Changes in brain function of depressed subjects during treatment with placebo
Changes in brain function of depressed subjects during treatment with placebo
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DOI：
10.1176/appi.ajp.159.1.122
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发表时间：
2002-01-01
影响因子：
17.7
通讯作者：
Abrams, M
中科院分区：
文献类型：
--
作者：
Leuchter, AF;Cook, IA;Abrams, M
目的：已有研究表明，抗抑郁药物疗效的50%-75%代表了安慰剂效应，因为许多抑郁症患者在接受药物或安慰剂治疗后都会有所改善。这项研究检测了接受积极药物或安慰剂治疗的抑郁症受试者的大脑功能，并试图确定定量脑电(QEEG)是否可以检测到药物和安慰剂应答者之间的大脑功能差异。同时检测QEEG功率和Cordance，Cordance是一种反映脑血流灌注的新指标，对抗抑郁药物的效果很敏感。方法：51例重度抑郁症患者参加了两项独立的、为期9周的双盲安慰剂对照研究，其中氟西汀(N=24)或文拉法辛(N=27)为活性药物。在治疗过程中进行系列qEEG记录。9周后，失明被打破，并将受试者分为药物应答者、安慰剂应答者、药物无应答者和安慰剂无应答者。结果：四组结果组的临床或qEEG测量在治疗前没有显著差异。然而，安慰剂应答者显示，从治疗早期开始，前额叶Cordance显著增加，这在药物应答者(Cordance降低)或药物无效者或安慰剂无应答者(没有明显变化)中没有看到。在治疗过程中，qEEG功率没有显著变化。结论：这些发现表明，“有效的”安慰剂治疗会导致不同于抗抑郁药物治疗的脑功能变化。如果这些结果得到证实，Cordance可能有助于区分药物应答者和安慰剂应答者。
Objective: it has been proposed that 50%-75% of the efficacy of antidepressant medication represents the placebo effect, since many depressed patients improve when treated with either medication or placebo. This study examined brain function in depressed subjects receiving either active medication or placebo and sought to determine whether quantitative electroencephalography (QEEG) could detect differences in brain function between medication and placebo responders. Both QEEG power and cordance, a new measure that reflects cerebral perfusion and is sensitive to the effect of antidepressant medication, were examined.Method: Fifty-one subjects with major depression were enrolled in one of two independent, 9-week double-blind, placebo-controlled studies in which either fluoxetine (N=24) or venlafaxine (N=27) was the active medication. Serial QEEG recordings were performed during the course of treatment. After 9 weeks, the blind was broken and subjects were classified as medication responders, placebo responders, medication nonresponders, or placebo nonresponders.Results: No significant pretreatment differences in clinical or QEEG measures were found among the four outcome groups. Placebo responders, however, showed a significant increase in prefrontal cordance starting early in treatment that was not seen in medication responders (who showed decreased cordance) or in medication nonresponders or placebo nonresponders (who showed no significant change). There was no significant change in QEEG power during treatment.Conclusions: These findings suggest that "effective" placebo treatment induces changes in brain function that are distinct from those associated with antidepressant medication. If these results are confirmed, cordance may be useful for differentiating between medication and placebo responders.