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Depressive Syndromes

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Neuropsychodynamic Psychiatry

Abstract

The self is a core dimension in depression. It is attributed to negative emotions (e.g. failure, guilt). The increased inward focus in depression is connected with a decreased environmental focus.

The development of neuropsychodynamic hypotheses of the altered self-reference is based on the investigation of the emotional-cognitive interaction in depressed patients. It may be hypothesized that the increased negative self-attributions—as typical characteristics of an increased self-focus in depression—may result from altered neuronal activity in subcortical-cortical midline structures in the brain (especially from hyperactivity in the cortical-subcortical midline regions and hypoactivity in the lateral regions).

A mechanism-based approach was developed focussing on the psychodynamic, psychological and neuronal mechanisms in healthy and depressed persons.

The increased resting state activity in depression is especially associated with an increased resting state activity in the default mode network (DMN). By means of this, changes in the complete spatiotemporal structure of the intrinsic activity of the brain and the dysbalance between default mode network and executive network (EN) are induced.

It is neither lesions nor disturbances of adaptive neuronal mechanisms which generate depressive symptoms, but rather increasingly dysfunctional mechanisms of compensation on the basis of the increased resting state activity.

Possible therapeutic consequences of the neuropsychodynamic approach to depression involve the necessary emotional attunement in psychotherapy of depressed patients and the adequate timing of therapeutic interventions The hypotheses which have been developed in the context of the neuropsychodynamic model of depression may be used for more specific psychotherapeutic interventions, aiming at specific mechanisms of compensation and defence, which are related to the increased resting state activity and the disturbed resting state-stimulus interaction.

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Authors and Affiliations

  1. Department of Psychiatry, Psychotherapy, and Psychosomatics, Psychiatric University Hospital Zurich, University of Zurich, Zurich, Switzerland

    Heinz Boeker

  2. Mind, Brain Imaging, and Neuroethics, Institute of Mental Health Research, University of Ottawa, Ottawa, ON, Canada

    Georg Northoff

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  1. Heinz Boeker
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Correspondence to Heinz Boeker .

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  1. Psychiatric University Hospital Zurich, Zurich, Switzerland

    Heinz Boeker

  2. Hospital of Psychiatry-Psychotherapy-Psychosomatic, General Hospital Frankfurt, Teaching Hospital of the University, Frankfurt, Germany

    Peter Hartwich

  3. Mind, Brain Imaging, and Neuroethics, Institute of Mental Health Research, University of Ottawa, Ottawa, ON, Canada

    Georg Northoff

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Boeker, H., Northoff, G. (2018). Depressive Syndromes. In: Boeker, H., Hartwich, P., Northoff, G. (eds) Neuropsychodynamic Psychiatry. Springer, Cham. https://doi.org/10.1007/978-3-319-75112-2_11

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