title: Selective serotonin reuptake inhibitor discontinuation syndrome is associated with a rostral anterior cingulate choline metabolite decrease: a proton magnetic resonance spectroscopic imaging study.
abstract: The selective serotonin reuptake inhibitor (SSRI) discontinuation syndrome (DS) is an important potential complication of treatment for major depression. We hypothesized that SSRI treatment discontinuation, resulting in change in clinical state, would be associated with reduced rostral anterior cingulate choline (Cho) metabolite ratios. Individuals with a DSM-III-R diagnosis of unipolar major depression who had been stabilized on paroxetine (n = 13) or fluoxetine (n = 13) were study subjects. They were monitored for change in clinical state (mood ratings, discontinuation symptoms) and underwent proton magnetic resonance spectroscopic imaging of the rostral anterior cingulate 3 days after medication substitution with active SSRI and placebo.Placebo-day Cho/Cre (choline/total creatine) metabolite ratios were decreased in four paroxetine and two fluoxetine subjects meeting DS criteria, as compared with asymptomatic subjects (Mann-Whitney z = -2.31, p =.021). Discontinuation syndrome is associated with a rostral anterior cingulate Cho/Cre metabolite ratio decrease that may reflect dynamics of rostral anterior cingulate function.
authors.affiliation: Brain Imaging Center, McLean Hospital, Harvard Medical School, Belmont, Massachusetts 02478, USA.
authors.forename: Marc J
authors.initials: MJ
authors.lastname: Kaufman
authors.forename: Michael E
authors.initials: ME
authors.lastname: Henry
authors.forename: Blaise deB
authors.initials: Bd
authors.lastname: Frederick
authors.forename: John
authors.initials: J
authors.lastname: Hennen
authors.forename: Rosemond A
authors.initials: RA
authors.lastname: Villafuerte
authors.forename: Eve P
authors.initials: EP
authors.lastname: Stoddard
authors.forename: Mark E
authors.initials: ME
authors.lastname: Schmidt
authors.forename: Bruce M
authors.initials: BM
authors.lastname: Cohen
authors.forename: Perry F
authors.initials: PF
authors.lastname: Renshaw
mesh_terms: D000328:Adult; D001931:Brain Mapping; D002794:Choline / Q000378:metabolism*; D003865:Major Depressive Disorder / Q000188:drug therapy* / Q000378:metabolism; D005260:Female; D005473:Fluoxetine / Q000009:adverse effects / Q000627:therapeutic use; D006179:Gyrus Cinguli / Q000378:metabolism*; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D009682:Magnetic Resonance Spectroscopy; D017374:Paroxetine / Q000009:adverse effects / Q000627:therapeutic use; D010725:Phosphocreatine / Q000378:metabolism; D011569:Psychiatric Status Rating Scales; D017367:Selective Serotonin Reuptake Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D013375:Substance Withdrawal Syndrome / Q000209:etiology / Q000378:metabolism*; D013577:Syndrome
chemical_list: D002794:Choline; D005473:Fluoxetine; D017374:Paroxetine; D010725:Phosphocreatine; D017367:Selective Serotonin Reuptake Inhibitors