Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Stratenum 6.131, PO Box 85500, 3508 GA, Utrecht, The Netherlands.
J Neurol. 2013 Jan;260(1):197-206. doi: 10.1007/s00415-012-6616-1. Epub 2012 Aug 5.
Although a relation between depression and white matter lesions (WML) is frequently observed, the direction of causation remains unknown. We investigated whether depressed mood was associated with baseline severity and change in WML volume during 4 years of follow-up, and the relative contribution of mood symptoms and antidepressant use to this relation. Within the SMART-MR study 594 patients (58 ± 10 years) with symptomatic atherosclerotic disease had assessments of mood symptoms and antidepressant use and 1.5 T MRI at baseline and after 3.9 ± 0.4 years of follow-up. Mood symptoms were assessed using the Mental Health Index (MHI-5). Depressed mood was defined as antidepressant use and/or MHI-5 score ≤ 52. Volumetric WML measures (deep and periventricular) were obtained with automated segmentation. Linear regression analyses were adjusted for age, sex, baseline WML volume, follow-up time, vascular risk factors and infarcts. Depressed mood was not associated with larger WML volume at baseline. However, when separate contributions were distinguished, antidepressant use was associated with greater deep (B = 0.50 mL, 95 % CI 0.04-0.96) and periventricular WML volume (B = 0.47 mL, 95 % CI 0.05-0.89) at baseline, while mood symptoms were not. Antidepressants were associated with a modest but non-significant increase in progression of periventricular WML volume over 4 years of follow-up (B = 0.21 mL, 95 % CI -0.05 to 0.47). WML at baseline were not associated with new-onset depressed mood at follow-up. Antidepressants, but not mood symptoms, were associated with greater WML volume and a modest, although non-significant increase in periventricular WML volume in patients with symptomatic atherosclerotic disease. Future studies are needed to determine whether this may be a direct effect, or whether other underlying diseases for which antidepressants are prescribed influence this relation.
尽管抑郁与脑白质病变（WML）之间经常存在关联，但因果关系尚不清楚。我们研究了抑郁情绪与 4 年随访期间 WML 体积的基线严重程度和变化之间的关系，以及情绪症状和抗抑郁药使用对这种关系的相对贡献。在 SMART-MR 研究中，594 名（58±10 岁）有症状性动脉粥样硬化疾病的患者在基线和 3.9±0.4 年随访后进行了情绪症状和抗抑郁药使用评估以及 1.5T MRI。使用心理健康指数（MHI-5）评估情绪症状。抑郁情绪定义为使用抗抑郁药和/或 MHI-5 评分≤52。使用自动分割法获取脑白质病变体积（深部和脑室周围）测量值。线性回归分析调整了年龄、性别、基线脑白质病变体积、随访时间、血管危险因素和梗死。抑郁情绪与基线时更大的脑白质病变体积无关。然而，当区分单独的贡献时，抗抑郁药的使用与更大的深部（B=0.50ml，95%CI 0.04-0.96）和脑室周围脑白质病变体积（B=0.47ml，95%CI 0.05-0.89）相关，而情绪症状则不相关。抗抑郁药与随访 4 年内脑室周围脑白质病变体积的轻度但无统计学意义的进展相关（B=0.21ml，95%CI -0.05 至 0.47）。基线脑白质病变与随访时新发抑郁情绪无关。在有症状性动脉粥样硬化疾病的患者中，抗抑郁药但不是情绪症状与更大的脑白质病变体积和脑室周围脑白质病变体积的适度但无统计学意义的增加相关。需要进一步的研究来确定这是否是直接影响，还是其他抗抑郁药治疗的潜在疾病影响了这种关系。
