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Brain structural abnormalities in patients with major depression with or without generalized anxiety disorder comorbidity

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Abstract

An overlap frequently occurs between major depression disorder (MDD) and generalized anxiety disorder (GAD). Aim of this study was to assess cortical and white matter (WM) alterations in MDD patients with or without GAD comorbidity. Seventy-one MDD patients and 71 controls were recruited. All subjects underwent T1-weighted and diffusion tensor (DT)/MRI. MRI metrics of cortical thickness and WM integrity were obtained from atlas-based cortical regions and the interhemispheric and major long association WM tracts. Between-group MRI comparisons and multiple regressions with clinical scale scores were performed. Compared to controls, both MDD and MDD-GAD patients showed a cortical thinning of the middle frontal cortex bilaterally, left medial frontal gyrus and frontal pole. Compared to controls and MDD patients, MDD-GAD cases also showed a thinning of the right medial orbitofrontal and fusiform gyri, and left temporal pole and lateral occipital cortices. Compared to controls, MDD patients showed DT MRI abnormalities of the right parahippocampal tract and superior longitudinal fasciculus bilaterally, while no WM alterations were found in MDD-GAD. In all patients, brain abnormalities were related with symptom severity. MDD and MDD-GAD share a common pattern of cortical alterations located in the frontal regions. However, while both the cortex and WM integrity are affected in MDD, only the former is affected in MDD-GAD. These findings support the notion of MDD-GAD as a distinct clinical entity, providing insights into patient vulnerability for specific networks as well as into patient resilience factors reflected by the integrity of other cerebral circuits.

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Acknowledgments

No outside funding was used for this study.

Conflicts of interest

Elisa Canu, Milutin Kostić, Ana Munjiza, Pilar M Ferraro, Danilo Pesic, Massimiliano Copetti, and Amir Peljto report no disclosures. Federica Agosta serves on the editorial board of the Journal of Neurology; has received speaker honoraria from Biogen Idec, and EXCEMED—Excellence in Medical Education; and receives research supports from the Italian Ministry of Health, and AriSLA (Fondazione Italiana di Ricerca per la SLA). Dusica Lecic Tosevski is Editor-in-Chief of the Journal Psychiatry Today; has received compensation for speaking activites from Janssen-Cylag, Pfizer, Hemopharm, Astra Zeneka; and receives research support from Serbian Ministry of Education and Science and Serbian Academy of Sciences and Arts. Massimo Filippi is Editor-in-Chief of the Journal of Neurology; serves on scientific advisory boards for Teva Pharmaceutical Industries; has received compensation for consulting services and/or speaking activities from Bayer Schering Pharma, Biogen Idec, Merck Serono, Novartis, and Teva Pharmaceutical Industries; and receives research support from Bayer Schering Pharma, Biogen Idec, Merck Serono, Teva Pharmaceutical Industries, Novartis, Italian Ministry of Health, Fondazione Italiana Sclerosi Multipla, Cure PSP, Alzheimer’s Drug Discovery Foundation (ADDF), the Jacques and Gloria Gossweiler Foundation (Switzerland), and ARiSLA (Fondazione Italiana di Ricerca per la SLA).

Ethical standard

Approval was obtained from the local ethical standards committee on human experimentation and written informed consent from all subjects before enrolment. The study has been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

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Authors and Affiliations

  1. Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Via Olgettina, 60, 20132, Milan, Italy

    Elisa Canu, Federica Agosta, Pilar M. Ferraro & Massimo Filippi

  2. Department of Neurology, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy

    Massimo Filippi

  3. Institute of Mental Health, Belgrade, Serbia

    Milutin Kostić, Ana Munjiza, Danilo Pesic, Amir Peljto & Dusica Lecic Tosevski

  4. School of Medicine, University of Belgrade, Belgrade, Serbia

    Dusica Lecic Tosevski

  5. Serbian Academy of Sciences and Arts, Belgrade, Serbia

    Dusica Lecic Tosevski

  6. Biostatistics Unit, IRCCS-Ospedale Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia, Italy

    Massimiliano Copetti

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  1. Elisa Canu
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  2. Milutin Kostić
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  3. Federica Agosta
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  8. Amir Peljto
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  9. Dusica Lecic Tosevski
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  10. Massimo Filippi
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Correspondence to Massimo Filippi.

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Canu, E., Kostić, M., Agosta, F. et al. Brain structural abnormalities in patients with major depression with or without generalized anxiety disorder comorbidity. J Neurol 262, 1255–1265 (2015). https://doi.org/10.1007/s00415-015-7701-z

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  • DOI: https://doi.org/10.1007/s00415-015-7701-z

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