title: Self-referential processing, rumination, and cortical midline structures in major depression.
abstract: Major depression is associated with a bias toward negative emotional processing and increased self-focus, i.e., the process by which one engages in self-referential processing. The increased self-focus in depression is suggested to be of a persistent, repetitive and self-critical nature, and is conceptualized as ruminative brooding. The role of the medial prefrontal cortex in self-referential processing has been previously emphasized in acute major depression. There is increasing evidence that self-referential processing as well as the cortical midline structures play a major role in the development, course, and treatment response of major depressive disorder. However, the links between self-referential processing, rumination, and the cortical midline structures in depression are still poorly understood. Here, we reviewed brain imaging studies in depressed patients and healthy subjects that have examined these links. Self-referential processing in major depression seems associated with abnormally increased activity of the anterior cortical midline structures. Abnormal interactions between the lateralized task-positive network, and the midline cortical structures of the default mode network, as well as the emotional response network, may underlie the pervasiveness of ruminative brooding. Furthermore, targeting this maladaptive form of rumination and its underlying neural correlates may be key for effective treatment.
authors.affiliation: AP-HP, Service Universitaire de Psychiatrie de l'Adulte et du Sujet Âgé, Hôpitaux Universitaires Paris Ouest , Paris , France ; USR 3246, CR-ICM, CNRS, Université Pierre et Marie Curie Paris-VI , Paris , France.
authors.forename: Ayna Baladi
authors.initials: AB
authors.lastname: Nejad
authors.forename: Philippe
authors.initials: P
authors.lastname: Fossati
authors.forename: Cédric
authors.initials: C
authors.lastname: Lemogne
keywords: anterior cingulate cortex; default mode network; fMRI; major depression; medial prefrontal cortex; neuroimaging; rumination; self-referential processing