Neural Correlates of Outcome of the Psychotherapy Compared to Antidepressant Therapy in Anxiety and Depression Disorders: A Meta-Analysis

Abstract

The most prevalent mental disorders, anxiety and depression, are commonly associated with structural and functional changes in the fronto-limbic brain areas. The clinical trials investigating patients with affective disorders showed different outcome to different treatments such as psychotherapy or pharmacotherapy. It is, however, still unexplored how these interventions approach affect the functional brain. This meta-analysis aims to compare the effects of psychotherapy compared to antidepressant therapy on functional brain activity in anxiety and depression disorders. Twenty-one samples with psychotherapy and seventeen samples with antidepressant therapy were included. The main finding showed an inverse effect of the two treatments on the right paracingulate activity. The patients undergoing psychotherapy showed an increase in the right paracingulate activity while pharmacological treatment led to a decrease of activation of this area. This finding seems to support the recent studies that hypothesize how psychotherapy, through the self-knowledge and the meaning processing, involves a top-down emotional regulation.

Reward Network Modulation as a Mechanism of Change in Behavioral Activation

“…Neural mechanisms of treatment response to BA treatment.-Research into the neural patterns of treatment response in depression are consistent with the notion that depression is a disorder of corticolimbic networks. A recent meta-analysis of task-based and resting state fMRI studies suggests that both psychotherapy and medication result in posttreatment decreases in activation of the right inferior frontal gyrus, superior frontal gyrus, ACC, and right insula (Kalsi et al, 2017). However, unique correlates of treatment response were also identified.…”

“…However, unique correlates of treatment response were also identified. Changes in activation in the right paracingulate gyrus differentiated between response to medication versus psychotherapy; decreased activation predicted improved response under medication, while increased activation predicted improved response during psychotherapy (Kalsi et al, 2017). However, studies in this meta-analysis only addressed the effects of interventions on broadly defined depression severity.…”

“…Group × Time interactions revealed a number of prefrontal regions showed decreased activation during the negative stimuli context associated with BATD, including the paracingulate gyrus, right OFC, and right frontal pole. Modulation of the paracingulate gyrus is especially significant given the extensive literature implicating this region as a marker of antidepressant treatment response (Kalsi et al, 2017). Finally, analyses again showed no effects of BATD on behavioral indices of the task such as accuracy, reaction time, or self-reported affective ratings.…”

Neuropsychodynamic Approach to Depression: Integrating Resting State Dysfunctions of the Brain and Disturbed Self-Related Processes

“…A recent meta-analysis on neuroimaging findings of neural change in brain networks associated to emotion regulation after psychotherapy of depression by Messina et al ( 2013 ) detected consistent changes in the DMPFC and in the posterior cingulated gyrus/precuneus, and in several areas in the temporal lobes in depression. A further meta-analysis by Kalsi et al ( 2017 ) compared the effects of psychotherapy compared to antidepressant therapy on brain activity in depression. They found that patients undergoing psychotherapy showed an increase in the right paracingulate activity while pharmacological treatment led to a decrease of activation of this area.…”

Cognitive neuropsychological theory: Reconciliation of psychological and biological approaches for depression

“…It is known that over the course of treatment, CBT leads to a shift in in emotional bias, which is indeed one of its key treatment goals. It was suggested that, in general terms, CBT works mainly by increasing top-down control in executive and dorsal attention networks, but also, although to a lesser extent, by reducing overreactivity of ventral cortico-limbic structures, the latter being main mode of action of pharmacological treatments (DeRubeis et al 2008, Kalsi et al 2017. Unfortunately studies investigating early shifts in emotional processing during CBT are scarce and were applied to panic disorder (Reinecke et al 2014), not depression.…”