Major depressive disorder (MDD) is characterized by the presence of disturbances in emotional processing and its associated neural responses. A critical question in this domain is whether the neural correlates of these alterations are affected by therapeutic interventions. This study used fMRI to compare neural responses to emotionally positive, negative, and neutral pictures in patients with MDD relative to control participants. To measure the impact of cognitive behavioral therapy (CBT) on these effects, this comparison was made both before and after patients received CBT. Before treatment, patients showed reduced activity relative to controls in the ventromedial PFC, as well diminished discrimination between emotional and neutral items in the amygdala. MDD patients also showed a bias toward greater activity for negative than positive stimuli in the dorsolateral PFC and anterior temporal lobe. After treatment, these emotion-related disturbances were mitigated, in that activation profiles in patients became more similar to controls. Finally, neural responses to emotional materials predicted how much each patient’s symptoms improved with treatment: for example, patients who showed greater ventromedial PFC activity before treatment benefited the most from CBT. Altogether, components of the neural networks corresponding to emotion processing disturbances in MDD appear to resolve following treatment and are predictive of treatment response, possibly reflecting improvements in emotion regulation processes in response to CBT.
Ritchey, M., Dolcos, F., Eddington, K.M., Strauman, T. J., Cabeza, R. (2011). Neural correlates of emotional processing in depression: Changes with cognitive behavioral therapy and predictors of treatment response. Journal of Psychiatric Research.