期刊
BRITISH JOURNAL OF PSYCHIATRY
卷 219, 期 4, 页码 546-550出版社
CAMBRIDGE UNIV PRESS
DOI: 10.1192/bjp.2021.16
关键词
Antidepressants; cognitive-behavioural therapies; anxiety disorders; depressive disorders; imaging
类别
资金
- UK Medical Research Council [SUAG/043 G101400]
- National Institute for Health Research Cambridge Biomedical Research Centre
- AXA Research Foundation Fellowship [G102329]
- National Institutes of Health Director's Pioneer Award [DP1OD003312]
- US Army Research Institute for the Behavioral and Social Sciences [W5J9CQ11-C-0046]
- National Natural Science Foundation of China [31722026, 31771204]
This study examined the neural changes evoked by antidepressant medication and psychological therapies, finding that they have distinct effects on the brain and affect network. However, both treatments induce changes in affect processing via separate neurocognitive mechanisms.
Background Influential theories predict that antidepressant medication and psychological therapies evoke distinct neural changes. Aims To test the convergence and divergence of antidepressant- and psychotherapy-evoked neural changes, and their overlap with the brain's affect network. Method We employed a quantitative synthesis of three meta-analyses (n = 4206). First, we assessed the common and distinct neural changes evoked by antidepressant medication and psychotherapy, by contrasting two comparable meta-analyses reporting the neural effects of these treatments. Both meta-analyses included patients with affective disorders, including major depressive disorder, generalised anxiety disorder and panic disorder. The majority were assessed using negative-valence tasks during neuroimaging. Next, we assessed whether the neural changes evoked by antidepressants and psychotherapy overlapped with the brain's affect network, using data from a third meta-analysis of affect-based neural activation. Results Neural changes from psychotherapy and antidepressant medication did not significantly converge on any region. Antidepressants evoked neural changes in the amygdala, whereas psychotherapy evoked anatomically distinct changes in the medial prefrontal cortex. Both psychotherapy- and antidepressant-related changes separately converged on regions of the affect network. Conclusions This supports the notion of treatment-specific brain effects of antidepressants and psychotherapy. Both treatments induce changes in the affect network, but our results suggest that their effects on affect processing occur via distinct proximal neurocognitive mechanisms of action.
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