Cerebral volume measurements and subcortical white matter lesions and short-term treatment response in late life depression

Utrecht University, Utrecht, Utrecht, Netherlands
International Journal of Geriatric Psychiatry (Impact Factor: 2.87). 05/2007; 22(5):468-74. DOI: 10.1002/gps.1790
Source: PubMed


Late life depression is associated with volumetric reductions of gray matter and increased prevalence of subcortical white matter lesions. Previous studies have shown a poorer treatment outcome in those with more severe structural brain abnormalities. In this study, quantitative and semi-quantitative magnetic resonance imaging (MRI) measures were studied in relation to response to a 12-week controlled antidepressant monotherapy trial.
MRI (1.5 T) brain scans of 42 elderly inpatients with major depression, of which 23 were non-responder to a controlled 12-week antidepressant monotherapy trial, were acquired. In addition, clinical outcome was assessed after a one year period. Measures were volumes of global cerebral and subcortical structures.
After controlling for confounding, no differences were found between non-responders and responders after 12 weeks and after one year in volumes of cerebral gray and white matter, orbitofrontal cortex, hippocampus and white matter lesions.
Structural brain measures associated with late life depression may not be related to short-term treatment response.

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Available from: Rob Kok
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    • "Indeed, a major limitation of the studies presented here is the low sample size, with most studies below 50 subjects and only one over 100 [62] [131]. Moreover, it is impossible to draw conclusions on the effect of single specific compounds because many studies include multiple antidepressants [49] [67] [68] [84] [119] [132] [133] [147] and very few studies focused on the effect of " non SSRIs " antidepressants [138] [148] [149]. Although these designs are closer to real world interventions which apply multiple drugs [150] they limit the possibility to investigate the contribute of different compounds to the brain altered circuits, in order to plan more effective and targeted interventions. "
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    • "As the neurobiological hypothesis that antidepressants may take its effects through enhancing neuroplasticity and neurogenesis in specific brain regions [44], [45] especially frontal cortex [46], we speculate that medication-induced changes are likely to be observed in structure as in function, which may be detected after short time treatment in MDD. However, the confound findings such as Vythilingam et al reported no significant differences in hippocampal volume after 7±3 months antidepressant treatment [29] in MDD as well as Janssen et al reported no cerebral volume differences after 12 weeks treatment with venlafaxine or nortriptyline in late life depression [47] suggest that medication-induced changes in MDD should be investigated with long time longitudinal imaging studies in future. "
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    • "Moreover, a positive correlation exists between the structural brain abnormalities in patients with LLD and their treatment responses, especially in the volumes of the hippocampus [17] and anterior cingulate cortex [18,19]. However, this issue remains controversial as another study [20] did not find any correlation. A recent review of the biological basis of LLD [21] indicated that only a few studies to date have examined how the structural changes observed in patients with LLD influence clinical outcomes [22], and the results are not conclusive. "
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