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A number of studies using a variety of imaging modalities have identified functional abnormalities within the frontal and prefrontal cortex of patients with unipolar depression (Table 45–15) and bipolar disorder (Table 45–16). Compared with nondepressed individuals, patients with unipolar depression have a lateralized decrease in activity in the left lateral prefrontal cortex repeatedly documented by PET and single photon emission computed tomography (SPECT) investigations (Baxter et al. 1985, 1989; Bench et al. 1992; Dolan et al. 1992, 1993; Hurwitz et al. 1990; J. L. Martinot et al. 1990; Navarro et al. 2002), although this finding is apparently not specific to depression and has been seen in patients with schizophrenia (Barch et al. 2003; K. F. Berman et al. 1988; Dolan et al. 1993; Weinberger et al. 1986), depressed patients with Parkinson's disease (Ring et al. 1994) or traumatic brain injury (Jorge et al. 2004), and patients with other neurological diseases with depression as a secondary outcome (Mayberg 1994). Similarly, structural magnetic resonance imaging (MRI) studies have revealed prefrontal cortex abnormalities in unipolar depression, including reduced left subgenual prefrontal cortex volume (Botteron et al. 2002), increased lesion density in medial orbital prefrontal white matter (MacFall et al. 2001), and decreased medial orbitofrontal cortical volume (Ballmaier et al. 2004; Bremner et al. 2002; Lacerda et al. 2004; Monkul et al. 2007). Reductions in left prefrontal gray matter volume have also been reported in patients with bipolar disorder (Lopez-Larson et al. 2002).

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Table Reference Number
TABLE 45–15. Abnormalities of the frontal and prefrontal cortex in unipolar depression by neuroimaging
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TABLE 45–16. Abnormalities of the frontal and prefrontal cortex in bipolar disorder by neuroimaging
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TABLE 45–17. Abnormalities of the subgenual cingulate in depression by neuroimaging
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TABLE 45–18. Abnormalities of the hippocampus in depression by neuroimaging
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TABLE 45–19. Abnormalities of the basal ganglia in unipolar depression by neuroimaging
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TABLE 45–20. Abnormalities of the basal ganglia in bipolar disorder by neuroimaging
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TABLE 45–21. Abnormalities of the amygdala in unipolar depression and bipolar disorder by neuroimaging
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TABLE 45–22. Abnormalities of the thalamus in unipolar depression and bipolar disorder by neuroimaging
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TABLE 45–23. Abnormalities of the pituitary in unipolar depression and bipolar disorder by neuroimaging

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