Neural correlates of altered interoception in depressive and anxiety disorders: a systematic review and meta-analysis

BACKGROUND: Interoceptive dysfunction, the impaired sensing and interpretation of internal bodily states, has emerged as a potential transdiagnostic feature across several psychiatric conditions, particularly depressive and anxiety disorders. Despite their high comorbidity, it remains unclear whether these conditions are associated with similar or distinct alterations in brain regions underlying this process. To clarify this, we conducted a systematic review and meta-analysis of functional magnetic resonance imaging studies examining interoceptive processing in depressive and anxiety disorders. METHODS: Using a pre-registered protocol (registration number: CRD42024579900), we conducted systematic searches across five databases: PsycINFO, EMBASE, PubMed, Scopus, and Web of Science. Our initial search yielded 315 unique studies. After applying our inclusion criteria, we identified 11 relevant studies with a total of 659 participants (269 healthy controls and 390 clinical participants). RESULTS: Our systematic review and meta-analysis revealed significantly reduced activation in the right dorsal mid-insula and left posterior insula during interoceptive tasks in individuals with major depressive disorder. Interestingly, no significant effects were observed for anxiety disorders or the combined sample compared with healthy controls. Qualitative synthesis suggested potential insula hyperactivation in anxiety, aligning with theories of interoceptive hypervigilance. CONCLUSION: These findings support models of allostatic dysfunction in depressive and anxiety disorders, highlighting the insula’s role in interpreting bodily signals. Clinically, this underscores the potential of interoception-focused interventions to recalibrate insula processing and alleviate symptoms. Further research in anxiety disorders with reduced methodological heterogeneity would aid in clarifying the effects suggested by the qualitative synthesis.