title: Subtype-specific alterations of gamma-aminobutyric acid and glutamate in patients with major depression.
abstract: BACKGROUND
  Measurement of cortical gamma-aminobutyric acid (GABA) and glutamate concentrations is possible using proton magnetic resonance spectroscopy. An initial report, using this technique, suggested that occipital cortex GABA concentrations are reduced in patients with major depressive disorder (MDD) relative to healthy comparison subjects.
  
  
  OBJECTIVE
  To replicate the GABA findings in a larger sample of MDD patients, to examine the clinical correlates of the GABA reductions in these subjects, and to examine other critical metabolite levels.
  
  
  METHODS
  Study for association.
  
  
  METHODS
  Academic clinical research program.
  
  
  METHODS
  The GABA measurements were made on 38 healthy control subjects and 33 depressed subjects.
  
  
  METHODS
  Occipital cortex metabolite levels were measured using proton magnetic resonance spectroscopy.
  
  
  METHODS
  The levels of occipital cortex GABA, glutamate, N-acetylaspartate, aspartate, creatine, and choline-containing compounds, along with several measures of tissue composition, were compared between the 2 groups.
  
  
  RESULTS
  Depressed subjects had significantly lower occipital cortex GABA concentrations compared with healthy controls (P =.01). In addition, mean glutamate levels were significantly increased in depressed subjects compared with healthy controls (P<.001). Significant reductions in the percentage of solid tissue (P =.009) and the percentage of white matter (P =.04) in the voxel were also observed. An examination of a combined database including subjects from the original study suggests that GABA and glutamate concentrations differ among MDD subtypes.
  
  
  CONCLUSIONS
  The study replicates the findings of decreased GABA concentrations in the occipital cortex of subjects with MDD. It also demonstrates that there is a change in the ratio of excitatory-inhibitory neurotransmitter levels in the cortex of depressed subjects that may be related to altered brain function. Last, the combined data set suggests that magnetic resonance spectroscopy GABA measures may serve as a biological marker for a subtype of MDD.
authors.affiliation: Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06519, USA. gerard.sanacora@yale.edu
authors.forename: Gerard
authors.initials: G
authors.lastname: Sanacora
authors.forename: Ralitza
authors.initials: R
authors.lastname: Gueorguieva
authors.forename: C Neill
authors.initials: CN
authors.lastname: Epperson
authors.forename: Yu-Te
authors.initials: YT
authors.lastname: Wu
authors.forename: Michael
authors.initials: M
authors.lastname: Appel
authors.forename: Douglas L
authors.initials: DL
authors.lastname: Rothman
authors.forename: John H
authors.initials: JH
authors.lastname: Krystal
authors.forename: Graeme F
authors.initials: GF
authors.lastname: Mason
mesh_terms: D000328:Adult; D001224:Aspartic Acid / Q000031:analogs & derivatives* / Q000032:analysis / Q000378:metabolism; D002794:Choline / Q000032:analysis / Q000378:metabolism; D003866:Depressive Disorder / Q000145:classification / Q000175:diagnosis / Q000378:metabolism*; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D018698:Glutamic Acid / Q000032:analysis / Q000378:metabolism*; D005973:Glutamine / Q000032:analysis / Q000378:metabolism; D006801:Humans; D009682:Magnetic Resonance Spectroscopy; D008297:Male; D008875:Middle Aged; D009778:Occipital Lobe / Q000737:chemistry* / Q000378:metabolism; D011569:Psychiatric Status Rating Scales; D012720:Severity of Illness Index; D005680:gamma-Aminobutyric Acid / Q000032:analysis / Q000378:metabolism*
chemical_list: D005973:Glutamine; D001224:Aspartic Acid; D018698:Glutamic Acid; D005680:gamma-Aminobutyric Acid; C000179:N-acetylaspartate; D002794:Choline