The functional neuroanatomy of the placebo effect
The functional neuroanatomy of the placebo effect
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DOI：
10.1176/appi.ajp.159.5.728
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发表时间：
2002-05-01
影响因子：
17.7
通讯作者：
Jerabek, PA
中科院分区：
文献类型：
--
作者：
Mayberg, HS;Silva, JA;Jerabek, PA
目的：服用安慰剂的临床反应与服用积极抗抑郁药物的临床反应没有什么区别。与这一现象相关的大脑功能尚未得到充分的描述。方法：在氟西汀的住院影像研究中，使用安慰剂治疗的单极抑郁症住院患者，通过正电子发射断层扫描测量脑葡萄糖代谢的变化。在为期6周的双盲试验后，对安慰剂或氟西汀的常见和独特反应效果进行了评估。结果：安慰剂反应与涉及前额叶、前扣带、前运动、顶叶、后岛和后扣带的区域代谢增加和涉及亚属扣带、旁海马体和丘脑的代谢减少有关，这些变化与使用活性氟西汀的应答者所见的区域重叠。然而，氟西汀反应与脑干、纹状体、前岛和海马体的额外皮质下和边缘变化有关，这是两种药物确定的反应特异性区域的输出输入来源。结论：在安慰剂和氟西汀应答者中，皮质糖代谢增加而边缘-旁边缘代谢降低的共同模式表明，无论采用何种治疗方式，促进这些变化可能是抑郁症缓解所必需的。作为住院研究的一部分，接受安慰剂组的临床改善与众所周知的改变治疗环境可能显著有助于减轻临床症状的效果是一致的。在氟西汀应答者中观察到的额外皮质下和边缘代谢降低可能在维持长期临床反应和预防复发方面具有额外的优势。
Objective: Administration of placebo can result in a clinical response indistinguishable from that seen with active antidepressant treatment. Functional brain correlates of this phenomenon have not been fully characterized.Method: Changes in brain glucose metabolism were measured by using positron emission tomography in hospitalized men with unipolar depression who were administered placebo as part of an inpatient imaging study of fluoxetine. Common and unique response effects to administration of placebo or fluoxetine were assessed after a 6-week, double-blind trial.Results: Placebo response was associated with regional metabolic increases involving the prefrontal, anterior cingulate, premotor, parietal, posterior insula, and posterior cingulate and metabolic decreases involving the subgenual cingulate, para-hippocampus, and thalamus, Regions of change overlapped those seen in responders administered active fluoxetine. Fluoxetine response, however, was associated with additional subcortical and limbic changes in the brainstem, striatum, anterior insula, and hippocampus, sources of efferent input to the response-specific regions identified with both agents.Conclusions: The common pattern of cortical glucose metabolism increases and limbic-paralimbic metabolism decreases in placebo and fluoxetine responders suggests that facilitation of these changes may be necessary for depression remission, regardless of treatment modality. Clinical improvement in the group receiving placebo as part of an inpatient study is consistent with the well-recognized effect that altering the therapeutic environment may significantly contribute to reducing clinical symptoms. The additional subcortical and limbic metabolism decreases seen uniquely in fluoxetine responders may convey additional advantage in maintaining long-term clinical response and in relapse prevention.