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Preliminary Findings

Arthur L. Brody, MD; Sanjaya Saxena, MD; Paula Stoessel, PhD; Laurie A. Gillies, PhD; Lynn A. Fairbanks, PhD; Shervin Alborzian, BS; Michael E. Phelps, PhD; Sung-Cheng Huang, PhD; Hsiao-Ming Wu, PhD; Matthew L. Ho, BS; Mai K. Ho; Scott C. Au, BS; Karron Maidment, RN; Lewis R. Baxter, Jr, MD

Arch Gen Psychiatry. 2001;58:631-640.

Background  In functional brain imaging studies of major depressive disorder (MDD), regional abnormalities have been most commonly found in prefrontal cortex, anterior cingulate gyrus, and temporal lobe. We examined baseline regional metabolic abnormalities and metabolic changes from pretreatment to posttreatment in subjects with MDD. We also performed a preliminary comparison of regional changes with 2 distinct forms of treatment (paroxetine and interpersonal psychotherapy).

Methods  Twenty-four subjects with unipolar MDD and 16 normal control subjects underwent resting F 18 (¹⁸F) fluorodeoxyglucose positron emission tomography scanning before and after 12 weeks. Between scans, subjects with MDD were treated with either paroxetine or interpersonal psychotherapy (based on patient preference), while controls underwent no treatment.

Results  At baseline, subjects with MDD had higher normalized metabolism than controls in the prefrontal cortex (and caudate and thalamus), and lower metabolism in the temporal lobe. With treatment, subjects with MDD had metabolic changes in the direction of normalization in these regions. After treatment, paroxetine-treated subjects had a greater mean decrease in Hamilton Depression Rating Scale score (61.4%) than did subjects treated with interpersonal psychotherapy (38.0%), but both subgroups showed decreases in normalized prefrontal cortex (paroxetine-treated bilaterally and interpersonal psychotherapy–treated on the right) and left anterior cingulate gyrus metabolism, and increases in normalized left temporal lobe metabolism.

Conclusions  Subjects with MDD had regional brain metabolic abnormalities at baseline that tended to normalize with treatment. Regional metabolic changes appeared similar with the 2 forms of treatment. These results should be interpreted with caution because of study limitations (small sample size, lack of random assignment to treatment groups, and differential treatment response between treatment subgroups).

From the Departments of Psychiatry and Biobehavioral Sciences (Drs Brody, Saxena, Stoessel, Fairbanks, and Baxter; Messrs Alborzian, Ho, and Au; and Mss Ho and Maidment) and Medical and Molecular Pharmacology (Drs Phelps, Huang, Wu, and Baxter), University of California–Los Angeles, Los Angeles, Calif; Veterans Affairs Greater Los Angeles Health Care System (Dr Brody); Department of Psychiatry, University of Toronto, Toronto, Ontario (Dr Gillies); and Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham (Dr Baxter).

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