Differences in brain glucose metabolism between responders to CBT and venlafaxine in a 16-week randomized controlled trial
Differences in brain glucose metabolism between responders to CBT and venlafaxine in a 16-week randomized controlled trial
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DOI：
10.1176/appi.ajp.164.5.778
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发表时间：
2007-05-01
影响因子：
17.7
通讯作者：
Mayberg, Helen S.
中科院分区：
文献类型：
--
作者：
Kennedy, Sidney H.;Konarski, Jakub Z.;Mayberg, Helen S.
目的：神经影像学研究揭示葡萄糖代谢（氟-18-氟脱氧葡萄糖正电子发射断层扫描[PET]）的变化与不同抗抑郁治疗方式的反应相关，包括认知行为治疗（CBT）、抗抑郁药物治疗和深部脑刺激。采用非随机设计，作者先前比较了抑郁症患者接受CBT或帕罗西汀治疗后的变化。在这项研究中，作者报告了在一项随机对照试验中，对CBT或文拉法辛有反应的患者氟-18-氟脱氧葡萄糖PET的变化。方法：符合DSM-IV-TR重度抑郁发作标准并诊断为重度抑郁障碍的受试者在随机分组前和接受16周CBT （N=12）或文拉法辛（N=12）抗抑郁治疗后接受氟-18-氟脱氧葡萄糖PET扫描。分析了与反应状态相关的模式特异性和模式非依赖性区域脑代谢变化。结果：CBT组（7/12）和文拉法辛组（9/12）的有效率相当。对任何一种治疗方式的反应都与双侧眶额皮质和左侧内侧前额皮质的葡萄糖代谢降低有关，同时与右侧枕颞皮质的代谢增加有关。亚属扣带皮层前部和后部以及尾状核分化CBT和文拉法辛应答者的代谢变化。结论：对两种治疗方式均有反应的患者表现出几个前额叶区域的代谢降低。与先前的报道一致，CBT的反应与皮质-边缘连接的相互调节有关，而文拉法辛参与了以前未在神经影像学调查中报道的额外皮质和纹状体区域。
Objective: Neuroimaging investigations reveal changes in glucose metabolism (fluorine-18-fluorodeoxyglucose positron emission tomography [PET]) associated with response to disparate antidepressant treatment modalities, including cognitive behavior therapy (CBT), antidepressant pharmacotherapies, and deep brain stimulation. Using a nonrandomized design, the authors previously compared changes following CBT or paroxetine in depressed patients. In this study, the authors report changes in fluorine-18-fluorodeoxyglucose PET in responders to CBT or venlafaxine during a randomized controlled trial.Methods: Subjects meeting DSM-IV-TR criteria for a major depressive episode and a diagnosis of a major depressive disorder received a fluorine-18-fluorodeoxyglucose PET scan before randomization and after 16 weeks of antidepressant treatment with either CBT (N=12) or venlafaxine (N=12). Modality-specific and modality-independent regional brain metabolic changes associated with response status were analyzed.Results: Response rates were comparable between the CBT (7/12) and venlafaxine (9/12) groups. Response to either treatment modality was associated with decreased glucose metabolism bilaterally in the orbitofrontal cortex and left medial prefrontal cortex, along with increased metabolism in the right occipital-temporal cortex. Changes in metabolism in the anterior and posterior parts of the subgenual cingulate cortex and the caudate differentiated CBT and venlafaxine responders.Conclusions: Responders to either treatment modality demonstrated reduced metabolism in several prefrontal regions. Consistent with earlier reports, response to CBT was associated with a reciprocal modulation of cortical-limbic connectivity, while venlafaxine engaged additional cortical and striatal regions previously unreported in neuroimaging investigations.