Using real-time fMRI to modulate metacognitive thought processes in patients with recurrent unipolar depression

About 15 per cent of adults experience major depression at some time in their lives. This debilitating mental disorder can cause depressed moods, loss of energy, insomnia and, in severe cases, suicidal ideas and acts. Although current treatments such as antidepressant drugs and psychotherapy help a majority of patients, a significant number of people have a high rate of relapse. In recent years, several cognitive therapies have been developed to try to prevent relapse. One successful method trains patients to increase their ability to reflect on and change the direction of their own thoughts (called meta-cognitive awareness). Depression involves a reduction in certain parts of the brain. Functional Magnetic Resonance Imaging (fMRI) scans show depressed people have abnormally low activity in the front part of the prefrontal cortex, a region of the brain involved in planning cognitive behaviours and pleasure. fMRI scans also show an increased activation in this area of the brain when patients use reflective thinking. Kamyar Keramatian is investigating whether normal subjects and patients with depression can be trained to improve their own brain activation, by combining self-reflective therapy with real-time fMRI; a new tool that allows patients and researchers to see brain activation data as it is collected. If so, this approach could be an effective way to treat people who do not respond to conventional therapies.