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Investigating the association between depression and cerebral haemodynamics-A systematic review and meta-analysis
Tamara Chithiramohan1, Jvalant Nayan Parekh2, Golo Kronenberg3
1University of Leicester, Department of Cardiovascular Sciences, Leicester, UK.
Insights
Cerebral blood flow (CBF) is reduced in depression, suggesting vascular mechanisms may be involved. Further research is needed to understand specific subgroups and potential interventions.
Area of Science:
- Neuroscience
- Vascular Biology
- Psychiatry
Background:
- Vascular mechanisms are increasingly implicated in the pathophysiology of depression.
- Understanding alterations in cerebral haemodynamics is crucial for depression research.
Purpose of the Study:
- To systematically review and synthesize evidence on cerebral haemodynamic changes in depression.
- To conduct a meta-analysis on key cerebral blood flow parameters in depressed individuals.
Main Methods:
- A comprehensive literature search was performed across multiple databases (MEDLINE, Embase, Web of Science, PsycINFO, CINAHL, CENTRAL).
- Meta-analysis was conducted for global cerebral blood flow (CBF), CBF velocity (CBFv), combined CBF and CBFv, and Tc 99m HMPAO uptake ratios.
- Narrative synthesis was employed for studies not included in the meta-analysis.
Main Results:
- Meta-analysis of 15 studies revealed significantly reduced global CBF in depressed patients compared to healthy controls (HC) [MD: -2.24 ml/min/100 g, p=0.02].
- No statistically significant differences were found for other analyzed parameters.
- Narrative synthesis indicated variable CBF changes, particularly in the anterior cingulate and prefrontal cortices.
Conclusions:
- Reduced CBF in depression suggests a potential role for vascular assessment and interventions.
- Heterogeneity in study designs, depression severity, medication use, and imaging modalities limits direct comparisons.
- Further investigation into specific subgroups is warranted due to inconsistent findings across studies.
Background:
Vascular mechanisms may play a role in depression. The aim of this review is to summarise the evidence on alterations in cerebral haemodynamics in depression.
Methods:
MEDLINE (1946- present), Embase (1947-present), Web of Science (1970-present), PsycINFO (1984-present), CINAHL (1976-present) and CENTRAL were searched using a predefined search strategy. A meta-analysis was conducted in four groups: 1) global cerebral blood flow (CBF) in ml/min/100 g, 2) CBF velocity (CBFv) in cm/s (maximum flow of left middle cerebral artery, 3) combined CBF and CBFv, 4) Ratio of uptake of Tc 99 m HMPAO (region of interest compared to whole brain). Data are presented as mean difference or standardised mean difference and 95% confidence interval (95% CI). A narrative synthesis of the remaining studies was performed.
Results:
87 studies were included. CBF was significantly reduced in depressed patients compared to HC [15 studies, 538 patients, 416 HC, MD: -2.24 (95% CI -4.12, -0.36), p = 0.02, I2 = 64%]. There were no statistically significant differences in other parameters. The narrative synthesis revealed variable changes in CBF in depressed patients, particularly affecting the anterior cingulate and prefrontal cortices.
Limitations:
There were various sources of heterogeneity including the severity of depression, use of antidepressant medication, imaging modality used and reporting of outcomes. All of these factors made direct comparisons between studies difficult.
Conclusions:
The reduction in CBF in depressed patients compared to HCs may indicate a role for assessment and CBF altering interventions in high-risk groups. However, results were inconsistent across studies, warranting further work to investigate specific subgroups.
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