It is poorly understood how stressors modulate neurobiological mechanisms that may contribute to the heterogeneity of Major Depressive Disorder (MDD). Unmedicated patients diagnosed with MDD (n = 15) and individually matched healthy controls (n = 15) completed stress questionnaires and were studied with functional magnetic resonance imaging while viewing emotional words. Significant effects of recent negative life stressors, but not early life stress/trauma, were observed on regional blood oxygen level dependent activity during presentation of negative words in patients with MDD. No significant effects of stress on brain activation to negative words were found in controls. In MDD patients, positive correlations were found bilaterally in orbitofrontal areas 11l/47/12m, which are involved in representing negatively-valenced stimuli. Negative correlations were also found in the right ventrolateral prefrontal area 45, subgenual cingulate area 25, and nucleus accumbens, all of which are implicated in the pathophysiology of MDD. Negative memory bias was additionally positively associated with recent negative life stress and negatively associated with subgenual cingulate activation, suggesting a mechanism by which stress may contribute to these abnormalities. The severity of recent negative life stressors is an important modifier of neurobiological and cognitive function in MDD and may help explain heterogeneity in the disorder.

Objective

The endogenous opioid system and μ-opioid receptors are known to interface environmental events, both positive (e.g., relevant emotional stimuli) and negative (e.g., stressors) with pertinent behavioral responses, regulating motivated behavior. Here we examined the degree to which trait impulsiveness, the tendency to act on cravings and urges rather than delaying gratification, is predicted by either baseline μ-opioid receptor availability or the response of this system to a standardized, experientially-matched stressor.

Method

Nineteen (19) young healthy male volunteers completed a personality questionnaire (NEO PI-R) and positron emission tomography scans with the μ-opioid receptor selective radiotracer [11C]carfentanil. Measures of receptor concentrations were obtained at rest and during the receipt of an experimentally maintained pain stressor of matched intensity between subjects. Baseline receptor levels and stress-induced activation of μ-opioid neurotransmission were compared between subjects scoring above and below the population median of the NEO impulsiveness subscale and the orthogonal dimension, deliberation, expected to interact with it.

Results

High impulsiveness and low deliberation scores were associated with significantly higher regional μ-opioid receptor concentrations and greater stress-induced endogenous opioid system activation. Effects were obtained in regions involved in motivated behavior and the effects of drugs of abuse: prefrontal and orbitofrontal cortex, anterior cingulate, thalamus, nucleus accumbens and basolateral amygdala. Mu-opioid receptor availability, and the magnitude of stress-induced endogenous opioid activation in these regions accounted for 21 to 49% of the variance in these personality traits.

Conclusions

Our data demonstrate that individual differences in the function of the endogenous μ-opioid system predicts personality traits that confer vulnerability or resiliency for risky behaviors, such as the predisposition to develop substance use disorders. These personality traits are also implicated in psychopathological states (e.g., personality disorders), where variations in the function of this neurotransmitter system may play a role as well.

The serotonergic system, including the serotonin 1A (5-HT1A) receptor, has been implicated in the pathophysiology of a number of neuropsychiatric disorders. Current data shows substantial inter-individual variation in the regional concentration of this receptor site, the source of which is unclear. Monoamine oxidase A (MAO-A) is a key regulator of serotonin metabolism, and polymorphic variation in the X-linked MAO-A gene influences its expression. We hypothesized that polymorphism in the MAO-A gene would be associated with sex-specific variation in 5-HT1A receptor expression. We used positron emission tomography and [11C]WAY-100635 to quantify 5-HT1A receptors in a group of 31 healthy and un-medicated depressed individuals. The same individuals were genotyped for an upstream variable number tandem repeat polymorphism in the promoter of the MAO-A gene. Analysis of variance of 5-HT1A receptor availability demonstrated a significant effect of MAO-A genotype in the raphe nuclei, medial and inferior temporal cortex, insula, medial prefrontal cortex, and anterior cingulate (p<0.05). The effect persisted when age, race, body mass index, and diagnosis were included in the model. Genotypes with greater putative MAO-A activity were associated with greater 5-HT1A receptor availability in women, but not in men. Genotype predicted a substantial 42-74% of the variance in receptor availability in women, depending on the brain region (p<0.05). Depression diagnosis was not associated with MAO-A genotype or 5-HT1A receptor availability in these regions. These results demonstrate a sex-specific interaction between two key molecules of the human serotonergic system, and suggest a neurobiological basis for sexual dimorphism in serotonin-modulated phenotypes.

Dopamine (DA) neurotransmission through D2 receptors (DRD2) has been implicated in the regulation of reward processing, cognition and the effects of drugs of abuse, and also has significant effects in responses to stressors and salient aversive stimuli. An examination of the influence of genetic variation across multiple psychophysical measures therefore appears critical to understand the neurobiology of DA-modulated complex personality traits and psychiatric illnesses. To examine interindividual variation in the function of DRD2 modulated mechanisms in healthy humans, we used a haplotype-based and single nucleotide polymorphism (SNP) investigation. Their effects were interrogated with functional magnetic resonance imaging (fMRI) during reward and emotional processing. We found that a haplotype block composed by two SNPs, rs4274224 and rs4581480, affected the hemodynamic responses of the dorsolateral prefrontal cortex (DLPFC) during reward expectation and the subgenual anterior cingulate cortices (sgACC) during implicit emotional processing. Exploratory analysis within the significant haplotype block revealed the same functional effects only for the SNP rs4274224. Further analysis on rs4274224 using functional connectivity and positron emission tomography (PET) measures of DA D2/3 receptor mediated neurotransmission confirmed a gene effect on the functional connectivity of the DLPFC during reward anticipation and subcortical stress induced dopamine release. At a phenotypic trait level, significant effects of genotype were obtained for the NEO PI-R “Openness to Experience” and further correlated with neuroimaging data. Overall, these results show significant neurobiological effects of genotype variation in DRD2 on multiple functional domains, such as emotional, stress and reward processing. As such, it contributes to normal variation and potentially to vulnerability to psychopathology associated with those functions, such as risk for mood and substance use disorders.

Children of alcoholics (COAs) are at elevated risk to develop alcohol and other substance use disorders. The neurobiological underpinnings of this heightened vulnerability are presently not well understood. This study investigated whether, in humans, COAs have different functioning of the mesolimbic reward circuitry beyond prior substance use confounds, and examined potential group differences in neural response in relation to alcohol use and behavioral risk. We studied twenty 18 to 22 year-old COAs and 20 controls, developmentally well-characterized for substance use and selected to match on sex, age, IQ, lifetime substance use and associated problems, and precursive (age 12–14) externalizing behavioral risk. None met criteria for DSM-IV diagnosis. Neural responses to anticipation of reward and loss were assessed using functional magnetic resonance imaging during a monetary incentive delay task. Overall, COAs showed reduced ventral striatum activation during anticipation of monetary reward and loss compared to controls. However, further analysis revealed that blunted nucleus accumbens (NAcc) response was only observed in COAs who have not demonstrated any problem drinking behavior. In addition, uniquely in COAs, NAcc activation was positively correlated with precursive externalizing risk, as well as current and lifetime alcohol consumption. These findings suggest a multilevel developmental process whereby lower precursive behavioral risk appears protective of later problem alcohol use in COAs, which is further associated with a blunted NAcc response to incentive anticipation, potentially reflecting a resilience mechanism. Moreover, the results suggest a close association between motivational responses, alcohol consumption, and behavioral risk, may underlie addiction vulnerability in COAs.

Poor impulse inhibition is associated with behavioral problems including aggression and violence as well as clinical diagnoses such as attention deficit hyperactivity disorder (ADHD) and substance abuse, all of which are more prevalent in men than women. Studies have found that fronto-parietal and fronto-striatal-thalamic networks are critical for successful impulse inhibition. However, few studies have investigated neural differences in these networks between men and women. In this study, we use a well established behavioral task, the parametric Go/noGo task, to explore the relationships between brain regional activity during impulse control and impulsivity trait measures, as well as sex differences in these relationships. We found that males showed heightened activation of the rostral anterior cingulate, which correlated with ratings related to impulsivity. We also found that the activation/deactivation in males and females correlates with personality ratings in a sex-specific manner.

Mesoaccumbal and nigrostriatal projections are sensitive to stress, and heightened stress sensitivity is thought to confer risk for neuropsychiatric disorders. Serotonin 2C (5-HT2C) receptors mediate the inhibitory effects of serotonin on dopaminergic circuitry in experimental animals, and preclinical findings have implicated 5-HT2C receptors in motivated behaviors and psychotropic drug mechanisms. In humans, a common missense single-nucleotide change (rs6318, Cys23Ser) in the 5-HT2C receptor gene (HTR2C) has been associated with altered activity in vitro and with clinical mood disorders. We hypothesized that dopaminergic circuitry would be more sensitive to stress in humans carrying the Ser23 variant. To test this hypothesis, we studied 54 healthy humans using positron emission tomography and the displaceable D2/D3 receptor radiotracer [11C]raclopride. Binding potential (BPND) was quantified before and after a standardized stress challenge consisting of 20 minutes of moderate deep muscular pain, and reduction in BPND served as an index of dopamine release. The Cys23Ser variant was genotyped on a custom array, and ancestry informative markers were used to control for population stratification. We found greater dopamine release in the nucleus accumbens, caudate nucleus, and putamen among Ser23 carriers, after controlling for sex, age, and ancestry. Genotype accounted for 12% of the variance in dopamine release in the nucleus accumbens. There was no association of Cys23Ser with baseline BPND. These findings indicate that a putatively functional HTR2C variant (Ser23) is associated with greater striatal dopamine release during pain in healthy humans. Mesoaccumbal stress sensitivity may mediate the effects of HTR2C variation on risk of neuropsychiatric disorders.

Cushing syndrome (CS) is the classic condition of cortisol dysregulation, and cortisol dysregulation is the prototypic finding in Major Depressive Disorder (MDD). We hypothesized that subjects with active CS would show dysfunction in frontal and limbic structures relevant to affective networks, and also manifest poorer facial affect identification accuracy, a finding reported in MDD.Twenty-one patients with confirmed CS (20 ACTH-dependent and 1 ACTH-independent) were compared to 21 healthy controlsubjects. Identification of affective facial expressions (Facial Emotion Perception Test) was conducted in a 3 Tesla GE fMRI scanner using BOLD fMRI signal. The impact of disease (illness duration, current hormone elevation and degree of disruption of circadian rhythm), performance, and comorbid conditions secondary to hypercortisolemia were evaluated.CS patients made more errors in categorizing facial expressions and had less activation in left anterior superior temporal gyrus, a region important in emotion processing. CS patients showed higher activation in frontal, medial, and subcortical regions relative to controls. Two regions of elevated activation in CS, left middle frontal and lateral posterior/pulvinar areas, were positively correlated with accuracy in emotion identification in the CS group, reflecting compensatory recruitment. In addition, within the CSgroup, greater activation in left dorsal anterior cingulatewas related to greater severity of hormone dysregulation. In conclusion, cortisol dysregulation in CS patients is associated with problems in accuracy of affective discrimination and altered activation of brain structures relevant to emotion perception, processing and regulation, similar to the performance decrements and brain regions shown to be dysfunctional in MDD.

Despite considerable evidence for potential effects of estrogen on emotional processing, several studies of postmenopausal women who began hormone therapy (HT) remote from menopause report no effects of HT on emotional measures. As early HT initiation may preserve brain mechanisms, we examined effects of HT on emotional processing in postmenopausal women who started HT early after menopause. We performed a cross-sectional comparison of 52 postmenopausal women 66±5 years old, including 15 users of conjugated equine estrogen, 20 users of conjugated equine estrogen plus medroxyprogesterone acetate, and 17 who never used hormones (NT). All hormone users started therapy within two years of menopause, and received at least 10 years of continuous therapy. Outcomes were fMRI-detected brain activity and behavioral measures during an emotional processing picture rating task. During processing of positive pictures, NT women had greater activation than estrogen treated women in medial prefrontal cortex extending to the anterior cingulate, and more activation than estrogen plus progestin treated women in the insula. During processing of negative pictures, estrogen treated women had higher activation than NT women in the entorhinal cortex. Current compared to past HT users showed greater activation in the hippocampus and higher emotion recognition accuracy of neutral stimuli. Estrogen plus progestin treated women had slower response time than NT women when rating all pictures. In conclusion, hormone use was associated with differences in brain functional responses during emotional processing. These fMRI effects were more prominent than those observed for behavioral measures and involved brain regions implicated in cognitive-emotional integration.

We developed a unique protocol where transcranial direct current stimulation (tDCS) of the motor cortex is performed during positron emission tomography (PET) scan using a μ-opioid receptor (μOR) selective radiotracer, [11C]carfentanil. This is one of the most important central neuromechanisms associated with pain perception and regulation. We measured μOR non-displaceable binding potential (μOR BPND) in a trigeminal neuropathic pain patient (TNP) without creating artifacts, or posing risks to the patient (e.g., monitoring of resistance). The active session directly improved in 36.2% the threshold for experimental cold pain in the trigeminal allodynic area, mandibular branch, but not the TNP patient’s clinical pain. Interestingly, the single active tDCS application considerably decreased μORBPND levels in (sub)cortical pain-matrix structures compared to sham tDCS, especially in the posterior thalamus. Suggesting that the μ-opioidergic effects of a single tDCS session are subclinical at immediate level, and repetitive sessions are necessary to revert ingrained neuroplastic changes related to the chronic pain. To our knowledge, we provide data for the first time in vivo that there is possibly an instant increase of endogenous μ-opioid release during acute motor cortex neuromodulation with tDCS.

Predicting the trajectories of moving objects in our surroundings is important for many life scenarios, such as driving, walking, reaching, hunting and combat. We determined human subjects’ performance and task-related brain activity in a motion trajectory prediction task. The task required spatial and motion working memory as well as the ability to extrapolate motion information in time to predict future object locations. We showed that the neural circuits associated with motion prediction included frontal, parietal and insular cortex, as well as the thalamus and the visual cortex. Interestingly, deactivation of many of these regions seemed to be more closely related to task performance. The differential activity during motion prediction vs. direct observation was also correlated with task performance. The neural networks involved in our visual motion prediction task are significantly different from those that underlie visual motion memory and imagery. Our results set the stage for the examination of the effects of deficiencies in these networks, such as those caused by aging and mental disorders, on visual motion prediction and its consequences on mobility related daily activities.

The first implementation of real-time acquisition and analysis of Arterial Spin Labeling (ASL) based functional MRI time series is presented in this article. The implementation uses a pseudo-continuous labeling scheme followed by a spiral k-space acquisition trajectory. Real-time reconstruction of the images, preprocessing and regression analysis of the fMRI data were implemented on a laptop computer interfaced with the MRI scanner. The method allows the user to track the current raw data, subtraction images, and the cumulative t-statistic map overlaid on a cumulative subtraction image. The user is also able to track the time course of individual time courses, and interactively select an ROI as a nuisance covariate. The pulse sequence allows the user to adjust acquisition and labeling parameters while observing their effect on the image within two successive TRs. This method is illustrated on a stimulation paradigm consisting of simultaneous finger-tapping and visual stimulation and on a bimanual finger tapping task alternating hands.

Genetic factors, externalizing personality traits such as impulsivity, and brain processing of salient stimuli all can affect individual risk for alcoholism. One of very few confirmed genetic association findings differentiating alcoholics from non-alcoholics is with variants in the inhibitory gamma-amino butyric acid α2 receptor subunit (GABRA2) gene. Here we report the association of two of these GABRA2 variants with measures of alcohol symptoms, impulsivity and with insula cortex activation during anticipation of reward or loss using functional magnetic resonance imaging (fMRI).

In a sample of 173 families (449 subjects), 129 of whom had at least one member diagnosed with alcohol dependence or abuse, carriers for the G allele in two SNPs and haplotypes were more likely to have alcohol dependence symptoms (rs279858 p = 0.01; rs279826 p = 0.05; haplotype p = 0.02) and higher NEO-PI-R Impulsiveness scores (rs279858 p = 0.016; rs279826 p = 0.012; haplotype p = 0.032) with a stronger effect in females (rs279858 p = 0.011; rs279826 p = 0.002; haplotype p = 0.006), all p values are corrected for family history and age. A subset of offspring from these families (n = 44, 20 females), genotyped for GABRA2, participated in an fMRI study using a monetary incentive delay task. Increased insula activation during reward (r2 = 0.4; p = 0.026) and loss (r2 = 0.38; p = 0.039) anticipation was correlated with NEO-PI-R Impulsiveness and further associated with the GG genotype for both SNPs (ps’ < 0.04). Our results suggest that GABRA2 genetic variation is associated with Impulsiveness through variation of insula activity responses, here evidenced during anticipatory responses.

Capsule

Using a randomized, double-blind placebo-controlled cross-over design, we showed that short-term hormone replacement therapy increases brain activation in parietal and prefrontal areas during verbal memory tasks in postmenopausal women.

Objective

To study the effects of hormone therapy on brain activation patterns during verbal memory in postmenopausal women.

Design

A randomized, double-blind placebo-controlled cross-over study was performed.

Setting

A tertiary care university medical center.

Participants

Ten healthy postmenopausal women (age range 50-60 years) were recruited from the local community.

Interventions

Women were randomized to the order they received combined hormone therapy, 5 ug ethinyl estradiol and 1 mg norethindrone acetate, and placebo. Volunteers received hormone therapy or placebo for 4 weeks, followed by a one month washout period, and then received the other treatment for 4 weeks. An fMRI was performed at the end of each 4 week treatment utilizing a verbal memory task.

Main Outcome Measure

Brain activation patterns were compared between hormone therapy and placebo.

Results

Hormone therapy was associated with increased activation in left middle/superior frontal cortex (BA 6,9), medial frontal cortex and dorsal anterior cingulate (BA 24,32), posterior cingulate (BA 6), and left inferior parietal (BA 40) during memory encoding. All regions were significant at p ≤ 0.05 with correction for multiple comparisons.

Conclusions

Hormone therapy increased neural activation in frontal and parietal areas in postmenopausal women during a verbal memory task.

The corticotropin-releasing hormone (CRH) system coordinates neuroendocrine and behavioral responses to stress and has been implicated in the development of major depressive disorder (MDD). Recent reports suggest that GG-homozygous individuals of a single nucleotide polymorphism (rs110402) in the CRH receptor 1 (CRHR1) gene show behavioral and neuroendocrine evidence of stress vulnerability. The present study explores whether those observations extend to the neuronal processing of emotional stimuli in humans. CRHR1 was genotyped in 83 controls and preliminary sample of 16 unmedicated patients with MDD who completed a functional magnetic resonance imaging scan while viewing blocks of positive, negative, and neutral words. In addition, potential mediating factors such as early life stress, sex, personality traits, and negative memory bias were examined. Robust differences in blood oxygenation-level dependent (BOLD) signal were found in healthy controls (A allele carriers > GG-homozygotes) while viewing negative versus neutral words in the right middle temporal/angular gyrus. Among GG-homozygotes, BOLD signal in the subgenual cingulate was greater in MDD participants (n = 9) compared to controls (n = 33). Conversely, among A-carriers, BOLD signal was smaller in MDD (n = 7) compared to controls (n = 50) in the hypothalamus, bilateral amygdala, and left nucleus accumbens. Early life stress, personality traits, and levels of negative memory bias were associated with brain activity depending on genotype. Results from healthy controls and a preliminary sample of MDD participants show that CRHR1 SNP rs110402 moderates neural responses to emotional stimuli, suggesting a potential mechanism of vulnerability for the development of MDD.

Context

Pain problems are exceedingly prevalent among psychiatric patients. Moreover, clinical impressions and neurobiological research suggest that physical and psychological aspects of pain are closely related entities. Nonetheless, remarkably few pain-related themes are presently included in psychiatric residency training.

Objective

Our objective is twofold: (1) to provide clinical and scientific rationale for psychiatric training enrichment with basic tenets of pain medicine and (2) to raise the awareness and sensitivity of clinicians, scientists and educators alike to the important yet unmet clinical and public health need.

Results

Three lines of translational research evidence, extracted from the comprehensive literature review, are presented in support of the objective. First, the neuroanatomical and functional overlap between pain and emotion/reward/motivation brain circuits suggests integration and mutual modulation of these systems. Second, psychiatric disorders are commonly associated with alterations in pain processing, whereas chronic pain may impair emotional and neurocognitive functioning. Third, pain may serve as a functional probe for unraveling pathophysiological mechanisms inherent in psychiatric morbidity given its stressful nature for the organism.

Conclusions

Pain training in psychiatry will not only contribute to deeper and more sophisticated insights into pain syndromes but also into psychiatric morbidity at large regardless of patients’ pain status. Furthermore, it will ease artificial boundaries separating psychiatric and medical formulations of brain disorders, thus fostering cross-fertilizing interactions between specialists in various disciplines entrusted with the care of pain patients.

Background

Parental alcoholism substantially raises risk for offspring alcoholism, an effect thought to be mediated by a dysregulation in impulse control. Adult alcoholics have alterations in the frontostriatal system involved in regulating impulsive responses. However, it remains controversial whether these alterations reflect pre-existing traits predisposing to problem alcohol use, or are secondary to alcohol involvement.

Methods

Sixty-one 16 to 22 year olds were tested using a go/no-go task during functional MRI. Forty-one had at least one parent with a diagnosis of alcohol use disorder (AUD; FH+) and 20 had no parent with AUD (FH−). Two FH+ subgroups were created to disentangle alcohol involvement from preexisting risk: the FH+ control (n=20) group had low alcohol problems, differing from the FH− group only by family history. The FH+ problem group (n=21) had high alcohol problems.

Results

The ventral caudate deactivated during successful inhibition in the FH− but not the FH+ groups, regardless of problem alcohol involvement. Regression analyses showed that ventral caudate deactivation was related to fewer externalizing problems as well as family history. Orbital and left medial prefrontal regions were deactivated in both the FH− and FH+ control groups but not the FH+ problem group. Activation in these regions was associated with alcohol and other drug use.

Conclusions

These findings suggest a preexisting abnormality in ventral striatal function in youth at risk for AUD, which may lead to inappropriate motivational responding; and suggest that with alcohol use, the prefrontal “control” mechanism loses efficiency, further dysregulating the frontostriatal motivational circuitry.

Objective

Cognitive benefit of postmenopausal hormone use is controversial; however, timing treatment close to menopause may increase the likelihood of preserving cognitive function. We examined effects of early-initiation hormone use on visual working memory, hypothesizing that long-term hormone use is associated with greater brain activation during visual working memory.

Methods

This is a cross-sectional comparison of long-term early hormone users – current (n=13) and past (n=24, 2.1±1.0 years off hormones) – to never-users (n=18), using a visual memory task and functional MRI. We evaluated 55 women over age 60 at the University of Michigan’s General Clinical Research Center. Hormone users had completed at least ten continuous years of conjugated equine estrogens with or without medroxyprogesterone acetate, began within two years of menopause. Women were excluded for illness, medication, intermittent estrogen use, phytoestrogen use, recent smoking, and MRI contraindications. The primary outcome was functional MRI-detected brain activity during the visual memory task.

Results

Compared to never-users, both hormone-user groups had increased activation in the frontal and parietal cortices, insula, hippocampus, and cingulate; combined hormone-users also had increased activation in the putamen and raphe (corrected p<0.05 or uncorrected p<0.001 with a priori hypothesis). Across the entire sample, medial temporal cortex (p<0.000 right; p<0.018 left) and right hippocampus (p<0.000) positively correlated with task performance.

Conclusions

Hormone use was associated with increased brain activation during the visual memory task, in regions used for visual working memory. A positive correlation between activation and task performance suggests that early-initiated long-term postmenopausal hormone use may benefit visual working memory.

With the dawn of the 21st Century, imaging has assumed a new role in disease-oriented science. Regarding pain, the emphasis clearly turned from structural to functional imaging with functional molecular imaging assuming the leading edge. This trend parallels the efforts of biologists working to understand the molecular messages of cell and cell systems’ of relevance to human disease processes. While originally imaging has been a stand-alone, documentary tool, today’s metabolic and molecular imaging technologies provide quantitative insight into inter-and intra-individual pathogenetic processes of relevance to human disease, complementing and expanding upon bench-type research. Imaging has become an indispensable tool in pain research.

The present study resolves some of the discrepancies in the literature by correlating the effects of tobacco smoking on hormone release with venous plasma nicotine levels. Cortisol, prolactin, and β-endorphin concentrations were measured. Habitual male tobacco users smoked denicotinized (very low nicotine) and average nicotine cigarettes in the A.M. after overnight tobacco abstinence. Several venous blood samples were withdrawn before and during the smoking sessions for subsequent analyses. The increases in plasma nicotine correlated well with plasma cortisol and prolactin levels (correlation coefficients r = 0.66 and 0.53, respectively, p< 0.05). This study quantifies the well known increase in plasma cortisol and prolactin after nicotine postsmoking for about 1 hr with peak plasma levels up to 35 ng/ml. Contrary to most abused drugs which release dopamine and decrease prolactin, nicotine concentration correlated with increased prolactin release. Increases in maximal plasma β-endorphin levels following tobacco smoking were barely statistically significant with insufficient data to obtain a correlation coefficient.

Objective

To study the effects of combination hormone therapy (HT) on emotional processing in postmenopausal women using functional neuroimaging.

Design

A randomized, double-blind placebo-controlled cross-over study was performed.

Setting

A tertiary care university medical center.

Participants

Ten healthy postmenopausal women (mean age 56.9 years, S.D. = 1.4) were recruited.

Interventions

Women were randomized to the order they received combined hormone therapy, 5 ug ethinyl estradiol and 1 mg norethindrone acetate, and placebo. Volunteers received hormone therapy or placebo for 4 weeks, followed by a one month washout period, and then received the other treatment for 4 weeks. Subjects participated in an fMRI emotional processing task, where they were asked to rate emotional pictures as positive, negative, or neutral.

Main Outcome Measure

Brain activation patterns were compared between hormone therapy and placebo conditions within subjects.

Results

During negative emotional presentations, after subtracting the effect of neutral images, areas of significant differences between HT and placebo conditions were identified in the orbital, frontal, cingulate and occipital cortices. During positive emotional image presentation there were significant differences between placebo and HT conditions within the medial frontal cortex.

Conclusions

Short-term menopausal treatment with combination hormone therapy affects regional brain activity within areas implicated in emotional processing.

Background

One of the principal theories regarding the biological basis of Major Depressive Disorder (MDD) implicates a dysregulation of emotion processing circuitry. Gender differences in how emotions are processed and relative experience with emotion processing might help to explain some of the disparities in the prevalence of MDD between women and men. The current study sought to explore how gender and depression status relate to emotion processing.

Methods

This study employed a 2 (MDD status) × 2 (gender) factorial design to explore differences in classifications of posed facial emotional expressions (N = 151).

Results

For errors, there was an interaction between gender and depression status. Women with MDD made more errors than did non-depressed women and men with MDD, particularly for fearful and sad stimuli (ps < .02), which they were likely to misinterpret as angry (ps < .04). There was also an interaction of diagnosis and gender for response cost for negative stimuli, with significantly greater interference from negative faces present in women with MDD compared with non-depressed women (p = .01). Men with MDD, conversely, performed similarly to control men (p = .61).

Conclusions

These results provide novel and intriguing evidence that depression in younger adults (< 35 years) differentially disrupts emotion processing in women as compared to men. This interaction could be driven by neurobiological and social learning mechanisms, or interactions between them, and may underlie differences in the prevalence of depression in women and men.

Controversy remains regarding the mechanisms of acupuncture analgesia. A prevailing theory, largely unproven in humans, is that it involves the activation of endogenous opioid antinociceptive systems and μ-opioid receptors (MORs). This is also a neurotransmitter system that mediates the effects of placebo-induced analgesia. This overlap in potential mechanisms may explain the lack of differentiation between traditional acupuncture and either non-traditional or sham acupuncture in multiple controlled clinical trials. We compared both short- and long-term effects of traditional Chinese acupuncture (TA) versus sham acupuncture (SA) treatment on in vivo MOR binding availability in chronic pain patients diagnosed with fibromyalgia (FM). Patients were randomized to receive either TA or SA treatment over the course of four weeks. Positron emission tomography (PET) with 11C-carfentanil was performed once during the first treatment session and then repeated a month later following the eighth treatment. Acupuncture therapy evoked short-term increases in MOR binding potential, in multiple pain and sensory processing regions including the cingulate (dorsal and subgenual), insula, caudate, thalamus, and amygdala. Acupuncture therapy also evoked long-term increases in MOR binding potential in some of the same structures including the cingulate (dorsal and perigenual), caudate, and amygdala. These short- and long-term effects were absent in the sham group where small reductions were observed, an effect more consistent with previous placebo PET studies. Long-term increases in MOR BP following TA were also associated with greater reductions in clinical pain. These findings suggest that divergent MOR processes may mediate clinically relevant analgesic effects for acupuncture and sham acupuncture.

Objective

To test whether black cohosh (BC) exhibits an action on the central endogenous opioid system in postmenopausal women.

Design

A mechanistic study conducted in the same individuals of LH pulsatility with a saline/naloxone (NAL) challenge (n=6) and PET imaging with [11C]carfentanil, a selective μ-opioid receptor radioligand (n= 5), before and after 12 weeks of unblinded treatment with a popular black cohosh daily supplement.

Results

Black cohosh treatment for 12 weeks at a standard dose (Remifemin, 40 mg/day) had no effect on spontaneous LH pulsatility or estrogen concentrations. With NAL blockade, there was an unexpected suppression of mean LH pulse frequency (saline vs NAL = 9.0+.6 vs 6.0+.7 pulses/16 hrs; p= 0.056), especially during sleep when the mean interpulse interval (IPI) was prolonged by approximately 90 minutes (SAL night IPI = 103± 9 mins vs NAL night IPI = 191± 31min, p = 0.03). There were significant increases in μ-opioid receptor binding potential (BP) in the posterior and subgenual cingulate, temporal and orbitofrontal cortex, thalamus and nucleus accumbens ranging from 10% to 61 % across regions - brain regions involved in emotional and cognitive function. In contrast, BP reductions of lesser magnitude were observed in regions known to be involved in the placebo response (anterior cingulate and anterior insular cortex).

Conclusion

Using two different challenge paradigms for the examination of central opioid function, a neuropharmacologic action of black cohosh treatment was demonstrated in postmenopausal women.