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Wade-Bohleber L, Zölch N, Lehmann M, Ernst J, Richter A, Seifritz E, Boeker H, Grimm S. Effects of Psychotherapy on Glutamatergic Neurotransmission. Neuropsychobiology 2023; 82:203-209. [PMID: 37321187 PMCID: PMC10614498 DOI: 10.1159/000530312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 03/14/2023] [Indexed: 06/17/2023]
Abstract
INTRODUCTION Psychodynamic psychotherapy is an effective and widely used treatment for major depressive disorder (MDD); however, little is known about neurobiological changes associated with induced symptom improvement. METHODS Proton magnetic resonance spectroscopy with a two-dimensional J-resolved sequence served to test the relationship between glutamate (Glu) and glutamine (Gln) levels, measured separately in pregenual anterior cingulate cortex (pgACC) and the anterior midcingulate cortex (aMCC) as a control region, with change in depression symptoms after 6 months of weekly psychodynamic psychotherapy sessions in MDD patients. Depressed (N = 45) and healthy (N = 30) subjects participated in a baseline proton magnetic resonance spectroscopy measurement and a subgroup of MDD subjects (N = 21) then received once-a-week psychodynamic psychotherapy and participated in a second proton magnetic resonance spectroscopy measurement after 6 months. Change in depression symptoms was assessed using the Hamilton Depression Rating Scale (HAMD). RESULTS Higher pretreatment pgACC Gln concentrations in MDD patients compared to healthy controls were associated with symptom severity. Patients and controls did not differ regarding Gln levels in aMCC nor regarding Glu levels in both regions. The association of pgACC Gln concentration and severity of depressive symptoms was reversed after 6 months of psychotherapy in MDD subjects. Regarding Gln in aMCC as well as Glu in both regions, there were no significant associations with improvement of depressive symptoms in the course of psychotherapy. DISCUSSION Findings indicate specific regional effects of psychodynamic psychotherapy on glutamatergic neurotransmission and thereby highlight the key role of the pgACC in both depression pathophysiology and recovery.
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Affiliation(s)
- Laura Wade-Bohleber
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Psychological Institute, Zurich University of Applied Sciences, Zurich, Switzerland
| | - Niklaus Zölch
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Zurich, Switzerland
| | - Mick Lehmann
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Jutta Ernst
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - André Richter
- Department of Consultation-Liaison-Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Erich Seifritz
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Heinz Boeker
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Simone Grimm
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Medical School Berlin, Berlin, Germany
- Department of Psychiatry, Charité Campus Benjamin Franklin, Berlin, Germany
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Erchinger VJ, Craven AR, Ersland L, Oedegaard KJ, Bartz-Johannessen CA, Hammar Å, Haavik J, Riemer F, Kessler U, Oltedal L. Electroconvulsive therapy triggers a reversible decrease in brain N-acetylaspartate. Front Psychiatry 2023; 14:1155689. [PMID: 37363174 PMCID: PMC10289547 DOI: 10.3389/fpsyt.2023.1155689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 05/02/2023] [Indexed: 06/28/2023] Open
Abstract
Introduction Based on previous research on electroconvulsive therapy (ECT) we have proposed a model where disruption, potentiation, and rewiring of brain networks occur in sequence and serve as the underlying therapeutic mechanism of ECT. This model implies that a temporary disturbance of neuronal networks (disruption) is followed by a trophic effect (potentiation), which enables the rewiring of neuronal circuits to a more euthymic functioning brain. We hypothesized that disruption of neuronal networks could trigger biochemical alterations leading to a temporary decrease in N-acetylaspartate (tNAA, considered a marker of neuronal integrity), while choline (a membrane component), myo-Inositol (mI, astroglia marker), and glutamate/glutamine (Glx, excitatory neurotransmitter) were postulated to increase. Previous magnetic resonance spectroscopy studies, reporting diverse findings, have used two different referencing methods - creatine ratios and tissue corrected values referenced to water - for the quantification of brain metabolites. Changes in creatine during ECT have also been reported, which may confound estimates adopting this as an internal reference. Methods Using MR spectroscopy, we investigated 31 moderately to severely depressed patients and 19 healthy controls before, during, and after ECT or at similar time points (for controls). We tested whether biochemical alterations in tNAA, choline, mI, and Glx lend support to the disrupt, potentiate, and rewire hypothesis. We used both creatine ratios and water-scaled values for the quantification of brain metabolites to validate the results across referencing methods. Results Levels of tNAA in the anterior cingulate cortex decreased after an ECT treatment series (average 10.6 sessions) by 6% (p = 0.007, creatine ratio) and 3% (p = 0.02, water referenced) but returned to baseline 6 months after ECT. Compared to after treatment series tNAA levels at 6-month follow-up had increased in both creatine ratio (+6%, p < 0.001) and water referenced data (+7%, p < 0.001). Findings for other brain metabolites varied and could not be validated across referencing methods. Discussion Our findings suggest that prior research must be interpreted with care, as several referencing and processing methods have been used in the past. Yet, the results for tNAA were robust across quantification methods and concur with relevant parts of the disrupt, potentiate, and rewire model.
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Affiliation(s)
- Vera J. Erchinger
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Mohn Medical Imaging and Visualization Centre, Department of Radiology, Haukeland University Hospital, Bergen, Norway
| | - Alexander R. Craven
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway
- NORMENT—Norwegian Centre for Mental Disorders Research, University of Bergen, Bergen, Norway
- Department of Clinical Engineering, Haukeland University Hospital, Bergen, Norway
| | - Lars Ersland
- Department of Clinical Engineering, Haukeland University Hospital, Bergen, Norway
| | - Ketil J. Oedegaard
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- NORMENT—Norwegian Centre for Mental Disorders Research, University of Bergen, Bergen, Norway
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | | | - Åsa Hammar
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway
| | - Jan Haavik
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
- Department of Biomedicine, University of Bergen, Bergen, Norway
| | - Frank Riemer
- Mohn Medical Imaging and Visualization Centre, Department of Radiology, Haukeland University Hospital, Bergen, Norway
| | - Ute Kessler
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- NORMENT—Norwegian Centre for Mental Disorders Research, University of Bergen, Bergen, Norway
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Leif Oltedal
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Mohn Medical Imaging and Visualization Centre, Department of Radiology, Haukeland University Hospital, Bergen, Norway
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He J, Wang D, Ban M, Kong L, Xiao Q, Yuan F, Zhu X. Regional metabolic heterogeneity in anterior cingulate cortex in major depressive disorder: A multi-voxel 1H magnetic resonance spectroscopy study. J Affect Disord 2022; 318:263-271. [PMID: 36087788 DOI: 10.1016/j.jad.2022.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 08/29/2022] [Accepted: 09/05/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Previous studies have shown major depressive disorder (MDD) is associated with altered neuro-metabolites in the anterior cingulate cortex (ACC). However, the regional metabolic heterogeneity in the ACC in individuals with MDD remains unclear. METHODS We recruited 59 first-episode, treatment-naive young adults with MDD and 50 healthy controls who underwent multi-voxel 1H-MRS scanning at 3 T (Tesla) with voxels placed in the ACC, which was divided into two subregions, pregenual ACC (pACC) and anterior midcingulate cortex (aMCC). Between and within-subjects metabolite concentration variations were analyzed with SPSS. RESULTS Compared with control subjects, patients with MDD exhibited higher glutamate (Glu) and glutamine (Gln) levels in the pACC and higher myo-inositol (MI) level in the aMCC. We observed higher Glu and Gln levels and lower N-acetyl-aspartate (NAA) level in the pACC than those in the aMCC in both MDD and healthy control (HC) groups. More importantly, the metabolite concentration gradients of Glu, Gln and NAA were more pronounced in MDD patients relative to HCs. In the MDD group, the MI level in the aMCC positively correlated with the age of onset. LIMITATIONS The use of the relative concentration of metabolites constitutes a key study limitation. CONCLUSIONS We observed inconsistent alterations and distribution of neuro-metabolites concentration in the pACC and aMCC, revealing regional metabolic heterogeneity of ACC in first-episode, treatment-naive young individuals with MDD. These results provided new evidence for abnormal neuro-metabolites of ACC in the pathophysiology of MDD and suggested that pACC and aMCC might play different roles in MDD.
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Affiliation(s)
- Jincheng He
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, China
| | - Dongcui Wang
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, China
| | - Meiting Ban
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, China
| | - Lingyu Kong
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, China
| | - Qian Xiao
- Mental Health Centre, Xiangya Hospital, Central South University, Changsha, China
| | - Fulai Yuan
- Health Management Center, Xiangya Hospital, Central South University, Changsha, China
| | - Xueling Zhu
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China.
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Leaver AM, Espinoza R, Wade B, Narr KL. Parsing the Network Mechanisms of Electroconvulsive Therapy. Biol Psychiatry 2022; 92:193-203. [PMID: 35120710 PMCID: PMC9196257 DOI: 10.1016/j.biopsych.2021.11.016] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 11/03/2021] [Accepted: 11/19/2021] [Indexed: 12/17/2022]
Abstract
Electroconvulsive therapy (ECT) is one of the oldest and most effective forms of neurostimulation, wherein electrical current is used to elicit brief, generalized seizures under general anesthesia. When electrodes are positioned to target frontotemporal cortex, ECT is arguably the most effective treatment for severe major depression, with response rates and times superior to other available antidepressant therapies. Neuroimaging research has been pivotal in improving the field's mechanistic understanding of ECT, with a growing number of magnetic resonance imaging studies demonstrating hippocampal plasticity after ECT, in line with evidence of upregulated neurotrophic processes in the hippocampus in animal models. However, the precise roles of the hippocampus and other brain regions in antidepressant response to ECT remain unclear. Seizure physiology may also play a role in antidepressant response to ECT, as indicated by early positron emission tomography, single-photon emission computed tomography, and electroencephalography research and corroborated by recent magnetic resonance imaging studies. In this review, we discuss the evidence supporting neuroplasticity in the hippocampus and other brain regions during and after ECT, and their associations with antidepressant response. We also offer a mechanistic, circuit-level model that proposes that core mechanisms of antidepressant response to ECT involve thalamocortical and cerebellar networks that are active during seizure generalization and termination over repeated ECT sessions, and their interactions with corticolimbic circuits that are dysfunctional prior to treatment and targeted with the electrical stimulus.
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Affiliation(s)
- Amber M Leaver
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Evanston, Illinois.
| | - Randall Espinoza
- Department of Psychiatry and Behavioral Sciences, Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Benjamin Wade
- Department of Neurology, Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Katherine L Narr
- Department of Neurology, Geffen School of Medicine, University of California Los Angeles, Los Angeles, California; Department of Psychiatry and Behavioral Sciences, Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
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Ermis C, Aydin B, Kucukguclu S, Yurt A, Renshaw PF, Yildiz A. Association Between Anterior Cingulate Cortex Neurochemical Profile and Clinical Remission After Electroconvulsive Treatment in Major Depressive Disorder: A Longitudinal 1H Magnetic Resonance Spectroscopy Study. J ECT 2021; 37:263-269. [PMID: 33840802 DOI: 10.1097/yct.0000000000000766] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The aim of the study was to assess anterior cingulate cortex (ACC) neurochemical profile of patients with unipolar major depressive disorder (MDD) before and after electroconvulsive therapy (ECT) by using 1H magnetic resonance spectroscopy (1H-MRS). METHOD Using 1H-MRS, the metabolite levels of choline, glutamate + glutamine (Glx), myo-inositol, N-acetylaspartate, and total creatine were measured in ACC before and after 4-week ECT. The Montgomery-Åsberg Depression Rating Scale (MADRS) was implemented by blind raters to evaluate the efficacy of the treatment. Electroconvulsive therapy-remitter (ER) and nonremitter groups were compared using the 1-way repeated measures analysis of variance. RESULTS Thirty patients with unipolar MDD (aged 41.3 ± 10.0 years, 66.7% female) were included in the study. The ER group (n = 16, 53.3%) and NR group did not differ regarding baseline Global Assessment of Functioning and MADRS scores. At the end of 4-week ECT treatment, results did not suggest any significant difference for metabolite levels in ACC. When compared with the NR group, the ER group had higher baseline levels of Glx (8.8 ± 1.8 vs 6.3 ± 2.0, P = 0.005) and total creatine (5.3 ± 0.6 vs 4.7 ± 0.5, P = 0.010). In addition, elevated baseline Glx (r = -0.68, P = 0.002) was associated with lower MADRS scores at the end treatment. Finally, the change in Glx levels was correlated with change in MADRS scores after ECT (r = 0.47, P = 0.049). LIMITATIONS Modest sample size and 1H-MRS at 1.5 Tesla are limitations of the study. CONCLUSIONS Results suggested that Glx levels could be a predictor of remission. Studies with larger samples should explore neurochemical correlates of ECT in unipolar MDD.
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Affiliation(s)
- Cagatay Ermis
- From the Department of Child and Adolescent Psychiatry, Dokuz Eylul University, School of Medicine, Izmir
| | - Burc Aydin
- Mehmet Akif Inan Training and Research Hospital, Sanliurfa
| | - Semih Kucukguclu
- Department of Anesthesiology and Reanimation, Dokuz Eylul University, School of Medicine
| | - Aysegul Yurt
- Department of Medical Physics, Dokuz Eylul University, Health Sciences Institute, Izmir, Turkey
| | | | - Aysegul Yildiz
- Department of Psychiatry, Dokuz Eylul University, School of Medicine, Izmir, Turkey
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Leaver AM, Vasavada M, Kubicki A, Wade B, Loureiro J, Hellemann G, Joshi SH, Woods RP, Espinoza R, Narr KL. Hippocampal subregions and networks linked with antidepressant response to electroconvulsive therapy. Mol Psychiatry 2021; 26:4288-4299. [PMID: 32029885 PMCID: PMC7415508 DOI: 10.1038/s41380-020-0666-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 12/11/2019] [Accepted: 01/28/2020] [Indexed: 01/29/2023]
Abstract
Electroconvulsive therapy (ECT) has been repeatedly linked to hippocampal plasticity. However, it remains unclear what role hippocampal plasticity plays in the antidepressant response to ECT. This magnetic resonance imaging (MRI) study tracks changes in separate hippocampal subregions and hippocampal networks in patients with depression (n = 44, 23 female) to determine their relationship, if any, with improvement after ECT. Voxelwise analyses were restricted to the hippocampus, amygdala, and parahippocampal cortex, and applied separately for responders and nonresponders to ECT. In analyses of arterial spin-labeled (ASL) MRI, nonresponders exhibited increased cerebral blood flow (CBF) in bilateral anterior hippocampus, while responders showed CBF increases in right middle and left posterior hippocampus. In analyses of gray matter volume (GMV) using T1-weighted MRI, GMV increased throughout bilateral hippocampus and surrounding tissue in nonresponders, while responders showed increased GMV in right anterior hippocampus only. Using CBF loci as seed regions, BOLD-fMRI data from healthy controls (n = 36, 19 female) identified spatially separable neurofunctional networks comprised of different brain regions. In graph theory analyses of these networks, functional connectivity within a hippocampus-thalamus-striatum network decreased only in responders after two treatments and after index. In sum, our results suggest that the location of ECT-related plasticity within the hippocampus may differ according to antidepressant outcome, and that larger amounts of hippocampal plasticity may not be conducive to positive antidepressant response. More focused targeting of hippocampal subregions and/or circuits may be a way to improve ECT outcome.
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Affiliation(s)
- Amber M. Leaver
- Ahmanson-Lovelace Brain Mapping Center, Department of
Neurology, University of California Los Angeles, Los Angeles, CA, 90095,Center for Translational Imaging, Department of Radiology,
Northwestern University, Chicago, IL, 60611,Corresponding Author: Amber M. Leaver Ph.D.,
Address: 737 N Michigan Ave, Suite 1600, Chicago, IL 60611, Phone 312 694 2966,
Fax 310 926 5991,
| | - Megha Vasavada
- Ahmanson-Lovelace Brain Mapping Center, Department of
Neurology, University of California Los Angeles, Los Angeles, CA, 90095
| | - Antoni Kubicki
- Ahmanson-Lovelace Brain Mapping Center, Department of
Neurology, University of California Los Angeles, Los Angeles, CA, 90095
| | - Benjamin Wade
- Ahmanson-Lovelace Brain Mapping Center, Department of
Neurology, University of California Los Angeles, Los Angeles, CA, 90095
| | - Joana Loureiro
- Ahmanson-Lovelace Brain Mapping Center, Department of
Neurology, University of California Los Angeles, Los Angeles, CA, 90095
| | - Gerhard Hellemann
- Department of Psychiatry and Biobehavioral Sciences,
University of California Los Angeles, Los Angeles, CA, 90095
| | - Shantanu H. Joshi
- Ahmanson-Lovelace Brain Mapping Center, Department of
Neurology, University of California Los Angeles, Los Angeles, CA, 90095
| | - Roger P. Woods
- Ahmanson-Lovelace Brain Mapping Center, Department of
Neurology, University of California Los Angeles, Los Angeles, CA, 90095,Department of Psychiatry and Biobehavioral Sciences,
University of California Los Angeles, Los Angeles, CA, 90095
| | - Randall Espinoza
- Department of Psychiatry and Biobehavioral Sciences,
University of California Los Angeles, Los Angeles, CA, 90095
| | - Katherine L. Narr
- Ahmanson-Lovelace Brain Mapping Center, Department of
Neurology, University of California Los Angeles, Los Angeles, CA, 90095,Department of Psychiatry and Biobehavioral Sciences,
University of California Los Angeles, Los Angeles, CA, 90095
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Erchinger VJ, Ersland L, Aukland SM, Abbott CC, Oltedal L. Magnetic Resonance Spectroscopy in Depressed Subjects Treated With Electroconvulsive Therapy-A Systematic Review of Literature. Front Psychiatry 2021; 12:608857. [PMID: 33841198 PMCID: PMC8027236 DOI: 10.3389/fpsyt.2021.608857] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 02/24/2021] [Indexed: 12/28/2022] Open
Abstract
Electroconvulsive therapy (ECT) is considered to be the most effective acute treatment for otherwise treatment resistant major depressive episodes, and has been used for over 80 years. Still, the underlying mechanism of action is largely unknow. Several studies suggest that ECT affects the cerebral neurotransmitters, such as gamma-aminobutyric acid (GABA) and glutamate. Magnetic resonance spectroscopy (MRS) allows investigators to study neurotransmitters in vivo, and has been used to study neurochemical changes in the brain of patients treated with ECT. Several investigations have been performed on ECT-patients; however, no systematic review has yet summarized these findings. A systematic literature search based on the Prisma guidelines was performed. PubMed (Medline) was used in order to find investigations studying patients that had been treated with ECT and had undergone an MRS examination. A search in the databases Embase, PsycInfo, and Web of Science was also performed, leading to no additional records. A total of 30 records were identified and screened which resulted in 16 original investigations for review. The total number of patients that was included in these studies, ignoring potential overlap of samples in some investigations, was 325. The metabolites reported were N-acetyl aspartate, Choline, Myoinositol, Glutamate and Glutamine, GABA and Creatine. The strongest evidence for neurochemical change related to ECT, was found for N-acetyl aspartate (reduction), which is a marker of neuronal integrity. Increased choline and glutamate following treatment was also commonly reported.
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Affiliation(s)
| | - Lars Ersland
- Department of Clinical Engineering, Haukeland University Hospital, Bergen, Norway.,Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway.,NORMENT Centre of Excellence, Haukeland University Hospital, Bergen, Norway
| | | | - Christopher C Abbott
- Department of Psychiatry, University of New Mexico School of Medicine, Albuquerque, NM, United States
| | - Leif Oltedal
- Department of Clinical Medicine, University of Bergen, Bergen, Norway.,Department of Radiology, Mohn Medical Imaging and Visualization Centre, Haukeland University Hospital, Bergen, Norway
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Draganov M, Vives-Gilabert Y, de Diego-Adeliño J, Vicent-Gil M, Puigdemont D, Portella MJ. Glutamatergic and GABA-ergic abnormalities in First-episode depression. A 1-year follow-up 1H-MR spectroscopic study. J Affect Disord 2020; 266:572-577. [PMID: 32056929 DOI: 10.1016/j.jad.2020.01.138] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 12/03/2019] [Accepted: 01/25/2020] [Indexed: 02/09/2023]
Abstract
BACKGROUND Previous magnetic resonance spectroscopic (MRS) studies have reported brain metabolic abnormalities in Major Depressive Disorder (MDD). Nevertheless, results have been inconsistent, focusing on fully developed major depression neglecting first episode patients (FED). Longitudinal studies have also been rare and with short follow-up periods. The aim of the current study was to investigate the differences between healthy controls and first episode patients at baseline, together with changes of metabolites after 1 year follow-up in the ventromedial prefrontal cortex. METHODS 1H-MRS images were obtained from 64 healthy controls and 31 FED patients using a 3T Philips Achieva scanner and processed with TARQUIN software at baseline and after 1 year. Examined metabolites included Glx (corresponding to Glu+Gln-peak), Glu, NAAG, myo-Ins, Cr, GSH and GABA. Clinical improvement was assessed by HDRS-17 scale. Differences in the concentrations of metabolites were evaluated by MANOVA/MANCOVA and GLM repeated measures for longitudinal changes. RESULTS FED patients had significantly decreased glutamate levels at baseline (p < 0.05) along with significantly elevated GABA (p < 0.01) compared to healthy controls. At the follow up, myo- Ins levels were significantly increased compared to baseline (p < 0.05) LIMITATIONS: The limited sample size, together with the unexpectedly high response rate after treatment (83%) might suggest decreased representativeness of the sample. CONCLUSIONS Results indicate glutamatergic and GABAergic changes taking place within the ventromedial prefrontal region even at the early stage of depression prior to any medication treatment.
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Affiliation(s)
- Metodi Draganov
- Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau (IIB-Sant Pau), Universitat Autònoma de Barcelona (UAB),Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain
| | | | - Javier de Diego-Adeliño
- Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau (IIB-Sant Pau), Universitat Autònoma de Barcelona (UAB),Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain
| | - Muriel Vicent-Gil
- Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau (IIB-Sant Pau), Universitat Autònoma de Barcelona (UAB),Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain
| | - Dolors Puigdemont
- Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau (IIB-Sant Pau), Universitat Autònoma de Barcelona (UAB),Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain
| | - Maria J Portella
- Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau (IIB-Sant Pau), Universitat Autònoma de Barcelona (UAB),Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain.
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Song J, Ma W, Gu X, Zhao L, Jiang J, Xu Y, Zhang L, Zhou M, Yang L. Metabolomic signatures and microbial community profiling of depressive rat model induced by adrenocorticotrophic hormone. J Transl Med 2019; 17:224. [PMID: 31307473 PMCID: PMC6631535 DOI: 10.1186/s12967-019-1970-8] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 07/05/2019] [Indexed: 12/17/2022] Open
Abstract
Background Adrenocorticotrophic hormone (ACTH)-treatment rat model has been utilized as a widely accepted model of treatment-resistant depression. Metabolomic signatures represent the pathophysiological phenotype of diseases. Recent studies in gut microbiota and metabolomics analysis revealed the dramatic role of microbiome in psychoneurological system diseases, but still, the mechanisms underlying gut microbiome–host interaction remain unclear. Methods Male Wistar rats were s.c. injection of ACTH fragment 1–24 for 14 days to induce treatment-resistant depression. Depression-related behavioral tests, analysis of serum monoamine neurotransmitters and hypothalamic–pituitary–adrenal (HPA) axis-related hormones were determined for assessment of ACTH-induced depression rat model. A gas chromatography-time-of-flight mass spectrometer based urinary metabolomic signatures integrated 16S rRNA sequence analysis based gut microbial profiling was performed, as well as Spearman’s correlation coefficient analysis was used to manifest the covariation between the differential urinary metabolites and gut microbiota of genus level. Results Chronic injection of ACTH-induced depression-like phenotype (increased immobility time in forced swimming test and tail suspension test) was accompanied by peripheral serotonin down-regulation and HPA axis overactivation (ACTH and corticosterone up-regulation). Urinary metabolomics analysis indicated that pyruvic acid, l-threonine, mannitol, d-gluconic acid, 4-hydroxybenzoic acid, d-arabitol, myo-inositol and ascorbic acid levels were reduced in ACTH-treated rats’ urine, while hippurate level was elevated. In addition, microbial community profiling revealed bacterial enrichment (e.g. Ruminococcus, Klebsiella) and reduction (e.g. Akkermansia, Lactobacillus) in the ACTH-induced depression rat model. Correlation analysis showed that Akkermansia and Lactobacillus were closely relevant to metabolites myo-inositol and hippurate, which were included in host inositol phosphate metabolism, and phenylalanine, tyrosine and tryptophan biosynthesis. Conclusions Depression rat model induced by ACTH is associated with disturbance of pyruvate metabolism, ascorbate and aldarate metabolism, inositol phosphate metabolism, glycine, serine and threonine metabolism, and glycolysis or gluconeogenesis, as well as changes in microbial community structure. Gut microbiota may participate in the mediation of systemic metabolomic changes in ACTH-induced depression model. Therefore, integrated metabolomic signatures and gut microbial community profiling would provide a basis for further studies on the pathogenesis of depression. Electronic supplementary material The online version of this article (10.1186/s12967-019-1970-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jing Song
- Center for Chinese Medicine Therapy and Systems Biology, Institute for Interdisciplinary Medicine Sciences, Shanghai University of Traditional Chinese Medicine, 1200 Cailun Road, Pudong District, Shanghai, 201203, China
| | - Weini Ma
- Center for Chinese Medicine Therapy and Systems Biology, Institute for Interdisciplinary Medicine Sciences, Shanghai University of Traditional Chinese Medicine, 1200 Cailun Road, Pudong District, Shanghai, 201203, China
| | - Xinyi Gu
- Center for Chinese Medicine Therapy and Systems Biology, Institute for Interdisciplinary Medicine Sciences, Shanghai University of Traditional Chinese Medicine, 1200 Cailun Road, Pudong District, Shanghai, 201203, China.,Experiment Center of Teaching & Learning, Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China.,School of Pharmacy, Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China
| | - Le Zhao
- Center for Chinese Medicine Therapy and Systems Biology, Institute for Interdisciplinary Medicine Sciences, Shanghai University of Traditional Chinese Medicine, 1200 Cailun Road, Pudong District, Shanghai, 201203, China
| | - Jiaye Jiang
- Experiment Center of Teaching & Learning, Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China
| | - Ying Xu
- Department of Physiology, Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China
| | - Lei Zhang
- Shanghai Innovation Center of TCM Health Service, Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China
| | - Mingmei Zhou
- Center for Chinese Medicine Therapy and Systems Biology, Institute for Interdisciplinary Medicine Sciences, Shanghai University of Traditional Chinese Medicine, 1200 Cailun Road, Pudong District, Shanghai, 201203, China.
| | - Li Yang
- Center for Chinese Medicine Therapy and Systems Biology, Institute for Interdisciplinary Medicine Sciences, Shanghai University of Traditional Chinese Medicine, 1200 Cailun Road, Pudong District, Shanghai, 201203, China
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10
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Leaver AM, Vasavada M, Joshi SH, Wade B, Woods RP, Espinoza R, Narr KL. Mechanisms of Antidepressant Response to Electroconvulsive Therapy Studied With Perfusion Magnetic Resonance Imaging. Biol Psychiatry 2019; 85:466-476. [PMID: 30424864 PMCID: PMC6380917 DOI: 10.1016/j.biopsych.2018.09.021] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 09/10/2018] [Accepted: 09/23/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND Converging evidence suggests that electroconvulsive therapy (ECT) induces neuroplasticity in patients with severe depression, though how this relates to antidepressant response is less clear. Arterial spin-labeled functional magnetic resonance imaging tracks absolute changes in cerebral blood flow (CBF) linked with brain function and offers a potentially powerful tool when observing neurofunctional plasticity with functional magnetic resonance imaging. METHODS Using arterial spin-labeled functional magnetic resonance imaging, we measured global and regional CBF associated with clinically prescribed ECT and therapeutic response in patients (n = 57, 30 female) before ECT, after two treatments, after completing an ECT treatment "index" (∼4 weeks), and after long-term follow-up (6 months). Age- and sex-matched control subjects were also scanned twice (n = 36, 19 female), ∼4 weeks apart. RESULTS Patients with lower baseline global CBF were more likely to respond to ECT. Regional CBF increased in the right anterior hippocampus in all patients irrespective of clinical outcome, both after 2 treatments and after ECT index. However, hippocampal CBF increases postindex were more pronounced in nonresponders. ECT responders exhibited CBF increases in the dorsomedial thalamus and motor cortex near the vertex ECT electrode, as well as decreased CBF within lateral frontoparietal regions. CONCLUSIONS ECT induces functional neuroplasticity in the hippocampus, which could represent functional precursors of ECT-induced increases in hippocampal volume reported previously. However, excessive functional neuroplasticity within the hippocampus may not be conducive to positive clinical outcome. Instead, our results suggest that although hippocampal plasticity may contribute to antidepressant response in ECT, balanced plasticity in regions relevant to seizure physiology including thalamocortical networks may also play a critical role.
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Affiliation(s)
- Amber M. Leaver
- Ahmanson-Lovelace Brain Mapping Center, Department of Neurology, University of California Los Angeles, Los Angeles, CA, 90095,Department of Radiology, Northwestern University, Chicago, IL, 60611,Corresponding Author: Amber M. Leaver Ph.D., Address: 737 N Michigan Ave, Suite 1600,Chicago, IL 60611, Phone 312 694 2966, Fax 310 926 5991,
| | - Megha Vasavada
- Ahmanson-Lovelace Brain Mapping Center, Department of Neurology, University of California Los Angeles, Los Angeles, CA, 90095
| | - Shantanu H. Joshi
- Ahmanson-Lovelace Brain Mapping Center, Department of Neurology, University of California Los Angeles, Los Angeles, CA, 90095
| | - Benjamin Wade
- Ahmanson-Lovelace Brain Mapping Center, Department of Neurology, University of California Los Angeles, Los Angeles, CA, 90095
| | - Roger P. Woods
- Ahmanson-Lovelace Brain Mapping Center, Department of Neurology, University of California Los Angeles, Los Angeles, CA, 90095,Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, 90095
| | - Randall Espinoza
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, 90095
| | - Katherine L. Narr
- Ahmanson-Lovelace Brain Mapping Center, Department of Neurology, University of California Los Angeles, Los Angeles, CA, 90095,Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, 90095
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11
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Dome P, Tombor L, Lazary J, Gonda X, Rihmer Z. Natural health products, dietary minerals and over-the-counter medications as add-on therapies to antidepressants in the treatment of major depressive disorder: a review. Brain Res Bull 2019; 146:51-78. [DOI: 10.1016/j.brainresbull.2018.12.015] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 12/04/2018] [Accepted: 12/26/2018] [Indexed: 12/23/2022]
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12
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Drago T, O’Regan PW, Welaratne I, Rooney S, O’Callaghan A, Malkit M, Roman E, Levins KJ, Alexander L, Barry D, O’Hanlon E, O’Keane V, Roddy DW. A comprehensive regional neurochemical theory in depression: a protocol for the systematic review and meta-analysis of 1H-MRS studies in major depressive disorder. Syst Rev 2018; 7:158. [PMID: 30309391 PMCID: PMC6182786 DOI: 10.1186/s13643-018-0830-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 10/01/2018] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Magnetic resonance spectroscopy (MRS) is a non-invasive analytical technique that investigates the presence and concentrations of brain metabolites. In the context of major depressive disorder (MDD), MRS has revealed regional biochemical changes in GABA, glutamate, and choline across different brain compartments. Technical and methodological advances in MRS data acquisition, in particular proton-based 1H-MRS, have resulted in a significant increase in the incidence of reports utilizing the technique for psychiatric disorder research and diagnosis. The most recent comprehensive meta-analysis reviewing MRS in MDD stems from 2006. Using contemporary systemic reviews and meta-analysis, the aim is to first test a neurochemical circuit-based theory of depression and then to determine if clinical scores relate to metabolite concentrations before and during treatment. METHODS Region-specific metabolite changes in MDD will be assessed by systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Inclusion criteria will include participant age (18 to 65), English language studies, known regions of interest, and detailed documentation of 1H-MRS procedures. Reported brain regions will be standardized according neuroanatomical expertise allowing increased power of the meta-analysis. Regions of interest will initially include the hippocampus, thalamus, prefrontal cortex, anterior and posterior cingulate gyri, parietal lobe, and basal ganglia. Exclusion criteria will include comorbid psychiatric illness and drug use. Two independent reviewers will undertake all data extraction, while a third reviewer will check for reviewer discrepancies. Statistical analysis will be performed using STATA supplemented by Metan software and SPSS. DISCUSSION This data will shed new light on the biochemical basis of depression in different brain regions, thereby highlighting the potential of MRS in identifying biomarkers and generating models of MDD and treatment response. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42018091494.
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Affiliation(s)
- Thomas Drago
- Trinity College Institute of Neuroscience, Trinity College Dublin, Lloyd Building, Dublin 2, Ireland
| | - Patrick W O’Regan
- Department of Anatomy, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin 2, Ireland
| | - Ivan Welaratne
- Department of Anatomy, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin 2, Ireland
| | - Shane Rooney
- Trinity College Institute of Neuroscience, Trinity College Dublin, Lloyd Building, Dublin 2, Ireland
| | - Aoife O’Callaghan
- Trinity College Institute of Neuroscience, Trinity College Dublin, Lloyd Building, Dublin 2, Ireland
| | - Marissa Malkit
- Trinity College Institute of Neuroscience, Trinity College Dublin, Lloyd Building, Dublin 2, Ireland
| | - Elena Roman
- Trinity College Institute of Neuroscience, Trinity College Dublin, Lloyd Building, Dublin 2, Ireland
| | - Kirk J Levins
- Department of Anaesthesia, Intensive Care and Pain Medicine, St. Vincent’s University Hospital, Dublin 4, Ireland
| | - Lauren Alexander
- Trinity College Institute of Neuroscience, Trinity College Dublin, Lloyd Building, Dublin 2, Ireland
| | - Denis Barry
- Department of Anatomy, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin 2, Ireland
| | - Erik O’Hanlon
- Trinity College Institute of Neuroscience, Trinity College Dublin, Lloyd Building, Dublin 2, Ireland
| | - Veronica O’Keane
- Trinity College Institute of Neuroscience, Trinity College Dublin, Lloyd Building, Dublin 2, Ireland
| | - Darren William Roddy
- Trinity College Institute of Neuroscience, Trinity College Dublin, Lloyd Building, Dublin 2, Ireland
- Department of Physiology, School of Medicine, University College Dublin, Dublin 4, Ireland
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13
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Beluomini MA, da Silva JL, Stradiotto NR. Amperometric determination of myo-inositol by using a glassy carbon electrode modified with molecularly imprinted polypyrrole, reduced graphene oxide and nickel nanoparticles. Mikrochim Acta 2018; 185:170. [DOI: 10.1007/s00604-018-2710-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Accepted: 01/26/2018] [Indexed: 11/25/2022]
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14
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Wade BSC, Sui J, Njau S, Leaver AM, Vasvada M, Gutman BA, Thompson PM, Espinoza R, Woods RP, Abbott CC, Narr KL, Joshi SH. DATA-DRIVEN CLUSTER SELECTION FOR SUBCORTICAL SHAPE AND CORTICAL THICKNESS PREDICTS RECOVERY FROM DEPRESSIVE SYMPTOMS. PROCEEDINGS. IEEE INTERNATIONAL SYMPOSIUM ON BIOMEDICAL IMAGING 2017; 2017:502-506. [PMID: 30713592 DOI: 10.1109/isbi.2017.7950570] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Patients with major depressive disorder (MDD) who do not achieve full symptomatic recovery after antidepressant treatment have a higher risk of relapse. Compared to pharmacotherapies, electroconvulsive therapy (ECT) more rapidly produces a greater extent of response in severely depressed patients. However, prediction of which candidates are most likely to improve after ECT remains challenging. Using structural MRI data from 42 ECT patients scanned prior to ECT treatment, we developed a random forest classifier based on data-driven shape cluster selection and cortical thickness features to predict remission. Right hemisphere hippocampal shape and right inferior temporal cortical thickness was most predictive of remission, with the predicted probability of recovery decreasing when these regions were thicker prior to treatment. Remission was predicted with an average 73% balanced accuracy. Classification of MRI data may help identify treatment-responsive patients and aid in clinical decision-making. Our results show promise for the development of personalized treatment strategies.
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Affiliation(s)
- Benjamin S C Wade
- Ahmanson-Lovelace Brain Mapping Center, Department of Neurology, UCLA.,Imaging Genetics Center, USC
| | - Jing Sui
- The Mind Research Network and Lovelace Biomedical and Environmental Research Institute, Albuquerque, NM
| | - Stephanie Njau
- Ahmanson-Lovelace Brain Mapping Center, Department of Neurology, UCLA
| | - Amber M Leaver
- Ahmanson-Lovelace Brain Mapping Center, Department of Neurology, UCLA
| | - Megha Vasvada
- Ahmanson-Lovelace Brain Mapping Center, Department of Neurology, UCLA
| | | | | | | | - Roger P Woods
- Ahmanson-Lovelace Brain Mapping Center, Department of Neurology, UCLA
| | | | - Katherine L Narr
- Ahmanson-Lovelace Brain Mapping Center, Department of Neurology, UCLA
| | - Shantanu H Joshi
- Ahmanson-Lovelace Brain Mapping Center, Department of Neurology, UCLA
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15
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Shirayama Y, Takahashi M, Osone F, Hara A, Okubo T. Myo-inositol, Glutamate, and Glutamine in the Prefrontal Cortex, Hippocampus, and Amygdala in Major Depression. BIOLOGICAL PSYCHIATRY: COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2016; 2:196-204. [PMID: 29560915 DOI: 10.1016/j.bpsc.2016.11.006] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Revised: 11/13/2016] [Accepted: 11/28/2016] [Indexed: 01/05/2023]
Abstract
BACKGROUND The brains of patients with depression exhibit many changes in various regions. Recently, proton magnetic resonance spectroscopy has been used to measure brain metabolites, using saturation bands to shape the volume of interest. Our a priori hypothesis was that myo-inositol and glutamate were downregulated in the hippocampus and amygdala in depression. METHODS We measured brain metabolites from the medial prefrontal cortex, hippocampus, and amygdala of 22 drug-naïve, first-episode patients with major depressive disorder and 27 healthy control subjects using 3T proton magnetic resonance spectroscopy. RESULTS Compared with healthy control subjects, patients showed statistically significant reductions in myo-inositol levels in all three regions and reductions in glutamate levels in the medial prefrontal cortex. Furthermore, we found significant decreases in the ratios of glutamate to creatine plus phosphocreatine in the medial prefrontal cortex and amygdala. Additionally, the ratios of glutamine to creatine plus phosphocreatine were also decreased in all three regions examined, although not all the participants presented reliable data. Finally, glutamate levels in the medial prefrontal cortex and amygdala have significant correlations with executive function and those in the hippocampus with memory function. Hippocampal myo-inositol was significantly related to blood cortisol. CONCLUSIONS Our findings indicated abnormal myo-inositol, glutamate, and glutamine levels in the brains of major depressive disorder patients.
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Affiliation(s)
- Yukihiko Shirayama
- Department of Psychiatry, Teikyo University Chiba Medical Center, Ichihara, Chiba, Japan.
| | - Michio Takahashi
- Department of Psychiatry, Teikyo University Chiba Medical Center, Ichihara, Chiba, Japan
| | - Fumio Osone
- Department of Radiology, Teikyo University Chiba Medical Center, Ichihara, Chiba, Japan
| | - Akira Hara
- Department of Radiology, Teikyo University Chiba Medical Center, Ichihara, Chiba, Japan
| | - Toshiyuki Okubo
- Department of Radiology, Teikyo University Chiba Medical Center, Ichihara, Chiba, Japan
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