Center for Depression, Anxiety, and Stress Research & Neuroimaging Center, McLean Hospital, Harvard Medical School, Belmont, MA 02478, USA.
Neuropsychopharmacology. 2011 Jan;36(1):183-206. doi: 10.1038/npp.2010.166. Epub 2010 Sep 22.
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.
大脑前扣带回皮质前部（rACC）活性增加已成为抑郁症治疗反应的一个很有前途的预测指标，但该关系的可靠性及其支持机制尚未得到彻底研究。本综述从三个方面探讨了这些问题。首先，我进行了一项荟萃分析，表明静息 rACC 活性与治疗反应之间的关系是可靠的。其次，我提出 rACC 在默认网络中处于“枢纽”位置，因此在治疗结果中起着关键作用。具体来说，我假设升高的静息 rACC 活性通过促进适应性的自我参照加工，并帮助重新校准默认网络与包含背外侧前额叶和背侧扣带回区域的“任务正网络”之间的关系，从而带来更好的治疗效果，这些区域与认知控制有关。第三，我通过回顾神经心理学、电生理学和神经影像学在抑郁症中额扣带回功能障碍的数据来支持这一假设。最后，本文讨论了当前工作的局限性和未来的方向。
