Cerebral glucose metabolic response to combined total sleep deprivation and antidepressant treatment in geriatric depression: a randomized, placebo-controlled study.
A randomized, placebo-controlled study was performed to evaluate whether the onset of the glucose metabolic effects of a selective serotonin reuptake inhibitor (paroxetine) would be accelerated by total sleep deprivation (TSD). Patients were randomly assigned to one of three groups: TSD and paroxetine treatment, TSD and 2 weeks of placebo followed by paroxetine treatment, or 2 weeks of paroxetine treatment. Sixteen elderly depressed patients who met DSM-IV criteria for major depressive disorder and nine age-matched comparison subjects underwent positron emission tomography (PET) studies of cerebral glucose metabolism at baseline, post-TSD (or a normal night's sleep for the paroxetine- only group), post-recovery sleep and 2 weeks post-paroxetine or placebo treatment (patients only). TSD was not consistently associated with a decrease in depressive symptoms between groups nor with decreases in cerebral metabolism in cortical regions that have been associated with rapid and sustained clinical improvement (e.g. anterior cingulate gyrus). The observation of a synergistic antidepressant effect of combined TSD and paroxetine treatment that was observed in a previous "open label" pilot study was not observed in the present randomized study, consistent with lack of a cerebral metabolic effect in brains regions previously shown to be associated with improvement of depressive symptoms.
Smith
Gwenn S
GS
Department of Psychiatry Research, The Zucker Hillside Hospital, North-Shore-Long Island Jewish Health System, Glen Oaks, NY, USA. gwenn_smith@camh.net
Reynolds
Charles F
CF
Houck
Patricia R
PR
Dew
Mary Amanda
MA
Ginsberg
Joshua
J
Ma
Yilong
Y
Mulsant
Benoit H
BH
Pollock
Bruce G
BG
D000368:Aged; D001921:Brain / Q000033:anatomy & histology* / Q000378:metabolism*; D003072:Cognition Disorders / Q000175:diagnosis / Q000453:epidemiology; D003865:Major Depressive Disorder / Q000188:drug therapy* / Q000453:epidemiology* / Q000523:psychology; D005947:Glucose / Q000378:metabolism*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D009483:Neuropsychological Tests; D017374:Paroxetine / Q000627:therapeutic use*; D049268:Positron-Emission Tomography; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use*; D012892:Sleep Deprivation / Q000453:epidemiology*
D005947:Glucose; D017374:Paroxetine; D017367:Selective Serotonin Reuptake Inhibitors