Cingulate function in depression

TLDR

The study proposes that the rostral cingulate area 24a/b plays a critical role in the limbic‑cortical network underlying abnormal mood states. Pretreatment regional cerebral glucose metabolism was measured with PET in hospitalized unipolar depression patients to predict antidepressant response. Rostral anterior cingulate metabolism distinguished responders from non‑responders, with responders showing hypermetabolism and non‑responders hypometabolism, and no other region or clinical measure discriminated the groups, suggesting hypermetabolism may be an adaptive response whose failure underlies poor outcome.

Abstract

THE relationship between pretreatment regional cerebral glucose metabolism and eventual antidepressant drug response was measured using positron emission tomography (PET) in hospitalized patients with unipolar depression. Rostral anterior cingulate metabolism uniquely differentiated eventual treatment responders from non-responders. Hypometabolism characterized non-responders when compared with controls, in contrast to responders who were hypermetabolic. Metabolism in no other region discriminated the two groups, nor did associated demographic, clinical or behavioral measures, including motor speed, cognitive performance, depression severity or illness chronicity. Cingulate hypermetabolism may represent an important adaptive response to depression and failure of this response may underlie poor outcome. A critical role for rostral cingulate area 24a/b in the limbic-cortical network involved in abnormal mood states is proposed.