Cited by 945Treatment of Major DepressionNeural and Behavioral Psychology StudiesAnxiety, Depression, Psychometrics, Treatment, Cognitive Processes

Frontocingulate Dysfunction in Depression: Toward Biomarkers of Treatment Response

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Pizzagalli, Diego A·2011·Neuropsychopharmacology

Abstract

Increased rostral anterior cingulate cortex (rACC) activity has emerged as a promising predictor of treatment response in depression, but neither the reliability of this relationship nor the mechanisms supporting it have been thoroughly investigated. This review takes a three-pronged approach to these issues. First, I present a meta-analysis demonstrating that the relationship between resting rACC activity and treatment response is robust. Second, I propose that the rACC plays a key role in treatment outcome because of its 'hub' position in the default network. Specifically, I hypothesize that elevated resting rACC activity confers better treatment outcomes by fostering adaptive self-referential processing and by helping to recalibrate relationships between the default network and a 'task-positive network' that comprises dorsolateral prefrontal and dorsal cingulate regions implicated in cognitive control. Third, I support this hypothesis by reviewing neuropsychological, electrophysiological, and neuroimaging data on frontocingulate dysfunction in depression. The review ends with a discussion of the limitations of current work and future directions.

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Crossref · 10.1038/npp.2010.166

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  • Increased resting state functional connectivity in the perigenual anterior cingulate cortex predicted response to a variety of treatments including repetitive transcranial magnetic stimulation, pharmacotherapy, cognitive behavior therapy, and electroconvulsive therapy.

    “In a coordinate-based meta-analysis [69], increased rsFC in the pgACC predicted response to a variety of treatments (e.g., repetitive transcranial magnetic stimulation (rTMS), pharmacotherapy, cognitive behavior therapy, electroconvulsive therapy (ECT)) (see also [16]).”

    From Prefrontal cortex and depression (2022) · cites this paper as [16]

    The meta-analysis Results report that higher pretreatment rostral ACC activity predicted better response across several treatments, including drugs and rTMS. They do not establish that increased resting-state functional connectivity predicted response; the paper discusses connectivity as a treatment-associated change instead. The Results also explicitly except ECT from the positive prediction finding and report no pretreatment rACC difference between CBT responders and nonresponders in the cited CBT study. (LLM, conf=0.90)

    Experimental — accuracy not yet measured
  • The association between higher baseline anterior cingulate activity and better treatment response has been found by a more diverse set of studies, and has been meta-analytically confirmed.

    “The association between higher baseline anterior cingulate activity and better treatment response has been found by a more diverse set of studies, and has been meta-analytically confirmed (13, 40).”
  • Deficient recruitment of PFC (particularly dlPFC) regions has been coupled with hyperactivity in paralimbic (e.g., pgACC, sgACC) and limbic (e.g., amygdala) regions critically implicated in automatic processing of emotional cues.

    “Of note, deficient recruitment of PFC (particularly, dlPFC) regions has been coupled with hyperactivity in paralimbic (e.g., pgACC, sgACC) and limbic (e.g., amygdala) regions critically implicated in automatic processing of emotional cues (for review, see [16,157]).”

    From Prefrontal cortex and depression (2022) · cites this paper as [16]

  • Hyperactivation of, or a failure to deactivate, the pgACC has been reported in MDD across disparate affective tasks.

    “Similarly, hyperactivation of, or a failure to deactivate, the pgACC has been reported in MDD across disparate affective tasks [16,179], including (1) affective evaluation and cognitive reappraisal of negative stimuli; (2) self-referential processing of negative attributes; (3) inhibition of negative words; and in response to (4) sad words and commission errors.”

    From Prefrontal cortex and depression (2022) · cites this paper as [16]

  • In MDD subjects performing at the same level as controls, MDD is linked to potentiated pgACC, dACC, and left dlPFC; pgACC hyperactivation persists after remission.

    “in studies in which MDD subjects performed at the same level as controls, MDD has been linked to potentiated pgACC, dACC and left dlPFC [16,237,238] and pgACC hyperactivation persisted after remission [239].”

    From Prefrontal cortex and depression (2022) · cites this paper as [16]

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Research works printed but not linked: 1

  1. World Health Organization (WHO) 2008 The global burden of disease: 2004 update (PDF) WHO Press Geneva, Switzerland

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Authors
Pizzagalli, D. A.
Affiliations
Harvard University (US)
Corresponding author
Pizzagalli, Diego A
Venue
Neuropsychopharmacology
Published
2010-09-22
Volume
36
Issue
1
Pages
183-206
ISSN
  • 0893-133X (ISSN-L)
  • 1740-634X
OpenAlex
W2162541816
Cited by
945
References
294
Citations by year
2026: 49 · 2025: 63 · 2024: 51 · 2023: 42 · 2022: 45 · 2021: 87 · 2020: 58 · 2019: 60 · 2018: 55 · 2017: 61 · 2016: 71 · 2015: 83 · 2014: 73 · 2013: 74 · 2012: 45
FWCI
5.23
Type
journal article
Language
en
Open access
Locations
  • Neuropsychopharmacology (publishedVersion)
  • Europe PMC (PubMed Central) (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • National Alliance for Research on Schizophrenia and Depression
  • National Institute of Mental Health (R01MH068376, R21MH078979, R01 MH68376)
  • National Center for Complementary and Integrative Health (R21AT002974)
Topics
  • Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
  • Life Sciences › Neuroscience › Cognitive Neuroscience › Neural and Behavioral Psychology Studies
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
Keywords
depression, rostral anterior cingulate cortex, treatment response prediction, biomarkers, resting-state brain activity, default mode network, task-positive network, self-referential processing, cognitive control, dorsolateral prefrontal cortex
MeSH terms
Antidepressive Agents, Cognition, Major Depressive Disorder, Gyrus Cinguli, Humans, Nerve Net, Outcome Assessment, Health Care, Prefrontal Cortex, Biomarkers, Pharmacological

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