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J Neuropsychiatry Clin Neurosci 1994; 6:428-442
Copyright © 1994 by American Neuropsychiatric Association
Frontal lobe dysfunction in secondary depression
HS Mayberg
Department of Medicine (Neurology), University of Texas Health Science Center at San Antonio 78284-6240.
Depression is common in patients with neurological disease, particularly
with diseases involving the basal ganglia. Although the mechanisms of mood
disorders in these patients are poorly understood, selective neural
pathways affected directly and indirectly by basal ganglia injury provide a
strategy for examining these patients with functional imaging techniques.
Studies of regional cerebral glucose metabolism by use of positron-emission
tomography are reviewed. These studies demonstrate bilateral hypometabolism
of orbital-inferior prefrontal cortex and anterior temporal cortex in
depressed subjects, independent of disease etiology. This pattern is
similar to that seen in patients with primary unipolar depression. These
findings suggest that disruption of paralimbic pathways linking frontal
cortex, temporal cortex, and striatum may contribute to both primary
depression and depression associated with basal ganglia disease. The
findings support the evolving concept of a neuroanatomical locus for mood
regulation.
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