Perini Giulia Ida, Toffanin Tommaso, Pigato Giorgio, Ferri Giovanni, Follador Halima, Zonta Filippo, Pastorelli Carlo, Piazzon Giulia, Denaro Luca, Rolma Giuseppe, Ermani Mario, DʼAvella Domenico
From the *Department of Neurosciences, Section of Psychiatry, University-Hospital of Padova, Padova; †Casa di Cura Parco dei Tigli, Teolo, Padova; ‡Department of Psychiatry, ULSS 6, Padova; §Department of Psychiatry, ULSS 2, Treviso; ∥Private Practitioner in Psychiatry, Padova; and ¶Neurosurgery Unit, #Neuroradiology Unit, and **Section of Neurology, Department of Neurosciences, University-Hospital of Padova, Padova, Italy.
J ECT. 2017 Sep;33(3):160-166. doi: 10.1097/YCT.0000000000000424.
Changes in hippocampal gray matter volumes are proposed to be involved in pathogenesis, course, and treatment response of major depressive disorder. Converging evidence suggests that reduced neurogenesis may occur in treatment-resistant depression (TRD). Vagus nerve stimulation (VNS) is a well-defined, long-term brain stimulation treatment for TRD. However, its in vivo positive effect on hippocampal modulation as mechanism of action has never been investigated before in clinical studies. In this study, we intended to explore hippocampal volumetric changes and clinical antidepressant responses in patients with TRD after 6 and 12 months of treatment with VNS.
The TRD outpatients were evaluated for VNS implantation. Right and left hippocampal volumes in 6 TRD patients, who met the criteria for VNS treatment, were measured at baseline before the implantation and after 6 and 12 months. The patients were assessed using Beck Depression Inventory and Hamilton Depression Rating Scale at baseline and at follow-up visits.
There was a statistically significant and progressive increase in right and left hippocampal volumes during the follow up (P < 0.05). Furthermore, patients showed a significant improvement on Hamilton Depression Rating Scale and Beck Depression Inventory scores (P < 0.05).
Our data suggest a VNS modulatory effect on hippocampal plasticity as measured by hippocampal gray volume increase in TRD patients. These preliminary findings indicate the fundamental role of hippocampal remodeling as a marker of response to VNS in TRD.
海马灰质体积的变化被认为与重度抑郁症的发病机制、病程及治疗反应有关。越来越多的证据表明，难治性抑郁症（TRD）可能存在神经发生减少的情况。迷走神经刺激（VNS）是一种针对TRD的明确的长期脑刺激治疗方法。然而，此前从未在临床研究中探究过其对海马调节的体内积极作用机制。在本研究中，我们旨在探讨TRD患者在接受VNS治疗6个月和12个月后的海马体积变化及临床抗抑郁反应。
对TRD门诊患者进行VNS植入评估。对6名符合VNS治疗标准的TRD患者，在植入前基线期以及6个月和12个月后测量其左右海马体积。在基线期和随访时使用贝克抑郁量表和汉密尔顿抑郁评定量表对患者进行评估。
随访期间，左右海马体积有统计学意义的逐步增加（P < 0.05）。此外，患者的汉密尔顿抑郁评定量表和贝克抑郁量表评分有显著改善（P < 0.05）。
我们的数据表明，通过TRD患者海马灰质体积增加来衡量，VNS对海马可塑性具有调节作用。这些初步发现表明海马重塑作为TRD中对VNS反应的标志物具有重要作用。
