technetium-tc-99m-bicisate and Depressive-Disorder--Major

The purpose of this study is to investigate the impact of cognitive group therapy and happiness training objectively in the local cerebral blood flow of patients with major depression (MD).. The present research is semi-experimental to pre- and post-test with a control group. Three groups were formed, and this number was incorporated in each group: 12 patients were chosen randomly; the first group of depressed patients benefited from the combination of pharmacotherapy and sessions of cognitive group therapy; the second group used a combination of pharmacotherapy and sessions of happiness training; and a third group used only pharmacotherapy. We compared cognitive-behavioural therapy and happiness training efficacy with only pharmacotherapy in MD patients. We performed brain perfusion SPECT in each group, before and after each trial.. The study was conducted on 36 patients with MD (32 women and 4 men; mean age: 41.22 ± 9.08; range: 27-65 years). There were significant differences regarding the two trial effects into two experimental groups (p < 0/001) before and after trials, while such differences were not significant in the control group (p > 0.05). In addition, there was significant difference among the regional cerebral blood flow in the frontal and prefrontal regions into two experimental groups before and after trials (p < 0/001), while such differences were not significant in the control group (p > 0.05).. This study demonstrated decreased cerebral perfusion in the frontal regions in MD patients, which increased following cognitive group therapy and happiness training. Because of its availability, low costs, easy performance, and the objective semi-quantitative information supplied, brain perfusion SPECT scanning might be useful to assess the diagnosis and therapy efficacy. Further exploration is needed to validate its clinical role.

Topics: Adult; Blood Flow Velocity; Brain; Cerebrovascular Circulation; Cognitive Behavioral Therapy; Cysteine; Depressive Disorder, Major; Female; Happiness; Humans; Male; Organotechnetium Compounds; Perfusion Imaging; Psychotherapy, Group; Radiopharmaceuticals; Tomography, Emission-Computed, Single-Photon; Treatment Outcome

The aim of this study was to determine the predictive value of whole-brain voxel-based regional cerebral blood flow (rCBF) for repetitive transcranial magnetic stimulation (rTMS) response in patients with pharmacoresistant depression.. Thirty-three right-handed patients who met DSM-IV criteria for major depressive disorder (unipolar or bipolar depression) were included before rTMS. rTMS response was defined as at least 50% reduction in the baseline Beck Depression Inventory scores. The predictive value of (99m)Tc-ethyl cysteinate dimer (ECD) single photon emission computed tomography (SPECT) for rTMS response was studied before treatment by comparing rTMS responders to non-responders at voxel level using Statistical Parametric Mapping (SPM) (p < 0.001, uncorrected).. Of the patients, 18 (54.5%) were responders to rTMS and 15 were non-responders (45.5%). There were no statistically significant differences in demographic and clinical characteristics (p > 0.10). In comparison to responders, non-responders showed significant hypoperfusions (p < 0.001, uncorrected) in the left medial and bilateral superior frontal cortices (BA10), the left uncus/parahippocampal cortex (BA20/BA35) and the right thalamus. The area under the curve for the combination of SPECT clusters to predict rTMS response was 0.89 (p < 0.001). Sensitivity, specificity, positive predictive value and negative predictive value for the combination of clusters were: 94, 73, 81 and 92%, respectively.. This study shows that, in pharmacoresistant depression, pretreatment rCBF of specific brain regions is a strong predictor for response to rTMS in patients with homogeneous demographic/clinical features.

Topics: Brain; Cerebrovascular Circulation; Cysteine; Depressive Disorder, Major; Drug Resistance; Female; Humans; Male; Middle Aged; Organotechnetium Compounds; Perfusion Imaging; Predictive Value of Tests; ROC Curve; Tomography, Emission-Computed, Single-Photon; Transcranial Magnetic Stimulation; Treatment Outcome

Several studies have proved that low-frequency transcranial magnetic stimulation (TMS) of the right dorsolateral prefrontal cortex (DLPFC) showed an antidepressant effect, although its mechanism is still not completely elucidated. The aim of the present study was to clarify the alteration in neuroanatomical function elicited by low-frequency TMS of the right DLPFC in treatment-resistant depression and to detect the difference between responders and nonresponders to TMS. Single-photon emission computed tomography with (99m)Tc-ethyl cysteinate dimer was performed in 14 right-handed male patients with treatment-resistant unipolar depression before and after low-frequency TMS of the right DLPFC. Five 60-second 1-Hz trains were applied and 12 treatment sessions were administered within a 3-week period (total pulses, 3,600). The Hamilton Rating Scale for Depression was administered and the regional cerebral blood flow (rCBF) was analyzed using statistical parametric mapping (SPM2). After TMS treatment in 14 patients, the score on the Hamilton Rating Scale for Depression decreased significantly, and considerable decreases in rCBF were seen in the bilateral prefrontal, orbitofrontal, anterior insula, right subgenual cingulate, and left parietal cortex, but no significant increase in rCBF occurred. Additionally, as compared with 8 nonresponders, 6 responders showed significant increases in rCBF at baseline in the left hemisphere including the prefrontal and limbic-paralimbic regions. These results suggest that the antidepressant effect of low-frequency TMS of the right DLPFC is associated with a decrease in rCBF in the limbic-paralimbic regions via the ipsilateral subgenual cingulate, and increased rCBF at baseline in the left hemisphere may be involved in the response to low-frequency TMS treatment.

Topics: Adult; Antidepressive Agents; Blood Flow Velocity; Brain Mapping; Cerebrovascular Circulation; Cysteine; Depressive Disorder, Major; Drug Resistance; Functional Laterality; Humans; Male; Middle Aged; Organotechnetium Compounds; Prefrontal Cortex; Severity of Illness Index; Tomography, Emission-Computed, Single-Photon; Transcranial Magnetic Stimulation; Treatment Outcome

This study examined the relationship between resting regional cerebral blood flow (rCBF) patterns in patients with major depressive disorder (MDD) and specific symptom clusters derived from ratings on the Hamilton Rating Scale for Depression (HRSD) and the Mini Mental State Examination. We hypothesized that the functional activity in frontal, parietal, anterior cingulate, basal ganglia and limbic regions would be related to specific symptom domains. Fifteen patients fulfilling DSM-IV criteria for MDD who were off all psychotropic medications for >4 weeks and 15 normal volunteers were recruited. Single photon emission computed tomography (SPECT) images were obtained after (99m)Tc-ECD injection, and correlations between rCBF patterns and symptom severity ratings were calculated on a voxel-by-voxel basis, using statistical parametric mapping (SPM). Severity of depressive mood was inversely correlated with rCBF in the left amygdala, lentiform nucleus, and parahippocampal gyrus, and directly correlated with rCBF in the right postero-lateral parietal cortex (p < 0.001, uncorrected for multiple comparisons). Insomnia severity was inversely correlated with rCBF in the right rostral and subgenual anterior cingulate cortices, insula and claustrum. Anxiety severity was directly correlated with rCBF in the right antero-lateral orbitofrontal cortex, while cognitive performance was directly correlated with rCBF in the right postero-medial orbitofrontal cortex and in the left lentiform nucleus. Our findings confirmed the prediction that separate symptom domains of the MDD syndrome are related to specific rCBF patterns, and extend results from prior studies that suggested the involvement of anterior cingulate, frontal, limbic and basal ganglia regions in the pathophysiology of MDD.

Topics: Adolescent; Adult; Brain; Brain Mapping; Cerebrovascular Circulation; Cysteine; Depressive Disorder, Major; Female; Humans; Image Interpretation, Computer-Assisted; Male; Middle Aged; Organotechnetium Compounds; Prognosis; Psychiatric Status Rating Scales; Radiopharmaceuticals; Severity of Illness Index; Statistics as Topic; Tomography, Emission-Computed, Single-Photon

The mean score of HAMD and HAMA in the MDD patients was 25.49 ± 6.00, and 23.12 ± 5.83, respectively. There was a positive correlation between two scores. The MDD women had higher HAMD scores than MDD men. The decreased rCBF of MDD patients in frontal lobes (bilateral B11, B47 and right B4, B6, B10, B46), temporal lobe (right B21, B41, B42) and cingulated cortex (bilateral B24, B33), while their increased rCBF in occipital lobe (bilateral B17, B19 and left B18). Additionally, the depression severity was negatively correlated with decreased rCBF in left ventral anterior cingulate cortex B24, and was positively correlated with decreased rCBF in left inferior prefrontal gyrus B47 and increased rCBF in right associative visual cortex B19. The anxiety severity was negatively correlated with decreased rCBF in left subgenual cortex B25.. Although the mechanism underlying the correlation is not yet fully understood, our findings indicated that the rCBF SPECT/CT may provide an objective assessment for MDD severity. It might be used monitoring therapeutic efficacy in the management of MDD.

Topics: Adult; Brain Mapping; Cerebral Cortex; Cerebrovascular Circulation; Cysteine; Depressive Disorder, Major; Female; Frontal Lobe; Humans; Male; Middle Aged; Organotechnetium Compounds; Severity of Illness Index; Temporal Lobe; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed

The purpose of this study is to examine whether the reversal of compromised regional cerebral blood flow (rCBF) in older patients with major depressive disorder (MDD) is dependent on specific parameters of selective serotonin reuptake inhibitor (SSRI) treatment and to examine the efficacy of such treatment.. Forty-five patients with moderate MDD were studied following 8 weeks of treatment with SSRIs. Twelve patients displayed a positive response to SSRIs, whereas 33 patients did not respond to SSRI treatment. A comparison group of 30 healthy volunteers was also studied. The age of all participants was greater than 50 years. Age, gender, and the Hamilton Rating Scale for Depression scores were examined. The rCBF was assessed using 99mTc-ethyl cysteinate dimer single photon emission computed tomography after SSRI treatment.. The rCBF levels in the right middle frontal cortex in non-responsive MDD patients were lower compared with responsive MDD patients. Compared with healthy controls, non-responders had significantly lower rCBF levels in the bilateral middle frontal cortex and insula and had significantly higher rCBF levels in the bilateral inferior frontal cortex and left middle temporal cortex. Compared with healthy controls, responders had significantly higher rCBF levels in the left inferior frontal, middle temporal, precentral, and fusiform gyrus. We found no changes in single photon emission computed tomography between pre-treatment and post-treatment stages for the responders to SSRI treatment.. Hypoperfusion in older, non-responsive MDD patients was primarily localized in the middle frontal cortex. It is possible that the responders to SSRI treatment at baseline already displayed higher rCBF values in the frontal regions.

Topics: Aged; Aged, 80 and over; Antidepressive Agents; Brain; Case-Control Studies; Cerebrovascular Circulation; Cysteine; Depressive Disorder, Major; Female; Humans; Male; Middle Aged; Organotechnetium Compounds; Radiopharmaceuticals; Selective Serotonin Reuptake Inhibitors; Tomography, Emission-Computed, Single-Photon

Single-photon emission computed tomography (SPECT) is used as an ancillary diagnostic tool in clinical psychiatry. A variety of SPECT studies has been conducted on the findings and the factors that affect the findings, and there is a possibility that age has an effect on cerebral blood flow. We used SPECT to verify the cerebral blood flow findings of patients with major depressive disorder (MDD) considering the effect of age on the findings.. We conducted a retrospective survey of inpatients who fulfilled the DSM-IV diagnostic criteria for MDD and who had undergone imaging by technetium-99m ethyl cysteinate dimer ((99m)Tc-ECD) SPECT (N=98, 37 males). After excluding organic factors and comorbidities, we established a depression group (N=61, 24 males) and conducted an inter-group comparison with a normal control group by using SPM software considering the effect of age.. The depression group showed the reduction of cerebral blood flow in the prefrontal area bilaterally, predominantly on the left, including the orbitofrontal cortex, anterior portion of the gyrus cinguli, and dorsolateral prefrontal area, in the left temporal lobe, and in the occipital lobe bilaterally, predominantly on the left. The findings were common to all age groups and that age-specific pattern was not detected.. The facts that this was a retrospective study and small sample size in each age group were limitations of this research. Although it also seems important to evaluate the impact of medication on cerebral blood flow and conduct an evaluation according to the subtype of depression, but we couldn't in this study. In the future it will be necessary to accumulate additional cases and conduct additional studies, including a prospective survey.. The results of this study may suggest the existence of a common biological background in patients with MDD that is unaffected by age.

Topics: Adult; Age Factors; Aged; Cerebral Cortex; Cerebrovascular Circulation; Cysteine; Depressive Disorder, Major; Female; Humans; Male; Middle Aged; Organotechnetium Compounds; Radiopharmaceuticals; Retrospective Studies; Tomography, Emission-Computed, Single-Photon; Young Adult

This study aims to evaluate relationship between three different clinical conditions: Major Depressive Disorders (MDD), Hashimoto Thyroiditis (HT) and reduction in regional Cerebral Blood Flow (rCBF) in order to explore the possibility that patients with HT and MDD have specific pattern(s) of cerebral perfusion.. Analysis of data derived from two separate data banks.. 54 subjects, 32 with HT (29 women, mean age 38.8 ± 13.9); 22 without HT (19 women, mean age 36.5 ± 12.25).. Psychiatric diagnosis was carried out by Simplified Composite International Diagnostic Interview (CIDIS) using DSM-IV categories; cerebral perfusion was measured by (99 m)Tc-ECD SPECT. Statistical analysis was done through logistic regression.. MDD appears to be associated with left frontal hypoperfusion, left temporal hypoperfusion, diffuse hypoperfusion and parietal perfusion asymmetry. A statistically significant association between parietal perfusion asymmetry and MDD was found only in the HT group.. In HT, MDD is characterized by a parietal flow asymmetry. However, the specificity of rCBF in MDD with HT should be confirmed in a control sample with consideration for other health conditions. Moreover, this should be investigated with a longitudinally designed study in order to determine a possible pathogenic cause. Future studies with a much larger sample size should clarify whether a particular perfusion pattern is associated with a specific course or symptom cluster of MDD.

Topics: Adolescent; Adult; Aged; Celiac Disease; Cerebrovascular Circulation; Cerebrovascular Disorders; Cysteine; Depressive Disorder, Major; Female; Goiter; Hashimoto Disease; Humans; Male; Middle Aged; Organotechnetium Compounds; Radiopharmaceuticals; Tomography, Emission-Computed, Single-Photon

The clinical relationship between pain and depression has been extensively reported. The purpose of this study was to compare the cerebral blood flow (CBF) of patients with major depressive disorder (MDD) during stimulation with experimental pain tolerance or sham stimulation, before and after 2 weeks of at least partially effective antidepressant treatment (ADT), in order to determine the cerebral regions associated with pain processing in the two clinical states.. Twenty-four antidepressant-free outpatients diagnosed with MDD (DSM-IV), without any pain complaints and a basal score>or=20 points on the Hamilton Rating Scale for Depression were included. Cerebral SPECTs were performed before and after ADT. Patients were stimulated with pain pressure tolerance (PT) or sham stimulation during the radiotracer cerebral uptake time.. The comparison between PT and sham stimulation before ADT showed an increase of CBF of PT stimulated patients in right temporal gyrus, left amygdale, right anterior cingulated cortex, bilateral medial frontal gyrus, bilateral insula, lingual gyrus, right precentral gyrus and left postcentral gyrus. Equal comparison after ADT showed an increase of CBF of PT stimulated patients only in left middle frontal gyrus.. The sample includes exclusively outpatients with mild-moderate depression.. CBF before ADT increases in brain areas related with the affective and cognitive components of pain; in contrast, after ADT increases only in cognitive pain related areas. These results offer new avenues to investigate the cerebral substrate of the common relationship between pain and depression.

Topics: Adult; Ambulatory Care; Antidepressive Agents; Brain; Brain Mapping; Cerebral Cortex; Cysteine; Depressive Disorder, Major; Diagnostic and Statistical Manual of Mental Disorders; Female; Functional Laterality; Humans; Male; Organotechnetium Compounds; Pain; Pain Threshold; Physical Stimulation; Pressure; Psychiatric Status Rating Scales; Regional Blood Flow; Tomography, Emission-Computed, Single-Photon