Is Depression All In Your Head?

Brain Scans May Predict Recurrence Risk in Major Depression

A recent study funded by the Medical Research Council and published online in JAMA Psychiatry has found that neuroimaging/neurofeedback can add value in psychiatry, in this case specifically in major depressive disorder.

The study focused on 64 non-medicated patients who had been in remission from major depressive disorder for at least 6 months and 39 healthy control participants who had no personal or family history of MDD.

During fMRI, participants were asked to imagine acting badly toward their best friends, and they experienced self-blaming emotions such as guilt. Over the next 14 months, 37 patients remained in remission (stable group), and 27 developed a recurrent major depressive episode.

During the experience of emotions of guilt, the group with recurring MDD showed higher RSATL-SCSR connectivity than the group with stable MDD and the control group, the researchers reported. They noted “We corroborated our hypothesis that during the experience of self-blaming vs. other-blaming emotions, RSATL-SCSR connectivity predicted risk of subsequent recurrence.”

“The group with recurring MDD also exhibited RSATL hyperconnectivity with the right ventral putamen and claustrum and the temporoparietal junction. Together, these regions predicted recurrence with 75% accuracy (48 out of 64 predicted cases),” the researchers say.

The importance of the finding is to show a likely causal relationship between depression and altered functional connections in a neural network that is selective for blaming oneself relative to blaming others. This is in contrast with a common assumption that an overall increase in negative emotion–related brain responses is key to understanding depression.

Although more clinical study is needed to convince healthcare stakeholders to apply these findings to daily clinical practice, this exciting research has reinforced the concept that neurofeedback can be a way to help identify those individuals who are more likely to suffer from recurrent episodes of depression and will therefore benefit most from long-term treatment.