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Saccaro LF, Tassone M, Tozzi F, Rutigliano G. Proton magnetic resonance spectroscopy of N-acetyl aspartate in first depressive episode and chronic major depressive disorder: A systematic review and meta-analysis. J Affect Disord 2024; 355:265-282. [PMID: 38554884 DOI: 10.1016/j.jad.2024.03.150] [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: 03/15/2023] [Revised: 03/20/2024] [Accepted: 03/25/2024] [Indexed: 04/02/2024]
Abstract
N-acetyl aspartate (NAA) is a marker of neuronal integrity and metabolism. Deficiency in neuronal plasticity and hypometabolism are implicated in Major Depressive Disorder (MDD) pathophysiology. To test if cerebral NAA concentrations decrease progressively over the MDD course, we conducted a pre-registered meta-analysis of Proton Magnetic Resonance Spectroscopy (1H-MRS) studies comparing NAA concentrations in chronic MDD (n = 1308) and first episode of depression (n = 242) patients to healthy controls (HC, n = 1242). Sixty-two studies were meta-analyzed using a random-effect model for each brain region. NAA concentrations were significantly reduced in chronic MDD compared to HC within the frontal lobe (Hedges' g = -0.330; p = 0.018), the occipital lobe (Hedges' g = -0.677; p = 0.007), thalamus (Hedges' g = -0.673; p = 0.016), and frontal (Hedges' g = -0.471; p = 0.034) and periventricular white matter (Hedges' g = -0.478; p = 0.047). We highlighted a gap of knowledge regarding NAA levels in first episode of depression patients. Sensitivity analyses indicated that antidepressant treatment may reverse NAA alterations in the frontal lobe. We highlighted field strength and correction for voxel grey matter as moderators of NAA levels detection. Future studies should assess NAA alterations in the early stages of the illness and their longitudinal progression.
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Affiliation(s)
- Luigi F Saccaro
- Department of Psychiatry, Faculty of Medicine, University of Geneva, Campus Biotech, 9 Chemin des Mines, 1202 Geneva, Switzerland; Department of Psychiatry, Geneva University Hospital, 1205 Geneva, Switzerland.
| | - Matteo Tassone
- Department of Pathology, University of Pisa, via Savi 10, 56126 Pisa, Italy
| | - Francesca Tozzi
- Bio@SNS laboratory, Scuola Normale Superiore, 56124 Pisa, Italy
| | - Grazia Rutigliano
- Department of Pathology, University of Pisa, via Savi 10, 56126 Pisa, Italy; Institute of Clinical Sciences, Imperial College London, MRI Steiner Unit, Hammersmith Hospital Campus, Du Cane Road, W12 0NN London, United Kingdom of Great Britain and Northern Ireland
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Lagatta DC, Fassini A, Terzian AL, Corrêa FMA, Resstel LBM. The medial prefrontal cortex and the cardiac baroreflex activity: physiological and pathological implications. Pflugers Arch 2023; 475:291-307. [PMID: 36695881 DOI: 10.1007/s00424-022-02786-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 12/16/2022] [Accepted: 12/25/2022] [Indexed: 01/26/2023]
Abstract
The cardiac baroreflex is an autonomic neural mechanism involved in the modulation of the cardiovascular system. It influences the heart rate and peripheral vascular resistance to preserve arterial blood pressure within a narrow variation range. This mechanism is mainly controlled by medullary nuclei located in the brain stem. However, supramedullary areas, such as the ventral portion of medial prefrontal cortex (vMPFC), are also involved. Particularly, the glutamatergic NMDA/NO pathway in the vMPFC can facilitate baroreflex bradycardic and tachycardic responses. In addition, cannabinoid receptors in this same area can reduce or increase those cardiac responses, possibly through alteration in glutamate release. This vMPFC network has been associated to cardiovascular responses during stressful situations. Recent results showed an involvement of glutamatergic, nitrergic, and endocannabinoid systems in the blood pressure and heart rate increases in animals after aversive conditioning. Consequently, baroreflex could be modified by the vMPFC neurotransmission during stressful situations, allowing necessary cardiovascular adjustments. Remarkably, some mental, neurological and neurodegenerative disorders can involve damage in the vMPFC, such as posttraumatic stress disorder, major depressive disorder, Alzheimer's disease, and neuropathic pain. These pathologies are also associated with alterations in glutamate/NO release and endocannabinoid functions along with baroreflex impairment. Thus, the vMPFC seems to play a crucial role on the baroreflex control, either during pathological or physiological stress-related responses. The study of baroreflex mechanism under such pathological view may be helpful to establish causality mechanisms for the autonomic and cardiovascular imbalance found in those conditions. It can explain in the future the reasons of the high cardiovascular risk some neurological and neurodegenerative disease patients undergo. Additionally, the present work offers insights on the possible contributions of vMPFC dysfunction on baroreflex alterations, which, in turn, may raise questions in what extent other brain areas may play a role in autonomic deregulation under such pathological situations.
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Affiliation(s)
- Davi C Lagatta
- Faculty of Pharmaceutical Sciences, Food and Nutrition, Federal University of Mato Grosso do Sul, MS, 79070-900, Campo Grande, Brazil
| | - Aline Fassini
- Department of Pharmacology, Medical School of Ribeirão Preto, University of São Paulo, Avenida Bandeirantes 3900, Ribeirão Preto, SP, 14090-900, Brazil
| | - Ana L Terzian
- Department of Pharmacology, Medical School of Ribeirão Preto, University of São Paulo, Avenida Bandeirantes 3900, Ribeirão Preto, SP, 14090-900, Brazil
| | - Fernando M A Corrêa
- Department of Pharmacology, Medical School of Ribeirão Preto, University of São Paulo, Avenida Bandeirantes 3900, Ribeirão Preto, SP, 14090-900, Brazil
| | - Leonardo B M Resstel
- Department of Pharmacology, Medical School of Ribeirão Preto, University of São Paulo, Avenida Bandeirantes 3900, Ribeirão Preto, SP, 14090-900, Brazil.
- Center for Interdisciplinary Research On Applied Neurosciences (NAPNA), Medical School of Ribeirão Preto, University of São Paulo (USP), Ribeirão Preto, Brazil.
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Chen Y, Li X, Wang L, Tian S, Chen Y, Wang F, Gu K, Wang Y, Xu G, Zhang S, Liu J, Wang H, Jia Z, Li L, Wang X, Xie F, Wang X, Wang S, Xue C, Zhao Y, Qian L. Effects of Repetitive Transcranial Magnetic Stimulation on Cognitive Function in Patients With Stress-Related Depression: A Randomized Double-Blind fMRI and 1H-MRS Study. Front Neurol 2022; 13:844606. [PMID: 35493813 PMCID: PMC9051398 DOI: 10.3389/fneur.2022.844606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 03/14/2022] [Indexed: 12/04/2022] Open
Abstract
Objectives To reveal the effects of repetitive transcranial magnetic stimulation (rTMS) on the improvement of cognitive function in patients with stress-related depression, and to enrich the neural mechanism(s) underlying rTMS so as to improve cognitive function in patients with stress-related depression. Methods We conducted a randomized, double-blind, placebo-controlled study of rTMS in patients with stress-related depression who were 18–40 years of age. Patients were randomly allocated to either a sham or experimental group in a 1:1 ratio. A 10-session rTMS protocol was used with 10-Hz stimulation over the left dorsolateral prefrontal cortex (DLPFC). Clinical assessments (HAMD, HAMA, DASS, MoCA), neuropsychologic (Stroop, WCST), and resting state fMRI and 1H-MRS assessments were executed at two time points—baseline and after the 10th rTMS session. Results rTMS relieved the mental symptoms of patients in both groups. The MoCA score of patients in the experimental group increased; the number of correct answers increased significantly in Stroop testing, and the number of errors and omissions decreased significantly; the number of persistent errors decreased significantly; and the time used to complete the test decreased to an even greater extent in the WCST experimental group. The ReHo value in the lingual gyrus of the right hemisphere and the cuneus of the left and right hemispheres in the experimental group decreased after treatment. The DC value in the left and right hemispheric cuneus and postcentral gyrus of the left hemisphere in the experimental group diminished after treatment. The functional connections of these brain regions also changed as the Cho and NAA/Cr of the left DLPFC changed, with alterations related to the improvement in cognitive function. The level of choline (Cho) in the left DLPFC of the experimental group was significantly lower than that of the control group, and the level of N-acetylaspartate/creatine (NAA/Cr) in the left DLPFC of the control group was significantly higher than that of the experimental group. These changes were related to the overall improvement in cognitive function. Conclusions Ten-Hz rTMS over the left DLPFC improved the cognitive function of patients with stress-related depression. The governing mechanism for this phenomenon may be via rTMS effects on multiple visual-related brain regions and their functional connections, and on the somatosensory cortex and its functional connection with visual and auditory cortex, reducing the level of Cho and stabilizing the level of NAA/Cr in the left DLPFC.
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Affiliation(s)
- Yuxin Chen
- Laboratory of Stress Medicine, Beijing Institute of Basic Medical Sciences, Beijing, China
| | - Xiuzhen Li
- Department of Psychiatry, Hospital 984 of PLA, Beijing, China
| | - Lubin Wang
- Laboratory of Stress Medicine, Beijing Institute of Basic Medical Sciences, Beijing, China
| | - Shushi Tian
- Biochemical Laboratory, Hospital 984 of PLA, Beijing, China
| | - Yuanwang Chen
- Department of Psychiatry, Hospital 984 of PLA, Beijing, China
| | - Feng Wang
- Department of Psychiatry, Hospital 984 of PLA, Beijing, China
| | - Kesheng Gu
- Department of Psychiatry, Hospital 984 of PLA, Beijing, China
| | - Ying Wang
- Department of Psychiatry, Hospital 984 of PLA, Beijing, China
| | - Guangkai Xu
- Biochemical Laboratory, Hospital 984 of PLA, Beijing, China
| | - Shangrong Zhang
- Department of Psychiatry, Hospital 984 of PLA, Beijing, China
| | - Jie Liu
- Department of Psychiatry, Hospital 984 of PLA, Beijing, China
| | - Haipeng Wang
- Department of Psychiatry, Hospital 984 of PLA, Beijing, China
| | - Zongxin Jia
- Department of Psychiatry, Hospital 984 of PLA, Beijing, China
| | - Liqing Li
- Department of Imaging, Hospital 984 of PLA, Beijing, China
| | - Xiaohui Wang
- Department of Psychiatry, Hospital 984 of PLA, Beijing, China
| | - Fang Xie
- Laboratory of Stress Medicine, Beijing Institute of Basic Medical Sciences, Beijing, China
| | - Xue Wang
- Laboratory of Stress Medicine, Beijing Institute of Basic Medical Sciences, Beijing, China
| | - Shida Wang
- Laboratory of Stress Medicine, Beijing Institute of Basic Medical Sciences, Beijing, China
| | - Cong Xue
- Laboratory of Stress Medicine, Beijing Institute of Basic Medical Sciences, Beijing, China
| | - Yun Zhao
- Laboratory of Stress Medicine, Beijing Institute of Basic Medical Sciences, Beijing, China
- *Correspondence: Yun Zhao
| | - Lingjia Qian
- Laboratory of Stress Medicine, Beijing Institute of Basic Medical Sciences, Beijing, China
- Lingjia Qian
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Zhong S, Wang Y, Lai S, Liu T, Liao X, Chen G, Jia Y. Associations between executive function impairment and biochemical abnormalities in bipolar disorder with suicidal ideation. J Affect Disord 2018; 241:282-290. [PMID: 30142586 DOI: 10.1016/j.jad.2018.08.031] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 08/03/2018] [Accepted: 08/07/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Executive dysfunction and biochemical abnormalities using proton magnetic resonance spectroscopy (1H-MRS) have been reported in bipolar disorder (BD). Much less is known about the information from BD with suicidal ideation (SI). This study aimed to assess alterations of execution function and biochemical metabolism in BD with SI, in BD without SI, and in healthy controls. The associations between execution function and biochemical metabolism in the two BD patient groups were also been studied. METHODS 92 patients with bipolar disorder during a depressive episode (50 with current SI, and 42 without SI), as well as, 43 healthy controls were recruited in our study. Executive function was assessed by Wisconsin Card Sorting Test (WCST). Bilateral metabolite levels of prefrontal cortex (PFC), anterior cingulated cortex (ACC), lenticular nucleus (LN) of basal ganglia and thalamus were obtained by 1H-MRS at 3.0 T, then determined the ratios of N-acetyl aspartate (NAA), choline-containing compounds (Cho), myo-inositol (mI) to creatine (Cr). RESULTS Number of categories completed (CC) in BD with SI was significantly less than healthy controls. NAA/Cr ratios of left PFC in the two BD patient groups (with or without SI) were significantly lower than healthy controls, and NAA/Cr ratios of left thalamus were significantly higher than healthy controls. Moreover, NAA/Cr ratio of right LN in BD without SI was higher than BD with SI and healthy controls. For BD with SI, NAA/Cr ratio of left thalamus was negatively correlated with number of CC. CONCLUSIONS These results suggested that BD with or without SI may have abnormal NAA metabolism, and NAA/Cr ratio of right LN may distinguish SI from the BD patients. Further, BD with SI may have executive function impairment, which may be associated with the abnormal NAA metabolism in the left thalamus.
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Affiliation(s)
- Shuming Zhong
- Department of Psychiatry, First Affiliated Hospital, Jinan University, No. 613 West Huangpu Avenue Tianhe District, Guangzhou 510630, China
| | - Ying Wang
- Medical Imaging Center, First Affiliated Hospital, Jinan University, Guangzhou 510630, China
| | - Shunkai Lai
- Department of Psychiatry, First Affiliated Hospital, Jinan University, No. 613 West Huangpu Avenue Tianhe District, Guangzhou 510630, China
| | - Tao Liu
- Department of Psychiatry, First Affiliated Hospital, Jinan University, No. 613 West Huangpu Avenue Tianhe District, Guangzhou 510630, China
| | - Xiaoxiao Liao
- Department of Psychiatry, First Affiliated Hospital, Jinan University, No. 613 West Huangpu Avenue Tianhe District, Guangzhou 510630, China
| | - Guanmao Chen
- Medical Imaging Center, First Affiliated Hospital, Jinan University, Guangzhou 510630, China
| | - Yanbin Jia
- Department of Psychiatry, First Affiliated Hospital, Jinan University, No. 613 West Huangpu Avenue Tianhe District, Guangzhou 510630, China.
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Riley CA, Renshaw PF. Brain choline in major depression: A review of the literature. Psychiatry Res Neuroimaging 2018; 271:142-153. [PMID: 29174766 DOI: 10.1016/j.pscychresns.2017.11.009] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 10/03/2017] [Accepted: 11/13/2017] [Indexed: 12/18/2022]
Abstract
The focus of this review is to provide a synthesis of the current literature on the role of brain choline, as measured by proton magnetic resonance spectroscopy (1H-MRS), in major depressive disorder (MDD). The most recent 1H-MRS literature review took place over 10 years ago and, reflecting the high level of research on this topic, much has been learned since then. Higher brain choline levels have been linked to an increase in depression, and a cholinergic model for MDD development has been postulated. However, current 1H-MRS studies have been inconclusive regarding the role of choline in depression. Data from eighty-six peer-reviewed studies were analyzed for a random-effects model meta-analysis. Two significant findings are reported. Papers that did not report segmentation had a significant, moderate effect size. Higher choline concentrations in the frontal lobe were found in depressed patients, both in those who responded to treatment and those who did not, after treatment with psychiatric medication, repetitive transcranial magnetic stimulation, or electroconvulsive therapy. Findings from this review may add to existing information regarding the role of brain choline in MDD. This may provide a future target for treatment and drug development. It also may serve as a biomarker for treatment progress.
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Affiliation(s)
- Colin A Riley
- University of Utah, Department of Psychiatry, 383 Colorow Drive, Salt Lake City, UT, USA; Rocky Mountain MIRECC, Department of Veterans Affairs, 500 Foothill Drive, Salt Lake City, UT, USA.
| | - Perry F Renshaw
- University of Utah, Department of Psychiatry, 383 Colorow Drive, Salt Lake City, UT, USA; Rocky Mountain MIRECC, Department of Veterans Affairs, 500 Foothill Drive, Salt Lake City, UT, USA
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Li N, An L, Johnson C, Shen J. Phase-encoded single-voxel magnetic resonance spectroscopy for suppressing outer volume signals at 7 Tesla. BIOMEDICAL SPECTROSCOPY AND IMAGING 2017; 6:101-110. [PMID: 29755936 PMCID: PMC5942903 DOI: 10.3233/bsi-170168] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND Due to imperfect slice profiles, unwanted signals from outside the selected voxel may significantly contaminate metabolite signals acquired using in vivo magnetic resonance spectroscopy (MRS). The use of outer volume suppression may exceed the SAR threshold, especially at high field. OBJECTIVE We propose using phase-encoding gradients after radiofrequency (RF) excitation to spatially encode unwanted signals originating from outside of the selected single voxel. METHODS Phase-encoding gradients were added to a standard single voxel point-resolved spectroscopy (PRESS) sequence which selects a 2 × 2 × 2 cm3 voxel. Subsequent spatial Fourier transform was used to encode outer volume signals. Phantom and in vivo experiments were performed using both phase-encoded PRESS and standard PRESS at 7 Tesla. Quantification was performed using fitting software developed in-house. RESULTS Both phantom and in vivo studies showed that spectra from the phase-encoded PRESS sequence were relatively immune from contamination by oil signals and have more accurate quantification results than spectra from standard PRESS spectra of the same voxel. CONCLUSION The proposed phase-encoded single-voxel PRESS method can significantly suppress outer volume signals that may appear in the spectra of standard PRESS without increasing RF power deposition.
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Affiliation(s)
- Ningzhi Li
- Corresponding author: Ningzhi Li, 10 Center Dr., Room 3D46, Bethesda, MD, 20895, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland, USA. Tel.: +1 301-594-0962; Fax: +1 301-480-5904;
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Baeken C, Lefaucheur JP, Van Schuerbeek P. The impact of accelerated high frequency rTMS on brain neurochemicals in treatment-resistant depression: Insights from 1 H MR spectroscopy. Clin Neurophysiol 2017; 128:1664-1672. [DOI: 10.1016/j.clinph.2017.06.243] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2017] [Revised: 05/21/2017] [Accepted: 06/14/2017] [Indexed: 12/21/2022]
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Altered neuronal spontaneous activity correlates with glutamate concentration in medial prefrontal cortex of major depressed females: An fMRI-MRS study. J Affect Disord 2016; 201:153-61. [PMID: 27235818 DOI: 10.1016/j.jad.2016.05.014] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Revised: 04/18/2016] [Accepted: 05/11/2016] [Indexed: 12/15/2022]
Abstract
BACKGROUND Major depressive disorder (MDD) is twice more prevalent in females than in males. Yet, there have only been a few studies on the functional brain activity in female MDD patients and the detailed mechanisms underlying their neurobiology merit further investigations. In the present work, we used combined fMRI-MRS methods to investigate the altered intrinsic neuronal activity and its association with neurotransmitter concentration in female MDD patients. METHODS The whole brain amplitude of low frequency fluctuation (ALFF) analysis using resting state functional magnetic resonance imaging (fMRI) was performed to explore the alteration of intrinsic neuronal signals in MDD females (n=11) compared with female healthy controls (n=11). With a specific interest in the medial prefrontal cortex (mPFC) area, we quantified the concentration of amino acid neurotransmitters including GABA ((r-aminobutyric acid)), Glu (Glutamate), and Glx (Glutamate + Glutamine) using (1)H-MRS technology. Moreover, we conducted Pearson correlation analysis between the ALFF value and neurotransmitter concentration to find out the functional-biochemical relation in mPFC area. The relationship between the metabolites concentration and MDD symptomatology was also examined through Spearman correlation analysis. RESULTS We found that the female MDD patients showed increased neuronal spontaneous activity in left medial prefrontal cortex (mPFC) and left middle frontal cortex, with decreased ALFF level in right putamen and right middle temporal cortex (p<0.01, Alphasim corrected). The ALFF in mPFC was shown positively correlated with Glu concentration in female MDD patients (r=0.67, p=0.023). The Glu concentration in mPFC was positively correlated with patients HAMA scores (r=0.641, p=0.033). LIMITATIONS The relatively small sample size, metabolite information acquired only in mPFC and not all patients were unmedicated are the major limitations of our study. CONCLUSIONS Using combined fMRI-MRS methods, we found increased spontaneous neuronal activity was correlated with Glu concentration in mPFC of female MDD patients. Other regions including left middle frontal gyrus, right putamen and middle temporal gyrus also showed altered spontaneous neuronal activities. The abnormal intrinsic neuronal activities in fronto-cortical regions shed light on the pathogenesis underlying MDD females. The multimodal resting-state neuroimaging technique served as a useful tool for functional-biochemical investigation of MDD pathophysiology.
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Ferrari F, Villa RF. The Neurobiology of Depression: an Integrated Overview from Biological Theories to Clinical Evidence. Mol Neurobiol 2016; 54:4847-4865. [DOI: 10.1007/s12035-016-0032-y] [Citation(s) in RCA: 82] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Accepted: 08/01/2016] [Indexed: 12/21/2022]
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Li N, An L, Shen J. Spectral fitting using basis set modified by measured B0 field distribution. NMR IN BIOMEDICINE 2015; 28:1707-1715. [PMID: 26503305 PMCID: PMC4715526 DOI: 10.1002/nbm.3430] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Revised: 08/18/2015] [Accepted: 09/11/2015] [Indexed: 05/30/2023]
Abstract
This study sought to demonstrate and evaluate a novel spectral fitting method to improve quantification accuracy in the presence of large magnetic field distortion, especially with high fields. MRS experiments were performed using a point-resolved spectroscopy (PRESS)-type sequence at 7 T. A double-echo gradient echo (GRE) sequence was used to acquire B0 maps following MRS experiments. The basis set was modified based on the measured B0 distribution within the MRS voxel. Quantification results were obtained after fitting the measured MRS data using the modified basis set. The proposed method was validated using numerical Monte Carlo simulations, phantom measurements, and comparison of occipital lobe MRS measurements under homogeneous and inhomogeneous magnetic field conditions. In vivo results acquired from voxels placed in thalamus and prefrontal cortex regions close to the frontal sinus agreed well with published values. Instead of noise-amplifying complex division, the proposed method treats field variations as part of the signal model, thereby avoiding inherent statistical bias associated with regularization. Simulations and experiments showed that the proposed approach reliably quantified results in the presence of relatively large magnetic field distortion. Published 2015. This article is a U.S. Government work and is in the public domain in the USA.
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Affiliation(s)
- Ningzhi Li
- Molecular Imaging Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - Li An
- Molecular Imaging Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - Jun Shen
- Molecular Imaging Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
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The correlation between biochemical abnormalities in frontal white matter, hippocampus and serum thyroid hormone levels in first-episode patients with major depressive disorder. J Affect Disord 2015; 180:162-9. [PMID: 25913802 DOI: 10.1016/j.jad.2015.04.005] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Revised: 03/03/2015] [Accepted: 04/02/2015] [Indexed: 12/15/2022]
Abstract
BACKGROUND Previous neuroimaging studies found evidence of potential brain biochemical abnormalities in patients with major depressive disorder (MDD). Abnormal serum thyroid hormone levels were also found in MDD patients, which may correlated with the abnormal biochemical metabolism of brain. However, they rarely excluded the compounding effects of medication, and brain degeneration. This study sought to investigate the relationship between the biochemical metabolism and the serum thyroid hormone levels in first-episode, treatment-naive, non-late-life patients with MDD. METHODS 26 first-episode, treatment-naive, non-late-life patients with MDD and 13 healthy controls were enrolled in this study. Participants underwent two-dimensinal multivoxel proton magnetic resonance spectroscopy ((1)H MRS) [repetition time (TR)=1000ms; echo-time (TE)=144ms] at 1.5T to obtain bilateral metabolite levels from the white matter in prefrontal (WMP) lobe, anterior cingulate cortex (ACC), and hippocampus. The ratios of N-acetylaspartate (NAA)/creatine (Cr) and choline containg compounds (Cho)/creatine (Cr) were calculated. Morning serum free triiodothyronine (FT3), free thyroxin (FT4), total triiodothyronine (T3), total thyroxin (T4), and thyroid-stimulating hormone (TSH) were measured before antidepressant treatment. RESULTS On the comparison of brain biochemical changes, MDD patients had a significantly lower NAA/Cr ratio in the left WMP, and lower NAA/Cr and Cho/Cr ratios in the right WMP when compared to the controls. There were no significant differences in the metabolite ratios in the bilateral ACC, and hippocampus. On the comparison of serum thyroid hormone levels, MDD patients had a significantly decreased T3 and TSH levels. On the comparison of correlation of brain biochemical changes and serum thyroid hormone levels in patients with MDD, the NAA/Cr ratio in the right WMP was positively correlated with the level of TSH. CONCLUSION These findings suggest that biochemical abnormalities and thyroid dysfunction may emerge early in the course of MDD. Dysfunction of neuronal function in the WMP may correlate with the abnormal TSH in patients with MDD, which may be related to the neuropathology of depression.
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Lirng JF, Chen HC, Fuh JL, Tsai CF, Liang JF, Wang SJ. Increased myo-inositol level in dorsolateral prefrontal cortex in migraine patients with major depression. Cephalalgia 2014; 35:702-9. [DOI: 10.1177/0333102414557048] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Accepted: 10/04/2014] [Indexed: 11/17/2022]
Abstract
Background Although the comorbidity between migraine and major depressive disorder (MDD) has been recognized, the pathophysiology remains unclear. The dorsolateral prefrontal cortex (DLPFC) is a well-known neural substrate for MDD. We investigated the relationship between brain metabolites in DLPFC and comorbid MDD in migraine patients. Methods We recruited migraine patients from a tertiary headache clinic. A board-certified psychiatrist conducted a structured interview for MDD diagnosis. The severity of depression was evaluated by the Beck Depression Inventory (BDI). Thirty migraine patients (five men, 25 women; mean age: 40.4 ± 12.4 years) completed the study, and 16 of them were diagnosed with MDD. All patients underwent a magnetic resonance spectroscopy (MRS) examination focusing on bilateral DLPFC. The ratios of N-acetylaspartate (NAA), choline (Cho), and myo-inositol (mI) to total creatine (tCr) were compared between migraine patients with and without MDD, and were correlated with BDI scores. Results Relative to patients without MDD, migraine patients with MDD had higher mI/tCr ratios in the bilateral DLPFC ( p = 0.02, left; p = 0.02, right, Mann-Whitney U test). The mI/tCr ratios in the right DLPFC were positively correlated with BDI scores ( r = 0.52, p = 0.003). The NAA/tCr and Cho/tCr ratios did not differ between migraine patients with and without MDD. Conclusion Increased mI/tCr within the DLPFC might be associated with the presence of MDD in migraine patients.
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Affiliation(s)
- Jiing-Feng Lirng
- Faculty of Medicine, School of Medicine, National Yang-Ming University, Taiwan
- Department of Radiology, Taipei Veterans General Hospital, Taiwan
| | - Hung-Chieh Chen
- Faculty of Medicine, School of Medicine, National Yang-Ming University, Taiwan
- Department of Radiology, Taichung Veterans General Hospital, Taiwan
| | - Jong-Ling Fuh
- Faculty of Medicine, School of Medicine, National Yang-Ming University, Taiwan
- Brain Research Center, National Yang-Ming University, Taiwan
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taiwan
| | - Chia-Fen Tsai
- Faculty of Medicine, School of Medicine, National Yang-Ming University, Taiwan
- Institute of Brain Science, National Yang-Ming University, Taiwan
- Department of Psychiatry, Taipei Veterans General Hospital, Taiwan
| | - Jen-Feng Liang
- Faculty of Medicine, School of Medicine, National Yang-Ming University, Taiwan
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taiwan
| | - Shuu-Jiun Wang
- Faculty of Medicine, School of Medicine, National Yang-Ming University, Taiwan
- Brain Research Center, National Yang-Ming University, Taiwan
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taiwan
- Institute of Brain Science, National Yang-Ming University, Taiwan
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Zhong S, Wang Y, Zhao G, Xiang Q, Ling X, Liu S, Huang L, Jia Y. Similarities of biochemical abnormalities between major depressive disorder and bipolar depression: a proton magnetic resonance spectroscopy study. J Affect Disord 2014; 168:380-6. [PMID: 25106035 DOI: 10.1016/j.jad.2014.07.024] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2013] [Revised: 07/10/2014] [Accepted: 07/11/2014] [Indexed: 12/16/2022]
Abstract
BACKGROUND Depression in the context of bipolar disorder (BD) is often misdiagnosed as major depressive disorder (MDD), leading to mistreatments and poor clinical outcomes for many bipolar patients. Previous neuroimaging studies found mixed results on brain structure, and biochemical metabolism of the two disorders. To eliminate the compounding effects of medication, and aging, this study sought to investigate the brain biochemical changes of treatment-naïve, non-late-life patients with MDD and BD in white matter in prefrontal (WMP) lobe, anterior cingulate cortex (ACC) and hippocampus by using proton magnetic resonance spectroscopy ((1)H-MRS). METHODS Three groups of participants were recruited: 26 MDD patients, 20 depressed BD patients, and 13 healthy controls. The multi-voxel (1)H-MRS [repetition time (TR)=1000ms; echo-time (TE)=144ms] was used for the measurement of N-acetylaspartate(NAA), choline containg compounds (Cho), and creatine (Cr) in three brain locations: white matter in prefrontal (WMP) lobe, anterior cingulate cortex (ACC), and hippocampus. Two ratios of NAA/Cr and Cho/Cr as a measure of brain biochemical changes were compared among three experimental groups. RESULTS On the comparison of brain biochemical changes, both MDD patients and BD patients showed many similarities compared to the controls. They both had a significantly lower NAA/Cr ratio in the left WMP lobe. There were no significant differences among three experimental groups for Cho/Cr ratio in the WMP lobe, and for the ratios of NAA/Cr and Cho/Cr in the bilateral ACC and hippocampus. The only difference between MDD and BD patients existed for the NAA/Cr ratio in the right WMP lobe. While MDD patients had a significantly lower NAA/Cr ratio than controls, BD patients showed no such differences. On the comparison of correlation of medical variables and brain biochemical changes, all participants demonstrated no significant correlations. CONCLUSION Reduced NAA/Cr ratio at the left WMP lobe indicated the dysfunction of neuronal viability in deep white matter, in both MDD and BD patients who shared similarities of brain biochemical abnormalities, which might imply an overlap in neuropathology of depression.
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Affiliation(s)
- Shuming Zhong
- Department of Psychiatry, First Affiliated Hospital of Jinan University, Guangzhou 510630, China
| | - Ying Wang
- Medical Imaging Center, First Affiliated Hospital of Jinan University, Guangzhou 510630, China
| | - Guoxiang Zhao
- Department of Science and Education, Guangdong Emergency Hospital, Guangzhou 510316, China
| | - Qi Xiang
- Institute of Biomedicine, Jinan University, Guangzhou 510630, China
| | - Xueying Ling
- Medical Imaging Center, First Affiliated Hospital of Jinan University, Guangzhou 510630, China
| | - Sirun Liu
- Medical Imaging Center, First Affiliated Hospital of Jinan University, Guangzhou 510630, China
| | - Li Huang
- Medical Imaging Center, First Affiliated Hospital of Jinan University, Guangzhou 510630, China.
| | - Yanbin Jia
- Department of Psychiatry, First Affiliated Hospital of Jinan University, Guangzhou 510630, China.
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Timoshanko A, Desmond P, Camfield D, Downey L, Stough C. A magnetic resonance spectroscopy (1H MRS) investigation into brain metabolite correlates of ability emotional intelligence. PERSONALITY AND INDIVIDUAL DIFFERENCES 2014. [DOI: 10.1016/j.paid.2014.01.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Bajs Janović M, Kalember P, Janović S, Hrabač P, Folnegović Grošić P, Grošić V, Radoš M, Henigsberg N. No change in N-acetyl aspartate in first episode of moderate depression after antidepressant treatment: (1)H magnetic spectroscopy study of left amygdala and left dorsolateral prefrontal cortex. Neuropsychiatr Dis Treat 2014; 10:1753-62. [PMID: 25278754 PMCID: PMC4179760 DOI: 10.2147/ndt.s64702] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The role of brain metabolites as biological correlates of the intensity, symptoms, and course of major depression has not been determined. It has also been inconclusive whether the change in brain metabolites, measured with proton magnetic spectroscopy, could be correlated with the treatment outcome. METHODS Proton magnetic spectroscopy was performed in 29 participants with a first episode of moderate depression occurring in the left dorsolateral prefrontal cortex and left amygdala at baseline and after 8 weeks of antidepressant treatment with escitalopram. The Montgomery-Asberg Depression Rating Scale, the Hamilton Rating Scale for Depression, and the Beck Depression Inventory were used to assess the intensity of depression at baseline and at the endpoint of the study. At endpoint, the participants were identified as responders (n=17) or nonresponders (n=12) to the antidepressant therapy. RESULTS There was no significant change in the N-acetyl aspartate/creatine ratio (NAA/Cr) after treatment with antidepressant medication. The baseline and endpoint NAA/Cr ratios were not significantly different between the responder and nonresponder groups. The correlation between NAA/Cr and changes in the scores of clinical scales were not significant in either group. CONCLUSION This study could not confirm any significant changes in NAA after antidepressant treatment in the first episode of moderate depression, or in regard to therapy response in the left dorsolateral prefrontal cortex or left amygdala. Further research is necessary to conclude whether NAA alterations in the first episode of depression could possibly be different from chronic or late-onset depression, and whether NAA alterations in stress-induced (reactive) depression are different from endogenous depression. The potential role of NAA as a biomarker of a treatment effect has yet to be established.
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Affiliation(s)
- Maja Bajs Janović
- University Department of Psychiatry, Clinical Hospital Center Zagreb, Zagreb, Croatia ; University North, Varaždin, Croatia
| | - Petra Kalember
- Polyclinic Neuron, Croatian Institute for Brain Research, School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Spiro Janović
- University Department of Psychiatry, Clinical Hospital Center Zagreb, Zagreb, Croatia ; University North, Varaždin, Croatia
| | - Pero Hrabač
- Polyclinic Neuron, Croatian Institute for Brain Research, School of Medicine, University of Zagreb, Zagreb, Croatia
| | | | | | - Marko Radoš
- University Department of Radiology, Clinical Hospital Center Zagreb, Zagreb, Croatia
| | - Neven Henigsberg
- Polyclinic Neuron, Croatian Institute for Brain Research, School of Medicine, University of Zagreb, Zagreb, Croatia ; Psychiatric Clinic Vrapče, Zagreb, Croatia
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16
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Sözeri-Varma G, Kalkan-Oğuzhanoglu N, Efe M, Kıroglu Y, Duman T. Neurochemical metabolites in prefrontal cortex in patients with mild/moderate levels in first-episode depression. Neuropsychiatr Dis Treat 2013; 9:1053-9. [PMID: 23976854 PMCID: PMC3747025 DOI: 10.2147/ndt.s42627] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Previous studies have determined the neurochemical metabolite abnormalities in major depressive disorder (MDD). The results of studies are inconsistent. Severity of depression may relate to neurochemical metabolic changes. The aim of this study is to investigate neurochemical metabolite levels in the prefrontal cortex (PFC) of patients with mild/moderate MDD. METHODS Twenty-one patients with mild MDD, 18 patients with moderate MDD, and 16 matched control subjects participated in the study. Patients had had their first episode. They had not taken treatment. The severity of depression was assessed by the Hamilton Rating Scale for Depression (HAM-D). Levels of N-acetyl aspartate (NAA), choline-containing compounds (Cho), and creatine-containing compounds (Cr) were measured using proton magnetic resonance spectroscopy (1H-MRS) at 1.5 T, with an 8-cm(3) single voxel placed in the right PFC. RESULTS The moderate MDD patients had lower NAA/Cr levels than the control group. No differences were found in neurochemical metabolite levels between the mild MDD and control groups. No correlation was found between the patients' neurochemical metabolite levels and HAM-D scores. CONCLUSION Our findings suggest that NAA/Cr levels are low in moderate-level MDD in the PFC. Neurochemical metabolite levels did not change in mild depressive disorder. Our results suggest that the severity of depression may affect neuronal function and viability. Studies are needed to confirm this finding, including studies on severely depressive patients.
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Neurometabolites in schizophrenia and bipolar disorder - a systematic review and meta-analysis. Psychiatry Res 2012; 203:111-25. [PMID: 22981426 PMCID: PMC3466386 DOI: 10.1016/j.pscychresns.2012.02.003] [Citation(s) in RCA: 156] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2011] [Revised: 02/02/2012] [Accepted: 02/08/2012] [Indexed: 01/10/2023]
Abstract
This meta-analysis evaluates alterations of neurometabolites in schizophrenia and bipolar disorder. PubMed was searched to find controlled studies evaluating N-acetylaspartate (NAA), Choline (Cho) and Creatine (Cr) assessed with ((1))H-MRS (proton magnetic resonance spectroscopy) in patients with schizophrenia and bipolar disorder up to September 2010. Random effects meta-analyses were conducted to estimate pooled standardized mean differences. The statistic was used to quantify inconsistencies. Subgroup analyses were conducted to explore potential explanations for inconsistencies. The systematic review included 146 studies with 5643 participants. NAA levels were affected in schizophrenia and bipolar disorder. Decreased levels in the basal ganglia and frontal lobe were the most consistent findings in schizophrenia; decreased levels in the basal ganglia were the most consistent findings in bipolar disorder. Cho and Cr levels were not altered in either disorder. Findings for Cr were most consistent in the thalamus, frontal lobe and dorsolateral prefrontal cortex in schizophrenia and the basal ganglia and frontal lobe in bipolar disorder. Findings for Cho were most consistent in the thalamus, frontal lobe and anterior cingulate cortex in schizophrenia and basal ganglia in bipolar disorder. Large, carefully designed studies are needed to better estimate the extent of alterations in neurometabolites.
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Allen PJ. Creatine metabolism and psychiatric disorders: Does creatine supplementation have therapeutic value? Neurosci Biobehav Rev 2012; 36:1442-62. [PMID: 22465051 PMCID: PMC3340488 DOI: 10.1016/j.neubiorev.2012.03.005] [Citation(s) in RCA: 119] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2011] [Revised: 03/07/2012] [Accepted: 03/14/2012] [Indexed: 12/12/2022]
Abstract
Athletes, body builders, and military personnel use dietary creatine as an ergogenic aid to boost physical performance in sports involving short bursts of high-intensity muscle activity. Lesser known is the essential role creatine, a natural regulator of energy homeostasis, plays in brain function and development. Creatine supplementation has shown promise as a safe, effective, and tolerable adjunct to medication for the treatment of brain-related disorders linked with dysfunctional energy metabolism, such as Huntington's Disease and Parkinson's Disease. Impairments in creatine metabolism have also been implicated in the pathogenesis of psychiatric disorders, leaving clinicians, researchers and patients alike wondering if dietary creatine has therapeutic value for treating mental illness. The present review summarizes the neurobiology of the creatine-phosphocreatine circuit and its relation to psychological stress, schizophrenia, mood and anxiety disorders. While present knowledge of the role of creatine in cognitive and emotional processing is in its infancy, further research on this endogenous metabolite has the potential to advance our understanding of the biological bases of psychopathology and improve current therapeutic strategies.
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Affiliation(s)
- Patricia J Allen
- Department of Psychology, Tufts University, Psychology Building, 490 Boston Ave., Medford, MA 02155, USA.
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19
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Wang Y, Jia Y, Xu G, Ling X, Liu S, Huang L. Frontal white matter biochemical abnormalities in first-episode, treatment-naive patients with major depressive disorder: a proton magnetic resonance spectroscopy study. J Affect Disord 2012; 136:620-6. [PMID: 22129769 DOI: 10.1016/j.jad.2011.10.020] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2011] [Revised: 10/14/2011] [Accepted: 10/14/2011] [Indexed: 12/13/2022]
Abstract
BACKGROUND Previous neuroimaging studies found evidence of brain functional and structural abnormalities in patients with major depressive disorder (MDD), but they rarely excluded compounding effects of some important factors, such as medication and brain degeneration. This study sought to explore the brain biochemical changes of first-episode, treatment-naive, non-late-life adult patients with MDD in the frontal white matter and gray matter by using proton magnetic resonance spectroscopy (1H MRS). METHODS Twenty-four first-episode, treatment-naive, non-late-life adult depressed patients and 13 healthy controls were enrolled in this study. Subjects underwent two-dimensional multivoxel 1H MRS at 1.5 T to obtain bilateral metabolite levels from the dorsolateral prefrontal white matter and anterior cingulate gray matter. RESULTS Patients with MDD showed significantly lower N-acetylaspartate/creatine (NAA/Cr) and choline/creatine (Cho/Cr) ratios in the left dorsolateral prefrontal white matter, and lower NAA/Cr ratios in the right dorsolateral prefrontal white matter when compared with the control subjects. There were no significant differences in the metabolite ratios in the bilateral anterior cingulate gray matter. CONCLUSIONS These findings suggest that biochemical abnormalities in prefrontal white matter may occur early in the course of MDD and may be related to the neuropathology of depression.
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Affiliation(s)
- Ying Wang
- Medical Imaging Center, First Affiliated Hospital of Jinan University, Guangzhou 510630, China
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20
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Abstract
Magnetic Resonance Spectroscopy (MRS) is a unique technique that can directly assess the concentration of various biochemical metabolites in the brain. Thus, it is used in the study of molecular pathophysiology of different neuropsychiatric disorders, such as, the major depressive disorder and has been an area of active research. We conducted a computer-based literature search using the Pubmed database with 'magnetic resonance spectroscopy', 'MRS', 'depression', and 'major depressive disorder' as the key words, supplemented by a manual search of bibliographic cross-referencing. Studies in depression report abnormalities in the frontal cortex, basal ganglia, hippocampus, anterior cingulate cortex, and the occipital cortex. These abnormalities improve after treatment with selective serotonin reuptake inhibitor, electroconvulsive therapy, and yoga, and thus, are possibly state-dependent. The findings are consistent with other morphometric and clinical studies and support the proposed pathophysiological theory of dysfunction in the neuronal circuits involving the frontal cortex, limbic cortex, and basal ganglia. Spectroscopy also has potential implications in predicting the response to treatment and formulating individualized pharmacotherapy.
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Affiliation(s)
- Naren P Rao
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India.
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21
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Bellani M, Dusi N, Yeh PH, Soares JC, Brambilla P. The effects of antidepressants on human brain as detected by imaging studies. Focus on major depression. Prog Neuropsychopharmacol Biol Psychiatry 2011; 35:1544-52. [PMID: 21138750 DOI: 10.1016/j.pnpbp.2010.11.040] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2010] [Revised: 11/26/2010] [Accepted: 11/26/2010] [Indexed: 11/19/2022]
Abstract
Recent brain imaging studies have shed light on understanding the pathogenesis of mood disorders. Evidence of structural, chemical, and functional brain changes, particularly in prefrontal cortex, cingulate, and amygdala, has been revealed in major depressive disorder (MDD). Furthermore, imaging techniques have been applied to monitor the effects of antidepressants (ADs) both in the brains of healthy volunteers and MDD patients. Although with some discrepancies due to the differences in study designs and patient samples, imaging findings have shown that ADs, particularly those having effects on the serotonergic system, modulate the volumes, functions and biochemistry of brain structures, i.e. dorsolateral prefrontal cortex, anterior cingulate and amygdala, which have been demonstrated abnormal in MDD by earlier imaging studies. This paper reviews imaging studies conducted in MDD patients and healthy controls treated with different ADs.
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Affiliation(s)
- Marcella Bellani
- Department of Public Health and Community Medicine, Section of Psychiatry and Clinical Psychology, Inter-University Center for Behavioural Neurosciences, University of University of Verona, Verona, Italy
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22
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Biomarkers for major depression and its delineation from neurodegenerative disorders. Prog Neurobiol 2011; 95:703-17. [PMID: 21854829 DOI: 10.1016/j.pneurobio.2011.08.001] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2011] [Revised: 06/24/2011] [Accepted: 08/04/2011] [Indexed: 12/14/2022]
Abstract
Major depressive disorders (MDD) are among the most debilitating diseases worldwide and occur with a high prevalence in elderly individuals. Neurodegenerative diseases (in particular Alzheimer's disease, AD) do also show a strong age-dependent increase in incidence and prevalence among the elderly population. A high number of geriatric patients with MDD show cognitive deficits and a very high proportion of AD patients present co-morbid MDD, which poses difficult diagnostic and prognostic questions. Especially in prodromal and in very early stages of AD, it is almost impossible to differentiate between pure MDD and MDD with underlying AD. Here, we give a comprehensive review of the literature on the current state of candidate biomarkers for MDD ("positive MDD markers") and briefly refer to established and validated diagnostic AD biomarkers in order to rule out underlying AD pathophysiology in elderly MDD subjects with cognitive impairments ("negative MDD biomarkers"). In summary, to date there is no evidence for positive diagnostic MDD biomarkers and the only way to delineate MDD from AD is to use "negative MDD" biomarkers. Because of this highly unsatisfactory current state of MDD biomarker research, we propose a research strategy targeting to detect and validate positive MDD biomarkers, which is based on a complex (genetic, molecular and neurophysiological) biological model that incorporates current state of the art knowledge on the pathobiology of MDD. This model delineates common pathways and the intersection between AD and MDD. Applying these concepts to MDD gives hope that positive MDD biomarkers can be successfully identified in the near future.
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23
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Nery FG, Stanley JA, Chen HH, Hatch JP, Nicoletti MA, Monkul ES, Matsuo K, Caetano SC, Peluso MA, Najt P, Soares JC. Normal metabolite levels in the left dorsolateral prefrontal cortex of unmedicated major depressive disorder patients: a single voxel (1)H spectroscopy study. Psychiatry Res 2009; 174:177-83. [PMID: 19910168 DOI: 10.1016/j.pscychresns.2009.05.003] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2007] [Revised: 05/06/2009] [Accepted: 05/15/2009] [Indexed: 02/02/2023]
Abstract
Few proton magnetic resonance spectroscopy ((1)H spectroscopy) studies have investigated the dorsolateral prefrontal cortex (DLPFC), a key region in the pathophysiology of major depressive disorder (MDD). We used (1)H spectroscopy to verify whether MDD patients differ from healthy controls (HC) in metabolite levels in this brain area. Thirty-seven unmedicated DSM-IV MDD patients were compared with 40 HC. Subjects underwent a short echo-time (1)H spectroscopy examination at 1.5 T, with an 8-cm(3) single voxel placed in the left DLPFC. Reliable absolute metabolite levels of N-acetyl aspartate (NAA), phosphocreatine plus creatine (PCr+Cr), choline-containing compounds (GPC+PC), myo-inositol, glutamate plus glutamine (Glu+Gln), and glutamate were obtained using the unsuppressed water signal as an internal reference. Metabolite levels in the left DLPFC did not statistically differ between MDD patients and HC. We found an interaction between gender and diagnosis on PCr+Cr levels. Male MDD patients presented lower levels of PCr+Cr than male HC, and female MDD patients presented higher levels of PCr+Cr than female HC. Moreover, length of illness was inversely correlated with NAA levels. These findings suggest that there is not an effect of diagnosis on the left DLPFC neurochemistry. Possible effects of gender on PCr+Cr levels of MDD patients need to be further investigated.
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Affiliation(s)
- Fabiano G Nery
- Department of Psychiatry, The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
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Ertugrul A, Volkan-Salanci B, Basar K, Karli Oguz K, Demir B, Ergun EL, Senturk S, Erbas B, Cila A, Ulug B. The effect of clozapine on regional cerebral blood flow and brain metabolite ratios in schizophrenia: relationship with treatment response. Psychiatry Res 2009; 174:121-9. [PMID: 19837567 DOI: 10.1016/j.pscychresns.2009.04.007] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2007] [Revised: 01/13/2009] [Accepted: 04/15/2009] [Indexed: 10/20/2022]
Abstract
The purpose of this study was to investigate the effect of clozapine on regional cerebral blood flow (rCBF) and its relationship with response to treatment. In addition, we aimed to study the influence of clozapine on proton magnetic resonance spectroscopy ((1)H-MRS) findings in the dorsolateral prefrontal cortex (DLPFC) in a subgroup of patients. Psychopathology, neurocognitive functioning, and SPECT imaging of 22 patients were assessed at the baseline and 8 weeks after the initiation of clozapine treatment. In 10 of these patients intermediate-echo (TE: 135 ms) single-voxel (1)H-MRS was also performed at the baseline and after 8 weeks. Clozapine treatment increased the right frontal (superior and medial)/caudate perfusion ratio in the whole group, while it increased bilateral frontal (superior and medial)/caudate perfusion ratios in treatment responders. In addition, percentage changes in left and right frontal (superior and medial)/caudate perfusion ratios compared to the baseline were higher in treatment responders than in non-responders. The improvement in attention was related to the increase in percentage change in the right frontal (superior and medial)/caudate perfusion ratio, while the improvement in verbal fluency was related to the increase in percentage changes in both right and left frontal (superior and medial)/caudate perfusion ratios and to right frontal (superior and medial)/thalamus perfusion. Baseline frontal (superior and medial)/thalamus perfusion could explain 32% of the variability of percentage improvements in psychopathology. (1)H-MRS showed that the baseline PANSS general psychopathology score was inversely correlated with the baseline NAA/Cre ratio. An increased NAA/Cre ratio in DLPFC after 8 weeks of clozapine treatment was also revealed by (1)H-MRS. Our SPECT imaging results suggest the presence of an imbalance in fronto-striato-thalamic circuitry that changes with clozapine, especially in the responders, while (1)H-MRS results indicate a supportive effect of clozapine on neuronal integrity.
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Affiliation(s)
- Aygun Ertugrul
- Hacettepe University, Faculty of Medicine, Department of Psychiatry, Ankara, Turkey.
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HONG ST, CHOI CB, PARK C, MOON HY, HONG KS, CHEONG C, CHAE JH, CHOE BY. Specific hippocampal choline decrease in an animal model of depression. Br J Radiol 2009; 82:549-53. [DOI: 10.1259/bjr/25165760] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Chen CS, Chiang IC, Li CW, Lin WC, Lu CY, Hsieh TJ, Liu GC, Lin HF, Kuo YT. Proton magnetic resonance spectroscopy of late-life major depressive disorder. Psychiatry Res 2009; 172:210-4. [PMID: 19303260 DOI: 10.1016/j.pscychresns.2009.01.003] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2008] [Revised: 01/19/2009] [Accepted: 01/20/2009] [Indexed: 10/21/2022]
Abstract
The primary goal of this study was to examine the biochemical abnormalities of late-life major depression by using 3-tesla (3-T) proton magnetic resonance spectroscopy ((1)H-MRS). The antidepressant effects on the biochemical abnormalities were investigated as well. Study participants were 27 elderly patients with major depressive disorders (among which 9 were on antidepressant medication) and 19 comparison elderly subjects. (1)H-MRS spectra were acquired from voxels that were placed in the left frontal white matter, left periventricular white matter, and left basal ganglia. Ratios of N-acetylaspartate (NAA), choline (Cho) and myo-inositol to creatine were calculated. Patients with late-life major depressive disorder had a significantly lower NAA/creatine ratio in the left frontal white matter, and higher Cho/creatine and myo-inositol/creatine ratios in the left basal ganglia when compared with the control subjects. The myo-inositol correlated with global cognitive function among the patients. The biochemical abnormalities in late-life major depressive disorder were found on the left side of the frontal white matter and the basal ganglia. Neuron degeneration in the frontal white matter and second messenger system dysfunction or glial dysfunction in the basal ganglia are suggested to be associated with late-life depression.
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Affiliation(s)
- Cheng-Sheng Chen
- Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
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27
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Kaymak SU, Demir B, Oğuz KK, Sentürk S, Uluğ B. Antidepressant effect detected on proton magnetic resonance spectroscopy in drug-naïve female patients with first-episode major depression. Psychiatry Clin Neurosci 2009; 63:350-6. [PMID: 19566767 DOI: 10.1111/j.1440-1819.2009.01951.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM Recent neuroimaging studies support functional and structural alterations in the dorsolateral prefrontal cortex (DLPFC), particularly on the left side in patients with major depressive disorders (MDD). The aim of the present study was to examine the biochemical characteristics of left DLPFC as measured on proton ((1)H) magnetic resonance spectroscopy (MRS) in patients with drug-naïve first-episode MDD and a healthy control group. A second aim was to assess the effect of antidepressant treatment on the metabolites of DLPFC. METHODS Short-echo single-voxel (1)H-MRS was done for the left DLPFC in 17 female drug-free MDD patients (mean age +/- SD, 30.9 +/- 6.9 years) and 13 matched control subjects (mean age +/- SD, 29.1 +/- 6.2 years) and was repeated at 8 weeks following antidepressant treatment. RESULTS Comparison of baseline values indicated that there were no significant differences in any of the metabolite ratios (N-acetyl aspartate/creatine [NAA/Cr], myoinositol [Ino]/Cr, and choline [Cho]/Cr) between patients and controls. Significant differences were detected between pre- and post-treatment Ino/Cr ratios (0.67 +/- 0.13, 0.58 +/- 0.22, P = 0.032, respectively), although there was no difference in NAA/Cr and Cho/Cr ratios. CONCLUSION Although no significant metabolic alterations exist in female patients with drug-naïve first-episode MDD as evaluated on (1)H-MRS, an increase in Ino/Cr was observed following 8-week antidepressant treatment. These findings give rise to the possibility that non-neuronal cells, particularly glial cells that are probably damaged, play a role in the action of antidepressant treatment.
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Affiliation(s)
- Semra Ulusoy Kaymak
- Psychiatry Clinic, Ankara Oncology Training and Research Hospital, Ankara, Turkey.
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Capizzano AA, Jorge RE, Acion LC, Robinson RG. In vivo proton magnetic resonance spectroscopy in patients with mood disorders: a technically oriented review. J Magn Reson Imaging 2008; 26:1378-89. [PMID: 17968885 DOI: 10.1002/jmri.21144] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Proton MR spectroscopy (1HMRS) has been extensively used among mood disorders patients. A review of the published literature in 1HMRS studies of mood disorders was carried out for the period 1991 to July 2006. Of 71 1HMRS studies, 77.5% were done at 1.5T and 66.2% used single voxel sequences (SVS), implying limitations of spectral resolution and anatomic coverage, respectively. In all, 47.9% of studies relied on creatine (Cr) as internal signal standard, although Cr changes were reported in major depression (MD). Most reported metabolic alterations related to mood state affected the left frontal lobe. Depressed adult and pediatric MD patients had reduced glutamate (Glu) in frontal lobe regions, which reversed with successful treatment. A consistent reduction of N-acetyl-aspartate (NAA) was reported in the hippocampal formation among bipolar disorder (BD) patients, along with an increment in frontal Glu. The differences in results of 1HMRS studies in mood disorders reflect heterogeneity of technical factors and subject selection. Future studies should benefit from higher spectral resolution and more extensive anatomic coverage as well as standardized data-processing protocols and subject selection criteria.
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Affiliation(s)
- Aristides A Capizzano
- Psychiatry Department, University of Iowa Hospitals and Clinics, Iowa City, Iowa 52242, USA.
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Roitman S, Green T, Osher Y, Karni N, Levine J. Creatine monohydrate in resistant depression: a preliminary study. Bipolar Disord 2007; 9:754-8. [PMID: 17988366 DOI: 10.1111/j.1399-5618.2007.00532.x] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Creatine plays a pivotal role in brain energy homeostasis, and altered cerebral energy metabolism may be involved in the pathophysiology of depression. Oral creatine supplementation may modify brain high-energy phosphate metabolism in depressed subjects. METHODS Eight unipolar and two bipolar patients with treatment-resistant depression were treated for four weeks with 3-5 g/day of creatine monohydrate in an open add-on design. Outcome measures were the Hamilton Depression Rating Scale, Hamilton Anxiety Scale, and Clinical Global Impression scores, recorded at baseline and at weeks 1, 2, 3 and 4. RESULTS One patient improved considerably after one week and withdrew. Both bipolar patients developed hypomania/mania. For the remaining seven patients, all scale scores significantly improved. Adverse reactions were mild and transitory. CONCLUSIONS This small, preliminary, open study of creatine monohydrate suggests a beneficial effect of creatine augmentation in unipolar depression, but possible precipitation of a manic switch in bipolar depression.
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Affiliation(s)
- Suzana Roitman
- Ness Ziona Mental Health Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Mu J, Xie P, Yang ZS, Yang DL, Lv FJ, Luo TY, Li Y. 1H magnetic resonance spectroscopy study of thalamus in treatment resistant depressive patients. Neurosci Lett 2007; 425:49-52. [PMID: 17723272 DOI: 10.1016/j.neulet.2007.08.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2007] [Revised: 08/04/2007] [Accepted: 08/07/2007] [Indexed: 11/17/2022]
Abstract
Treatment-resistant depression (TRD) is a common clinical problem, and represents a considerable challenge to treatment, however, the pathogenesis of this disease is poorly understood. Thalamus is generally believed to have a role in the pathophysiology of depression. In this study, we adopted 1.5T (1)H magnetic resonance spectroscopy ((1)H MRS) to examine possible alterations of thalamus metabolism in 20 adult TRD patients. Our results suggested there might be damage and loss of neurons, as well as membrane phospholipids associated metabolism abnormality in the TRD thalamus.
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Affiliation(s)
- Jun Mu
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, The Key Laboratory of Diagnostic Medicine Designated by the Ministry of Education, Chongqing, 400016, China
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Glodzik-Sobanska L, Slowik A, McHugh P, Sobiecka B, Kozub J, Rich KE, Urbanik A, Szczudlik A. Single voxel proton magnetic resonance spectroscopy in post-stroke depression. Psychiatry Res 2006; 148:111-20. [PMID: 17088051 DOI: 10.1016/j.pscychresns.2006.08.004] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2006] [Revised: 07/06/2006] [Accepted: 08/27/2006] [Indexed: 11/16/2022]
Abstract
Mood disorders are associated with structural, metabolic and spectroscopic changes in prefrontal regions. In the case of depression associated with stroke, there is little information about the biochemical profile of these regions, as assessed by proton magnetic resonance spectroscopy ((1)H-MRS). In a group of first-ever stroke patients, we studied the association between post-stroke depression and (1)H-MRS measurements in unaffected frontal lobes. Twenty-six patients with a first ischemic stroke located outside the frontal lobes were included in the study. Single voxel proton magnetic resonance spectroscopy ((1)H-MRS) was performed to assess N-acetylaspartate/creatine (NAA)/Cr, glutamate+glutamine (Glx)/Cr, choline (Cho)/Cr and myo-inositol (mI)/Cr ratios. Patients were assessed within the first 10 days after stroke and again four months later. The diagnosis of depression was made on the basis of clinical observation, interview and Hamilton Depression Rating Scale scores. In a group of 26 patients, eight (31%) met criteria for depression at the first assessment, and nine (35%) met criteria for depression at follow-up. Patients with depression in the immediate post-stroke phase had significantly higher Glx/Cr ratios in the contralesional hemisphere than non-depressive patients. No biochemical differences were found between the groups at 4-month follow-up. These findings suggest that post-stroke depression is accompanied by changes in frontal lobe glutamate/glutamine levels, perhaps reflecting abnormalities in glutamatergic transmission in the immediate post-stroke period.
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Affiliation(s)
- Lidia Glodzik-Sobanska
- Center for Brain Health, New York University School of Medicine, New York, NY 10016, USA.
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Yildiz-Yesiloglu A, Ankerst DP. Review of 1H magnetic resonance spectroscopy findings in major depressive disorder: a meta-analysis. Psychiatry Res 2006; 147:1-25. [PMID: 16806850 DOI: 10.1016/j.pscychresns.2005.12.004] [Citation(s) in RCA: 184] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2004] [Revised: 11/23/2005] [Accepted: 12/12/2005] [Indexed: 11/20/2022]
Abstract
In a review of the current literature, we identified (1)H MRS studies of major depressive disorder (MDD) that examined the metabolites N-acetylaspartate (NAA), choline (Cho), myo-inositol (mI), glutamate/glutamine/gamma-aminobutyric acid-GABA (Glx), and creatine (Cr). Separate meta-analyses comparing adult and pediatric MDD patients with healthy controls were performed. For adults, 14 studies with 227 patients/246 controls for NAA, 15 studies with 240 patients/261 controls for Cho, seven studies with 96 patients/104 controls for mI, six studies with 86 patients/109 controls for Glx, and nine studies with 146 patients/173 controls for Cr were identified. There were six studies containing a total of 79 pediatric depressed patients. We performed 15 separate meta-analyses to combine results from studies with similar characteristics. Adult MDD patients had higher Cho/Cr values than controls in the basal ganglia. In contrast, three studies on Glx levels indicated significantly lower Glx levels in the frontal lobe of MDD patients. The review indicated increased Cho/Cr in the basal ganglia in MDD and no alteration of NAA, suggesting an increased membrane turnover in MDD without a neurodegenerative outcome. Lower Glx levels in depressed patients in contrast to a likely hyperglutamatergic state in bipolar disorder may implicate a different pathophysiological ground in MDD.
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Ende G, Demirakca T, Tost H. The biochemistry of dysfunctional emotions: proton MR spectroscopic findings in major depressive disorder. PROGRESS IN BRAIN RESEARCH 2006; 156:481-501. [PMID: 17015098 DOI: 10.1016/s0079-6123(06)56027-3] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Key neural systems involved in the processing and communication of emotions are impaired in patients with major depressive disorder (MDD). Emotional and behavioral symptoms are thought to be caused by damage or dysfunction in specific areas of the brain that are responsible for directing attention, motivating behavior, and learning the significance of environmental stimuli. Functional brain studies with positron emission tomography (PET) and functional magnetic resonance imaging (fMRI) give support for functional abnormalities in MDD that are predominantly located in areas known to play an important role in the communication and processing of emotions. Disturbances in emotional processing as they are observed in MDD, if any, have very subtle morphometrical brain correlates. With proton magnetic resonance spectroscopy (1H MRS), brain metabolites can be measured noninvasively in vivo, thus furthering the understanding of the effects of changes in neurotransmitters within the brain. The current literature on 1H MRS studies in MDD is small with a large diversity of MRS methods applied, brain regions studied, and metabolite changes found. Nevertheless, there is strong evidence that changes in neurometabolite concentrations in MDD occur within brain regions, which are involved in the processing and communication of emotions that can be monitored by 1H MRS. This review summarizes the literature about biochemical changes quantified via 1H MRS in MDD patients in brain regions that play an important role for the communication and processing of emotions.
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Affiliation(s)
- Gabriele Ende
- NMR Research in Psychiatry, Central Institute of Mental Health, J5, 68159 Mannheim, Germany.
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