Association of Cerebral Metabolic Activity Changes with Vagus Nerve Stimulation Antidepressant Response in Treatment-Resistant Depression

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• 作者：Charles R. Conway ; John T. Chibnall ; Marie Anne Gebara ; Joseph L. Price ; Abraham Z. Snyder ; Mark A. Mintun ; A.D. (Bud) Craig ; Martha E. Cornell ; Dana C. Perantie ; Luis A. Giuffra ; Richard D. Bucholz ; Yvette I. Sheline
• 关键词：Treatment resistant depression ; Vagus nerve stimulation ; Positron emission tomography ; Depression ; Antidepressant
• 刊名：Brain Stimulation
• 出版年：2013
• 出版时间：September, 2013
• 年：2013
• 卷：6
• 期：5
• 页码：788-797
• 全文大小：1179 K

文摘

Background

Vagus nerve stimulation (VNS) has antidepressant effects in treatment resistant major depression (TRMD); these effects are poorly understood. This trial examines associations of subacute (3?months) and chronic (12?months) VNS with cerebral metabolism in TRMD.

Objective

¹⁷Fluorodeoxyglucose positron emission tomography was used to examine associations between 12-month antidepressant VNS response and cerebral metabolic rate for glucose (CMRGlu) changes at 3 and 12?months.

Methods

Thirteen TRMD patients received 12?months of VNS. Depression assessments (Hamilton Depression Rating Scale [HDRS]) and PET scans were obtained at baseline (pre-VNS) and 3/12?months. CMRGlu was assessed in eight a priori selected brain regions (bilateral anterior insular [AIC], orbitofrontal [OFC], dorsolateral prefrontal [DLPFC], and anterior cingulate cortices [ACC]). Regional CMRGlu changes over time were studied in VNS responders (decreased 12?month HDRS by ¡Ý50 % ) and nonresponders.

Results

A significant trend (decreased 3?month CMRGlu) in the right DLPFC was observed over time in VNS responders (n?=?9; P?=?0.006). An exploratory whole brain analysis (P_uncorrected?=?0.005) demonstrated decreased 3?month right rostral cingulate and DLPFC CMRGlu, and increased 12?month left ventral tegmental CMRGlu in responders.

Conclusions/Limitations

VNS response may involve gradual (months in duration) brain adaptations. Early on, this process may involve decreased right-sided DLPFC/cingulate cortical activity; longer term effects (12?months) may lead to brainstem dopaminergic activation. Study limitations included: a) a small VNS nonresponders sample (N?=?4), which limited conclusions about nonresponder CMRGlu changes; b) no control group; and, c) patients maintained their psychotropic medications.