] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2008] [Revised: 11/21/2008] [Accepted: 01/09/2009] [Indexed: 12/30/2022]
Abstract
Behaviour is shaped by environmental challenge in the context of homoeostatic need. Emotional and cognitive processes evoke patterned changes in bodily state that may signal emotional state to others. This dynamic modulation of visceral state is neurally mediated by sympathetic and parasympathetic divisions of the autonomic nervous system. Moreover neural afferents convey representations of the internal state of the body back to the brain to further influence emotion and cognition. Neuroimaging and lesion studies implicate specific regions of limbic forebrain in the behavioural generation of autonomic arousal states. Activity within these regions may predict emotion-specific autonomic response patterns within and between bodily organs, with implications for psychosomatic medicine. Feedback from the viscera is mapped hierarchically in the brain to influence efferent signals, and ultimately at the cortical level to engender and reinforce affective responses and subjective feeling states. Again neuroimaging and patient studies suggest discrete neural substrates for these representations, notably regions of insula and orbitofrontal cortex. Individual differences in conscious access to these interoceptive representations predict differences in emotional experience, but equally the misperception of heightened arousal level may evoke changes in emotional behaviour through engagement of the same neural centres. Perturbation of feedback may impair emotional reactivity and, in the context of inflammatory states give rise to cognitive, affective and psychomotor expressions of illness. Changes in visceral state during emotion may be mirrored in the responses of others, permitting a corresponding representation in the observer. The degree to which individuals are susceptible to this 'contagion' predicts individual differences in questionnaire ratings of empathy. Together these neuroimaging and clinical studies highlight the dynamic relationship between mind and body and help identify neural substrates that may translate thoughts into autonomic arousal and bodily states into feelings that can be shared.
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Affiliation(s)
- Hugo D Critchley
- Brighton and Sussex Medical School, Falmer Campus, Brighton, UK.
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34
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Harmer CJ, Goodwin GM, Cowen PJ. Why do antidepressants take so long to work? A cognitive neuropsychological model of antidepressant drug action. Br J Psychiatry 2009; 195:102-8. [PMID: 19648538 DOI: 10.1192/bjp.bp.108.051193] [Citation(s) in RCA: 380] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND The neuropharmacological actions of antidepressants are well characterised but our understanding of how these changes translate into improved mood are still emerging. AIMS To investigate whether actions of antidepressant drugs on emotional processing are a mediating factor in the effects of these drugs in depression. METHOD We examined key published findings that explored the effects of antidepressants on behavioural and functional magnetic resonance imaging (fMRI) measures of emotional processing. RESULTS Negative emotional bias has been reliably associated with depression. Converging results suggest that antidepressants modulate emotional processing and increase positive emotional processing much earlier than effects on mood. These changes in emotional processing are associated with neural modulation in limbic and prefrontal circuitry. CONCLUSIONS Antidepressants may work in a manner consistent with cognitive theories of depression. Antidepressants do not act as direct mood enhancers but rather change the relative balance of positive to negative emotional processing, providing a platform for subsequent cognitive and psychological reconsolidation.
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Affiliation(s)
- Catherine J Harmer
- University Department of Psychiatry, Warneford Hospital, Oxford OX3 7JX, UK.
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35
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Freedland KE, de Geus EJC, Golden RN, Kop WJ, Miller GE, Vaccarino V, Brumback B, Llabre MM, White VJ, Sheps DS. What's in a name? Psychosomatic medicine and biobehavioral medicine. Psychosom Med 2009; 71:1-4. [PMID: 19124618 DOI: 10.1097/psy.0b013e3181954848] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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36
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Harmer CJ. Serotonin and emotional processing: Does it help explain antidepressant drug action? Neuropharmacology 2008; 55:1023-8. [DOI: 10.1016/j.neuropharm.2008.06.036] [Citation(s) in RCA: 159] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2008] [Revised: 06/18/2008] [Accepted: 06/19/2008] [Indexed: 11/16/2022]
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Daban C, Martinez-Aran A, Cruz N, Vieta E. Safety and efficacy of Vagus Nerve Stimulation in treatment-resistant depression. A systematic review. J Affect Disord 2008; 110:1-15. [PMID: 18374988 DOI: 10.1016/j.jad.2008.02.012] [Citation(s) in RCA: 110] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2007] [Revised: 02/12/2008] [Accepted: 02/13/2008] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The main objective of this review of the literature was to evaluate the safety and efficacy of Vagus Nerve Stimulation (VNS) in treatment-resistant depression (TRD) by means of systematic review and meta-analysis. METHODS A systematic review of the literature was made using the major databases (Medline, Psychological Abstracts, Current Contents), beginning in January 2000 and ending in September 2007. Ninety-eight references were found, but only 18 add-on studies met the required quality criteria and were included in this review. Only one double-blind, randomized study was available and therefore a meta-analysis was not feasible. RESULTS In a majority of the preliminary open studies selected for this review, VNS was associated with a significant reduction of the depressive symptoms (primary outcome: Hamilton Depression Rating Scale, HDRS) in the short and long term. Unfortunately, the only double-blind study gave rather inconclusive results. Generally, VNS is reported to be a safe and feasible procedure, despite its invasive nature. CONCLUSIONS VNS seems to be an interesting new approach to treating TRD. However, despite the promising results reported mainly in open studies, further clinical trials are needed to confirm its efficacy in major depression. Moreover, studies on its mechanism of action and cost-effectiveness are also required to better understand and develop VNS therapy for affective disorder.
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Affiliation(s)
- Claire Daban
- Bipolar Disorders Program, Hospital Clinic, University of Barcelona, IDIBAPS, CIBER-SAM, Barcelona, Spain
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38
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Uncoupling of behavioral and autonomic responses after lesions of the primate orbitofrontal cortex. Proc Natl Acad Sci U S A 2008; 105:9787-92. [PMID: 18621690 DOI: 10.1073/pnas.0800417105] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Successful adaptation to changes in an animal's emotional and motivational environment depends on behavioral flexibility accompanied by changes in bodily responses, e.g., autonomic and endocrine, which support the change in behavior. Here, we identify the orbitofrontal cortex (OFC) as pivotal in the flexible regulation and coordination of behavioral and autonomic responses during adaptation. Using an appetitive Pavlovian task, we demonstrate that OFC lesions in the marmoset (i) impair an animal's ability to rapidly suppress its appetitive cardiovascular arousal upon termination of a conditioned stimulus and (ii) cause an uncoupling of the behavioral and autonomic components of the adaptive response after reversal of the reward contingencies. These findings highlight the role of the OFC in emotional regulation and are highly relevant to our understanding of disorders such as schizophrenia and autism in which uncoupling of emotional responses may contribute to the experiential distress and disadvantageous behavior associated with these disorders.
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Chronic vagus nerve stimulation for treatment-resistant depression decreases resting ventromedial prefrontal glucose metabolism. Neuroimage 2008; 42:879-89. [PMID: 18595737 DOI: 10.1016/j.neuroimage.2008.04.267] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2007] [Revised: 03/25/2008] [Accepted: 04/30/2008] [Indexed: 11/22/2022] Open
Abstract
Vagus nerve stimulation (VNS) is used as an adjunctive therapy for treatment-resistant depression (TRD). Its mechanism of action is not fully understood. Longitudinal measurement of changes in brain metabolism associated with VNS can provide insights into this new treatment modality. Eight severely depressed outpatients who were highly treatment-resistant underwent electrical stimulation of the left vagus nerve for approximately one year. The main outcome measures were resting regional brain glucose uptake measured with positron emission tomography (PET) and the 24-item Hamilton Depression Scale. The most significant and extensive change over one year of chronic VNS localized to the ventromedial prefrontal cortex extending from the subgenual cingulate to the frontal pole. This region continued to decline in metabolism even toward the end of the study. Clinically, this cohort showed a trend for improvement. No correlations surfaced between change in glucose uptake and depression scores. However, the sample size was small; none remitted; and the range of depression scores was limited. Chronic VNS as adjunctive therapy in patients with severe TRD produces protracted and robust declines in resting brain activity within the ventromedial prefrontal cortex, a network with dense connectivity to the amygdala and structures monitoring the internal milieu.
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