title: Paralimbic hypoperfusion in unipolar depression.
abstract: METHODS
  Relative regional cerebral blood flow was measured with SPECT using 99mTc-hexamethylpropyleneamine oxime in 13 patients with severe unipolar depression that was nonresponsive to drug therapy and 11 age-matched nondepressed controls.
  
  
  RESULTS
  All patients were clinically depressed and taking antidepressant drugs at the time of the study. The relative blood flow was significantly decreased bilaterally in the frontal cortex, anterior temporal cortex, anterior cingulate gyrus and caudate in the depressed patients compared with the nondepressed healthy controls. The greatest decreases were seen in the paralimbic regions, specifically, the inferior frontal and cingulate cortex. No significant changes were seen in the parietal cortex, occipital cortex or thalami. Psychiatric rating scales correlated poorly with regional blood flow, except for the degree of psychomotor slowing, which was negatively correlated with frontal and cingulate perfusion.
  
  
  CONCLUSIONS
  These findings implicate selective dysfunction of paralimbic brain regions in clinically depressed patients, independent of their medication use, and support the concept of specific neural systems that regulate mood. Recognition of these regional abnormalities may have clinical utility in both the diagnosis and treatment of depression.
authors.affiliation: Department of Radiology/Division of Nuclear Medicine, Johns Hopkins Medical Institutions, Baltimore, Maryland.
authors.forename: H S
authors.initials: HS
authors.lastname: Mayberg
authors.forename: P J
authors.initials: PJ
authors.lastname: Lewis
authors.forename: W
authors.initials: W
authors.lastname: Regenold
authors.forename: H N
authors.initials: HN
authors.lastname: Wagner
mesh_terms: D000328:Adult; D001921:Brain / Q000000981:diagnostic imaging*; D002421:Caudate Nucleus / Q000000981:diagnostic imaging; D002560:Cerebrovascular Circulation; D003866:Depressive Disorder / Q000000981:diagnostic imaging / Q000503:physiopathology*; D005260:Female; D005625:Frontal Lobe / Q000000981:diagnostic imaging; D006179:Gyrus Cinguli / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D008875:Middle Aged; D015609:Organotechnetium Compounds; D010091:Oximes; D019690:Technetium Tc 99m Exametazime; D013702:Temporal Lobe / Q000000981:diagnostic imaging; D015899:Tomography, Emission-Computed, Single-Photon
chemical_list: D015609:Organotechnetium Compounds; D010091:Oximes; D019690:Technetium Tc 99m Exametazime