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The Clinical Applicability of Functional Connectivity in Depression: Pathways Toward More Targeted Intervention

  • Adina S. Fischer
    Affiliations
    Department of Psychiatry and Behavioral Sciences and Stanford Neurosciences Institute, Stanford University School of Medicine, Stanford

    VA Palo Alto Health Care System, Palo Alto, California
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  • Corey J. Keller
    Affiliations
    Department of Psychiatry and Behavioral Sciences and Stanford Neurosciences Institute, Stanford University School of Medicine, Stanford

    VA Palo Alto Health Care System, Palo Alto, California
    Search for articles by this author
  • Amit Etkin
    Correspondence
    Address correspondence to: Amit Etkin, MD, PhD, Department of Psychiatry and Behavioral Sciences, Stanford University, 401 Quarry Road, Stanford, CA 94305.
    Affiliations
    Department of Psychiatry and Behavioral Sciences and Stanford Neurosciences Institute, Stanford University School of Medicine, Stanford

    VA Palo Alto Health Care System, Palo Alto, California
    Search for articles by this author
Published:March 01, 2016DOI:https://doi.org/10.1016/j.bpsc.2016.02.004

      Abstract

      Resting-state functional magnetic resonance imaging provides a noninvasive method to rapidly map large-scale brain networks affected in depression and other psychiatric disorders. Dysfunctional connectivity in large-scale brain networks has been consistently implicated in major depressive disorder (MDD). Although advances have been made in identifying neural circuitry implicated in MDD, this information has yet to be translated into improved diagnostic or treatment interventions. In the first section of this review, we discuss dysfunctional connectivity in affective salience, cognitive control, and default mode networks observed in MDD in association with characteristic symptoms of the disorder. In the second section, we address neurostimulation focusing on transcranial magnetic stimulation and evidence that this approach may directly modulate circuit abnormalities. Finally, we discuss possible avenues of future research to develop more precise diagnoses and targeted interventions within the heterogeneous diagnostic category of MDD as well as the methodological limitations to clinical implementation. We conclude by proposing, with cautious optimism, the future incorporation of neuroimaging into clinical practice as a tool to aid in more targeted diagnosis and treatment guided by circuit-level connectivity dysfunction in patients with depression.

      Keywords

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