Early-stage psychotherapy produces elevated frontal white matter integrity in adult major depressive disorder

PLoS One. 2013 Apr 30;8(4):e63081. doi: 10.1371/journal.pone.0063081. Print 2013.

Abstract

Background: Psychotherapy has demonstrated comparable efficacy to antidepressant medication in the treatment of major depressive disorder. Metabolic alterations in the MDD state and in response to treatment have been detected by functional imaging methods, but the underlying white matter microstructural changes remain unknown. The goal of this study is to apply diffusion tensor imaging techniques to investigate psychotherapy-specific responses in the white matter.

Methods: Twenty-one of forty-five outpatients diagnosed with major depression underwent diffusion tensor imaging before and after a four-week course of guided imagery psychotherapy. We compared fractional anisotropy in depressed patients (n = 21) with healthy controls (n = 22), and before-after treatment, using whole brain voxel-wise analysis.

Results: Post-treatment, depressed subjects showed a significant reduction in the 17-item Hamilton Depression Rating Scale. As compared to healthy controls, depressed subjects demonstrated significantly increased fractional anisotropy in the right thalamus. Psychopathological changes did not recover post-treatment, but a novel region of increased fractional anisotropy was discovered in the frontal lobe.

Conclusions: At an early stage of psychotherapy, higher fractional anisotropy was detected in the frontal emotional regulation-associated region. This finding reveals that psychotherapy may induce white matter changes in the frontal lobe. This remodeling of frontal connections within mood regulation networks positively contributes to the "top-down" mechanism of psychotherapy.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Case-Control Studies
  • Depressive Disorder, Major / pathology*
  • Depressive Disorder, Major / therapy*
  • Diffusion Tensor Imaging
  • Female
  • Frontal Lobe / pathology*
  • Humans
  • Male
  • Psychotherapy*
  • Treatment Outcome
  • Young Adult

Grant support

This study was supported by the National Basic Research Program of China (973 Program, No: 2009CB918300) and the National Natural Science Foundation of China (Grant No. 31271189). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.