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Functional neuroanatomy of major depression

Nervenheilkunde, ISSN: 2567-5788, Vol: 41, Issue: 3, Page: 161-175
2022
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Article Description

In contrast to older concepts of a depression center in the brain, the current view of functional anatomy of major depression comprises distributed parts of cortical and subcortical grey matter, connected by fibers, constituting so called networks, circuits, or loops, respectively. These networks can be measured by means of functional imaging in healthy subjects, as well as in depressed patients, yielding differences in connectivity related to psychopathology. In the light of this background, a more rational understanding of the therapeutic action of deep brain stimulation (DBS) as well as transcranial magnetic stimulation (rTMS) appears possible. The concurrent development of functional imaging and brain stimulation techniques is reviewed and translational applications are discussed. In recent rTMS treatment studies it is postulated that an optimal stimulation site can be chosen, dependent upon patterns of psychopathology and specific changes in connectivity. As regards THS, a case report has been published recently demonstrating a mapping procedure based on 10 implanted electrodes. Different stimulation sites resulted in immediate, reproducible positive changes of mood. This patient is now doing well for several months through treatment with closed-loop stimulation controlled by activity of the right amygdala.

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