Neural responses to sad facial expressions in major depression following cognitive behavioral therapy.
BACKGROUND
Affective facial processing is an important component of interpersonal relationships. The neural substrate has been examined following treatment with antidepressant medication but not with psychological therapies. The present study investigated the neural correlates of implicit processing of sad facial expressions in depression pretreatment and posttreatment with cognitive behavioral therapy (CBT).


METHODS
The patient group consisted of 16 medication-free subjects (mean age 40 years) with a DSM-IV diagnosis of acute unipolar major depression, and the comparison group were 16 matched healthy volunteers. Subjects participated in a prospective study with functional magnetic resonance imaging (fMRI) at weeks 0 and 16. During the fMRI scans, subjects performed an affect recognition task with facial stimuli morphed to display varying intensities of sadness. Patients received 16 sessions of CBT. Functional magnetic resonance imaging data were analyzed for the mean activation and differential response to variable intensity (load-response) of facial affect processing.


RESULTS
During an acute depressive episode, patients showed elevated amygdala-hippocampal activity relative to healthy individuals. Baseline dorsal anterior cingulate activity in patients showed a significant relationship with subsequent clinical response.


CONCLUSIONS
These data provide further support for elevated amygdala activity in depression and suggest that anterior cingulate activity may be a predictor of treatment response to both pharmacotherapy and CBT.
Institute of Psychiatry, King's College London, London. c.fu@iop.kcl.ac.uk
Cynthia H Y
CH
Fu
Steven C R
SC
Williams
Anthony J
AJ
Cleare
Jan
J
Scott
Martina T
MT
Mitterschiffthaler
Nicholas D
ND
Walsh
Catherine
C
Donaldson
John
J
Suckling
Chris
C
Andrew
Herbert
H
Steiner
Robin M
RM
Murray
D000328:Adult; D000339:Affect; D000679:Amygdala / Q000503:physiopathology*; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003865:Major Depressive Disorder / Q000503:physiopathology* / Q000628:therapy*; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005149:Facial Expression; D006179:Gyrus Cinguli / Q000503:physiopathology; D006624:Hippocampus / Q000503:physiopathology*; D006801:Humans; D008279:Magnetic Resonance Imaging; D011446:Prospective Studies; D014796:Visual Perception