[Cortico-limbic mechanisms of affect regulation in the therapy of depression]

Complex functional mechanisms underlie the etiopathogenesis of affective disorders. However, therapeutic implications of new insights are still limited. From the neuropsychological perspective therapy focuses on limbic-cortical (bottom-up) processes whereas cortical-limbic regulatory systems (top-down) were rarely mentioned, although first evidence of their relevance was given in the 80ties, e.g. the use of GABAergic anticonvulsants in affective disorders. Meanwhile modern brain imaging studies support a pronounced role of cortical-limbic top-down mechanisms in the regulation of mood and the therapy of depression, e.g. the effects of cognitive behavioural therapy. The article briefly reviews relevant literature focusing on the neuropsychological hypothesis and the therapeutic implications of these and pharmacologic data. Psychotherapy as well as anticonvulsants appear to mainly affect cortico-limbic mechanisms compared to antidepressants which influence mostly limbic-cortical processes. The combination of both regulatory systems, e.g. the combination of antidepressants and anticonvulsants, appear to have synergistic effects. Such combinations may also be effective in low doses of each compound which does, furthermore, reduce the amount of unwanted side-effects. Studies combining classical antidepressants and mood-stabilizing medication (anticonvulsants and newer neuroleptics) should be performed to substantiate these findings.