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Zhang X, Wang X, Dong D, Sun X, Zhong X, Xiong G, Cheng C, Lei H, Chai Y, Yu M, Quan P, Gehrman PR, Detre JA, Yao S, Rao H. Persistent Ventral Anterior Cingulate Cortex and Resolved Amygdala Hyper-responses to Negative Outcomes After Depression Remission: A Combined Cross-sectional and Longitudinal Study. Biol Psychiatry 2023; 93:268-278. [PMID: 36567087 DOI: 10.1016/j.biopsych.2022.09.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 08/31/2022] [Accepted: 09/01/2022] [Indexed: 12/27/2022]
Abstract
BACKGROUND Major depressive disorder (MDD) is a highly prevalent mood disorder affecting more than 300 million people worldwide. Biased processing of negative information and neural hyper-responses to negative events are hallmarks of depression. This study combined cross-sectional and longitudinal experiments to explore both persistent and resolved neural hyper-responses to negative outcomes from risky decision making in patients with current MDD (cMDD) and remitted MDD (rMDD). METHODS A total of 264 subjects participated in the cross-sectional study, including 117 patients with medication-naïve, first-episode current depression; 45 patients with rMDD with only 1 episode of depression; and 102 healthy control subjects. Participants completed a modified balloon analog risk task during functional magnetic resonance imaging. In the longitudinal arm of the study, 42 patients with cMDD were followed and 26 patients with rMDD were studied again after 8 weeks of antidepressant treatment. RESULTS Patients with cMDD showed hyper-responses to loss outcomes in multiple limbic regions including the amygdala and ventral anterior cingulate cortex (vACC). Amygdala but not vACC hyperactivity correlated with depression scores in patients with cMDD. Furthermore, amygdala hyperactivity resolved while vACC hyperactivity persisted in patients with rMDD in both cross-sectional and longitudinal studies. CONCLUSIONS These findings provide consistent evidence supporting differential patterns of amygdala and vACC hyper-responses to negative outcomes during depression remission. Amygdala hyperactivity may be a symptomatic and state-dependent marker of depressive neural responses, while vACC hyperactivity may reflect a persistent and state-independent effect of depression on brain function. These findings offer new insights into the neural underpinnings of depression remission and prevention of depression recurrence.
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Affiliation(s)
- Xiaocui Zhang
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, China; Medical Psychological Institute of Central South University, Changsha, China; National Clinical Research Center for Mental Disorders, Changsha, China; Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania; School of Educational Science, Cognition and Human Behavior Key Laboratory of Hunan Province, Hunan Normal University, Changsha, China.
| | - Xiang Wang
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, China; Medical Psychological Institute of Central South University, Changsha, China; National Clinical Research Center for Mental Disorders, Changsha, China
| | - Daifeng Dong
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, China; Medical Psychological Institute of Central South University, Changsha, China
| | - Xiaoqiang Sun
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, China; Medical Psychological Institute of Central South University, Changsha, China
| | - Xue Zhong
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, China; Medical Psychological Institute of Central South University, Changsha, China
| | - Ge Xiong
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, China; Medical Psychological Institute of Central South University, Changsha, China
| | - Chang Cheng
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, China; Medical Psychological Institute of Central South University, Changsha, China
| | - Hui Lei
- College of Education, Hunan Agricultural University, Changsha, Hunan, China; Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ya Chai
- Key Laboratory of Applied Brain and Cognitive Sciences, Shanghai International Studies University, Shanghai, China; Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Meichen Yu
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, Indiana
| | - Peng Quan
- Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania; Research Center for Quality of Life and Applied Psychology, Guangdong Medical University, Dongguan, China
| | - Philip R Gehrman
- Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania
| | - John A Detre
- Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Shuqiao Yao
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, China; Medical Psychological Institute of Central South University, Changsha, China; National Clinical Research Center for Mental Disorders, Changsha, China
| | - Hengyi Rao
- Key Laboratory of Applied Brain and Cognitive Sciences, Shanghai International Studies University, Shanghai, China; Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania.
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Kleshchova O, Rieder JK, Grinband J, Weierich MR. Resting amygdala connectivity and basal sympathetic tone as markers of chronic hypervigilance. Psychoneuroendocrinology 2019; 102:68-78. [PMID: 30529716 PMCID: PMC6605037 DOI: 10.1016/j.psyneuen.2018.11.036] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 11/16/2018] [Accepted: 11/24/2018] [Indexed: 01/30/2023]
Abstract
BACKGROUND Chronic hypervigilance, a state of sustained alertness and hyperarousal in the absence of threat, has been shown to predict poorer clinical outcomes post-trauma. An exaggerated and persistent amygdala alerting response to affective information has been proposed as a reactivity-based, and thus indirect, marker of hypervigilance. However, because chronic hypervigilance is a persistent rather than reactive state, it should be directly observable under resting-state conditions without the need for exposure to affectively charged stimuli. OBJECTIVE We tested resting amygdala connectivity and basal sympathetic and hypothalamic-pituitary-adrenal axis activity as direct neural and neuroendocrine markers of chronic hypervigilance. PARTICIPANTS 24 trauma-exposed women (age M = 22.9, SD = 5.5) and 20 no-trauma controls (age M = 21.1, SD = 3.2). MEASURES Amygdala connectivity was measured using functional magnetic resonance imaging at rest and during viewing of novel and familiar affective scenes. Elevated amygdala connectivity during the viewing of novel scenes (exaggerated alerting response) and familiar scenes (persistent alerting response) was used as a reactivity-based index of hypervigilance. Resting amygdala connectivity and basal salivary alpha-amylase (sAA) and cortisol were tested as neural and neuroendocrine markers of hypervigilance, respectively. RESULTS Compared to no-trauma controls, trauma-exposed women showed greater connectivity between the left amygdala and the ventral anterior cingulate cortex (vACC) both during affective processing and at rest. Exaggerated neural novelty response was associated with greater resting left amygdala-vACC connectivity and higher basal sAA, but not cortisol. CONCLUSIONS Greater synchronization of threat-detection circuitry in the absence of threat and basal sympathetic tone might serve as complementary resting-state markers of the cognitive and physiological components of chronic hypervigilance, respectively.
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Affiliation(s)
- Olena Kleshchova
- Hunter College, The City University of New York, 695 Park Avenue, New York, NY 10065, USA,The Graduate Center, The City University of New York, 365 Fifth Avenue, New York, NY 10016, USA
| | - Jenna K. Rieder
- Hunter College, The City University of New York, 695 Park Avenue, New York, NY 10065, USA,The Graduate Center, The City University of New York, 365 Fifth Avenue, New York, NY 10016, USA
| | - Jack Grinband
- Department of Radiology and Neurology, Columbia University, 622 W 168th St, New York, NY 10032, USA
| | - Mariann R. Weierich
- Hunter College, The City University of New York, 695 Park Avenue, New York, NY 10065, USA,The Graduate Center, The City University of New York, 365 Fifth Avenue, New York, NY 10016, USA
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