Applying Functional Imaging to Clinical Practice: Are We Making Progress Toward Its Promise?

With the introduction in 1919 of pneumoencephalography, brain imaging promised to change how we manage neurologic and psychiatric disease. Fortunately, better, less invasive, and less painful imaging methods were developed, moving psychiatric imaging through X-ray, computed tomography, single-photon emission computed tomography, positron emission tomography, and especially, in the past three decades, magnetic resonance imaging. In particular, the advent of increasingly sophisticated MRI techniques led many investigators, including me, to predict more than two decades ago that these technologies would change how we practice. In their study, Dunlop et al applied functional MRI (fMRI) techniques to explore how antidepressant medication and cognitive-behavioral therapy (CBT) altered functional connectivity, similarly and differently, within commonly described resting-state networks in individuals with major depression. Specifically, they focused on the default mode, executive control, salience, and anterior limbic networks, as these networks each have reports of associations with major depressive disorder.