Brain metabolic changes in major depressive disorder from pre- to post-treatment with paroxetine
Brain metabolic changes in major depressive disorder from pre- to post-treatment with paroxetine
复制标题
DOI：
10.1016/s0925-4927(99)00034-7
复制
发表时间：
1999-10-11
影响因子：
2.3
通讯作者：
Baxter, LR
中科院分区：
文献类型：
--
作者：
Brody, AL;Saxena, S;Baxter, LR
对重度抑郁障碍(MDD)受试者的脑功能成像研究表明，背外侧(DLPFC)和腹外侧(VLPFC)前额叶皮质活动增加参与了抑郁状态的调节。治疗前后的研究表明，随着治疗的成功，这些异常会恢复正常。我们对16例门诊MDD患者在帕罗西汀(靶剂量=40 mg/d)治疗前后进行了[F-18]脱氧葡萄糖正电子发射断层扫描(FDG-PET)。这项分析的感兴趣区(ROI)是由对每个受试者的磁共振图像上的受试者身份视而不见的评分者绘制的，并被转移到他们共同登记的PET扫描上。我们假设DLPFC的代谢会增加，而腹侧额叶[VLPFC、眶前皮质(OFC)和额叶下回(IFG)]的代谢会随着治疗的成功而减少。治疗反应被定义为汉密尔顿抑郁量表评分恐慌下降50%，临床全球改善量表评分为‘很大’或‘非常’改善。根据这些标准，其中9名受试者被归类为治疗应答者。这些应答者在正常化的VLPFC和OFC代谢方面的降幅明显大于无应答者。在本样本中，治疗反应对DLPFC或IFG的变化没有显著影响。然而，HAM-D评分的变化与标准化IFG和VLPFC代谢的变化呈正相关。与偏侧性没有显著的交互作用。在治疗前的扫描中，左侧腹侧扣带回前部代谢较低与较好的治疗反应有关。这些发现暗示腹侧前额叶-皮质下脑回路在MDD对5-羟色胺再摄取抑制剂的反应中起中介作用。(C)1999爱思唯尔爱尔兰科学有限公司。保留所有权利。
Functional brain imaging studies of subjects with Major Depressive Disorder (MDD) have suggested that decreased dorsolateral (DLPFC) and increased ventrolateral (VLPFC) prefrontal cortical activity mediate the depressed state. Pre- to post-treatment studies indicate that these abnormalities normalize with successful treatment. We performed [F-18]fluorodeoxyglucose positron emission tomography (FDG-PET) scans on 16 outpatients with MDD before and after treatment with paroxetine (target dose = 40 mg/day). Regions of interest (ROIs) for this analysis were drawn by a rater blind to subject identity on the magnetic resonance image of each subject and transferred onto their coregistered PET scans. We hypothesized that DLPFC metabolism would increase, while ventral frontal metabolism [in the VLPFC, the orbitofrontal cortex (OFC), and the inferior frontal,gyrus (IFG)] would decrease with successful treatment. Treatment response was defined as a decrease in the Hamilton Depression Rating Scare of > 50% and a Clinical Global Improvement Scale rating of 'much' or 'very much' improved. By these criteria, nine of the subjects were classified as treatment responders. These responders had significantly greater decreases in normalized VLPFC and OFC metabolism than did non-responders. There were no significant effects of treatment response on change in the DLPFC or IFG in this sample. However, there was a positive correlation between change in HAM-D scores and change in normalized IFG and VLPFC metabolism. There were no significant interactions with laterality. On pre-treatment scans, lower metabolism in the left ventral anterior cingulate gyrus was associated with better treatment response. These findings implicate ventral prefrontal-subcortical brain circuitry in the mediation of response to serotonin reuptake inhibitors in MDD. (C) 1999 Elsevier Science Ireland Ltd. All rights reserved.