Hostname: page-component-f554764f5-nqxm9 Total loading time: 0 Render date: 2025-04-11T07:29:28.610Z Has data issue: false hasContentIssue false
  • English
  • Français

The anatomy of melancholia – focal abnormalities of cerebral blood flow in major depression

Published online by Cambridge University Press:  09 July 2009

Christopher J. Bench ,
Karl J. Friston ,
Richard G. Brown ,
Lynette C. Scott ,
Richard S. J. Frackowiak  and
Raymond J. Dolan
Christopher J. Bench*
Affiliation:
Academic Department of Psychiatry, Royal Free Hospital and School of Medicine; MRC Cyclotron Unit, Hammersmith Hospital; National Hospital for Neurology and Neurosurgery; MRC Human Movement and Balance Unit, London
Karl J. Friston
Affiliation:
Academic Department of Psychiatry, Royal Free Hospital and School of Medicine; MRC Cyclotron Unit, Hammersmith Hospital; National Hospital for Neurology and Neurosurgery; MRC Human Movement and Balance Unit, London
Richard G. Brown
Affiliation:
Academic Department of Psychiatry, Royal Free Hospital and School of Medicine; MRC Cyclotron Unit, Hammersmith Hospital; National Hospital for Neurology and Neurosurgery; MRC Human Movement and Balance Unit, London
Lynette C. Scott
Affiliation:
Academic Department of Psychiatry, Royal Free Hospital and School of Medicine; MRC Cyclotron Unit, Hammersmith Hospital; National Hospital for Neurology and Neurosurgery; MRC Human Movement and Balance Unit, London
Richard S. J. Frackowiak
Affiliation:
Academic Department of Psychiatry, Royal Free Hospital and School of Medicine; MRC Cyclotron Unit, Hammersmith Hospital; National Hospital for Neurology and Neurosurgery; MRC Human Movement and Balance Unit, London
Raymond J. Dolan
Affiliation:
Academic Department of Psychiatry, Royal Free Hospital and School of Medicine; MRC Cyclotron Unit, Hammersmith Hospital; National Hospital for Neurology and Neurosurgery; MRC Human Movement and Balance Unit, London
*
1 Address for correspondence: Dr Christopher J. Bench, MRC Cyclotron Unit, Hammersmith Hospital, DuCane Road, London W12 0HS.
Get access Rights & Permissions [Opens in a new window]

Synopsis

Using positron emission tomography (PET) and 15Oxygen, regional cerebral blood flow (rCBF) was measured in 33 patients with primary depression, 10 of whom had an associated severe cognitive impairment, and 23 age-matched controls. PET scans from these groups were analysed on a pixel-by-pixel basis and significant differences between the groups were identified on Statistical Parametric Maps (SPMs). In the depressed group as a whole rCBF was decreased in the left anterior cingulate and the left dorsolateral prefrontal cortex (P < 0·05 Bonferroni-corrected for multiple comparisons). Comparing patients with and without depression-related cognitive impairment, in the impaired group there were significant decreases in rCBF in the left medial frontal gyrus and increased rCBF in the cerebellar vermis (P < 0·05 Bonferroni-corrected). Therefore an anatomical dissociation has been described between the rCBF profiles associated with depressed mood and depression-related cognitive impairment. The pre-frontal and limbic areas identified in this study constitute a distributed anatomical network that may be functionally abnormal in major depressive disorder.

Type
Original Articles
Information
Psychological Medicine , Volume 22 , Issue 3 , August 1992 , pp. 607 - 615
Copyright
Copyright © Cambridge University Press 1992

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Article purchase

Temporarily unavailable

References

REFERENCES

Altshuler, L. L., Conrad, A., Hauser, P., Li, X., Guze, B. H., Denikoff, K., Tourtellotte, W. & Post, R. (1991). Reduction of temporal lobe volume in bipolar disorder: a preliminary report of magnetic resonance imaging. Archives of General Psychiatry 48, 482–483.Google ScholarPubMed
Baleydier, C. & Mauguiére, F. (1980). The duality of the cingulated gyrus in the monkey. Brain 103, 525–554.CrossRefGoogle ScholarPubMed
Baxter, L. R., Phelps, M. E., Mazziotta, J. C., Schwartz, J. M., Gerner, R. H., Selin, C. E. & Sumida, R. M. (1985). Cerebral metabolic rates for glucose in mood disorders. Studies with positron emission tomography and fluorodeoxyglucose F18. Archives of General Psychiatry 42, 441–447.CrossRefGoogle Scholar
Baxter, L. R., Schwartz, J. M., Phelps, M. E., Mazziotta, J. C., Guze, B. H., Selin, C. E., Gerner, R. H. & Sumida, R. M. (1989). Reduction of prefrontal cortex metabolism common to three types of depression. Archives of General Psychiatry 46, 243–250.CrossRefGoogle ScholarPubMed
Buchsbaum, M. S., DeLisi, L. E., Holcomb, H. H., Cappelletti, J., King, A. C., Johnson, J., Hazlett, E., Dowling-Zimmerman, S., Post, R. M., Morihisa, J., Carpenter, W., Cohen, R., Pickar, D., Weinberger, D. R., Margolin, R. & Kessler, R. M. (1984). Anteroposterior gradients in cerebral glucose use in schizophrenia and affective disorders. Archives of General Psychiatry 41, 1159–1166.CrossRefGoogle ScholarPubMed
Dolan, R. J., Calloway, S. P. & Mann, A. H. (1985). Cerebral ventricular size in depressed subjects. Psychological Medicine 15, 873–878.CrossRefGoogle ScholarPubMed
Dolan, R. J., Calloway, S. P., Thacker, P. & Mann, A. H. (1986). The cerebral cortical appearance in depressed subjects. Psychological Medicine 16, 775–779.CrossRefGoogle ScholarPubMed
Endicott, J. & Spitzer, R. L. (1978). A diagnostic interview. The Schedule for Affective Disorders and Schizophrenia. Archives of General Psychiatry 35, 837–844.CrossRefGoogle ScholarPubMed
Fazekas, F., Alavi, A., Chawluk, J. B., Zimmerman, R. A., Hackney, D., Bilaniuk, L., Rosen, M., Alves, W. M., Hurtig, H. I., Jamieson, D. G., Kushner, M. J. & Reivich, M. (1989). Comparison of CT, MR and PET in Alzheimer's dementia and normal aging. Journal of Nuclear Medicine 30, 1607–1615.Google ScholarPubMed
Flor-Henry, P. (1979). On certain aspects of the localization of the cerebral systems regulating and determining emotion. Biological Psychiatry 14, 677–698.Google ScholarPubMed
Foltz, E. L. & White, L. E. Jr (1962). Pain ‘relief’ by frontal cingulotomy. Journal of Neurosurgery 19, 89–100.CrossRefGoogle Scholar
Frackowiak, R. S. J., Lenzi, G.-L., Jones, T. & Heather, J. D. (1980). Quantitative measurement of regional cerebral blood flow and oxygen metabolism in man using 15O and positron emission tomography: theory, procedure, and normal values. Journal of Computer Assisted Tomography 4, 727–736.CrossRefGoogle ScholarPubMed
Frackowiak, R. S. J., Pozzilli, C., Legg, N. J., Du Boulay, G. H., Marshall, J., Lenzi, G. L. & Jones, T. (1981). Regional cerebral oxygen supply and utilization in dementia. A clinical and physiological study with Oxygen-15 and positron tomography. Brain 104, 753–778.CrossRefGoogle ScholarPubMed
Friston, K. J. & Frackowiak, R. S. J. (1991). Imaging functional anatomy. In Brain Work and Metal Activity, Alfred Benzon Symposium 31 (ed. Lassen, N. A., Ingvar, D. H.Raichle, M. E. and Friberg, L.), pp. 267–277. Munksgaard: Copenhagen.Google Scholar
Friston, K. J., Passingham, R. E., Nutt, J. G., Heather, J. D., Sawle, G. V. & Frackowiak, R. S. J. (1989). Localisation in PET images: direct fitting of the intercommissural (AC-PC) line. Journal of Cerebral Blood Flow and Metabolism 9, 690–695.CrossRefGoogle ScholarPubMed
Friston, K. J., Frith, C. D., Liddle, P. F., Dolan, R. J., Lammertsma, A. A. & Frackowiak, R. S. J. (1990). The relationship between global and local changes in PET scans. Journal of Cerebral Blood Flow and Metabolism 10, 458–466.CrossRefGoogle ScholarPubMed
Friston, K. J., Frith, C. D., Liddle, P. F. & Frackowiak, R. S. J. (1991). Comparing functional (PET) images: the assessment of significant change. Journal of Cerebral Blood Flow and Metabolism 11, 690–699.CrossRefGoogle ScholarPubMed
Hachinski, V. C., Iliff, L. D., Zilhka, E., Du Boulay, G. H., McAllister, V. L., Marshall, J., Ross Russell, R. W. & Symon, L. (1975). Cerebral blood flow in dementia. Archives of Neurology 32, 632–637.CrossRefGoogle ScholarPubMed
Hamilton, M. (1960). A rating scale for depression. Journal of Neurology, Neurosurgery, and Psychiatry 23, 56–62.CrossRefGoogle ScholarPubMed
Hamilton, N. G., Frick, R. B., Takahashi, T. & Hopping, M. W. (1983). Psychiatric symptoms and cerebellar pathology. American Journal of Psychiatry 140, 1322–1326.Google ScholarPubMed
Heath, R. G. & Harper, J. W. (1974). Ascending projections of the cerebellar fastigial nucleus to the hippocampus, amygdala, and other temporal lobe sites: evoked potential and histological studies in monkeys and cats. Experimental Neurology 45, 268–287.CrossRefGoogle Scholar
Heath, R. G., Dempsey, C. W., Fontana, C. J. & Myers, W. A. (1978). Cerebellar stimulation: effects on septal region, hippocampus, and amygdala of cats and rats. Biological Psychiatry 13, 501–529.Google ScholarPubMed
Heath, R. G., Franklin, D. E. & Shraberg, D. (1979). Gross pathology of the cerebellum in patients diagnosed and treated as functional psychiatric disorders. Journal of Nervous and Mental Disease 167, 585–591.CrossRefGoogle ScholarPubMed
Helgason, L. (1977). Psychiatric services and mental illness in Iceland. Acta Psychiatrica Scandinavica Suppl. 268.Google Scholar
House, A., Dennis, M., Warlow, C., Hawton, K. & Molyneux, A. (1990). Mood disorders after stroke and their relation to lesion location. A CT scan study. Brain 113, 1113–1129.CrossRefGoogle ScholarPubMed
Liddle, P. F., Friston, K. J., Hirsch, S. R. & Frackowiak, R. S. J. (1990). Regional cerebral metabolic activity in chronic schizophrenia. Schizophrenia Research 3, 23–24.CrossRefGoogle Scholar
MacLean, P. D. (1952). Some psychiatric implications of physiological studies on frontotemporal portion of limbic system (visceral brain). Electroencephalography and Clinical Neurophysiology 4, 407–418.CrossRefGoogle ScholarPubMed
Marsden, C. D. & Harrison, M. J. G. (1972). Outcome of investigation of patients with presenile dementia. British Medical Journal ii, 249–252.CrossRefGoogle Scholar
Martin, A. J., Friston, K. J.,Colebatch, J. G. & Frackowiak, R. S. J. (1991). Decreases in regional cerebral blood flow with normal aging. Journal of Cerebral Blood Flow and Metabolism 11, 684–689.CrossRefGoogle ScholarPubMed
Martinot, J. L., Hardy, P., Feline, A., Huret, J. D., MazoyerB., Attar-Levy, D. B., Attar-Levy, D., PappataS. & Syrota, A. S. & Syrota, A. (1990). Left prefrontal glucose hypometabolism in the depressed state: a confirmation. American Journal of Psychiatry 147, 1313–1317.Google ScholarPubMed
Mesulam, M.-M. (1986). Frontal cortex and behavior. Annals of Neurology 19, 320–325.CrossRefGoogle ScholarPubMed
Montgomery, S. A. & Åsberg, M. (1979). A new depression scale designed to be sensitive to change. British Journal of Psychiatry 134, 382–389.CrossRefGoogle ScholarPubMed
Nielsen, J. (1976). The Samso project from 1957 to 1974. Acta Psychiatrica Scandinavica 54, 198–222.CrossRefGoogle Scholar
Oldfield, R. C. (1971). The assessment and analysis of handedness; the Edinburgh inventory. Neuropsychologia 9, 97–113.CrossRefGoogle ScholarPubMed
Pandya, D. N., Van Hoesen, G. W. & Mesulam, M.-M. (1981). Efferent connections of the cingulate gyrus in the Rhesus monkey. Experimental Brain Research 42, 319–330.CrossRefGoogle ScholarPubMed
Papez, J. W. (1937). A proposed mechanism of emotion. Archives of Neurology and Psychiatry 79, 217–224.Google Scholar
Pardo, J. V., Pardo, P. J., Janer, K. W. & Raichle, M. E. (1990). The anterior cingulate cortex mediates processing selection in the Stroop attentional conflict paradigm. Proceedings of the National Academy of Sciences 87, 256–259.CrossRefGoogle ScholarPubMed
Pearlson, G. D., Rabins, P. V., Kim, W. S., Speedie, L. J., Moberg, P. J., Burns, A. & Bascom, M. J. (1989). Structural brain CT changes and cognitive deficits in elderly depressives with and without reversible dementia (‘pseudodementia’). Psychological Medicine 19, 573–584.CrossRefGoogle Scholar
Powell, E. & Hines, G. (1974). The limbic system: an interface. Behavioral Biology 12, 149–164.CrossRefGoogle ScholarPubMed
Raichle, M. E. (1987). In Handbook of Physiology, section 1, Nervous System, vol. 5, Higher Functions of the Brain (ed. Plum, F.), pp. 643–669. Oxford University Press: New York.Google Scholar
Reiman, E. M., Raichle, M. E., Robins, E., Mintun, M., Fusselman, M. J., Fox, P. T., Price, J. L. & Hackman, K. A. (1989). Neuroanatomical correlates of a lactate-induced anxiety attack. Archives of General Psychiatry 46, 493–500.CrossRefGoogle ScholarPubMed
Robins, L. N., Helzer, J. E., Weissman, M. M., Orvaschel, H., Gruenbuerg, E., Burke, J. D. Jr, & Regier, D. A. (1984). Lifetime prevalence of specific psychiatric disorders in three sites. Archives of General Psychiatry 41, 949–958.CrossRefGoogle ScholarPubMed
Robinson, R. G., Starr, L. B., Kudos, K. L. & Price, T. R. (1983). A two-year longitudinal study of post-stroke mood disorders: findings during the initial evaluation. Stroke 14, 736–741.CrossRefGoogle ScholarPubMed
Robinson, R. G., Kubos, K. L., Starr, L. B., Rao, K. & Price, T. R. (1984). Mood disorders in stroke patients. Importance of location of lesion. Brain 107, 81–91.CrossRefGoogle ScholarPubMed
Sackeim, H. A., Prohovnik, I., Moeller, J. R., Brown, R. P., Apter, S., Prudic, J., Devanand, D. P. & Mukherjee, S. (1990). Regional cerebral blood flow in mood disorders. I. Comparison of major depressives and normal controls at rest. Archives of General Psychiatry 47, 60–70.CrossRefGoogle ScholarPubMed
Schwartz, J. M., Baxter, L. R., Mazziotta, J. C., Gerner, R. H. & Phelps, M. E.(1987). The differential diagnosis of depression. Relevance of Positron Emission Tomography studies of cerebral glucose metabolism to the bipolar–unipolar dichotomy. Journal of the American Medical Association 258, 1368–1374.CrossRefGoogle Scholar
Sharpe, M., Hawton, K., House, A., Molyneux, A., Sandercock, P., Bamford, J. & Warlow, C. (1990). Mood disorders in long-term survivors of stroke: associations with brain lesion location and volume. Psychological Medicine 20, 815–828.CrossRefGoogle ScholarPubMed
Spinks, T. J., Jones, T., Gilardi, M. C. & Heather, J. D. (1988). Physical performance of the latest generation of commercial positron scanner. IEEE Transactions on Nuclear Science 35, 721–725.CrossRefGoogle Scholar
Spitzer, R. L., Endicott, J. & Robins, E. (1977). Research Diagnostic Criteria for a Selected Group of Functional Disorders. Biometrics Research Division, New York State Psychiatric Institute: New York.Google Scholar
Talairach, J. & Tournoux, P. (1988). Co-Planar Stereotaxic Atlas of the Human Brain. Georg Thieme Verlag: Stuttgart.Google Scholar
van Praag, H. M. (1982). The significance of biological factors in the diagnosis of depressions. II. Hormonal variables. Comprehensive Psychiatry 23, 216–226.CrossRefGoogle ScholarPubMed
van Praag, H. M., Korf, J. & Puite, J. (1970). 5-hydroxyindoleacetic acid levels in the cerebrospinal fluid of depressed patients treated with probenecid. Nature 225, 1259–1260.CrossRefGoogle ScholarPubMed
Weinberger, D. R., Berman, K. F. & Zec, R. F. (1986). Physiologic dysfunction of dorsolateral prefrontal cortex in schizophrenia. 1. Regional cerebral blood flow evidence. Archives of General Psychiatry 43, 114–124.CrossRefGoogle Scholar