Cited by 667Treatment of Major DepressionNeurotransmitter Receptor Influence on BehaviorNeural and Behavioral Psychology Studies

The DOI matches its Crossref record; 290 of the 290 references it cites were found in a registry or an index; 194 of the 286 sources its claims cite were checked for support.

Prefrontal cortex and depression

Open access
Pizzagalli, Diego A., Roberts, Angela C.·2022·Neuropsychopharmacology

Abstract

The prefrontal cortex (PFC) has emerged as one of the regions most consistently impaired in major depressive disorder (MDD). Although functional and structural PFC abnormalities have been reported in both individuals with current MDD as well as those at increased vulnerability to MDD, this information has not translated into better treatment and prevention strategies. Here, we argue that dissecting depressive phenotypes into biologically more tractable dimensions - negative processing biases, anhedonia, despair-like behavior (learned helplessness) - affords unique opportunities for integrating clinical findings with mechanistic evidence emerging from preclinical models relevant to depression, and thereby promises to improve our understanding of MDD. To this end, we review and integrate clinical and preclinical literature pertinent to these core phenotypes, while emphasizing a systems-level approach, treatment effects, and whether specific PFC abnormalities are causes or consequences of MDD. In addition, we discuss several key issues linked to cross-species translation, including functional brain homology across species, the importance of dissecting neural pathways underlying specific functional domains that can be fruitfully probed across species, and the experimental approaches that best ensure translatability. Future directions and clinical implications of this burgeoning literature are discussed.

Overview

AI snapshot

Written from the paper’s full text.

TL;DR

This review argues that prefrontal cortex (PFC) dysfunction in major depressive disorder (MDD) is heterogeneous and context-dependent, and that parsing depression into anhedonia, negative processing biases, and learned helplessness/despair can better align clinical and preclinical evidence. It synthesizes human imaging findings with rodent and non-human primate work, emphasizing cross-species translation and treatment effects.

Key findings

  • Across reward-processing tasks, MDD is generally linked to blunted ventral/dorsal striatal, pgACC/dACC, and central/medial OFC responses, but hyperactivation in mPFC/vmPFC/sgACC, dlPFC, and lateral OFC to non-rewards; many markers correlate with anhedonia and predict later symptoms. Examples include a voxel-wise meta-analysis comparing 1,399 MDD with 1,332 controls showing increased medial OFC/pgACC ALFF, and the largest structural MRI study (1,902 MDD vs. 7,658 controls) showing thinner ACC and OFC/vmPFC gray matter. In IMAGEN (N = 1,877 at age 14; N = 1,140 at age 19), higher depression severity related to reduced central OFC reward sensitivity and potentiated lateral OFC non-reward responses; in a youth sample (N = 1,576), blunted ventral striatal reward response predicted depression 2 years later, and in children (N = 637), reward-pathway resting connectivity predicted onset 3 years later.
  • Negative processing biases in MDD and vulnerability are associated with dlPFC/dACC hypoactivation and pgACC/sgACC/amygdala hyperactivation, plus altered vmPFC–amygdala and dmPFC–amygdala coupling. A meta-analysis of 44 fMRI studies found reduced left dlPFC activation to negative stimuli in MDD, and a meta-analysis of 60 treatment studies found antidepressants decreased middle frontal gyrus/pgACC responses to negative stimuli while increasing rostral vmPFC, dlPFC, and pgACC responses to positive stimuli.
  • Learned helplessness/despair has fewer human studies, but PFC regions are implicated in controllability and stressor effects. Rodent work suggests prelimbic cortex promotes active coping while infralimbic cortex promotes passive coping, with ketamine’s delayed effects requiring an intact infralimbic cortex; marmoset studies show area 25 overactivation blunts anticipatory/motivational arousal and increases threat reactivity, while area 14 inactivation increases appetitive arousal, and systemic ketamine can ameliorate area 25-induced reductions.
  • Executive dysfunction in MDD involves reduced dACC/dlPFC recruitment and failure to deactivate pgACC/default-mode regions; greater deactivation of anteromedial PFC during working memory predicts better escitalopram response, and greater dmPFC deactivation before ketamine predicts greater cognitive symptom reduction.

Methods

  • Narrative, integrative review rather than a systematic review or meta-analysis; the authors synthesize clinical and preclinical literature relevant to selected depressive phenotypes and PFC subregions.
  • Human evidence includes fMRI, resting-state functional connectivity, structural MRI, meta-analyses, and large cohorts such as ENIGMA, IMAGEN, and UK Biobank, plus high-risk and remitted samples.
  • Preclinical evidence includes rodent chronic stress models and selective PFC/OFC interventions, and non-human primate studies using lesions, inactivations, microstimulation, and ketamine; the main analysis is qualitative cross-species comparison.

Limitations

  • The paper states that cross-species translation is limited by uncertain functional homology/analogy, especially for dl/vlPFC regions with no clear rodent counterpart, inconsistent prefrontal nomenclature, symptom complexity, and the difficulty of modeling chronic MDD with acute interventions. It also cautions that forced swim and tail suspension tests may reflect coping or anxiety rather than despair, and that chronic stress models vary in etiology and treatment response.
  • The authors state that the review presents a selected summary due to space limitations, not an exhaustive account.
  • Evident from the text: as a narrative review, it does not use formal systematic search, risk-of-bias assessment, or quantitative pooling; causal claims rely mainly on animal interventions, while many human findings are correlational.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1038/s41386-021-01101-7

Cites

290 of 290 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Verification

Claims the paper makes

73 Own interpretation · 70 Partly supported · 66 Supported · 41 No full text of the sources · 23 No basis given · 15 Sources not found · 7 Not supported · 5 Supported so far · 4 Not checked yet · 3 Mixed support · 3 Couldn’t confirm · accuracy not yet measured

Show all 202 claims

  • It may state two separate claims as one. 103
  • Probably not a substantial claim. 14
108 of 108
  • The paper relies on this without support.

    The majority of preclinical studies relevant to major depressive disorder are performed in rodents.

    “but the majority of preclinical studies relevant to MDD are performed in rodents.”
  • The paper relies on this without support.

    Cross-species translation from animal models to humans is possible and valuable for understanding major depressive disorder.

    “This highlights the importance of NHP research, where back translation to rodents and forward translation into the clinic can bridge the gap.”
  • The paper relies on this without support.

    Functional homology exists between PFC regions in rodents/monkeys and humans such that findings in animals can inform MDD.

    “altered activity in the PFC of both macaques and marmosets was found to induce negative biases akin to those reported in depression”
    “Integrating the MDD and preclinical animal studies, it is apparent that a number of regions within the mPFC may contribute either directly in the learning and maintenance of action-outcome associations that underlie the ability of humans and other animals to control their environment”
  • The paper relies on this without support.

    Negative biases measured in animal tasks are equivalent to negative processing biases in MDD.

    “negative biases akin to those reported in depression”
    “Negative biases are also multi-determined contributed to by altered activity in primate areas 24, 32, OFC and vlPFC.”
  • The paper relies on this without support.

    The intermediate phenotypes (anhedonia, negative bias, learned helplessness) are valid constructs that map onto MDD.

    “these intermediate phenotypes of MDD”
  • The paper relies on this without support.

    Chronic stress models in animals are valid models of MDD.

    “results from chronic stress models and interventions in otherwise healthy animals provide causal evidence for the induction of these intermediate phenotypes of MDD”
6 of 6

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

3 of 3

Citations

Cites

Show all 286 references

Research works printed but not linked: 1

  1. Seligman MEP. Depression and learned helplessness. In The psychology of depression: contemporary theory and research. New York: Winston-Wiley; 1974, p. 83–113.

Cited by

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Metadata

Authors
Pizzagalli, D. A., & Roberts, A. C.
Affiliations
  • Harvard University (US)
  • University of Cambridge (GB)
Corresponding author
  • Pizzagalli, Diego A.
  • Roberts, Angela C.
Venue
Neuropsychopharmacology
Published
2021-08-02
Volume
47
Issue
1
Pages
225-246
ISSN
  • 0893-133X (ISSN-L)
  • 1740-634X
OpenAlex
W3189676709
Cited by
667
References
286
Citations by year
2026: 164 · 2025: 198 · 2024: 149 · 2023: 109 · 2022: 42 · 2021: 4
FWCI
9.17
Type
journal article
Language
en
Open access
Locations
  • Neuropsychopharmacology (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • U.S. Department of Health & Human Services | NIH | National Institute of Mental Health (R37 MH068376, R01 MH108602, P50 MH119467, R01 MH095809)
  • RCUK | Medical Research Council (M023990/1)
  • Wellcome Trust (108089/Z/15/Z)
Topics
  • Health Sciences › Medicine › Pharmacology (medical) › Treatment of Major Depression
  • Life Sciences › Neuroscience › Cellular and Molecular Neuroscience › Neurotransmitter Receptor Influence on Behavior
  • Life Sciences › Neuroscience › Cognitive Neuroscience › Neural and Behavioral Psychology Studies
Keywords
prefrontal cortex, major depressive disorder, anhedonia, learned helplessness, despair-like behavior, neural pathways, depression treatment, depression vulnerability
MeSH terms
Brain, Depression, Major Depressive Disorder, Humans, Magnetic Resonance Imaging, Prefrontal Cortex, Anhedonia

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