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Effects of Stress?

Thomas S. Frodl, MD; Nikolaos Koutsouleris, MD; Ronald Bottlender, MD; Christine Born, MD; Markus Jäger, MD; Isabel Scupin; Maximilian Reiser, MD; Hans-Jürgen Möller, MD; Eva M. Meisenzahl, MD

Arch Gen Psychiatry. 2008;65(10):1156-1165.

Context  Results of experimental studies suggest that neuroplastic changes may occur during depressive episodes. These effects have not been confirmed in patients with depression, to our knowledge.

Objective  To examine changes in the brains of patients with major depression vs those of healthy control subjects.

Design  Prospective longitudinal 3-year study.

Setting  Inpatients with major depression were recruited from the Department of Psychiatry and Psychotherapy, Ludwig Maximilians University of Munich, Munich, Germany, and controls were recruited from the local community.

Participants  The study included 38 patients with major depression and 30 healthy controls.

Main Outcome Measures  High-resolution magnetic resonance imaging was performed at baseline and 3 years later. Voxel-based morphometric measurements were estimated from magnetic resonance images, and psychopathologic findings were assessed at baseline, weekly during the inpatient phase, and then after 1, 2, and 3 years.

Results  Compared with controls, patients showed significantly more decline in gray matter density of the hippocampus, anterior cingulum, left amygdala, and right dorsomedial prefrontal cortex. Patients who remitted during the 3-year period had less volume decline than nonremitted patients in the left hippocampus, left anterior cingulum, left dorsomedial prefrontal cortex, and bilaterally in the dorsolateral prefrontal cortex.

Conclusion  This study supports findings from animal studies of neuroplastic stress-related processes that occur in the hippocampus, amygdala, dorsomedial prefrontal cortex, dorsolateral prefrontal cortex, and anterior cingulum during depressive episodes.

Author Affiliations: Departments of Psychiatry and Psychotherapy (Drs Frodl, Koutsouleris, Bottlender, Jäger, Möller, and Meisenzahl and Ms Scupin) and Radiology (Drs Born and Reiser), Ludwig Maximilians University of Munich, Munich, Germany. Dr Frodl is now with the Department of Psychiatry, School of Medicine, Trinity College Dublin, Trinity Centre for Health Sciences, St James Hospital and Adelaide and Meath Hospital incorporating the National Children’s Hospital (AMiNCH), Dublin, Ireland.

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