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Abnormal emotional processing serves as a common deficit across psychiatric disorders and a primary target of pharmacotherapy. However, the neuroimaging findings underlying emotion processing recovery (EPR) are heterogeneous, hampering the development of new therapies.

Here, we reviewed neuroimaging studies of pharmacotherapy in psychiatric disorders, focusing on brain activation associated with pharmacotherapy-induced EPR. Using a novel therapeutic network mapping approach with a functional connectome dataset (n = 652), we tested whether the identified brain activations could be reconciled into a common brain network. We also collected longitudinal functional MRI and emotion data of 213 patients with psychiatric disorders before and after clinical treatment for further clinical validation.

Across 23 experiments spanning four psychiatric disorders (major depressive disorder, bipolar disorder, anxiety disorders, and substance use disorder), we identified 208 brain activation coordinates associated with pharmacotherapy-induced EPR. These heterogeneous regions were reconciled into a common EPR network anchored in the bilateral insula and putamen. This network was robust across multiple analytical strategies and closely aligned with networks associated with psychiatric genetic and neurotransmitter features. The pharmacotherapy-induced EPR network showed generalizability to electroconvulsive therapy but not to psychotherapy. Finally, we found that effective emotional treatment targets were highly co-localized with this network. After clinical treatment, patients with psychiatric disorders exhibiting enhanced functional connectivity within this network demonstrated a high probability of emotional improvement.

The heterogeneous EPR findings across four psychiatric disorders could be reconciled on a common brain network, which provides a potential basis for transdiagnostic emotion treatment.