Functional Neuroimaging of State, Course, and Symptom Specificity in Affective Psychopathology

Why is one person depressed for three months, while the other is depressed for three years? Does the brain recover after a depressive episode? Does the brain of depressed patients who think about suicide differ from the brain of patients who do not have suicidal thoughts? Does the brain fail to take control over emotions in a similar manner in schizophrenia as in bipolar disorder? These questions formed the basis of this thesis. Findings from this thesis suggest that functional neuroimaging may be used in addition to clinical measures to predict who will recover or who will continue to suffer from depression. Also, findings suggest that after recovery from a depression, the responsivity of the brain recovers to normal and that different symptoms and disorders could be distinguished based on regional brain responses. Based on these findings, we suggest that despite the high costs and limited availability (only in large medical centers) of MRI techniques that restrict their potential use in daily practice, fMRI-markers may play a role in clinical risk assessment and treatment selection. To be of clinical use, future neuroimaging researchers first need to employ new approaches for decoding distributed patterns of brain activity in order to translate functional MRI data into meaningful information at the individual level. This individual approach is especially important considering the large individual differences found in psychiatric disorders.