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Dr Shock MD PhD
Based on the results from functional neuroimaging studies, lesion patient studies and brain stimulation studies two important brain areas play an important role in the pathophysiology of depression. These two brain area s are the ventromedial prefrontal cortex and the dorsolateral prefrontal cortex. The ventromedial prefrontal cortex is depicted in red on the picture above and the dorsolateral prefrontalcortex in blue. The red part is in the forehead on the inside of the two brain half’s (hemispheres) (A) and the blue part is on the outside of the frontal part of both brain parts (B).
The funny thing is that with functional neuroimaging these centers show opposite changes during recovery. While depressed the ventromedial part of the brain is hyperactive and activity decreases during remission of depression and the dorsolateral part is hypoactive during depression and becomes more active during remission of symptoms. This makes it plausible that during depression there is an imbalance in activity between these two brain areas. However, from these studies it is not possible to point to cause and effect. These changes can be the cause of depression but it could also be a consequence of the disease.
Lesion studies demonstrate opposite effects of damage to these areas on depression: dorsolateral prefrontal cortex lesions exacerbate depressive symptoms whereas ventromedial prefrontal cortex lesions diminish depressive symptoms
The ventromedial prefrontal cortex plays an important role in negative affect. Damage to this brain area results in a reduction of negative affect such as guilt, shame, embarrassment and regret. Disturbances of activity of this brain area is believed to lead to these “depressed symptoms”.
The dorsolateral prefrontal cortex is important for “cognitive” and “executive” functions such as working memory, intention formation, goal-directed action, abstract reasoning, and attentional control. Moreover, this brain area is believed to be important for the regulation of negative affect. This brain area is important for the reappraisal/suppression of negative affect. A defect in this regulation of negative affect due …