Bupropion and venlafaxine responders differ in pretreatment regional cerebral metabolism in unipolar depression.
BACKGROUND
Pretreatment functional brain imaging was examined for never-hospitalized outpatients with unipolar depression compared with control subjects in a crossover treatment trial involving bupropion or venlafaxine monotherapy.


METHODS
Patients (n = 20) with unipolar depression received baseline (medication-free) fluorine-18 deoxyglucose (FDG) positron emission tomography (PET) scan and then at least 6 weeks of bupropion or venlafaxine monotherapy in a single-blind crossover trial. Age-matched healthy control subjects (n = 20) also received baseline FDG PET scans. For each medication PET data from patients compared with control subjects was analyzed as a function of treatment response (defined as moderate to marked improvement on the Clinical Global Impression Scale).


RESULTS
Treatment response rates were similar for buproprion (32%) and venlafaxine (33%). Compared with control subjects, responders but not nonresponders, to both drugs demonstrated frontal and left temporal hypometabolism. Selectively, compared with control subjects bupropion responders (n = 6) also had cerebellar hypermetabolism, whereas venlafaxine responders (n = 7) showed bilateral temporal and basal ganglia hypometabolism.


CONCLUSIONS
These data suggest that pretreatment frontal and left temporal hypometabolism in never-hospitalized depressed outpatients compared with control subjects is linked to positive antidepressant response and that additional alterations in regional metabolism may be linked to differential responsivity to bupropion and venlafaxine monotherapy.
Little
John T
JT
Division of Psychiatric Neuroimaging, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Ketter
Terence A
TA
Kimbrell
Tim A
TA
Dunn
Robert T
RT
Benson
Brenda E
BE
Willis
Mark W
MW
Luckenbaugh
David A
DA
Post
Robert M
RM
D000328:Adult; D018687:Antidepressive Agents, Second-Generation / Q000627:therapeutic use*; D001931:Brain Mapping; D016642:Bupropion / Q000627:therapeutic use*; D016022:Case-Control Studies; D002540:Cerebral Cortex / Q000000981:diagnostic imaging / Q000378:metabolism*; D018592:Cross-Over Studies; D003511:Cyclohexanols / Q000627:therapeutic use*; D003710:Demography; D003866:Depressive Disorder / Q000188:drug therapy* / Q000378:metabolism; D005260:Female; D019788:Fluorodeoxyglucose F18 / Q000378:metabolism; D007839:Functional Laterality / Q000502:physiology; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008297:Male; D008875:Middle Aged; D049268:Positron-Emission Tomography / Q000379:methods; D011569:Psychiatric Status Rating Scales; D016037:Single-Blind Method; D016896:Treatment Outcome; D000069470:Venlafaxine Hydrochloride
D018687:Antidepressive Agents, Second-Generation; D003511:Cyclohexanols; D016642:Bupropion; D019788:Fluorodeoxyglucose F18; D000069470:Venlafaxine Hydrochloride