title: Striatal and cortical midline circuits in major depression: implications for suicide and symptom expression.
abstract: BACKGROUND
  In major depression, the neural mechanisms underlying suicide related thoughts and behaviors as well as the expression of other depressive symptoms are incompletely characterized. Evidence indicates that both the striatum and cortical midline structures (CMS) may be involved with both suicide and emotional dysregulation in unipolar illness. The aim of this study was to identify striatal-CMS circuits associated with current depression severity and suicidal ideation (SI) as well as a history of self-harm.
  
  
  METHODS
  Twenty-two male subjects with recurrent unipolar depression were studied using functional MRI. All subjects were unmedicated and without current psychiatric comorbidity. Correlational analyses were used to determine whether striatal-CMS functional connectivity was associated with any of the three clinical variables.
  
  
  RESULTS
  A network involving the bilateral striatum and anterior CMS was found to be associated with depressive symptom severity. Current SI was associated with a similar but less extensive circuit in the left hemisphere. A distinct striatal motor/sensory network was associated with self-harm behaviors, but not current SI or depression severity.
  
  
  CONCLUSIONS
  The striatal-anterior CMS circuit likely plays a significant role in the expression of depressive symptoms and SI. In contrast, a striatum-motor/sensory cortex network may be a trait marker of suicide-related behaviors. If replicated, this result might eventually lead to the development of a biomarker that would be useful for studies of pharmacologic and/or psychotherapeutic suicide prevention interventions.
authors.affiliation: George E. Wahlen Veterans Affairs Medical Center, 500 Foothill Drive, Salt Lake City, UT 84148, USA. wmarchand@me.com
authors.forename: William R
authors.initials: WR
authors.lastname: Marchand
authors.forename: James N
authors.initials: JN
authors.lastname: Lee
authors.forename: Susanna
authors.initials: S
authors.lastname: Johnson
authors.forename: John
authors.initials: J
authors.lastname: Thatcher
authors.forename: Phillip
authors.initials: P
authors.lastname: Gale
authors.forename: Nicole
authors.initials: N
authors.lastname: Wood
authors.forename: Eun-Kee
authors.initials: EK
authors.lastname: Jeong
mesh_terms: D000328:Adult; D002540:Cerebral Cortex / Q000503:physiopathology*; D003342:Corpus Striatum / Q000503:physiopathology*; D003865:Major Depressive Disorder / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology* / Q000523:psychology*; D059907:Functional Neuroimaging / Q000379:methods / Q000523:psychology; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods / Q000523:psychology* / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009434:Neural Pathways / Q000503:physiopathology; D017397:Prefrontal Cortex / Q000503:physiopathology; D011569:Psychiatric Status Rating Scales / Q000706:statistics & numerical data; D011597:Psychomotor Performance / Q000502:physiology; D016728:Self-Injurious Behavior / Q000150:complications / Q000503:physiopathology / Q000523:psychology; D013405:Suicide / Q000523:psychology*