Kunas, Stefanie L., Yang, Yunbo, Straube, Benjamin ORCID: 0000-0002-9837-0944, Kircher, Tilo ORCID: 0000-0002-2514-2625, Gerlach, Alexander L. ORCID: 0000-0001-6794-5349, Pfleiderer, Bettina, Arolt, Volker, Wittmann, Andre, Stroehle, Andreas, Wittchen, Hans-Ulrich and Lueken, Ulrike (2019). The impact of depressive comorbidity on neural plasticity following cognitive-behavioral therapy in panic disorder with agoraphobia. J. Affect. Disord., 245. S. 451 - 461. AMSTERDAM: ELSEVIER. ISSN 1573-2517

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Abstract

Background: : Depressive disorders are a frequent comorbidity of panic disorder with agoraphobia (PD/AG). Cognitive-behavioral therapy (CBT) for PD/AG effectively reduces anxiety and depressive symptoms, irrespective of comorbidities. However, as depressive comorbidities can confound fear circuitry activation (i.e. amygdalae, insulae, anterior cingulate cortex) in PD/AG, we investigated whether comorbid depressive disorders alter neural plasticity following CBT. Methods: : Within a randomized, controlled clinical trial on exposure-based CBT, forty-two PD/AG patients including fifteen (35.7%) with a comorbid depressive disorder (PD/AG+DEP) participated in a longitudinal functional magnetic resonance imaging (fMRI) study. A differential fear conditioning task was used as probe of interest. A generalized psycho-physiological interaction analysis (gPPI) served to study functional connectivity patterns. Results: : After CBT, only PD/AG patients without comorbid depressive disorders (PD/AG-DEP) showed reduced activation in the left inferior frontal gyrus (IFG) extending to the insula. While PD/AG-DEP patients showed enhanced functional connectivity (FC) between the left IFG and subcortical structures (anterior cingulate cortex, thalamus and midbrain), PD/AG+DEP patients exhibited increased FC between the left IFG and cortical structures (prefrontal, parietal regions). In both groups, FC decreased following CBT. Limitations: : Primary depressed and medicated patients were excluded. Major depression and dysthymia were collapsed. Conclusions: : Reduced activation in the left IFG, as previously shown in PD/AG, appears to be a specific substrate of CBT effects in PD/AG-DEP patients only. Differential patterns of FC pertaining to fear circuitry networks in patients without depression vs. cognitive networks in patients with comorbid depression may point towards different pathways recruited by CBT as a function of comorbidity.

Item Type: Journal Article
Creators:
CreatorsEmailORCIDORCID Put Code
Kunas, Stefanie L.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Yang, YunboUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Straube, BenjaminUNSPECIFIEDorcid.org/0000-0002-9837-0944UNSPECIFIED
Kircher, TiloUNSPECIFIEDorcid.org/0000-0002-2514-2625UNSPECIFIED
Gerlach, Alexander L.UNSPECIFIEDorcid.org/0000-0001-6794-5349UNSPECIFIED
Pfleiderer, BettinaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Arolt, VolkerUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Wittmann, AndreUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Stroehle, AndreasUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Wittchen, Hans-UlrichUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Lueken, UlrikeUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
URN: urn:nbn:de:hbz:38-156582
DOI: 10.1016/j.jad.2018.11.026
Journal or Publication Title: J. Affect. Disord.
Volume: 245
Page Range: S. 451 - 461
Date: 2019
Publisher: ELSEVIER
Place of Publication: AMSTERDAM
ISSN: 1573-2517
Language: English
Faculty: Unspecified
Divisions: Unspecified
Subjects: no entry
Uncontrolled Keywords:
KeywordsLanguage
RANDOMIZED CONTROLLED-TRIAL; DEFAULT MODE NETWORK; PSYCHOPHYSIOLOGICAL INTERACTIONS; PERIAQUEDUCTAL GRAY; MAJOR DEPRESSION; ANXIETY; ACTIVATION; SYSTEMS; FMRI; METAANALYSISMultiple languages
Clinical Neurology; PsychiatryMultiple languages
Refereed: Yes
URI: http://kups.ub.uni-koeln.de/id/eprint/15658

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