Decreased occipital cortical glutamate levels in response to successful cognitive-behavioral therapy and pharmacotherapy for major depressive disorder.
Decreased occipital cortical glutamate levels in response to successful cognitive-behavioral therapy and pharmacotherapy for major depressive disorder.
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DOI：
10.1159/000361078
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发表时间：
2014
影响因子：
22.8
通讯作者：
Sanacora G
中科院分区：
文献类型：
--
作者：
Abdallah CG;Niciu MJ;Fenton LR;Fasula MK;Jiang L;Black A;Rothman DL;Mason GF;Sanacora G
先前的研究表明，抗抑郁药物和电休克治疗可增加重度抑郁症（MDD）枕皮质GABA，但一项小规模的初步研究未能显示认知行为治疗（CBT）对枕皮质GABA的类似效果。根据这些发现，我们试图确定基线GABA水平是否能预测治疗反应，并在这项更大的研究中将分析范围扩大到其他代谢物和神经递质。40名MDD门诊患者接受基线1H-MRS， 30名受试者完成cbt前和cbt后的1H-MRS。9名CBT无应答者完成了开放标签用药阶段，随后进行了额外的/第三次1H-MRS。治疗反应的程度与枕部氨基酸神经递质水平相关。基线GABA不能预测治疗结果。此外，CBT对GABA水平无显著影响。然而，我们发现显著的组x时间相互作用（F(1,28) = 6.30, p = 0.02），表明CBT应答者谷氨酸减少，而CBT无应答者谷氨酸无显著变化。这些发现证实了在更大的样本中，成功的CBT对枕皮质GABA水平缺乏影响。另一方面，治疗后谷氨酸水平的降低与成功的CBT和抗抑郁药物反应相关。基于这一发现和其他报道，枕部谷氨酸降低可能是一种抗抑郁反应的生物标志物。健康对照比较组和非干预组可能阐明这些结果的敏感性和特异性。
Previous studies have demonstrated that antidepressant medication and electroconvulsive therapy increase occipital cortical GABA in major depressive disorder (MDD), but, a small pilot study failed to show a similar effect of cognitive behavioral therapy (CBT) on occipital GABA. In light of these findings we sought to determine if baseline GABA levels predict treatment response and to broaden the analysis to other metabolites and neurotransmitters in this larger study. 40 MDD outpatients received baseline 1H-MRS, and 30 subjects completed both pre- and post-CBT 1H-MRS. Nine CBT non-responders completed an open-label medication phase followed by an additional/third 1H-MRS. The magnitude of treatment response was correlated with occipital amino acid neurotransmitter levels. Baseline GABA did not predict treatment outcome. Furthermore, there was no significant effect of CBT on GABA levels. However, we found a significant group x time interaction (F(1,28) = 6.30, p = 0.02), demonstrating reduced glutamate in CBT responders with no significant glutamate change in CBT non-responders. These findings corroborate the lack of effect of successful CBT on occipital cortical GABA levels in a larger sample. A reduction in glutamate levels following treatment, on the other hand, correlated with successful CBT and antidepressant medication response. Based on this finding and other reports, decreased occipital glutamate may be an antidepressant response biomarker. Healthy control comparator and non-intervention groups may shed light on the sensitivity and specificity of these results.
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