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Am J Psychiatry. 2019 Jul 29:appiajp201918101144. doi: 10.1176/appi.ajp.2019.18101144. [Epub ahead of print]

No Alterations of Brain Structural Asymmetry in Major Depressive Disorder: An ENIGMA Consortium Analysis.

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The Department of Language and Genetics, Max Planck Institute for Psycholinguistics, Nijmegen, the Netherlands (de Kovel, Francks); Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Australia (Davey); the Department of Psychiatry, Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam (Veltman); the Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine of USC, University of Southern California, Marina del Rey (Jahanshad, Thompson); the Laboratory of Affective, Cognitive, and Translational Neuroscience, Scientific Research Institute of Physiology and Basic Medicine, Novosibirsk, Russian Federation (Aftanas, Brack, Osipov); the Department of Neuroscience, Neuroimaging Center, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands (Aleman); the Department of Psychiatry, University of Melbourne, Melbourne (Baune); the Institute for Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Greifswald, Germany (Bülow); the Laboratory of Psychiatric Neuroimaging (LIM-21), Departamento e Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil (Busatto Filho, Rosa); the Department of Psychiatry, Trinity College Dublin (Carballedo, Frodl); the Department of Psychiatry and the Weill Institute for Neurosciences, Division of Child and Adolescent Psychiatry, University of California, San Francisco (Connolly, Ho, Yang); the Department of Psychiatry, University of Minnesota Medical School, Minneapolis (Cullen, Mueller, Ubani, Schreiner); the Department of Psychiatry, University of Münster, Münster, Germany (Dannlowski, Dohm, Grotegerd, Leehr, Sindermann, Winter, Zaremba); the Department of Psychology, School of Arts and Social Sciences, City, University of London, London (Dima); the Department of Psychiatry and Psychotherapy, University Medical Center Göttingen, Göttingen, Germany (Erwin-Grabner; Goya-Maldonado, Schnell, Singh); the Department of Psychiatry and Psychotherapy, Otto von Guericke University Magdeburg, Magdeburg, Germany (Frodl); the Centre for Affective Disorders, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Fu); the Department of Psychology, Neuroscience, and Behaviour, McMaster University, Hamilton, Canada (Hall); the Department of Psychiatry, Yale School of Medicine, New Haven, Conn. (Alexander-Bloch, Glahn); the Psychopharmacology Research Unit, Department of Psychiatry, University of Oxford, Oxford, U.K. (Godlewska); the Department of Psychology, Stanford University, Stanford, Calif. (Gotlib, Ho); the Department of Psychiatry and Psychotherapy, University Medicine Greifswald (Grabe, Wittfeld); the Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion regulation, University Medical Center Groningen (Groenewold); the Section for Experimental Psychopathology and Neuroimaging, Department of General Psychiatry, Heidelberg University, Heidelberg, Germany (Gruber, Krämer, Simulionyte); the Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne, and Melbourne Health, Melbourne (Harrison); the Youth Mental Health Team, Brain and Mind Centre, University of Sydney, Sydney, Australia (Hatton, Hickie, Lagopoulos); the Department of Psychiatry and Psychotherapy, Philipps University Marburg, Marburg, Germany (Kircher, Krug, Nenadic, Yüksel); the Department of Neurology, University of Magdeburg, Magdeburg (Li); the Departments of Psychiatry and Paediatrics, University of Calgary, Calgary, Canada (MacMaster, McLellan); the Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary (MacQueen); the Division of Psychiatry, University of Edinburgh, Edinburgh (Harris, McIntosh, Papmeyer, Whalley); Psychiatric Genetics, QIMR Berghofer Medical Research Institute, Brisbane, Australia (Medland); the Department. of Psychiatry, Institute of Biomedical Research Sant Pau, Barcelona, Spain (Portella); the Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Amsterdam (Reneman, Schrantee); the Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford (Sacchet); West Region and Research Division, Institute of Mental Health, Singapore (Sim); Medical Research Council Unit on Risk and Resilience in Mental Disorders, Department of Psychiatry, University of Cape Town, Cape Town, South Africa (Groenewold, Stein); Brain Function and Dysfunction, Leids Universitair Medisch Centrum, Leiden, the Netherlands (Van der Wee); the Department of Psychiatry, Leiden University Medical Center, Leiden (Van der Werff); the Division of Mind and Brain Research, Department of Psychiatry and Psychotherapy CCM, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin (Veer, H. Walter); the Institute of Information and Communication Technologies (Instituto ITACA), Universitat Politècnica de València, València, Spain (Gilabert); the Institute for Community Medicine, University Medicine Greifswald, Greifswald (Völzke); the Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany (M. Walter); the Department of Psychology, University of Minnesota, Minneapolis (Schreiner); the German Center for Neurodegenerative Diseases, Site Rostock/Greifswald (Grabe, Wittfeld); the Department of Neuroscience, Novosibirsk State University, Novosibirsk (Aftanas); the Department of Psychology, University of Groningen, Groningen (Aleman); the Center for Interdisciplinary Research on Applied Neurosciences, University of São Paulo, São Paulo (Busatto Filho, Rosa); the Department of Biomedical Sciences, Florida State University, Tallahassee (Connolly); the Department of Neuroimaging, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Dima); the Donders Institute for Brain, Cognition, and Behavior, Radboud University Nijmegen (Francks); the School of Psychology, University of East London, London (Fu); the Sunshine Coast Mind and Neuroscience Thompson Institute, Queensland, Australia (Lagopoulos); Strategic Clinical Network for Addictions and Mental Health, Alberta, Canada (MacMaster); the Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh (McIntosh); the Rehabilitation Services and Care Unit, Swiss Paraplegic Research, Nottwil, Switzerland (Papmeyer); CIBERSAM, Madrid (Portella); the Centre for Youth Mental Health, University of Melbourne, Melbourne (Davey, Schmaal); the Spinoza Center for Neuroimaging, Royal Netherlands Academy of Arts and Sciences, Amsterdam (Schrantee); Yong Loo Lin School of Medicine, National University of Singapore; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore (Sim); the School of Public Health, Boston University, Boston (Ubani); the Leiden Institute for Brain and Cognition, Leiden (Van der Werff); the German Center for Cardiovascular Research, partner site Greifswald, Greifswald (Völzke).



Asymmetry is a subtle but pervasive aspect of the human brain, and it may be altered in several psychiatric conditions. MRI studies have shown subtle differences of brain anatomy between people with major depressive disorder and healthy control subjects, but few studies have specifically examined brain anatomical asymmetry in relation to this disorder, and results from those studies have remained inconclusive. At the functional level, some electroencephalography studies have indicated left fronto-cortical hypoactivity and right parietal hypoactivity in depressive disorders, so aspects of lateralized anatomy may also be affected. The authors used pooled individual-level data from data sets collected around the world to investigate differences in laterality in measures of cortical thickness, cortical surface area, and subcortical volume between individuals with major depression and healthy control subjects.


The authors investigated differences in the laterality of thickness and surface area measures of 34 cerebral cortical regions in 2,256 individuals with major depression and 3,504 control subjects from 31 separate data sets, and they investigated volume asymmetries of eight subcortical structures in 2,540 individuals with major depression and 4,230 control subjects from 32 data sets. T1-weighted MRI data were processed with a single protocol using FreeSurfer and the Desikan-Killiany atlas. The large sample size provided 80% power to detect effects of the order of Cohen's d=0.1.


The largest effect size (Cohen's d) of major depression diagnosis was 0.085 for the thickness asymmetry of the superior temporal cortex, which was not significant after adjustment for multiple testing. Asymmetry measures were not significantly associated with medication use, acute compared with remitted status, first episode compared with recurrent status, or age at onset.


Altered brain macro-anatomical asymmetry may be of little relevance to major depression etiology in most cases.


Laterality; Left-Right Asymmetry; MRI; Major Depressive Disorder

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