title: Imaging the neurobiological substrate of atypical depression by SPECT.
abstract: OBJECTIVE
  Neurobiological abnormalities underlying atypical depression have previously been suggested. The purpose of this study was to explore differences at functional brain imaging between depressed patients with and without atypical features and healthy controls.
  
  
  METHODS
  Twenty-three out-patients with chronic depressive disorder recruited from a service for patients with audiological symptoms were investigated. Eleven fulfilled the DSM-IV criteria for atypical depression (mood reactivity and at least two of the following: weight gain, hypersomnia, leaden paralysis and interpersonal rejection sensitivity). Twenty-three healthy subjects served as controls. Voxel-based analysis was applied to explore differences in (99m)Tc-HMPAO uptake between groups.
  
  
  RESULTS
  Patients in the atypical group had a higher prevalence of bilateral hearing impairment and higher depression and somatic distress ratings at the time of SPECT. Significantly higher tracer uptake was found bilaterally in the atypical group as compared with the non-atypicals in the sensorimotor (Brodmann areas, BA1-3) and premotor cortex in the superior frontal gyri (BA6), in the middle frontal cortex (BA8), in the parietal associative cortex (BA5, BA7) and in the inferior parietal lobule (BA40). Significantly lower tracer distribution was found in the right hemisphere in the non-atypicals compared with the controls in BA6, BA8, BA44, BA45 and BA46 in the frontal cortex, in the orbito-frontal cortex (BA11, BA47), in the postcentral parietal cortex (BA2) and in the multimodal association parietal cortex (BA40).
  
  
  CONCLUSIONS
  The differences found between atypical and non-atypical depressed patients suggest different neurobiological substrates in these patient groups. The putative links with the clinical features of atypical depression are discussed. These findings encourage the use of functional neuroimaging in psychiatric disorders.
authors.affiliation: Institute of Cognitive Sciences and Technologies, CNR, Rome & Padua, Italy. marco.pagani@istc.cnr.it
authors.forename: Marco
authors.initials: M
authors.lastname: Pagani
authors.forename: Dario
authors.initials: D
authors.lastname: Salmaso
authors.forename: Davide
authors.initials: D
authors.lastname: Nardo
authors.forename: Cathrine
authors.initials: C
authors.lastname: Jonsson
authors.forename: Hans
authors.initials: H
authors.lastname: Jacobsson
authors.forename: Stig A
authors.initials: SA
authors.lastname: Larsson
authors.forename: Ann
authors.initials: A
authors.lastname: Gardner
mesh_terms: D000328:Adult; D001921:Brain / Q000000981:diagnostic imaging* / Q000378:metabolism*; D003863:Depression / Q000000981:diagnostic imaging* / Q000378:metabolism*; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted / Q000379:methods; D008297:Male; D008875:Middle Aged; D019275:Radiopharmaceuticals / Q000493:pharmacokinetics; D019690:Technetium Tc 99m Exametazime / Q000493:pharmacokinetics*; D014018:Tissue Distribution; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods*
chemical_list: D019275:Radiopharmaceuticals; D019690:Technetium Tc 99m Exametazime