Brain imaging correlates of depressive symptom severity and predictors of symptom improvement after antidepressant treatment
Brain imaging correlates of depressive symptom severity and predictors of symptom improvement after antidepressant treatment
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DOI：
10.1016/j.biopsych.2006.09.018
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发表时间：
2007-09-01
影响因子：
10.6
通讯作者：
Bullmore, Edward T.
中科院分区：
文献类型：
--
作者：
Chen, Chi-Hua;Ridler, Khanum;Bullmore, Edward T.
背景：预测抗抑郁药物的临床反应在治疗上是有用的。我们评价了结构磁共振成像(MRI)和功能磁共振成像(FMRI)数据对抑郁症患者症状变化的预测作用。方法：对17例重度抑郁症患者在服用氟西汀20 mg/d前即刻用MRI测量脑结构和功能。对于功能磁共振成像，患者在视觉呈现代表不同程度悲伤的面部时进行扫描。临床反应通过汉密尔顿抑郁量表系列分数的变化来衡量。根据结构和功能MRI数据回归症状改变评分(和基线症状严重度)，以绘制灰质体积(或悲伤面部情感加工激活)与症状改变(或基线严重度)显著相关的脑区。结果：症状改善速度较快与前扣带皮质、脑岛和右侧颞顶皮质灰质体积较大密切相关。该系统中灰质体积大于中位数的患者在治疗8周后改善速度更快，残余症状评分显著降低。前扣带回皮质的更大功能激活也预示着更快的改善。基线症状严重程度与背侧、额叶和中扣带前区灰质体积呈负相关，在解剖学上有别于前扣带回和膝下扣带回的灰质体积预测疗效。结论：前扣带回皮质的结构MRI测量可提供有用的抗抑郁药物疗效预测指标。
Background: It would be therapeutically useful to predict clinical response to antidepressant drugs. We evaluated structural magnetic resonance imaging (MRI) and functional MRI (fMRI) data as predictors of symptom change in people with depression.Methods: Brain structure and function were measured with MRI in 17 patients with major depression immediately before 8 weeks treatment with fluoxetine 20 mg/day. For fMRI, patients were scanned during visual presentation of faces representing different intensities of sadness. Clinical response was measured by change in serial scores on the Hamilton Rating Scale for Depression. Symptom change scores (and baseline symptom severity) were regressed on structural and functional MRI data to map brain regions where grey matter volume, or activation by sad facial affect processing, was significantly associated with symptom change (or baseline severity).Results: Faster rates of symptom improvement were strongly associated with greater grey matter volume in anterior cingulate cortex, insula, and right temporo-parietal cortex. Patients with greater than median grey matter volume in this system had faster rates of improvement and significantly lower residual symptom scores after 8 weeks' treatment. Faster improvement was also predicted by greater functional activation of anterior cingulate cortex. Baseline symptom severity was negatively correlated with greater grey matter volume in dorsal prefrontal and anterior midcingulate regions anatomically distinct from the pregenual and subgenual cingulate regions predicting treatment response.Conclusions: Structural MRI measurements of anterior cingulate cortex could provide a useful predictor of antidepressant treatment response.