Frontocingulate dysfunction in depression: toward biomarkers of treatment response.
Increased rostral anterior cingulate cortex (rACC) activity has emerged as a promising predictor of treatment response in depression, but neither the reliability of this relationship nor the mechanisms supporting it have been thoroughly investigated. This review takes a three-pronged approach to these issues. First, I present a meta-analysis demonstrating that the relationship between resting rACC activity and treatment response is robust. Second, I propose that the rACC plays a key role in treatment outcome because of its 'hub' position in the default network. Specifically, I hypothesize that elevated resting rACC activity confers better treatment outcomes by fostering adaptive self-referential processing and by helping to recalibrate relationships between the default network and a 'task-positive network' that comprises dorsolateral prefrontal and dorsal cingulate regions implicated in cognitive control. Third, I support this hypothesis by reviewing neuropsychological, electrophysiological, and neuroimaging data on frontocingulate dysfunction in depression. The review ends with a discussion of the limitations of current work and future directions.
Pizzagalli
Diego A
DA
Center for Depression, Anxiety, and Stress Research & Neuroimaging Center, McLean Hospital, Harvard Medical School, Belmont, MA 02478, USA. dap@mclean.harvard.edu
D000928:Antidepressive Agents / Q000494:pharmacology / Q000627:therapeutic use; D054316:Biomarkers, Pharmacological / Q000737:chemistry / Q000378:metabolism; D003071:Cognition / Q000187:drug effects / Q000502:physiology; D003865:Major Depressive Disorder / Q000188:drug therapy* / Q000378:metabolism / Q000503:physiopathology*; D006179:Gyrus Cinguli / Q000737:chemistry* / Q000187:drug effects* / Q000502:physiology; D006801:Humans; D009415:Nerve Net / Q000737:chemistry* / Q000187:drug effects* / Q000502:physiology; D017063:Outcome Assessment, Health Care / Q000379:methods; D017397:Prefrontal Cortex / Q000737:chemistry* / Q000187:drug effects* / Q000502:physiology
D000928:Antidepressive Agents; D054316:Biomarkers, Pharmacological