Major Depressive Disorder Is Associated with Impaired Interoceptive Accuracy: A Systematic Review.

Michael Eggart,Silvia Queri,Bruno Müller-Oerlinghausen,Andreas Lange,Martin Binser

doi:10.3390/brainsci9060131

Abstract

Interoception is the sense of the physiological condition of the entire body. Impaired interoception has been associated with aberrant activity of the insula in major depressive disorder (MDD) during heartbeat perception tasks. Despite clinical relevance, studies investigating interoceptive impairments in MDD have never been reviewed systematically according to the guidelines of the PRISMA protocol, and therefore we collated studies that assessed accuracy in detecting heartbeat sensations (interoceptive accuracy, IAc) in MDD (databases: PubMed/Medline, PsycINFO, and PsycARTICLES). Out of 389 records, six studies met the inclusion criteria. The main findings suggest that (i) moderately depressed samples exhibit the largest interoceptive deficits as compared with healthy adults. (ii) difficulties in decision making and low affect intensity are correlated with low IAc, and (iii) IAc seems to normalize in severely depressed subjects. These associations may be confounded by sex, anxiety or panic disorder, and intake of selective serotonin reuptake inhibitors. Our findings have implications for the development of interoceptive treatments that might relieve MDD-related symptoms or prevent relapse in recurrent depression by targeting the interoceptive nervous system.

Highlights

The etiology and pathogenesis of major depressive disorder (MDD) symptomatology is complex and not sufficiently understood
The main findings suggest that differences between subjects with MDD and healthy controls on a heartbeat mental tracking task performance depend on depression severity
Displayed significantly lower interoceptive accuracy (IAc) than the healthy matched controls. These findings indicate that the association between depression severity and performance scores on a heartbeat perception task (i.e., IAc) is nonlinear

Summary

Introduction

The etiology and pathogenesis of major depressive disorder (MDD) symptomatology is complex and not sufficiently understood. Adult subjects regularly exhibit affective, cognitive, behavioral, psychomotor, and somatic symptoms [1]. The association between MDD and somatization is common and clinically highly relevant [2]. Individuals with MDD frequently suffer from pain, nausea, constipation, heart palpitations, shortness of breath, dizziness [2], or a common sense of physical malaise [3]. Meta-analytic evidence suggests an association between depression and functional somatic syndromes such as irritable bowel syndrome, non-ulcer dyspepsia, fibromyalgia, and chronic fatigue syndrome [4]. Functional somatic symptoms are positively correlated with depression severity [5,6]. There is clear evidence for clinically relevant associations between MDD and

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