Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston TX USA; Michael E DeBakey VA Medical Center, Houston TX, USA.
Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston TX USA.
J Affect Disord. 2019 Jan 1;242:211-219. doi: 10.1016/j.jad.2018.08.026. Epub 2018 Aug 9.
The habenula (Hb) is a small midbrain structure that signals negative events and may play a major role in the etiology of psychiatric disorders including depression. The lateral Hb has three major efferent connections: serotonergic raphe nuclei, noradrenergic locus coeruleus, and dopaminergic ventral tegmental area/substantia nigra compacta. We wanted to test whether Hb connectivity may be important to predict treatment outcomes in depression patients.
We studied whether habenular connectivity at admission into a psychiatric clinic can predict treatment response. We used an inpatient sample (N = 175) to assess habenular connectivity (diffusion tensor imaging and resting state functional connectivity (RSFC) between the Hb and its targets) close to admission. In addition, we obtained the Patient Health Questionnaire-depression module (PHQ-9) close to admission and at discharge. Inpatients in the study entered the clinic with at least moderately severe depression (score 15 and up). Inpatients considered treatment resistant had scores of 9 or more at discharge.
Compared to responders, treatment non-responders had lower fractional anisotropy in the right Hb afferent fibers and lower RSFC between right Hb and median raphe, but higher RSFC between left Hb and locus coeruleus. A logistic regression model was significantly different from chance, and explained 27.7% of the variance in treatment resistance (sensitivity = 75%; specificity = 71.9%).
The anatomical and functional connectivity of the Hb may be a predictor of treatment success in psychiatric populations. Limitations include the Hb small size and the limited time (5 min) of resting state data obtained.
缰核（Hb）是中脑的一个小结构，它传递负面事件的信号，可能在包括抑郁症在内的精神疾病的发病机制中起主要作用。外侧缰核有三个主要的传出连接：5-羟色胺能中缝核、去甲肾上腺素能蓝斑和多巴胺能腹侧被盖区/黑质致密部。我们想测试缰核的连接是否对预测抑郁症患者的治疗结果很重要。
我们研究了入院时缰核的连接是否可以预测治疗反应。我们使用住院患者样本（N=175）来评估入院时缰核的连接（弥散张量成像和缰核与其靶区之间的静息状态功能连接（RSFC））。此外，我们在入院时和出院时获得了患者健康问卷-抑郁模块（PHQ-9）。研究中的住院患者入院时至少有中度至重度抑郁症（评分 15 分及以上）。被认为治疗抵抗的住院患者在出院时的评分在 9 分或以上。
与反应者相比，治疗无反应者右侧缰核传入纤维的各向异性分数较低，右侧缰核与中缝核之间的 RSFC 较低，而左侧缰核与蓝斑之间的 RSFC 较高。逻辑回归模型显著优于随机模型，并且可以解释治疗抵抗的 27.7%的方差（敏感性为 75%；特异性为 71.9%）。
缰核的解剖和功能连接可能是精神科人群治疗成功的预测指标。限制包括缰核的体积小和静息状态数据（5 分钟）的时间有限。
