"The Heart Asks Pleasure First"-Conceptualizing Psychiatric Diseases as

MAINTENANCE OCD SEEKING TRD brain networks deep brain stimulation dopamine major depression reward system treatment resistant depression

Journal

Brain sciences
ISSN: 2076-3425
Titre abrégé: Brain Sci
Pays: Switzerland
ID NLM: 101598646

Informations de publication

Date de publication:
25 Mar 2022
Historique:
received: 06 02 2022
revised: 23 03 2022
accepted: 24 03 2022
entrez: 21 4 2022
pubmed: 22 4 2022
medline: 22 4 2022
Statut: epublish

Résumé

More than a decade ago, deep brain stimulation (DBS) of the superolateral medial forebrain bundle (slMFB), as part of the greater MFB system, had been proposed as a putative yet experimental treatment strategy for therapy refractory depression (TRD) and later for obsessive-compulsive disorders (OCD). Antidepressant and anti-OCD efficacy have been shown in open case series and smaller trials and were independently replicated. The MFB is anato-physiologically confluent with the SEEKING system promoting euphoric drive, reward anticipation and reward; functions realized through the mesocorticolimbic dopaminergic system. Growing clinical experience concerning surgical and stimulation aspects from a larger number of patients shows an MFB functionality beyond SEEKING and now re-informs the scientific rationale concerning the MFB's (patho-) physiology. In this white paper, we combine observations from more than 75 cases of slMFB DBS. We integrate these observations with a selected literature review to provide a new neuroethological view on the MFB. We here formulate a re-interpretation of the MFB as the main structure of an integrated SEEKING/MAINTENANCE circuitry, allowing for individual homeostasis and well-being through emotional arousal, basic and higher affect valence, bodily reactions, motor programing, vigor and flexible behavior, as the basis for the antidepressant and anti-OCD efficacy.

Identifiants

pubmed: 35447971
pii: brainsci12040438
doi: 10.3390/brainsci12040438
pmc: PMC9028695
pii:
doi:

Types de publication

Journal Article

Langues

eng

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Auteurs

Volker A Coenen (VA)

Department of Stereotactic and Functional Neurosurgery, Medical Center of Freiburg University, 79106 Freiburg, Germany.
Medical Faculty, Freiburg University, 79106 Freiburg, Germany.
Center for Deep Brain Stimulation, Medical Center of Freiburg University, 79106 Freiburg, Germany.
Laboratory of Stereotaxy and Interventional Neurosciences, Department of Stereotactic and Functional, Neurosurgery, Medical Center of Freiburg University, 79106 Freiburg, Germany.

Thomas E Schlaepfer (TE)

Medical Faculty, Freiburg University, 79106 Freiburg, Germany.
Center for Deep Brain Stimulation, Medical Center of Freiburg University, 79106 Freiburg, Germany.
Department of Interventional Biological Psychiatry, Medical Center of University of Freiburg, 79106 Freiburg, Germany.

Bastian E A Sajonz (BEA)

Department of Stereotactic and Functional Neurosurgery, Medical Center of Freiburg University, 79106 Freiburg, Germany.
Medical Faculty, Freiburg University, 79106 Freiburg, Germany.

Peter C Reinacher (PC)

Department of Stereotactic and Functional Neurosurgery, Medical Center of Freiburg University, 79106 Freiburg, Germany.
Medical Faculty, Freiburg University, 79106 Freiburg, Germany.
Fraunhofer Institute for Laser Technology (ILT), 52074 Aachen, Germany.

Máté D Döbrössy (MD)

Department of Stereotactic and Functional Neurosurgery, Medical Center of Freiburg University, 79106 Freiburg, Germany.
Medical Faculty, Freiburg University, 79106 Freiburg, Germany.
Laboratory of Stereotaxy and Interventional Neurosciences, Department of Stereotactic and Functional, Neurosurgery, Medical Center of Freiburg University, 79106 Freiburg, Germany.
Faculty of Biology, University of Freiburg, 79104 Freiburg, Germany.

Marco Reisert (M)

Department of Stereotactic and Functional Neurosurgery, Medical Center of Freiburg University, 79106 Freiburg, Germany.
Medical Faculty, Freiburg University, 79106 Freiburg, Germany.
Department of Diagnostic and Interventional Radiology, Medical Physics, Medical Center of University of Freiburg, 79106 Freiburg, Germany.

Classifications MeSH