Weill Cornell Institute of Geriatric Psychiatry, Department of Psychiatry, Weill Cornell Medicine, 21 Bloomingdale Road, White Plains, NY, United States.
Weill Cornell Institute of Geriatric Psychiatry, Department of Psychiatry, Weill Cornell Medicine, 21 Bloomingdale Road, White Plains, NY, United States.
J Affect Disord. 2019 Jan 15;243:62-69. doi: 10.1016/j.jad.2018.09.013. Epub 2018 Sep 11.
Negative self-referential thinking is a common symptom of depression associated with poor treatment response. In late-life depression, white matter abnormalities may contribute to negative self-referential thoughts following antidepressant treatment. We investigated the association of fractional anisotropy (FA) in select regions of the negative valence system (NVS) with residual negative self-referential thoughts following treatment with escitalopram for late-life depression.
The participants were older adults with major depression and psychiatrically normal controls. Depressed participants received 12 weeks of treatment with escitalopram. To assess self-referential thinking, participants completed a Trait Adjective Task at baseline and at week 12. Baseline MRI scans included a diffusion imaging sequence for FA analyses.
Participants with late-life depression differed from controls on all performance measures of the Trait Adjective Task at baseline and at 12 weeks. Depressed participants endorsed fewer negative personality traits and more positive personality traits at week 12 compared to baseline. Lower FA in the dorsal anterior cingulate and in the uncinate fasciculus in depressed participants was correlated with residual negative self-referential thinking (e.g., more endorsed negative adjectives, fewer rejected negative adjectives) at treatment end.
The sample size is modest so the findings are preliminary. FA analyses were restricted to predetermined regions.
Negative self-referential thinking improved in depressed older adults following 12 weeks of treatment with escitalopram. Baseline FA in select white matter regions of the NVS was associated with residual negative self-referential thinking. These findings may help identify treatment targets for residual negative self-referential thoughts.
消极的自我参照思维是与治疗反应不良相关的抑郁症的常见症状。在老年抑郁症中，抗抑郁治疗后白质异常可能导致消极的自我参照思维。我们研究了选择的负价系统（NVS）区域的各向异性分数（FA）与老年抑郁症患者接受依他普仑治疗后残留的消极自我参照思维之间的关联。
参与者为患有重度抑郁症和精神正常的老年人。抑郁患者接受依他普仑治疗 12 周。为了评估自我参照思维，参与者在基线和第 12 周完成了特质形容词任务。基线 MRI 扫描包括用于 FA 分析的扩散成像序列。
与对照组相比，基线和第 12 周时，患有老年抑郁症的参与者在特质形容词任务的所有表现测量中均存在差异。与基线相比，第 12 周时抑郁患者对负面人格特质的评价更少，对正面人格特质的评价更多。抑郁患者的背侧前扣带和钩束中的 FA 降低与治疗结束时的残留消极自我参照思维（例如，更多地认同负面形容词，更少地否定负面形容词）相关。
样本量不大，因此结果只是初步的。FA 分析仅限于预定的区域。
在依他普仑治疗 12 周后，老年抑郁症患者的消极自我参照思维得到改善。NVS 中选定的白质区域的基线 FA 与残留的消极自我参照思维有关。这些发现可能有助于确定残留消极自我参照思维的治疗靶点。
