Altered neural activities during emotion regulation in depression: a meta-analysis

Abstract

Background: Deficient neural activities during emotion regulation have been reported in depression. We sought to conduct a meta-analysis to provide a comprehensive description of these neural alterations during use of emotion regulation strategies among patients with depression, including major depressive disorder (MDD) and bipolar disorder (BD).

Methods: We identified neuroimaging studies of abnormal neural activities during emotion regulation in depression. We extracted the peak coordinates and effect sizes of differences in brain activity between patients and healthy controls. Using seed-based d mapping, we conducted voxel-wise meta-analyses of the neural activation pattern differences between the 2 groups across conditions involving emotion regulation and those where emotion regulation was not needed.

Results: We included 33 studies reporting 34 data sets, including 23 involving MDD (571 people with MDD and 578 matched controls) and 11 involving BD (358 people with BD and 369 matched controls). Overall, compared with controls, patients with depression showed hyperactivity in the insula and postcentral gyrus, and hypoactivity in the prefrontal part of the inferior, middle, and superior frontal gyrus, the middle temporal gyrus, and the supplementary motor area. In subgroup analyses, data from patients with MDD and studies focused on decreasing negative emotions or using the emotional strategy of reappraisal reported specific hypoactivity in the middle cerebellar peduncles.

Limitations: Given limited studies involving patients with BD, we were unable to detect the common and distinct abnormalities in neural activation between MDD and BD. We did not conduct any meta-regression analyses because of limited information.

Conclusion: In this meta-analysis, we identified hyperactivity in brain regions associated with emotional experience and hypoactivity in brain regions associated with cognitive control during emotion regulation among patients with depression, relative to healthy controls. These findings could help indicate a target for future interventions aimed at increasing emotion regulation capacity for patients with depression.

Figure 1

Study flow diagram. CBT = cognitive behavioural therapy; fMRI = functional magnetic rseonance imaging; ROI = region of interest.

Figure 2

Regional differences of task-evoked activation between patients with depression and healthy controls, including (A) all patients with depression versus healthy controls (HCs) during emotion regulation, (B) patients with major depressive disorder (MDD) versus HCs during emotion regulation, (C) all patients with depression versus HCs while decreasing negative emotions, and (D) all patients with depression versus HCs during use of reappraisal strategy to regulate emotions. Areas with decreased activity are displayed in blue and areas with increased activity are displayed in red. The colour bar indicates the maximum and minimum seed-based d mapping (SDM) z values. Supporting data are presented in Table 2.