scholarly journals Neural excitation/inhibition imbalance and the treatment of severe depression

2021 ◽  
Author(s):  
Freek ten Doesschate ◽  
Willem Bruin ◽  
Peter Zeidman ◽  
Christopher Abbott ◽  
Miklos Argyelan ◽  
...  

An influential hypothesis holds that depression is related to a neural excitation/inhibition imbalance, but its role in the treatment of depression remains unclear. Here, we show that unmedicated patients with severe depression demonstrated reduced inhibition of brain-wide resting-state networks relative to healthy controls. Patients using antidepressants showed inhibition that was higher than unmedicated patients and comparable to controls, but they still suffered from severe depression. Subsequent treatment with electroconvulsive therapy (ECT) reduced depressive symptoms, but its effectiveness did not depend on changes in network inhibition. Concomitant pharmacotherapy increased the effectiveness of ECT, but only when the strength of neural inhibition before ECT was within the normal range and not when inhibition was excessive. These findings suggest that reversing the excitation/inhibition imbalance may not be sufficient nor necessary for the effective treatment of severe depression, and that brain-state informed pharmacotherapy management may enhance the effectiveness of ECT.

2018 ◽  
pp. 174-207
Author(s):  
Nasim Mortazavi ◽  
Cecile Staquet ◽  
Audrey Vanhaudenhuyse ◽  
Andrea Soddu ◽  
Marie-Elisabeth Faymonville ◽  
...  

This chapter reviews current knowledge of the effects of hypnotic anesthetic agents on brain resting-state networks (RSNs) that sustain consciousness. Although full exploration of the networks under anesthesia is not yet available, current evidence indicates that anesthetic agents with hypnotic properties dose-dependently modulate RSN functioning. Each anesthetic agent has specific effects that are not uniform within a given network and probably correlate with the specific clinical features observed when one agent or another is used. Observations made on RSNs during anesthesia are supplementary arguments to link the networks with specific aspects of consciousness and connectedness to the environment and to confirm their physiological functions. The precise link between observations made on RSNs during anesthesia and known biochemical targets of anesthetic agents, or their effects on systems that regulate the sleep–wake cycle, is not established yet. PET studies using radiolabeled probes that specifically target a neurotransmission system offer insights into the links. New technological advances and modes of functional data analysis, such as Granger causality and dynamic causal modeling, will help in obtaining a more in-depth exploration of the complex interactions between brain regions, their modulation by anesthesia, and their role in information processing by the brain. Effects of hypnosis on RSNs also have been studied. The hypnotic state is useful for performing surgical procedures and explorations without general anesthesia. The hypnotic state is associated with specific changes in the activity of RSNs that confirm hypnosis as a specific brain state, different from normal wakeful consciousness and anesthetic states.


2018 ◽  
Author(s):  
Caroline Garcia Forlim ◽  
Leonie Klock ◽  
Johanna Bächle ◽  
Laura Stoll ◽  
Patrick Giemsa ◽  
...  

AbstractA diagnosis of schizophrenia is associated with a heterogeneous psychopathology including positive and negative symptoms. The disconnection hypothesis, an early pathophysiological framework conceptualizes the diversity of symptoms as a result from disconnections in neural networks. In line with this hypothesis, previous neuroimaging studies of patients with schizophrenia reported alterations within the default mode network (DMN), the most prominent network at rest.Aim of the present study was to investigate the functional connectivity during rest in patients with schizophrenia and healthy individuals and explore whether observed functional alterations are related to the psychopathology of patients. Therefore, functional magnetic resonance images at rest were recorded of 35 patients with schizophrenia and 41 healthy individuals. Independent component analysis (ICA) was used to extract resting state networks.Comparing ICA results between groups indicated alterations only within the network of the DMN. More explicitly, reduced connectivity in the precuneus was observed in patients with schizophrenia compared to healthy controls. Connectivity in this area was negatively correlated with the severity of negative symptoms, more specifically with the domain of apathy.Taken together, the current results provide further evidence for a role DMN alterations might play in schizophrenia and especially in negative symptom such as apathy.


2017 ◽  
Vol 16 (1) ◽  
pp. 10-14 ◽  
Author(s):  
Tiffany A. Kolesar ◽  
Elena Bilevicius ◽  
Jennifer Kornelsen

AbstractObjectiveThis study examined the altered patterns of functional connectivity in task-positive resting state networks in failed back surgery syndrome (FBSS) patients compared to healthy controls using functional magnetic resonance imaging (fMRI). This work stems from a previous study in which alterations in the task-negative default mode network were investigated.DesignParticipants underwent a 7-minute resting state fMRI scan in which they lay still, with eyes closed, in the absence of a task.SettingScanning took place at the National Research Council’s 3 Tesla MRI magnet in Winnipeg, Canada.SubjectsFourteen patients with FBSS and age- and gender-matched controls participated in this study. Three patients were removed from the analyses due to image artefact (n = 1) and effective pain treatment (n = 2). Eleven patients (5 female, mean age 52.7 years) and their matched controls were included in the final analyses.MethodsResting state fMRI data were analyzed using an independent component analysis, yielding three resting state networks of interest: the salience network (SN), involved in detection of external stimuli, central executive network (CEN), involved in cognitions, and sensorimotor network (SeN), involved in sensory and motor integration. Analysis of Variance contrasts were performed for each network, comparing functional connectivity differences between FBSS patients and healthy controls.ResultsAlterations were observed in all three resting state networks, primarily relating to pain and its processing in the FBSS group. Specifically, compared to healthy controls, FBSS patients demonstrated increased functional connectivity in the anterior cingulate cortex within the SN, medial frontal gyrus in the CEN, and precentral gyrus within the SeN. FBSS patients also demonstrated decreased functional connectivity in the medial frontal gyrus in the SeN compared to healthy controls. Interestingly, we also observed internetwork functional connectivity in the SN and SeN.ConclusionsFBSS is associated with altered patterns of functional connectivity in the SN, CEN, and SeN. Taken together with our previous work, this reveals that a chronic pain condition can have a dramatic effect on the connectivity of multiple resting state networks.ImplicationsThese data suggest that a chronic pain condition—FBSS—is associated with disruptions to networks of functional connectivity in brain areas that are involved in numerous functions, including pain processing, sensation, and movement. It is possible that the alterations in these networks may contribute to other common chronic pain comorbidities, such as disrupted cognitions or anxiety. Previous research shows that during experimentally-induced pain, these networks can return to initial levels of functioning, indicating that these functional alterations are likely not permanent.


2003 ◽  
Vol 11 (1) ◽  
pp. 34-38 ◽  
Author(s):  
Pete M. Ellis ◽  
Ian B. Hickie ◽  
Don A. R. Smith

Depression is common, serious and treatable. The Australian and New Zealand Clinical Practice Guideline for the Treatment of Depression by Specialist Services provides evidence-based treatment guidance across the spectrum of depressive disorders and delineates where specialist treatment and primary care management is indicated. The present summary version covers the key contents of the guideline. It includes assessment, treatment and general management issues by category type and severity of depressive disorder. Algorithms of first-line and subsequent treatment choices are provided for: (i) mild depression without complications; (ii) moderately severe depression (including with comorbid anxiety) and dysthymia; (iii) uncomplicated, melancholic or atypical depression; (iv) moderately severe depression with comorbid substance abuse; (v) moderate to severe depression with physical disorders; (vi) severe depression with melancholia; (vii) recurrent depression or failure to respond to a preferred first-line treatment; and (viii) psychotic depression, and severe depression with risk of suicide. Continuing and maintenance treatments for recurrent depression are discussed. Emerging evidence of the equal value of cognitive behaviour therapy (CBT) and interpersonal psychotherapy (IPT) to pharmacological treatments for some depression is discussed, and the need to ensure that they are provided by suitably trained practitioners. Indications for hospitalization and electroconvulsive therapy (ECT) are also provided.


Diabetes ◽  
2019 ◽  
Vol 68 (Supplement 1) ◽  
pp. 2092-P
Author(s):  
LETICIA ESPOSITO SEWAYBRICKER ◽  
SUSAN J. MELHORN ◽  
MARY K. ASKREN ◽  
MARY WEBB ◽  
VIDHI TYAGI ◽  
...  

2020 ◽  
Vol 10 (9) ◽  
Author(s):  
Xiang‐Xin Xing ◽  
Xu‐Yun Hua ◽  
Mou‐Xiong Zheng ◽  
Zhen‐Zhen Ma ◽  
Bei‐Bei Huo ◽  
...  

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1808.2-1809
Author(s):  
D. Karatas ◽  
Z. Öztürk ◽  
D. Cekic ◽  
Z. Yuertsever ◽  
Ü. Erkorkmaz ◽  
...  

Background:Familial Mediterranean Fever (FMF) is a hereditary autoinflammatory disease characterized by recurrent attacks of fever, peritonitis, pleuritis, arthritis, and skin eruption (1). It is shown by studies that chronic diseases like diabetes mellitus, chronic heart disease, hypertension which other than inflammatory – rheumatologic disease increase depression and anxiety (2). There are a few studies evaluating depression and anxiety in FMF patients, and these results are conflicting (3,4).Objectives:To assess the frequency of depression and anxiety in patients with Familial Mediterranean Fever (FMF)Methods:In this study, 77 FMF patients aged 18 and over who were followed up in Sakarya University Education and Research Hospital, Department of Rheumatology, and 78 healthy volunteers aged 18 and over as thecontrol group. Beck depression scale and Beck anxiety scale were used to depression and anxiety, respectively. Beck’sdepression scale was evaluated as 9 and below normal, 10-16 mild depression, 17-29 moderate depression, 30-63 severe depression. Beck anxiety scale was evaluated as 0-8 normal, 8-15 mild anxiety, 16-25 moderate anxiety, 26 and above severe anxiety.FMF disease severity was determined by Pras scoring.Results:The study group, comprised 77 diagnosed with FMF with a meanage of 37.18 and a control group comprised of 78 healthy controls (C) with a meanage of 35.32 (p=0,058). İn studygroup (P) %63.6, control group (C) %53.8 as female. %36.4 of thestudy group(C), %46.2 of the control group are male. (p=0,216). The prevalence of depression was significantly higher in FMF patients compared to the control group (in order P;C: normal %24,7; %47,4, mild depression: %40.3; %26.9, moderate depression %26; %19.2, severe depression %11.7; %6.4 p<0.015). Similarly in depression results; the prevalence of anxiety was significantly higher in FMF patients compared to the control group (in order P;C normal %23,4; %57.7, mild anxiety %26; %20.5, moderate anxiety %26; %15.4, severe anxiety %24.4; %6.4 p<0,001). Depression status was not correlated with FMF disease severity (p=0.645). A correlation was found between FMF severity and anxiety which it is which was found statistically significant (p=0.005).There was no relationship between erythrocyte sedimentation rate and C-reactive protein with depression and anxiety.Conclusion:Both anxiety and depression frequency are increased in FMF patients compared to healthy controls.References:[1]Livneh A, Langevitz P, Zemer D et al. (1997) Criteria for the diagnosis of familial Mediterranean fever. Arthritis Rheum 40 (10), 1879–85.[2]Alonso J, Ferrer M, Gandek B, Ware JE Jr, Aaronson NK, Mosconi P, Rasmussen NK, Bullinger M, Fukuhara S, Kaasa S, Leplège A, IQOLA Project Group (2004) Health-related quality of life associated with chronic conditions in eight countries: results from the International Quality of Life Assessment (IQOLA) Project. Qual Life Res 13:283–298[3]Makay B, Emiroglu N, Unsal E (2010) Depression andanxiety in children and adolescents with familial Mediterranean fever. Clin Rheumatol 29, 375–9.[4]Giese A, Ornek A, Kilic L, Kurucay M, Sendur S. N., Lainka E, Henning B. F. Anxiety and depression in adult patients with familialMediterranean fever: a study comparing patients living in Germany and Turkey. International Journal of Rheumatic Diseases 2017; 20: 2093–2100Disclosure of Interests:None declared


2020 ◽  
Vol 27 ◽  
pp. 102336
Author(s):  
Margherita Carboni ◽  
Pia De Stefano ◽  
Bernd J. Vorderwülbecke ◽  
Sebastien Tourbier ◽  
Emeline Mullier ◽  
...  

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