Glucose metabolic response to total sleep deprivation, recovery sleep, and acute antidepressant treatment as functional neuroanatomic correlates of treatment outcome in geriatric depression.
OBJECTIVE
The variable speed and durability of response to antidepressant medications in geriatric depression is a significant clinical problem. The authors evaluated changes in cerebral glucose metabolism measured with positron emission tomography (PET) during a clinical trial designed to accelerate medication response by the use of one night of total sleep deprivation (TSD), and they asked whether changes would correlate with treatment outcome after 12 weeks of antidepressant treatment.


METHODS
Twelve elderly, unipolar depressed patients underwent serial PET studies at baseline, post-TSD, post-recovery sleep (after an initial paroxetine dose), and after 2 weeks of paroxetine treatment.


RESULTS
Decreased regional glucose metabolism after TSD, recovery sleep, and 2 weeks of treatment was associated with clinical improvement at 12 weeks. The right cingulate gyrus area was consistently correlated with clinical improvement across treatment conditions.


CONCLUSIONS
These data indicate that the early metabolic alterations in the right cingulate gyrus and the persistence of these adaptive changes are associated with improvement in depressive symptoms.
Smith
Gwenn S
GS
Department of Psychiatry Research, Hillside Hospital of the North Shore-Long Island Jewish Health System, 75-59 263rd Street, Glen Oaks, NY 11004, USA. gsmith@lij.edu
Reynolds
Charles F
CF
Houck
Patricia R
PR
Dew
Mary Amanda
MA
Ma
Yilong
Y
Mulsant
Benoit H
BH
Pollock
Bruce G
BG
D000368:Aged; D018687:Antidepressive Agents, Second-Generation / Q000627:therapeutic use*; D001921:Brain / Q000000981:diagnostic imaging* / Q000187:drug effects*; D003866:Depressive Disorder / Q000000981:diagnostic imaging* / Q000188:drug therapy* / Q000523:psychology; D005260:Female; D005947:Glucose / Q000378:metabolism*; D006801:Humans; D008297:Male; D017374:Paroxetine / Q000627:therapeutic use*; D011569:Psychiatric Status Rating Scales; D012890:Sleep / Q000502:physiology; D012892:Sleep Deprivation / Q000000981:diagnostic imaging* / Q000188:drug therapy* / Q000503:physiopathology; D013997:Time Factors; D014055:Tomography, Emission-Computed
D018687:Antidepressive Agents, Second-Generation; D017374:Paroxetine; D005947:Glucose