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Preliminary Findings

Stephen D. Martin, MBBS,MRCPsych; Elizabeth Martin, RMN,BSc; Santoch S. Rai, MBChB,MRCPsych; Mark A. Richardson, BSc; Robert Royall, BSc,C.Eng,IEE,MIPEM

Arch Gen Psychiatry. 2001;58:641-648.

Background  Functional brain imaging studies in major depression have suggested abnormalities of areas, including the frontal cortex, cingulate gyrus, basal ganglia, and temporal cortex. We hypothesized that venlafaxine hydrochloride and interpersonal psychotherapy (IPT) might each alter brain blood flow in some or all of these areas on sequential single photon emission computed tomography (SPECT) scans.

Methods  Twenty-eight men and women aged 30 to 53 years with a DSM-IV major depressive episode, a 17-item Hamilton Rating Scale for Depression (HAM-D) rating of 18 or higher, and antidepressant-naive for at least 6 months were studied. After baseline ^99mtechnetium-hexa-methyl-propylene-amine-oxime scan, 1-T magnetic resonance imaging, and psychometric ratings, patients were assigned to different treatments. Thirteen patients had 1-hour weekly sessions of IPT from the same supervised therapist (E.M.). Fifteen patients took 37.5 mg twice-daily of venlafaxine hydrochloride. Single-photon emission computed tomography scans and ratings were repeated at 6 weeks.

Results  Both treatment groups improved substantially, more so with venlafaxine (mean [SD] HAM-D scores at pretreatment: IPT, 22.7 [2.7], and venlafaxine, 22.4 [3.1]; and posttreatment: IPT, 16.2 [7.1], and venlafaxine, 10.9 [8.6]). No patients had structural brain abnormalities. On analysis with statistical parametric mapping 96, the venlafaxine group showed right posterior temporal and right basal ganglia activation (P = .01), while the IPT group had limbic right posterior cingulate and right basal ganglia activation (P = .01).

Conclusions  This preliminary investigation has shown limbic blood flow increase with IPT yet not venlafaxine, while both treatments demonstrated increased basal ganglia blood flow. This was, however, a short trial with a small sample, no control group, and different symptom reduction in the 2 groups.

From the Research Unit, Cherry Knowle Hospital, Sunderland (Dr Martin and Ms Martin); the Hutton Centre, St Lukes Hospital, Middlesbrough (Dr Rai); and the Northern Regional Medical Physics Department, South Cleveland Hospital, Middlesbrough (Messrs Richardson and Royall, England).

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