CNRS USR 3246, Pitié-Salpêtrière Hospital, Paris, France.
J Affect Disord. 2010 Jul;124(1-2):196-201. doi: 10.1016/j.jad.2009.11.003. Epub 2009 Nov 27.
Depressed patients exhibit cognitive biases, including maladaptive self-focus. In a previous functional magnetic resonance imaging (fMRI) study, the dorsal medial prefrontal cortex (MPFC) activation during self-referential versus semantic processing was unique to patients, as was the left dorsolateral prefrontal cortex (DLPFC) activation. The aim of this pilot study was to examine whether this pattern was stable over the course of depression.
Sixteen participants (8 depressed inpatients, 8 healthy controls) viewed personality traits during fMRI and judged whether each trait described them or not ('self' condition), or whether it described a socially desirable trait or not ('general' condition). There were 2 scanning sessions with an interval of at least 6weeks, in which patients received an antidepressant treatment.
After a mean duration of 9 weeks, depressed patients displayed a more balanced activation of the left DLPFC but a greater activation of the dorsal MPFC in 'self' versus 'general' condition remained.
The small sample size and heterogeneous clinical features prevented subgroups analyses between responders and non-responders.
The change of the left DLPFC activation suggests that antidepressants are associated with a more balanced allocation of cognitive control across self-referential and non-self-referential processes. The apparent lack of effect on the dorsal MPFC activity is consistent with the specific effects of antidepressants versus cognitive behavior therapy (CBT) previously demonstrated in depression. Future studies could examine the relationships between the dorsal MPFC activity in depressed patients and the need to reduce self-focus through CBT to achieve remission and prevent relapse.
抑郁患者表现出认知偏差，包括适应不良的自我关注。在之前的一项功能性磁共振成像（fMRI）研究中，与语义处理相比，内侧背侧前额叶皮层（MPFC）在自我参照与自我参照加工过程中的激活在患者中是独特的，左侧背外侧前额叶皮层（DLPFC）的激活也是如此。本研究旨在考察这种模式在抑郁过程中的稳定性。
16 名参与者（8 名抑郁住院患者，8 名健康对照组）在 fMRI 期间观察人格特质，并判断每个特质是否描述了他们（“自我”条件），或者是否描述了一个具有社会吸引力的特质（“一般”条件）。有两次扫描，间隔至少 6 周，在此期间，患者接受抗抑郁治疗。
在平均 9 周后，抑郁患者在“自我”与“一般”条件下，左侧 DLPFC 的激活更为平衡，但 MPFC 背侧的激活仍然更大。
小样本量和异质性的临床特征使应答者和非应答者之间无法进行亚组分析。
左侧 DLPFC 激活的变化表明，抗抑郁药与自我参照和非自我参照过程之间的认知控制更平衡分配有关。MPFC 背侧活动似乎没有影响，这与抗抑郁药与认知行为疗法（CBT）在抑郁中的特定作用一致。未来的研究可以研究抑郁患者 MPFC 背侧活动与通过 CBT 减少自我关注以达到缓解和预防复发的需求之间的关系。
