title: Hippocampal 1H MRS in patients with bipolar disorder taking valproate versus valproate plus quetiapine.
abstract: BACKGROUND
  No study to date has examined the effects of mood stabilizer alone and the combination of mood stabilizer and atypical antipsychotic, quetiapine, on hippocampal neurochemical markers of bipolar disordered patients concurrently. We therefore undertook a proton magnetic resonance spectroscopy (1H MRS) study of drug-free patients with bipolar disorder (drug-free group), patients undergoing valproate treatment (valproate group), patients administered valproate+quetiapine (valprote+quetiapine group) and healthy controls, focusing on the in vivo neuroanatomy of the hippocampus.
  
  
  METHODS
  Thirty patients from the Firat University School of Medicine Department of Psychiatry and 10 healthy controls gave written informed consent to participate in the study. The patients and controls underwent proton magnetic resonance spectroscopic imaging (1H MRSI), and measures of N-acetylaspartate (NAA), choline-containing compounds (CHO), and creatine+phosphocreatine (CRE) in hippocampal regions were obtained.
  
  
  RESULTS
  The drug-free patients had significantly lower NAA/CRE and NAA/CHO ratios compared with the valproate and valproate+quetiapine groups and the healthy controls. The lower NAA/CRE and NAA/CHO ratios remained statistically significant even after covarying for age or whole brain volume compared with the valproate and valproate+quetiapine groups and healthy controls. In post hoc comparisons, a significant difference was found between the valproate+quetiapine group and the valproate group only with regard to NAA/CHO.
  
  
  CONCLUSIONS
  Our findings suggest that valproate has a neuroprotective effect. In post hoc comparisons, a significant difference was found between the valproate+quetiapine and the valproate group with regard to NAA/CHO, indicating that the addition of quetiapine further increases the level of NAA and provides an additional neuroprotective effect.
authors.affiliation: Department of Psychiatry, School of Medicine, Firat University, Elazig, Turkey. matmaca_p@yahoo.com
authors.forename: Murad
authors.initials: M
authors.lastname: Atmaca
authors.forename: Hanefi
authors.initials: H
authors.lastname: Yildirim
authors.forename: Huseyin
authors.initials: H
authors.lastname: Ozdemir
authors.forename: Erkin
authors.initials: E
authors.lastname: Ogur
authors.forename: Ertan
authors.initials: E
authors.lastname: Tezcan
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D018692:Antimanic Agents / Q000627:therapeutic use*; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D001714:Bipolar Disorder / Q000188:drug therapy*; D003987:Dibenzothiazepines / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005260:Female; D006624:Hippocampus / Q000378:metabolism* / Q000473:pathology; D006801:Humans; D009682:Magnetic Resonance Spectroscopy; D008297:Male; D000069348:Quetiapine Fumarate; D014635:Valproic Acid / Q000627:therapeutic use*
chemical_list: D018692:Antimanic Agents; D014150:Antipsychotic Agents; D003987:Dibenzothiazepines; D000069348:Quetiapine Fumarate; D014635:Valproic Acid