Microstructural brain abnormalities, affective temperaments, and suicidal behavior in patients with major depression

According to magnetic resonance imaging (MRI) studies, brain white matter (WM) abnormalities have been suggested to play a critical role in the pathogenesis of major depressive disorder (MDD) and related suicidal behavior. However, MRI findings may be limited by low spatial resolution; therefore, an important contribution to the understanding of the role and significance of WM alterations derived by the development of the most recent magnetic resonance techniques, such as diffusion tensor imaging (DTI). Several DTI studies reported an association between altered WM integrity and MDD/suicidal behavior. Microstructural WM abnormalities may be located in neural circuits critically implicated in emotional processes and mood regulation resulting in enhanced vulnerability to psychiatric morbidity. WM abnormalities detected using DTI may contribute to functional deficits and help to clarify the pathophysiological mechanisms underlying MDD as well as suicidal behavior. By a clinical point of view, research also suggested that affective temperaments may play a relevant role in the psychopathological characteristics of mood disorders, clinical trajectory of episodes and polarity, long‐term outcome and suicidality. Unfortunately, only few studies investigated the association between affective temperaments and WM abnormalities and discussed their possible implications in patients with MDD and suicidal behavior. Using a comprehensive search of Medline database, the aim of the present study was to critically review the current literature on the association between WM alterations as assessed by MRI and DTI techniques, affective temperaments, MDD and suicidal behavior.