Neuroimaging and the pathophysiology and treatment of depression: recent advances and future needs. : Recent advances and future needs

Imaging the human brain still cannot be considered a clinical tool in the field of psychiatry and currently (early 2010) does not contribute directly to the alleviation of patient suffering. However, recent years have witnessed a rapid increase in the number of studies moving us closer to this goal through incorporating neuroimaging techniques into studies of treatment mechanism and prediction of treatment response and those studies taking genotype into account. In addition, the range of neuroimaging modalities and outcome parameters in use, to index abnormalities of the brain, continues to expand and technical developments in the quality of derived parameters and images confer ever increasing levels of sensitivity. Disease models of depression currently include early- and later-life stress including immigration, genetic loading or liability, neurotransmitter system abnormalities, and structural and physiological perturbations that interfere with brain function. It is now indisputable that imaging of the brain has contributed profoundly to the development of the latter 3 models. However, despite these advances in our understanding of depression, imaging has not yet affected clinical monitoring or treatment practices, presaged treatment response, or ultimately affected outcome for patients today. This chapter endeavours to highlight the latest imaging findings that demonstrate the potential to achieve such goals in the near future.