Study reveals what depression, anxiety look like in the brain

People with depression and social anxiety have some common and specific structural abnormalities in their brains that can be spotted in imaging scans.

This was the major finding of a study from Sichuan University in Chengdu in China, which features this week at the annual meeting of the Radiological Society of North America in Chicago, IL.

The researchers — Dr. Youjin Zhao and co-author Dr. Su Lui — came to their conclusions after examining high-resolution magnetic resonance imaging (MRI) brain scans of 37 people with major depressive disorder (MDD), 24 with social anxiety disorder (SAD), and 41 people in good health (the controls).

They looked for differences in the gray matter of the brain, focusing specifically on the thickness of the cerebral cortex, a thick outer layer of tissue that is densely packed with neurons and deals with most of the brain's information processing.

MDD, commonly referred to as depression, is a serious medical illness characterized by persistent sadness and irritability. It is a leading cause of disease and injury worldwide.

Depression causes people to lose interest in things that they used to enjoy and find fulfilling; in some cases, the illness is so severe that it can be an enormous struggle just to get out of bed. It damages not only the individuals affected but also their families, friends, and communities.

In the United States, depression is a significant public health issue that affects more than 16 million people at any one time and costs the nation some $210 billion a year.

Depression and anxiety often occur together

SAD is an intense fear or anxiety of being judged or rejected in a social situation. The symptoms can be so debilitating that normal life becomes very difficult.
People with SAD struggle to find and keep friends and partners. There are around 15 million adults with SAD in the U.S.

It is not unusual for people diagnosed with depression to also have an anxiety disorder, and the other way around. Nearly half of people diagnosed with depression are also found to have an anxiety disorder.

Dr. Zhao explains that MDD and SAD also have some clinical symptoms in common that might suggest that they share some brain mechanisms. However, she notes that few studies have looked for similarities or differences in brain structure of people affected by MDD and SAD.
In their study, they found that the MDD and SAD patients had similar and different alterations in the thickness of parts of the cortex. Some of the alterations related to a thickening, while others to a thinning, of the affected region.

For example, both conditions showed differences in the "salience and dorsal attention networks" compared with the healthy controls. These two networks comprise brain regions that help to decide what we pay attention to and focus on from the wealth of stimuli around us.

Another area of the cortex, the insular cortex, a region that is important for perception and self-awareness, also appeared to be thicker in both the MDD and SAD patients compared with the controls.

What do the results mean?

The researchers say it is not clear what their findings mean. For instance, another area of the cortex that appears to be thicker in MDD and SAD patients is the anterior cingulate cortex, which is linked to emotion.

It is possible, says Dr. Zhao, "that a greater cortical thickness may reflect a compensatory mechanism that is related to inflammation or other aspects of the pathophysiology."
But there could be another reason, she explains: "Greater anterior cingulate cortical thickness could be the result of both the continuous coping efforts and emotion regulation attempts of MDD and SAD patients."

The researchers also found that patients with SAD had structural differences in their "fear circuitry," and that the MDD patients had differences in the region that contains the "visual recognition network."

Changes to the visual recognition network might explain why people with MDD sometimes have difficulty with selective attention and working memory, says Dr. Zhao.