“The Heart Asks Pleasure First”—Conceptualizing Psychiatric Diseases as <i>MAINTENANCE</i> Network Dysfunctions through Insights from slMFB DBS in Depression and Obsessive–Compulsive Disorder
More than a decade ago, deep brain stimulation (DBS) of the superolateral medial forebrain bundle (slMFB), as part of the greater MFB system, had been proposed as a putative yet experimental treatment strategy for therapy refractory depression (TRD) and later for obsessive–compulsive disorders (OCD)...
| Main Authors: | , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
MDPI AG
2022-03-01
|
| Series: | Brain Sciences |
| Subjects: | |
| Online Access: | https://www.mdpi.com/2076-3425/12/4/438 |
| _version_ | 1827621461525790720 |
|---|---|
| author | Volker A. Coenen Thomas E. Schlaepfer Bastian E. A. Sajonz Peter C. Reinacher Máté D. Döbrössy Marco Reisert |
| author_facet | Volker A. Coenen Thomas E. Schlaepfer Bastian E. A. Sajonz Peter C. Reinacher Máté D. Döbrössy Marco Reisert |
| author_sort | Volker A. Coenen |
| collection | DOAJ |
| description | More than a decade ago, deep brain stimulation (DBS) of the superolateral medial forebrain bundle (slMFB), as part of the greater MFB system, had been proposed as a putative yet experimental treatment strategy for therapy refractory depression (TRD) and later for obsessive–compulsive disorders (OCD). Antidepressant and anti-OCD efficacy have been shown in open case series and smaller trials and were independently replicated. The MFB is anato-physiologically confluent with the SEEKING system promoting euphoric drive, reward anticipation and reward; functions realized through the mesocorticolimbic dopaminergic system. Growing clinical experience concerning surgical and stimulation aspects from a larger number of patients shows an MFB functionality beyond SEEKING and now re-informs the scientific rationale concerning the MFB’s (patho-) physiology. In this white paper, we combine observations from more than 75 cases of slMFB DBS. We integrate these observations with a selected literature review to provide a new neuroethological view on the MFB. We here formulate a re-interpretation of the MFB as the main structure of an integrated SEEKING/MAINTENANCE circuitry, allowing for individual homeostasis and well-being through emotional arousal, basic and higher affect valence, bodily reactions, motor programing, vigor and flexible behavior, as the basis for the antidepressant and anti-OCD efficacy. |
| first_indexed | 2024-03-09T11:04:52Z |
| format | Article |
| id | doaj.art-24b0f0b9e31b4a69b12fa23b03634590 |
| institution | Directory Open Access Journal |
| issn | 2076-3425 |
| language | English |
| last_indexed | 2024-03-09T11:04:52Z |
| publishDate | 2022-03-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Brain Sciences |
| spelling | doaj.art-24b0f0b9e31b4a69b12fa23b036345902023-12-01T00:59:06ZengMDPI AGBrain Sciences2076-34252022-03-0112443810.3390/brainsci12040438“The Heart Asks Pleasure First”—Conceptualizing Psychiatric Diseases as <i>MAINTENANCE</i> Network Dysfunctions through Insights from slMFB DBS in Depression and Obsessive–Compulsive DisorderVolker A. Coenen0Thomas E. Schlaepfer1Bastian E. A. Sajonz2Peter C. Reinacher3Máté D. Döbrössy4Marco Reisert5Department of Stereotactic and Functional Neurosurgery, Medical Center of Freiburg University, 79106 Freiburg, GermanyMedical Faculty, Freiburg University, 79106 Freiburg, GermanyDepartment of Stereotactic and Functional Neurosurgery, Medical Center of Freiburg University, 79106 Freiburg, GermanyDepartment of Stereotactic and Functional Neurosurgery, Medical Center of Freiburg University, 79106 Freiburg, GermanyDepartment of Stereotactic and Functional Neurosurgery, Medical Center of Freiburg University, 79106 Freiburg, GermanyDepartment of Stereotactic and Functional Neurosurgery, Medical Center of Freiburg University, 79106 Freiburg, GermanyMore than a decade ago, deep brain stimulation (DBS) of the superolateral medial forebrain bundle (slMFB), as part of the greater MFB system, had been proposed as a putative yet experimental treatment strategy for therapy refractory depression (TRD) and later for obsessive–compulsive disorders (OCD). Antidepressant and anti-OCD efficacy have been shown in open case series and smaller trials and were independently replicated. The MFB is anato-physiologically confluent with the SEEKING system promoting euphoric drive, reward anticipation and reward; functions realized through the mesocorticolimbic dopaminergic system. Growing clinical experience concerning surgical and stimulation aspects from a larger number of patients shows an MFB functionality beyond SEEKING and now re-informs the scientific rationale concerning the MFB’s (patho-) physiology. In this white paper, we combine observations from more than 75 cases of slMFB DBS. We integrate these observations with a selected literature review to provide a new neuroethological view on the MFB. We here formulate a re-interpretation of the MFB as the main structure of an integrated SEEKING/MAINTENANCE circuitry, allowing for individual homeostasis and well-being through emotional arousal, basic and higher affect valence, bodily reactions, motor programing, vigor and flexible behavior, as the basis for the antidepressant and anti-OCD efficacy.https://www.mdpi.com/2076-3425/12/4/438brain networksdopaminedeep brain stimulationMAINTENANCEmajor depressionOCD |
| spellingShingle | Volker A. Coenen Thomas E. Schlaepfer Bastian E. A. Sajonz Peter C. Reinacher Máté D. Döbrössy Marco Reisert “The Heart Asks Pleasure First”—Conceptualizing Psychiatric Diseases as <i>MAINTENANCE</i> Network Dysfunctions through Insights from slMFB DBS in Depression and Obsessive–Compulsive Disorder Brain Sciences brain networks dopamine deep brain stimulation MAINTENANCE major depression OCD |
| title | “The Heart Asks Pleasure First”—Conceptualizing Psychiatric Diseases as <i>MAINTENANCE</i> Network Dysfunctions through Insights from slMFB DBS in Depression and Obsessive–Compulsive Disorder |
| title_full | “The Heart Asks Pleasure First”—Conceptualizing Psychiatric Diseases as <i>MAINTENANCE</i> Network Dysfunctions through Insights from slMFB DBS in Depression and Obsessive–Compulsive Disorder |
| title_fullStr | “The Heart Asks Pleasure First”—Conceptualizing Psychiatric Diseases as <i>MAINTENANCE</i> Network Dysfunctions through Insights from slMFB DBS in Depression and Obsessive–Compulsive Disorder |
| title_full_unstemmed | “The Heart Asks Pleasure First”—Conceptualizing Psychiatric Diseases as <i>MAINTENANCE</i> Network Dysfunctions through Insights from slMFB DBS in Depression and Obsessive–Compulsive Disorder |
| title_short | “The Heart Asks Pleasure First”—Conceptualizing Psychiatric Diseases as <i>MAINTENANCE</i> Network Dysfunctions through Insights from slMFB DBS in Depression and Obsessive–Compulsive Disorder |
| title_sort | the heart asks pleasure first conceptualizing psychiatric diseases as i maintenance i network dysfunctions through insights from slmfb dbs in depression and obsessive compulsive disorder |
| topic | brain networks dopamine deep brain stimulation MAINTENANCE major depression OCD |
| url | https://www.mdpi.com/2076-3425/12/4/438 |
| work_keys_str_mv | AT volkeracoenen theheartaskspleasurefirstconceptualizingpsychiatricdiseasesasimaintenanceinetworkdysfunctionsthroughinsightsfromslmfbdbsindepressionandobsessivecompulsivedisorder AT thomaseschlaepfer theheartaskspleasurefirstconceptualizingpsychiatricdiseasesasimaintenanceinetworkdysfunctionsthroughinsightsfromslmfbdbsindepressionandobsessivecompulsivedisorder AT bastianeasajonz theheartaskspleasurefirstconceptualizingpsychiatricdiseasesasimaintenanceinetworkdysfunctionsthroughinsightsfromslmfbdbsindepressionandobsessivecompulsivedisorder AT petercreinacher theheartaskspleasurefirstconceptualizingpsychiatricdiseasesasimaintenanceinetworkdysfunctionsthroughinsightsfromslmfbdbsindepressionandobsessivecompulsivedisorder AT mateddobrossy theheartaskspleasurefirstconceptualizingpsychiatricdiseasesasimaintenanceinetworkdysfunctionsthroughinsightsfromslmfbdbsindepressionandobsessivecompulsivedisorder AT marcoreisert theheartaskspleasurefirstconceptualizingpsychiatricdiseasesasimaintenanceinetworkdysfunctionsthroughinsightsfromslmfbdbsindepressionandobsessivecompulsivedisorder |