Incapacity to control emotion in major depression may arise from disrupted white matter integrity and OFC‐amygdala inhibition

• Published in: CNS neuroscience & therapeutics Vol. 24; no. 11; pp. 1053 - 1062
• Main Authors: Zheng, Kai‐Zhong, Wang, Hua‐Ning, Liu, Jian, Xi, Yi‐Bin, Li, Liang, Zhang, Xi, Li, Jia‐Ming, Yin, Hong, Tan, Qing‐Rong, Lu, Hong‐Bing, Li, Bao‐Juan
• Format: Journal Article
• Language: English
• Published: England John Wiley & Sons, Inc 01.11.2018; John Wiley and Sons Inc
• Subjects: Adult; Amygdala; Amygdala - diagnostic imaging; Amygdala - drug effects; Amygdala - physiopathology; Antidepressive Agents - therapeutic use; Brain Mapping; Cortex (frontal); Depressive Disorder, Major - diagnostic imaging; Depressive Disorder, Major - drug therapy; dynamic causal modeling; effective connectivity; Emotions - drug effects; Emotions - physiology; Female; Frontal Lobe - diagnostic imaging; Frontal Lobe - drug effects; Frontal Lobe - physiopathology; Functional magnetic resonance imaging; Hemispheric laterality; Humans; Image Processing, Computer-Assisted; Limbic system; Magnetic Resonance Imaging; major depressive disorder; Male; Mental depression; Middle Aged; Myelination; Neural Pathways - diagnostic imaging; Neural Pathways - drug effects; Original; Patients; Psychiatric Status Rating Scales; Substantia alba; uncinate fasciculus; White Matter - diagnostic imaging; White Matter - drug effects; white matter integrity; uncinate fasciculus; white matter integrity; major depressive disorder; dynamic causal modeling; effective connectivity
• DOI: 10.1111/cns.12800
• ISSN: 1755-5930; 1755-5949

Summary Background Disturbances in emotion regulation are the hallmarks of major depressive disorder (MDD). The incapacity to control negative emotion in patients has been associated with abnormal hyperactivation of the limbic system and hypoactivation of the frontal cortex. The amygdala and orbital frontal cortex (OFC) are two critical regions of the emotion regulation neural systems. Methods This study investigated the anatomical basis of abnormal emotion regulation by tracking the fiber tracts connecting the amygdala and OFC. In addition, using dynamic casual modeling on resting‐state fMRI data of 20 MDD patients and equivalent controls, we investigated the exact neural mechanism through which abnormal communications between these two nodes were mediated in MDD. Key Results The results revealed disrupted white matter integrity of fiber tracts in MDD, suggesting that functional abnormalities were accompanied by underlying anatomical basis. We also detected a failure of inhibition of the OFC on the activity of the amygdala in MDD, suggesting dysconnectivity was mediated through “top‐down” influences from the frontal cortex to the amygdala. Following 8 weeks of antidepressant treatment, the patients showed significant clinical improvement and normalization of the abnormal OFC‐amygdala structural and effective connectivity in the left hemisphere. Conclusions & Inferences Our findings suggest that pathways connecting these two nodes may be core targets of the antidepressant treatment. In particular, it raised the intriguing question: Does the reversal of structural markers of connectivity reflect a response to antidepressant medication or activity‐dependent myelination following a therapeutic restoration of effective connectivity?