Self-Referential Thinking, Suicide, and Function of the Cortical Midline Structures and Striatum in Mood Disorders: Possible Implications for Treatment Studies of Mindfulness-Based Interventions for Bipolar Depression

Abstract

Bipolar depression is often refractory to treatment and is frequently associated with anxiety symptoms and elevated suicide risk. There is a great need for adjunctive psychotherapeutic interventions. Treatments with effectiveness for depressive and anxiety symptoms as well as suicide-related thoughts and behaviors would be particularly beneficial. Mindfulness-based interventions hold promise, and studies of these approaches for bipolar disorder are warranted. The aim of this paper is to provide a conceptual background for such studies by reviewing key findings from diverse lines of investigation. Results of that review indicate that cortical midline structures (CMS) appear to link abnormal self-referential thinking to emotional dysregulation in mood disorders. Furthermore, CMS and striatal dysfunction may play a role in the neuropathology underlying suicide-related thoughts and behaviors. Thus, combining studies of mindfulness interventions targeting abnormal self-referential thinking with functional imaging of CMS and striatal function may help delineate the neurobiological mechanisms of action of these treatments.

Temporal Dissociation of Striatum and Prefrontal Cortex Uncouples Anhedonia and Defense Behaviors Relevant to Depression in 6-OHDA-Lesioned Rats

“…We observed that the appearance of anhedonia at 7 days was selectively associated with an increased density of both D 1 and D 2 receptors in the striatum, together with a decreased short-term plasticity and increased dopaminergic sensitivity in corticostriatal synapses. This is in notable agreement with the involvement in operant motivation of aberrant dopaminergic signaling in the striatum [43][44][45][46], suggesting that abnormal dopaminergic control of striatal function might be selectively associated with the hedonic alterations observed 7 days after 6-OHDA administration. This is re-enforced by the observation that there was a parallel disappearance of anhedonic behavior as well as striatal dopaminergic alterations at 21 days after 6-OHDA administration.…”

Multimodal Neuroimaging of Frontolimbic Structure and Function Associated With Suicide Attempts in Adolescents and Young Adults With Bipolar Disorder

“…Less is known about the role of the rostral prefrontal cortex in suicidal behavior. The experience of mental pain in attempters during recall of suicidal episodes showed associations with decreased functioning of the rostral prefrontal cortex (41), a region implicated in self-referential and introspective mental functions (42) altered in suicidal ideation and during suicidal acts (43). Frontal dysfunction was observed in a study of adult ideators (9).…”

The effectiveness of adjunct mindfulness-based intervention in treatment of bipolar disorder: A systematic review and meta-analysis

“…Furthermore, potentially relevant studies were also identified from the reference lists of the included studies, reviews, and meta-analyses of interventions that used MBIs as adjunctive therapy to treat patients with BD (Chiesa and Serretti, 2011;Marchand, 2012;Mehrmann and Karmacharya, 2013;Sipe and Eisendrath, 2012).…”