Functional anatomical correlates of antidepressant drug treatment assessed using PET measures of regional glucose metabolism
Functional anatomical correlates of antidepressant drug treatment assessed using PET measures of regional glucose metabolism
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DOI：
10.1016/s0924-977x(02)00102-5
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发表时间：
2002-12-01
影响因子：
5.6
通讯作者：
Raichle, ME
中科院分区：
文献类型：
--
作者：
Drevets, WC;Bogers, W;Raichle, ME
神经生理学的。使用PET成像进行的重性抑郁症的研究已经显示了多个前额皮质和边缘结构中的局部脑血流（CBF）和葡萄糖代谢的异常，这些结构更普遍地涉及情绪处理。目前的研究使用葡萄糖代谢的PET测量来调查抗抑郁药物治疗在这些区域的效果。原发性MDD受试者（n=27）在未用药和抑郁时进行成像，其中20例在慢性抗抑郁药物治疗后重新扫描。区域代谢之间进行了比较未用药的抑郁症和对照组之间的治疗前和治疗后的条件下，在区域的利益（ROI）的代谢或流量已被证明是异常的未用药的抑郁症。基线时，与对照组相比，未用药抑郁症患者的左右外侧眶皮质/腹外侧前额叶皮质（PFC）、左杏仁核和后扣带回皮质的平均代谢增加，膝下ACC和背内侧/背前外侧PFC的平均代谢减少，与既往研究结果一致。治疗后，左杏仁核和左膝下ACC的代谢显著降低，眼眶和后扣带回皮质的相应变化接近显著性。杏仁核和右膝下ACC的代谢减少似乎主要限于那些对治疗有反应且在6个月随访时保持良好的受试者，其中杏仁核代谢减少与HDRS评分减少密切相关。杏仁核中与治疗相关的代谢变化的幅度也与扫描期间测量的应激血浆皮质醇水平的变化呈正相关。这些数据与其他PET研究的数据一致，表明原发性MDD与近中颞叶和前额叶皮质的边缘系统和边缘系统结构的异常代谢有关。慢性抗抑郁药物治疗降低了受试者杏仁核和腹侧ACC的代谢，显示出持续的积极治疗反应。相比之下，治疗期间MDD背内侧/背侧前外侧PFC中异常代谢缺陷的持续存在可能与MDD尸检研究中这些区域报告的组织病理学变化有关。(C)2002年Elsevier Science B.V./© 2019 www.cnp.com版权所有
Neurophysiological. studies of major depression performed using PET imaging have shown abnormalities of regional cerebral blood flow (CBF) and glucose metabolism in multiple prefrontal cortical and limbic structures that have been more generally implicated in emotional processing. The current study investigated the effects of antidepressant drug treatment in these regions using PET measures of glucose metabolism. Subjects with primary MDD (n=27) were imaged while unmedicated and depressed, and, of these, 20 were rescanned following chronic antidepressant drug treatment. Regional metabolism was compared between unmedicated depressives and controls and between the pre- and post-treatment conditions in regions-of-interest (ROI) where metabolism or flow had previously been shown to be abnormal in unmedicated depressives. At baseline, the mean metabolism was increased in the left and right lateral orbital cortex/ventrolateral prefrontal cortex (PFC), left amygdala, and posterior cingulate cortex, and decreased in the subgenual ACC and dorsal medial/dorsal anterolateral PFC in the unmedicated depressives relative to controls, consistent with the results of previous studies. Following treatment, metabolism significantly decreased in the left amygdala and left subgenual ACC, and corresponding changes in the orbital and posterior cingulate cortices approached significance. The metabolic reduction in the amygdala and right subgenual ACC appeared largely limited to those subjects who both responded to treatment and remained well at 6 months follow-up, in whom the reduction in amygdala metabolism tightly correlated with the reduction in HDRS scores. The magnitude of the treatment-associated, metabolic change in the amygdala also correlated positively with the change in the stressed plasma cortisol levels measured during scanning. These data converge with those from other PET studies to indicate that primary MDD is associated with abnormal metabolism in limbic and paralimbic structures of the mesiotemporal and prefrontal cortices. Chronic antidepressant drug treatment reduces metabolism in the amygdala and ventral ACC in subjects showing a persistent, positive treatment response. In contrast, the persistence of the abnormal metabolic deficits in the dorsomedial/dorsal anterolateral PFC in MDD during treatment may conceivably relate to the histopathological changes reported in these regions in post mortem studies of MDD. (C) 2002 Elsevier Science B.V./ECNP All rights reserved.