TY - JOUR
T1 - The neurobiology of treatment-resistant depression
T2 - A systematic review of neuroimaging studies
AU - Runia, Nora
AU - Yücel, Dilan E.
AU - Lok, Anja
AU - de Jong, Kiki
AU - Denys, Damiaan A. J. P.
AU - van Wingen, Guido A.
AU - Bergfeld, Isidoor O.
N1 - Funding Information: This work was supported by ZonMw [grant number 636310016 ]. Publisher Copyright: © 2021 The Author(s)
PY - 2022/1/1
Y1 - 2022/1/1
N2 - Treatment-resistant depression (TRD) is a debilitating condition associated with higher medical costs, increased illness burden, and reduced quality of life compared to non-treatment-resistant major depressive disorder (MDD). The question arises whether TRD can be considered a distinct MDD sub-type based on neurobiological features. To answer this question we conducted a systematic review of neuroimaging studies investigating the neurobiological differences between TRD and non-TRD. Our main findings are that patients with TRD show 1) reduced functional connectivity (FC) within the default mode network (DMN), 2) reduced FC between components of the DMN and other brain areas, and 3) hyperactivity of DMN regions. In addition, aberrant activity and FC in the occipital lobe may play a role in TRD. The main limitations of most studies were related to inherent confounding factors for comparing TRD with non-TRD, such as differences in disease chronicity/severity and medication history. Future studies may use prospective longitudinal neuroimaging designs to delineate which effects are present in treatment-naive patients and which effects are the result of disease progression.
AB - Treatment-resistant depression (TRD) is a debilitating condition associated with higher medical costs, increased illness burden, and reduced quality of life compared to non-treatment-resistant major depressive disorder (MDD). The question arises whether TRD can be considered a distinct MDD sub-type based on neurobiological features. To answer this question we conducted a systematic review of neuroimaging studies investigating the neurobiological differences between TRD and non-TRD. Our main findings are that patients with TRD show 1) reduced functional connectivity (FC) within the default mode network (DMN), 2) reduced FC between components of the DMN and other brain areas, and 3) hyperactivity of DMN regions. In addition, aberrant activity and FC in the occipital lobe may play a role in TRD. The main limitations of most studies were related to inherent confounding factors for comparing TRD with non-TRD, such as differences in disease chronicity/severity and medication history. Future studies may use prospective longitudinal neuroimaging designs to delineate which effects are present in treatment-naive patients and which effects are the result of disease progression.
KW - Magnetic resonance imaging
KW - Major depressive disorder
KW - Neuroimaging
KW - Resting-state
KW - Systematic review
KW - Treatment-resistant depression
UR - http://www.scopus.com/inward/record.url?scp=85120994947&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/j.neubiorev.2021.12.008
DO - https://doi.org/10.1016/j.neubiorev.2021.12.008
M3 - Review article
C2 - 34890601
SN - 0149-7634
VL - 132
SP - 433
EP - 448
JO - Neuroscience and Biobehavioral Reviews
JF - Neuroscience and Biobehavioral Reviews
ER -