Cited by 25Psychosomatic Disorders and Their TreatmentsAnxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesTreatment of Major Depression

Impact of serotonergic medication on interoception in major depressive disorder

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Burrows, Kaiping, DeVille, Danielle C., Cosgrove, Kelly T., Kuplicki, Rayus T., Paulus, Martin P., Aupperle, Robin, Khalsa, Sahib S., Stewart, Jennifer L. +4 more·2022·Biological Psychology

Abstract

Unmedicated individuals with major depressive disorder (MDD) show abnormal interoception, but it is unclear whether antidepressant treatment via serotonergic medication alters this relationship. The current cross-sectional study examined associations between neural and behavioral indices of interoceptive processing and chronic serotonergic medication administration in MDD. 47 selective serotonin reuptake inhibitor (SSRI)-medicated MDD (MDD-SSRI) individuals were propensity-matched with 48 unmedicated current MDD (MDD-UnMed) and 41 healthy comparison (HC) participants on demographics including age, sex, body mass index, education, as well as on dimensional scales of symptom severity including depression and anxiety. All participants completed an interoceptive attention task during functional magnetic resonance imaging, and a behavioral heartbeat tapping task under three conditions: Guessing, No Guessing, and Breath Hold. Relative to HC, both MDD groups: (1) exhibited lower mid-insula, amygdala, putamen, and caudate activation during interoceptive versus exteroceptive attention; and (2) showed poorer heartbeat tapping performance during the Breath Hold condition. However, the MDD-SSRI group reported higher intensity ratings of heartbeat and stomach sensations than MDD-UnMed and HC during the interoceptive attention task. These findings suggest that the attenuated patterns of neural activation observed in depressed individuals during interoceptive attention are not ameliorated by the chronic administration of serotonergic medications. However, amplified interoceptive sensation ratings suggest a potential impact of chronic serotonergic medication on conscious experiences of internal body states. Future investigations will need to determine the extent to which serotonergic medications acutely influence interoceptive processing, and whether such changes play a role in therapeutic responses during treatment initiation.

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Crossref · 10.1016/j.biopsycho.2022.108286

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  • Qualitative synthesis found reduced activity in the insular cortex in major depressive disorder across multiple task modalities, with specific reductions in the posterior, dorsal mid- and anterior insula.

    “The most consistent finding was reduced activity in the insular cortex in MDD [36–38, 41, 42]. The effect was observed across multiple task modalities, including VIA, heartbeat, and CO2 reactivity, with specific reductions reported in the posterior, dorsal mid- and anterior insula.”

    From Neural correlates of altered interoception in depressive and anxiety disorders: a systematic review and meta-analysis (2026) · cites this paper as [37]

    The Results (Neuroimaging assessments of interoception; page unavailable) report lower dorsal mid-insula activity in both MDD groups than in healthy controls during the VIA task, and lower dorsal anterior insula activity in the SSRI-medicated group. The paper does not report a posterior-insula reduction or reduced insula activity across VIA, heartbeat tapping, and CO2-reactivity tasks; its heartbeat-tapping finding concerns performance, not brain activity. (LLM, conf=0.88)

    Experimental — accuracy not yet measured
  • All three whole-brain VIA studies reported decreased caudate nucleus activation in major depressive disorder.

    “All three studies reported decreased caudate nucleus activation in MDD.”

    From Neural correlates of altered interoception in depressive and anxiety disorders: a systematic review and meta-analysis (2026) · cites this paper as [37]

    The Results (Neuroimaging assessments of interoception; page not provided) report lower bilateral dorsal caudate signal in both medicated and unmedicated MDD groups than in healthy controls for the interoceptive-versus-exteroceptive VIA contrast. This paper reports one study, not findings from all three studies. The same Results section says the caudate difference appeared to be driven by greater MDD activation during visual attention, so it does not establish decreased caudate activation without that contrast qualifier. (LLM, conf=0.86)

    Experimental — accuracy not yet measured
  • Avery et al. and Burrows et al. found reduced right amygdala activity in major depressive disorder.

    “Both Avery et al. and Burrows et al. also found reduced right amygdala activity [36, 37].”
  • In whole-brain VIA studies, Burrows et al. and Avery et al. identified reduced dorsal mid-insula activation in major depressive disorder, and Park et al. found reduced left insula activation.

    “More specifically, Burrows et al. and Avery et al. identified reduced activation in the dorsal mid-insula [36, 37] and Park et al. found reduced activation of the left insula [38].”
  • All three whole-brain VIA studies reported decreased insula activation in major depressive disorder compared with healthy controls.

    “Three studies utilized a VIA task to examine interoception in MDD with whole-brain analysis [36–38]. All studies reported decreased insula activation in MDD compared to healthy controls.”

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Authors
Burrows, K., DeVille, D. C., Cosgrove, K. T., Kuplicki, R. T., Paulus, M. P., Aupperle, R., Khalsa, S. S., Stewart, J. L., Bodurka, J., Guinjoan, S., Savitz, J., & Victor, T. A.
Affiliations
Laureate Institute for Brain Research (US)
Corresponding author
Burrows, Kaiping
Venue
Biological Psychology
Publisher
Elsevier BV
Published
2022-03
Volume
169
Pages
108286
ISSN
0301-0511 (ISSN-L)
OpenAlex
W4210830701
Cited by
24
References
64
Citations by year
2026: 4 · 2025: 4 · 2024: 10 · 2023: 2 · 2022: 3 · 2021: 1
FWCI
3.10
Type
journal article
Language
en
Update notices
erratum (2022-05-01)
Open access
Locations
  • Biological Psychology (publishedVersion, cc-by-nc-nd)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • National Institute of General Medical Sciences (P20GM121312)
  • National Institute of Mental Health (K23MH112949)
  • National Institute on Drug Abuse (R01DA050677)
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
  • Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
Keywords
major depressive disorder, interoception, serotonergic medications, selective serotonin reuptake inhibitors, antidepressant treatment, interoceptive attention, heartbeat perception, breath-holding, insula, amygdala, putamen, caudate nucleus
MeSH terms
Attention, Cross-Sectional Studies, Major Depressive Disorder, Humans, Magnetic Resonance Imaging, Interoception

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