Department of Psychiatry, Buddhist Tzu-Chi General Hospital, Taipei Branch, Taipei, Taiwan.
Int J Neuropsychopharmacol. 2011 Mar;14(2):225-35. doi: 10.1017/S1461145710000829. Epub 2010 Jul 22.
We designed this study to investigate the modulating effects of duloxetine on symptoms and grey matter of patients with major depressive disorder combined with panic disorder. We also aimed to discover if there was any persistence of grey-matter deficits after remission and to find 'trait markers' for this comorbidity. High-resolution magnetic resonance imaging and voxel-based morphometric measurements were performed on 15 patients at baseline and remitted status (week 6) compared to 15 healthy control subjects who were scanned twice within 6 wk. The rating scales of depressive and panic symptoms improved with statistical significance (corrected p<0.001). A widespread pattern of grey-matter deficits in infero-frontal, limbic, occipital, temporo-parietal, cerebellar areas (trait marker regions) in drug-naive patients were observed compared to controls at baseline (family-wise error corrected p<0.0002). There were no significant changes of grey matter in healthy controls over the 6-wk period. Duloxetine-induced increases of grey matter were very subtle in left infero-frontal cortex, right fusiform gyrus, and right cerebellum VIIIa areas (state marker regions) after 6-wk therapy (uncorrected p<0.0005). Duloxetine did not increase grey matter to the level of control subjects and grey-matter deficits in patients appear largely unaffected by duloxetine. We suggest that short-term duloxetine therapy improved the clinical symptoms of patients with major depressive disorder combined with panic disorder. These improvements might be related to a modest increase of grey matter in state marker regions of the brain. The deficits of trait marker regions were more evident and are likely to be important for pathogenesis.
我们设计了这项研究，旨在探究度洛西汀对伴有惊恐障碍的重性抑郁障碍患者的症状和灰质的调节作用。我们还旨在发现缓解后灰质缺陷是否持续存在，并寻找这种合并症的“特征标志物”。与 15 名健康对照者（在 6 周内扫描两次）相比，15 名未经药物治疗的患者在基线和缓解期（第 6 周）进行了高分辨率磁共振成像和基于体素的形态计量学测量。抑郁和惊恐症状的评分显著改善（校正后 p<0.001）。与对照组相比，基线时未经药物治疗的患者存在广泛的下额-前额、边缘、枕叶、颞顶叶、小脑区域的灰质缺陷（特征标志物区域）（经家系错误校正后 p<0.0002）。健康对照组在 6 周内没有显著的灰质变化。经过 6 周的治疗，左额下回、右侧梭状回和右侧小脑 VIIIa 区域（状态标志物区域）的灰质出现了非常微小的度洛西汀诱导增加（未校正 p<0.0005）。度洛西汀没有使灰质增加到对照组的水平，而且患者的灰质缺陷似乎在很大程度上不受度洛西汀的影响。我们认为，度洛西汀短期治疗改善了伴有惊恐障碍的重性抑郁障碍患者的临床症状。这些改善可能与大脑状态标志物区域的灰质适度增加有关。特征标志物区域的缺陷更为明显，可能对发病机制很重要。
