Effects of Psychotherapy on Glutamatergic Neurotransmission.

INTRODUCTION: Psychodynamic psychotherapy is an effective and widely used treatment for major depressive disorder (MDD); however, little is known about neurobiological changes associated with induced symptom improvement. METHODS: Proton magnetic resonance spectroscopy with a two-dimensional J-resolved sequence served to test the relationship between glutamate (Glu) and glutamine (Gln) levels, measured separately in pregenual anterior cingulate cortex (pgACC) and the anterior midcingulate cortex (aMCC) as a control region, with change in depression symptoms after 6 months of weekly psychodynamic psychotherapy sessions in MDD patients. Depressed (N = 45) and healthy (N = 30) subjects participated in a baseline proton magnetic resonance spectroscopy measurement and a subgroup of MDD subjects (N = 21) then received once-a-week psychodynamic psychotherapy and participated in a second proton magnetic resonance spectroscopy measurement after 6 months. Change in depression symptoms was assessed using the Hamilton Depression Rating Scale (HAMD). RESULTS: Higher pretreatment pgACC Gln concentrations in MDD patients compared to healthy controls were associated with symptom severity. Patients and controls did not differ regarding Gln levels in aMCC nor regarding Glu levels in both regions. The association of pgACC Gln concentration and severity of depressive symptoms was reversed after 6 months of psychotherapy in MDD subjects. Regarding Gln in aMCC as well as Glu in both regions, there were no significant associations with improvement of depressive symptoms in the course of psychotherapy. DISCUSSION: Findings indicate specific regional effects of psychodynamic psychotherapy on glutamatergic neurotransmission and thereby highlight the key role of the pgACC in both depression pathophysiology and recovery.

[Can the GroupTherapy "Arriving" Support Refugee Mothers with their Young Children? Results from a Longitudinal Pilot Study]. / "Aacho" ­ ein niederschwelliges gruppentherapeutisches Angebot für geflüchtete Mütter mit Kleinkindern: Ergebnisse einer evaluativen Pilotstudie.

Refugee mothers are exposed to multiple sources of psychological distress given their migration histories and the experience of motherhood in a foreign country and often in social isolation. "Aacho" ("Arriving") is a psychoanalytic-oriented group therapy for refugee mothers with babies and toddlers in Switzerland.The present pilot study evaluated "Aacho" concomitantly and explored changes in the mothers' symptom burden, in the developmental status of their children, and in the quality of mother-child interaction. Five mother-child dyads participated in a longitudinal study with two to three time points. Mothers self-reported on symptomatology (HSCL, HTQ, SSS 8) and the groups' psychotherapists evaluated family functioning levels (HBS-L) and maternal levels of illness (CGI). In addition, the child's developmental level (Bayley-III) and the quality of mother-child interaction (CARE index) were assessed. The symptom burden of the mothers was severe over the entire study period with varying symptom development (decrease/increase). The children's language development tended to be delayed.The quality of mother-child interaction tended to increase over the study period. Refugee mothers with young children often experience severe psychological distress and require psychotherapeutic support that is specifically tailored to them. The evaluation of services offering such support poses specific methodological challenges.

Anticipating control over aversive stimuli is mediated by the medial prefrontal cortex: An fMRI study with healthy adults.

The anticipation of control over aversive events in life is relevant for our mental health. Insights on the underlying neural mechanisms remain limited. We developed a new functional magnetic resonance imaging (fMRI) task that uses auditory stimuli to explore the neural correlates of (1) the anticipation of control over aversion and (2) the processing of aversion. In a sample of 25 healthy adults, we observed increased neural activation in the medial prefrontal cortex (ventromedial prefrontal cortex and rostral anterior cingulate cortex), other brain areas relevant for reward anticipation (ventral striatum, brainstem [ventral tegmental area], midcingulate cortex), and the posterior cingulate cortex when they anticipated control over aversion compared with anticipating no control (1). The processing of aversive sounds compared to neutral sounds (2) was associated with increased neural activation in the bilateral posterior insula. Our findings provide evidence for the important role of medial prefrontal regions in control anticipation and highlight the relevance of conceiving the neural mechanisms involved within a reward-based framework.

Differential Alterations in Resting State Functional Connectivity Associated with Depressive Symptoms and Early Life Adversity.

Depression and early life adversity (ELA) are associated with aberrant resting state functional connectivity (FC) of the default mode (DMN), salience (SN), and central executive networks (CEN). However, the specific and differential associations of depression and ELA with FC of these networks remain unclear. Applying a dimensional approach, here we analyzed associations of FC between major nodes of the DMN, SN, and CEN with severity of depressive symptoms and ELA defined as childhood abuse and neglect in a sample of 83 healthy and depressed subjects. Depressive symptoms were linked to increased FC within the SN and decreased FC of the SN with the DMN and CEN. Childhood abuse was associated with increased FC within the SN, whereas childhood neglect was associated with decreased FC within the SN and increased FC between the SN and the DMN. Our study thus provides evidence for differential associations of depressive symptoms and ELA with resting state FC and contributes to a clarification of previously contradictory findings. Specific FC abnormalities may underlie specific cognitive and emotional impairments. Future research should link specific clinical symptoms resulting from ELA to FC patterns thereby characterizing depression subtypes with specific neurobiological signatures.

Associations of Social and Psychological Resources with Different Facets of Chronic Stress: A Study with Employed and Unemployed Adolescents.

Adolescents navigate many psychosocial changes. A critical transition in adolescence is the one from school to work life. Both taking the first steps in work life and the failure to achieve this transition and being unemployed can engender elevated levels of stress during adolescence. Stress, especially when experienced chronically, is an important risk factor for mental health problems. Social and psychological resources may mitigate the experience of chronic stress. This study explored associations of social and family support, self-esteem, and self-efficacy with different dimensions of chronic stress in a sample of 1405 employed and unemployed adolescents (M(age) = 17.84, SD = 1.63, range: 14.05-26.12) in Switzerland. Unemployed adolescents showed higher stress levels overall. Higher levels of social and psychological resources were generally linked to lower stress levels. Social support and self-esteem predicted stress levels most consistently and strongly. On several stress dimensions, the association between higher self-esteem and lower stress levels was more pronounced in employed youth whereas the association between higher social support and lower stress levels was stronger in unemployed youth. Our findings provide insights on the differential associations of social and psychological resources with various facets of chronic stress in the context of employment and unemployment during adolescence.