1
|
Myers J, Xiao J, Mathura R, Shofty B, Pirtle V, Adkinson J, Allawala AB, Anand A, Gadot R, Najera R, Rey HG, Mathew SJ, Bijanki K, Banks G, Watrous A, Bartoli E, Heilbronner SR, Provenza N, Goodman WK, Pouratian N, Hayden BY, Sheth SA. Intracranial Directed Connectivity Links Subregions of the Prefrontal Cortex to Major Depression. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.08.07.24311546. [PMID: 39148826 PMCID: PMC11326344 DOI: 10.1101/2024.08.07.24311546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 08/17/2024]
Abstract
Understanding the neural basis of major depressive disorder (MDD) is vital to guiding neuromodulatory treatments. The available evidence supports the hypothesis that MDD is fundamentally a disease of cortical disinhibition, where breakdowns of inhibitory neural systems lead to diminished emotion regulation and intrusive ruminations. Recent research also points towards network changes in the brain, especially within the prefrontal cortex (PFC), as primary sources of MDD etiology. However, due to limitations in spatiotemporal resolution and clinical opportunities for intracranial recordings, this hypothesis has not been directly tested. We recorded intracranial EEG from the dorsolateral (dlPFC), orbitofrontal (OFC), and anterior cingulate cortices (ACC) in neurosurgical patients with MDD. We measured daily fluctuations in self-reported depression severity alongside directed connectivity between these PFC subregions. We focused primarily on delta oscillations (1-3 Hz), which have been linked to GABAergic inhibitory control and intracortical communication. Depression symptoms worsened when connectivity within the left vs. right PFC became imbalanced. In the left hemisphere, all directed connectivity towards the ACC, from the dlPFC and OFC, was positively correlated with depression severity. In the right hemisphere, directed connectivity between the OFC and dlPFC increased with depression severity as well. This is the first evidence that delta oscillations flowing between prefrontal subregions transiently increase intensity when people are experiencing more negative mood. These findings support the overarching hypothesis that MDD worsens with prefrontal disinhibition.
Collapse
Affiliation(s)
- John Myers
- Baylor College of Medicine, Department of Neurosurgery
| | - Jiayang Xiao
- Baylor College of Medicine, Department of Neurosurgery
| | | | - Ben Shofty
- Baylor College of Medicine, Department of Neurosurgery
| | | | | | | | - Adrish Anand
- Baylor College of Medicine, Department of Neurosurgery
| | - Ron Gadot
- Baylor College of Medicine, Department of Neurosurgery
| | | | - Hernan G. Rey
- Baylor College of Medicine, Department of Neurosurgery
| | - Sanjay J. Mathew
- Baylor College of Medicine, Department of Psychiatry and Behavioral Science
| | - Kelly Bijanki
- Baylor College of Medicine, Department of Neurosurgery
| | - Garrett Banks
- Baylor College of Medicine, Department of Neurosurgery
| | | | | | | | | | - Wayne K. Goodman
- University of Texas: Southwestern, Department of Neurological Surgery
| | - Nader Pouratian
- University of Texas: Southwestern, Department of Neurological Surgery
| | | | | |
Collapse
|
2
|
Cosgrove L, Brhlikova P, Lyus R, Herrawi F, D'Ambrozio G, Abi-Jaoude E, Pollock AM. Global Burden Disease Estimates for Major Depressive Disorders (MDD): A review of diagnostic instruments used in studies of prevalence. Community Ment Health J 2024:10.1007/s10597-024-01302-6. [PMID: 38951416 DOI: 10.1007/s10597-024-01302-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 05/21/2024] [Indexed: 07/03/2024]
Abstract
Global Burden of Disease (GBD) estimates have significant policy implications nationally and internationally. Disease burden metrics, particularly for depression, have played a critical role in raising governmental awareness of mental health and in calculating the economic cost of depression. Recently, the World Health Organization ranked depression as the single largest contributor to global disability. The main aim of this paper was to assess the basis upon which GBD prevalence estimates for major depressive disorder (MDD) were made. We identify the instruments used in the 2019 GBD estimates and provide a descriptive assessment of the five most frequently used instruments. The majority of country studies, 356/566 (62.9%), used general mental health screeners or structured/semi-structured interview guides, 98/566 (17.3%) of the studies used dedicated depression screeners, and 112 (19.8%) used other tools for assessing depression. Thus, most of the studies used instruments that were not designed to make a diagnosis of depression or assess depression severity. Our results are congruent with and extend previous research that has identified critical flaws in the data underpinning the GBD estimates for MDD. Despite the widespread promotion of these prevalence estimates, caution is needed before using them to inform public policy and mental health interventions. This is particularly important in lower-income countries where resources are scarce.
Collapse
Affiliation(s)
- Lisa Cosgrove
- Centre for Mental Health, Human Rights, and Social Justice, University of Essex, Colchester, UK.
- Counseling Psychology Department, Applied Ethics Center, University of Massachusetts Boston, 100 William T Morrissey Blvd, Boston, MA, 02125, USA.
| | - Petra Brhlikova
- Population Health Sciences Institute, Newcastle University, Baddiley-Clark Bldg, Newcastle Upon Tyne, NE2 4AX, UK
| | - Rosanna Lyus
- Population Health Sciences Institute, Newcastle University, Baddiley-Clark Bldg, Newcastle Upon Tyne, NE2 4AX, UK
| | - Farahdeba Herrawi
- Counseling Psychology Department, Applied Ethics Center, University of Massachusetts Boston, 100 William T Morrissey Blvd, Boston, MA, 02125, USA
| | - Gianna D'Ambrozio
- Counseling Psychology Department, Applied Ethics Center, University of Massachusetts Boston, 100 William T Morrissey Blvd, Boston, MA, 02125, USA
| | - Elia Abi-Jaoude
- The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
| | - Allyson M Pollock
- Population Health Sciences Institute, Newcastle University, Baddiley-Clark Bldg, Newcastle Upon Tyne, NE2 4AX, UK
| |
Collapse
|
3
|
Cosgrove L, Montenegro C, Yarcia LE, D’Ambrozio G, Hannah J. "Reducing the Treatment Gap" Poses Human Rights Risks. Health Hum Rights 2024; 26:129-136. [PMID: 38933230 PMCID: PMC11197864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2024] Open
Affiliation(s)
- Lisa Cosgrove
- Professor in the Counseling Psychology Department and a faculty fellow at the Applied Ethics Center, University of Massachusetts Boston, United States, as well as co-founder of the Centre for Mental Health, Human Rights, and Social Justice, a multi-institutional platform dedicated to the study of rights-based approaches to mental health law, policy, and practices
| | - Cristian Montenegro
- Senior research fellow at the Wellcome Centre for Cultures and Environments of Health at the University of Exeter, UK, and a member of the Centre for Mental Health, Human Rights, and Social Justice
| | - Lee Edson Yarcia
- Senior lecturer at the College of Law at the University of the Philippines Diliman, Manila, Philippines; a drug policy expert at the United Nations Joint Programme for the Protection and Promotion of Human Rights in the Philippines; and a member of the Centre for Mental Health, Human Rights, and Social Justice
| | - Gianna D’Ambrozio
- Doctoral candidate in the Counseling Psychology Department at the University of Massachusetts Boston, United States
| | - Julie Hannah
- Director of the International Centre on Human Rights and Drug Policy at the University of Essex, Colchester, UK, and co-founder of the Centre for Mental Health, Human Rights, and Social Justice
| |
Collapse
|
4
|
Cosgrove L, Patterson EH, Bursztajn HJ. Industry influence on mental health research: depression as a case example. Front Med (Lausanne) 2024; 10:1320304. [PMID: 38322498 PMCID: PMC10845136 DOI: 10.3389/fmed.2023.1320304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 12/07/2023] [Indexed: 02/08/2024] Open
Abstract
Emotional distress has been rising since before the COVID-19 pandemic and the public is told that depression is a major public health problem. For example, in 2017 depressive disorders were ranked as the third leading cause of "years lost to disability" and the World Health Organization now ranks depression as the single largest contributor to global disability. Although critical appraisals of the epidemiological data raise questions about the accuracy of population-based depression estimates, the dominance of the medical model and the marketing of psychotropics as "magic bullets," have contributed to a dramatic rise in the prescription of psychiatric drugs. Unfortunately, the pharmaceutical industry's influence on psychiatric research and practice has resulted in over-estimates of the effectiveness of psychotropic medications and an under-reporting of harms. This is because the principles that govern commercial entities are incongruent with the principles that guide public health research and interventions. In order to conduct mental health research and develop interventions that are in the public's best interest, we need non-reductionist epistemological and empirical approaches that incorporate a biopsychosocial perspective. Taking depression as a case example, we argue that the socio-political factors associated with emotional distress must be identified and addressed. We describe the harms of industry influence on mental health research and show how the emphasis on "scaling up" the diagnosis and treatment of depression is an insufficient response from a public health perspective. Solutions for reform are offered.
Collapse
Affiliation(s)
- Lisa Cosgrove
- Department of Counseling & School Psychology, University of Massachusetts, Boston, MA, United States
| | - Elissa H. Patterson
- Departments of Psychiatry and Neurology, Institute for Healthcare Policy & Innovation, University of Michigan Medical School, Ann Arbor, MI, United States
| | | |
Collapse
|
5
|
Krupa AJ, Dudek D, Siwek M. Consolidating evidence on the role of insulin resistance in major depressive disorder. Curr Opin Psychiatry 2024; 37:23-28. [PMID: 37972981 PMCID: PMC10715694 DOI: 10.1097/yco.0000000000000905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
PURPOSE OF REVIEW The circular interactions between type 2 diabetes (TMD2) and major depressive disorder (MDD) are well documented but the understanding of their mechanisms has only recently gained more clarity. Latest research indicates, that the association between TMD2 and MDD is largely mediated by insulin resistance (IR). RECENT FINDINGS A metabolic subtype of MDD can be distinguished from other MDD subpopulations, that is characterized by predominantly atypical clinical presentation, IR and different responsiveness to antidepressant interventions. IR is a predictor of nonresponse to some antidepressants. The IR seems to be a state-marker of clinical or subclinical depression and the relationship between IR and MDD varies between sexes and ethnicities. Insulin has a direct impact on the monoaminergic systems known to underlie MDD symptoms: serotoninergic and dopaminergic, which are dysregulated in IR subjects. Several trials assessed the efficacy of insulin-sensitizing drugs in MDD with mixed results for metformin and more consistent evidence for pioglitazone and lifestyle intervention/physical activity. SUMMARY Recently published data suggest a significant role of IR in the clinical presentation, pathophysiology and treatment response in MDD. Further research of IR in MDD and integration of existing data into clinical practice are needed.
Collapse
Affiliation(s)
| | - Dominika Dudek
- Department of Adult Psychiatry, Jagiellonian University Collegium Medicum, Krakow, Poland
| | | |
Collapse
|