Kocmur M, Milcinski M, Budihna N V
Department of Psychiatry, University Medical Centre, Ljubljana, Slovenia.
Eur J Nucl Med. 1998 Oct;25(10):1412-4. doi: 10.1007/s002590050316.
Depression is one of the most common psychiatric illnesses. Its influence on brain perfusion has been demonstrated, but conflicting data exist on follow-up after drug treatment. The aim of our study was to evaluate the effects of antidepressant drugs on regional cerebral blood flow (rCBF) in patients with depression after 3 weeks and 6 months of drug therapy. Clinical criteria for depression without psychosis were met according to psychiatric evaluation. Severity of depression was evaluated with the Hamilton Depression Rating Scale (HAMD) before every scintigraphic study. rCBF was assessed using technetium-99m bicisate (Neurolite) brain single-photon emission tomography in nine patients with severe depression before the beginning of antidepressant drug therapy and 3 weeks and six months after initiation of therapy. Only patients with no change in antidepressant medication during the study were included. No antipsychotic drugs were used. Cerebellum was used as the reference region. rCBF was evaluated for eight regions in each study in three consecutive transversal slices. Follow-up studies were compared with the baseline study. The mean HAMD score was 25.5 points initially, 16 at the second examination and 8.8 after 6 months. Global CBF was decreased compared with the reference region in drug-free patients. Perfusion of left frontal and temporal regions was significantly lower (P < 0.005) in comparison with the contralateral side. After therapy, a moderate decrease in perfusion was seen in the right frontal region (P < 0.05). Perfusion decreased further after 6 months in the right frontal (P < 0.005) and temporal regions (P < 0.01). The highly significant asymmetry in perfusion between the left and right frontal and temporal lobes almost disappeared during treatment. Our findings implicate dysfunction of the frontal and temporal cortex in clinically depressed patients before specific drug treatment. Clinical improvement and decreases in HAMD score after 3 weeks and after 6 months reflect the treatment effect on mood-related rCBF changes.
抑郁症是最常见的精神疾病之一。其对脑灌注的影响已得到证实，但药物治疗后的随访数据存在矛盾。我们研究的目的是评估抗抑郁药物在药物治疗3周和6个月后对抑郁症患者局部脑血流量（rCBF）的影响。根据精神病学评估，符合无精神病性抑郁症的临床标准。在每次闪烁扫描研究前，使用汉密尔顿抑郁量表（HAMD）评估抑郁严重程度。在9例重度抑郁症患者开始抗抑郁药物治疗前、治疗开始后3周和6个月，使用锝-99m双半胱乙酯（Neurolite）脑单光子发射断层扫描评估rCBF。仅纳入研究期间抗抑郁药物治疗无变化的患者。未使用抗精神病药物。以小脑作为参照区域。在每次研究中，在三个连续的横向切片中对八个区域的rCBF进行评估。将随访研究与基线研究进行比较。最初的平均HAMD评分为25.5分，第二次检查时为16分，6个月后为8.8分。与未用药患者的参照区域相比，全脑CBF降低。与对侧相比，左侧额叶和颞叶区域的灌注显著降低（P<0.005）。治疗后，右侧额叶区域的灌注出现中度降低（P<0.05）。6个月后，右侧额叶（P<0.005）和颞叶区域（P<0.01）的灌注进一步降低。治疗期间，左右额叶和颞叶之间灌注的高度显著不对称几乎消失。我们的研究结果表明，在特定药物治疗前，临床抑郁症患者存在额叶和颞叶皮质功能障碍。3周和6个月后临床症状改善及HAMD评分降低反映了治疗对与情绪相关的rCBF变化的影响。
