Frontocingulate cerebral blood flow and cerebrovascular reactivity associated with antidepressant response in
Margarita Abi Zeid Daou1, Brian D Boyd1, Manus J Donahue2
1The Center for Cognitive Medicine, Department of Psychiatry, Vanderbilt University Medical Center, Nashville, TN 37212, USA.
Insights
In older adults with depression, lower cerebral blood flow (CBF) and cerebrovascular reactivity (CVR) in specific brain regions were linked to a poorer response to sertraline treatment. These vascular factors did not appear to negatively impact acute treatment outcomes in this study.
Area of Science:
- Neuroscience
- Gerontology
- Psychiatry
Background:
- Vascular pathology is prevalent in late-life depression (LLD), potentially impacting cerebral blood flow (CBF) and cerebrovascular reactivity (CVR).
- Hemodynamic deficits may negatively influence brain function and the clinical progression of LLD.
Purpose of the Study:
- To investigate if altered cerebral hemodynamics in elders with depression predict their response to antidepressant treatment.
- To examine the relationship between CBF, CVR, and antidepressant treatment outcomes in LLD.
Main Methods:
- 21 depressed elders underwent 3T MRI with pseudo-continuous Arterial Spin Labeling (pcASL) under room air and hypercapnia.
- Participants received 12 weeks of open-label sertraline, with statistical analyses correlating regional CBF and CVR with changes in depression ratings (MADRS).
Main Results:
- Greater improvement in MADRS scores was associated with lower pre-treatment normalized CBF in the caudal anterior cingulate cortex (cACC) and lateral orbitofrontal cortex (OFC).
- Lower CVR during hypercapnia in the caudal medial frontal gyrus (cMFG) was also linked to greater MADRS improvement.
- Remitters showed lower CBF in the cACC and lower CVR in the cMFG compared to non-remitters, after controlling for age and baseline MADRS.
Conclusions:
- Increased perfusion in the OFC and ACC is associated with a poorer antidepressant response in LLD.
- The study findings do not support the hypothesis that vascular pathology, as measured by CBF and CVR, negatively affects acute treatment outcomes in LLD.
Background:
Vascular pathology is common in late-life depression (LLD) and may contribute to alterations in cerebral blood flow (CBF) and cerebrovascular reactivity (CVR). In turn, such hemodynamic deficits may adversely affect brain function and clinical course. The goal of this study was to examine whether altered cerebral hemodynamics in depressed elders predicted antidepressant response.
Methods:
21 depressed elders completed cranial 3T MRI, including a pseudo-continuous Arterial Spin Labeling (pcASL) acquisition on both room air and during a hypercapnia challenge. Participants then completed 12 weeks of open-label sertraline. Statistical analyses examined the relationship between regional normalized CBF and CVR values and change in Montgomery-Asberg Depression Rating Scale (MADRS) and tested for differences based on remission status.
Results:
10 participants remitted and 11 did not. After controlling for age and baseline MADRS, greater change in MADRS with treatment was associated with lower pre-treatment normalized CBF in the caudal anterior cingulate cortex (cACC) and lateral orbitofrontal cortex (OFC), as well as lower CVR with hypercapnia in the caudal medial frontal gyrus (cMFG). After controlling for age and baseline MADRS score, remitters exhibited lower CBF in the cACC and lower CVR in the cMFG.
Limitations:
Our sample was small, did not include a placebo arm, and we examined only specific regions of interest.
Conclusions:
Our findings suggest that increased perfusion of the OFC and the ACC is associated with a poor antidepressant response. They do not support that vascular pathology as measured by CBF and CVR negatively affects acute treatment outcomes.
