Weill Cornell Medical College, Weill-Cornell Institute of Geriatric Psychiatry, United States.
J Affect Disord. 2009 Dec;119(1-3):132-41. doi: 10.1016/j.jad.2009.03.004. Epub 2009 Apr 17.
This study compared microstructural abnormalities in depressed elders and controls and studied the association of the serotonin transporter gene status to white matter abnormalities and to remission of depression.
The subjects were Caucasians with non-psychotic major depression and normal elders. Depressed subjects received escitalopram 10 mg daily for 12 weeks. Remission was defined as a HDRS score of 7 or below for 2 consecutive weeks. Diffusion tensor imaging was performed and voxel-based analysis of fractional anisotropy (FA) was conducted using age and mean diffusivity as covariates.
Depressed elders (N=27) had lower FA than controls (N=27) in several frontolimbic areas. Depressed elderly S-allele carriers also had lower FA than L homozygotes in frontolimbic brain areas, including the dorsal and rostral anterior cingulate, posterior cingulate, dorsolateral prefrontal and medial prefrontal regions, thalamus, and in other regions. S-allele carriers had a lower remission rate than L homozygotes.
Small number of subjects, lack of random sampling, fixed antidepressant dose, short follow-up.
Lower FA was observed in several frontolimbic and other regions in depressed elders compared to controls. Depressed S-allele carriers had both microstructural white matter abnormalities in frontolimbic networks and a low remission rate. It remains unclear whether the risk for chronicity of geriatric depression in S-allele carriers is mediated by frontolimbic compromise. However, these observations set the stage for studies aiming to identify the relationship of S allele to impairment in specific frontolimbic functions interfering with response of geriatric depression to antidepressants.
本研究比较了抑郁老年人和对照组的微观结构异常，并研究了 5-羟色胺转运体基因状态与白质异常和抑郁缓解的关系。
研究对象为非精神病性重度抑郁症的白种人患者和正常老年人。抑郁患者接受艾司西酞普兰 10mg/d，共 12 周。缓解定义为连续 2 周汉密尔顿抑郁量表（HDRS）评分≤7 分。进行弥散张量成像，以年龄和平均扩散率为协变量，进行各向异性分数（FA）的体素基分析。
与对照组（N=27）相比，抑郁老年人（N=27）在前额叶边缘区域有较低的 FA。在额叶边缘脑区，包括背侧和额前扣带回、后扣带回、背外侧前额叶和内侧前额叶、丘脑，以及其他区域，抑郁老年 S 等位基因携带者的 FA 也低于 L 纯合子。S 等位基因携带者的缓解率低于 L 纯合子。
受试者数量少，缺乏随机抽样，固定抗抑郁剂量，随访时间短。
与对照组相比，抑郁老年人在前额叶边缘和其他区域观察到较低的 FA。抑郁 S 等位基因携带者在前额叶网络中存在微观结构的白质异常和较低的缓解率。尚不清楚 S 等位基因携带者的老年抑郁症慢性风险是否通过额叶边缘损害来介导。然而，这些观察结果为研究 S 等位基因与干扰抗抑郁药治疗老年抑郁症反应的特定额叶边缘功能障碍之间的关系奠定了基础。
