THE FUNCTIONAL NEUROANATOMY OF MAJOR DEPRESSION - AN FMRI STUDY USINGAN EMOTIONAL ACTIVATION PARADIGM

AN important issue regarding the neural basis of major depression is w hether the functional brain changes associated with the affect disturb ance seen in this syndrome are similar to those that accompany transie nt sadness in normal subjects. To address this question, we carried ou t an fMRI study using an emotional activation paradigm. Brain activity associated with passive viewing of an emotionally laden film clip aim ed at inducing a transient state of sadness was contrasted with that a ssociated with passive viewing of an emotionally neutral film clip in patients suffering from unipolar depression and in normal control subj ects. Results showed that transient sadness produced significant activ ation in the medial and inferior prefrontal cortices, the middle tempo ral cortex, the cerebellum and the caudate in both depressed and norma l subjects. They also revealed that passive viewing of the emotionally laden film clip produced a significantly greater activation in the le ft medial prefrontal cortex and in the right cingulate gyrus in depres sed patients than in normal control subjects. These findings suggest t hat these two cortical regions might be part of a neural network impli cated in the pathophysiology of major depression. Taken together, thes e results strongly support the view that activation paradigms represen t an extremely useful and powerful way of delineating the functional a natomy of the various symptoms that characterize major depression. (C) 1998 Lippincott Williams & Wilkins.