Rostral anterior cingulate glutamate predicts response to subcallosal deep brain stimulation for resistant depression
| Autor: | Rajamannar Ramasubbu, Darren L. Clark, Frank P. MacMaster, Zelma H. T. Kiss, Elliot C. Brown |
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| Rok vydání: | 2020 |
| Předmět: |
Adult
Oncology medicine.medical_specialty Deep brain stimulation Deep Brain Stimulation medicine.medical_treatment Glutamic Acid Gyrus Cinguli behavioral disciplines and activities Depressive Disorder Treatment-Resistant 03 medical and health sciences 0302 clinical medicine Internal medicine medicine Humans Anterior cingulate cortex Depression (differential diagnoses) business.industry Glutamate receptor Hamilton Rating Scale for Depression medicine.disease 030227 psychiatry Glutamine Psychiatry and Mental health Clinical Psychology Treatment Outcome medicine.anatomical_structure Biomarker (medicine) business Treatment-resistant depression 030217 neurology & neurosurgery |
| Zdroj: | Journal of Affective Disorders. 266:90-94 |
| ISSN: | 0165-0327 |
| DOI: | 10.1016/j.jad.2020.01.058 |
| Popis: | Background Deep brain stimulation (DBS) of the subcallosal cingulate (SCC) provided benefit for treatment-resistant depression (TRD) in open-label studies but failed in a recent randomized sham-controlled trial. Informed patient selection, based on reliable biomarkers, is needed to optimize outcome. We investigated if rostral anterior cingulate (rACC) glutamate/glutamine concentration could serve as a potential biomarker of response. Methods Sixteen adults with TRD (Major Depression; MDD = 14; Bipolar Depression; BD =2) underwent proton magnetic resonance spectroscopy using a short-echo proton spectroscopy with a voxel placed in the rACC, prior to DBS. Improvement in depression was assessed using the 17-item Hamilton Rating Scale for Depression (HDRS). Glutamate and glutamine concentrations at baseline in the rACC were examined in relation to clinical outcomes at six months. Results Lower baseline glutamate predicted significant reduction in HDRS scores in all TRD patients (p = 0.018), and predicted both HDRS reduction (p = 0.002) and 6-month response outcome in MDD-TRD patients (p = 0.013). Neither baseline glutamine nor glutamine/glutamate ratio significantly related to outcome or symptom improvement. Limitations Our study was limited by sample size, though it is large for a DBS study. We measured from a single voxel in the brain, so we cannot be certain our findings are specific to the rACC. Conclusions These preliminary results suggest that baseline rACC-glutamate concentration could serve as a response-predictive biomarker for SCC-DBS, particularly in patients with resistant major depression. If our findings are replicated and validated, rACC-glutamate may provide a basis to prospectively select TRD patients to improve likelihood of response to SCC-DBS. |
| Databáze: | OpenAIRE |
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