Department of Internal Medicine, Radiology Division, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil; Department of Neuroscience and Behavior, Psychiatric Division, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil.
Psychiatry and Behavioral Sciences at the University of Texas Health Science Center at Houston, USA.
Psychiatry Res Neuroimaging. 2017 Jul 30;265:18-25. doi: 10.1016/j.pscychresns.2017.04.008. Epub 2017 Apr 26.
Although postpartum depression (PPD) is a prevalent subtype of major depressive disorder, neuroimaging studies on PPD are rare, particularly those identifying neurochemical abnormalities obtained by proton magnetic resonance spectroscopy (¹H-MRS). The dorsolateral prefrontal (DLPF) and the anterior cingulate gyrus (ACG) are part of the neural pathways involved in executive functions and emotional processing, and both structures have been implicated in the neurobiology of depressive disorders. This study aimed to evaluate brain metabolites abnormalities in women with PPD compared with healthy postpartum (HP) women. Thirty-six PPD (34 without antidepressants) and 25 HP women underwent a ¹H-MRS acquired on a 3-T MRI system, with the volume of interest positioned in ACG and DLPF. An ANCOVA was conducted with age, postpartum time, and contraceptive type as covariates. PPD group presented significantly lower Glutamate+Glutamine (Glx, -0.95mM) and N-acetylaspartate+N-acetylaspartylglutamate (NAA, -0.60mM) values in DLPF. There were no significant differences between groups in ACG, but we found a significant increase of Glutamate (Glu, 2.18mM) and Glx (1.84mM) in participants using progestogen-only contraceptives. These findings suggest glutamatergic dysfunction and neuronal damage in the DLPF of PPD patients, similarly to other subtypes of depressive disorders. Progestogens seem to interfere in the neurochemistry of ACG.
虽然产后抑郁症（PPD）是一种常见的重度抑郁症亚型，但针对 PPD 的神经影像学研究很少，特别是那些通过质子磁共振波谱（¹H-MRS）确定神经化学异常的研究。背外侧前额叶（DLPF）和前扣带回（ACG）是参与执行功能和情绪处理的神经通路的一部分，这两个结构都与抑郁障碍的神经生物学有关。本研究旨在评估与健康产后（HP）女性相比，患有 PPD 的女性大脑代谢物的异常。36 名 PPD（34 名未服用抗抑郁药）和 25 名 HP 女性在 3T MRI 系统上进行了¹H-MRS 检查，感兴趣区位于 ACG 和 DLPF。采用协方差分析（ANCOVA），以年龄、产后时间和避孕类型为协变量。PPD 组 DLPF 中的谷氨酸+谷氨酰胺（Glx，-0.95mM）和 N-乙酰天冬氨酸+N-乙酰天门冬氨酸谷氨酸（NAA，-0.60mM）值明显较低。两组在 ACG 中没有显著差异，但我们发现使用单纯孕激素避孕的参与者的谷氨酸（Glu，2.18mM）和 Glx（1.84mM）明显增加。这些发现表明 PPD 患者的 DLPF 中存在谷氨酸能功能障碍和神经元损伤，与其他类型的抑郁障碍相似。孕激素似乎会干扰 ACG 的神经化学。
