title: Possible structural abnormality of the brainstem in unipolar depressive illness: a transcranial ultrasound and diffusion tensor magnetic resonance imaging study.
abstract: BACKGROUND
  Most empirically derived antidepressants increase monoamine levels. The nuclei of cells synthesising these monoamines are located in the brainstem, and projection tracts such as the medial forebrain bundle reach virtually all other brain areas. Two studies of unipolar depressive illness using transcranial ultrasound have reported reduced echogenicity of the brainstem midline in unipolar depressed patients. This may be consistent with disruption of white matter tracts, including the medial forebrain bundle, and it has been suggested that the effect of such disruption could be reversed by antidepressants.
  
  
  OBJECTIVE
  To replicate these findings in a group of unipolar depressed patients and controls.
  
  
  METHODS
  Fifteen unipolar depressed patients and 15 controls were studied using transcranial ultrasound imaging and diffusion tensor magnetic resonance imaging (DT-MRI).
  
  
  RESULTS
  No difference in echogenicity of the brainstem midline of unipolar depressed patients was found. A possible trend (Cohen's d = 0.39) in the direction of previous studies was found. Although the echogenicity of the brainstem midline of the control group was found to be similar to previous reports, there was no reduction in the patient group. Additionally, no structural abnormality of the brainstem was identified using DT-MRI.
  
  
  CONCLUSIONS
  While these data do not replicate the findings of previous studies reporting a significant reduction in the echogenicity of the brainstem midline in unipolar depressed patients, the ultrasound investigation indicated that there may be a trend in this direction. Given the importance of identifying the causes of depressive illness, it is important that other groups attempt similar studies.
authors.affiliation: Department of Mental Health, University of Aberdeen, Royal Cornhill Hospital, UK. jds333@dsteele.demon.co.uk
authors.forename: J D
authors.initials: JD
authors.lastname: Steele
authors.forename: M E
authors.initials: ME
authors.lastname: Bastin
authors.forename: J M
authors.initials: JM
authors.lastname: Wardlaw
authors.forename: K P
authors.initials: KP
authors.lastname: Ebmeier
mesh_terms: D000328:Adult; D000368:Aged; D000928:Antidepressive Agents / Q000494:pharmacology / Q000627:therapeutic use; D001933:Brain Stem / Q000002:abnormalities* / Q000000981:diagnostic imaging* / Q000187:drug effects; D003866:Depressive Disorder / Q000188:drug therapy / Q000503:physiopathology*; D038524:Diffusion Magnetic Resonance Imaging; D004453:Echoencephalography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011903:Raphe Nuclei / Q000000981:diagnostic imaging / Q000187:drug effects; D012886:Skull
chemical_list: D000928:Antidepressive Agents