title: Cross-sectional and longitudinal assessment of structural brain alterations in melancholic depression.
abstract: BACKGROUND
  Whole-brain imaging approaches may contribute to the characterization of neuroanatomic alterations in major depression, especially in clinically homogenous patient groups such as those with melancholic features. We assessed brain anatomic alterations, both cross-sectionally and longitudinally, in patients with melancholic depression using a whole-brain voxel-wise approach.
  
  
  METHODS
  Whole-brain magnetic resonance images were collected from a relatively aged sample of 70 consecutively recruited major depressive disorder inpatients with melancholic features and from a group of 40 healthy control subjects. All patients were clinically followed for at least 2 years, and a subset of 30 depressive patients and 20 control subjects were rescanned after a 7-year period. Imaging data were analyzed with voxel- and tensor-based morphometry techniques.
  
  
  RESULTS
  Melancholic patients showed gray matter reductions in the left insula and white matter increases in the upper brainstem tegmentum. Male patients showed gray matter decreases in the right thalamus, and periventricular white matter reductions were specifically observed in older patients. Volume decreases in the left insula, hippocampus, and lateral parietal cortex predicted a slower recovery after treatment initiation. In longitudinal assessment, white matter of the upper brainstem tegmentum showed a different temporal evolution between groups. Additionally, bilateral gray matter reductions in the insulae were associated with the number of relapses during follow-up.
  
  
  CONCLUSIONS
  Structural alterations were identified in regions potentially related to relevant aspects of melancholia pathophysiology. Longitudinal analyses indicated region-specific interactions of baseline alterations with age as well as a significant association of clinical severity with focal changes occurring over time.
authors.affiliation: Institut d'Alta Tecnologia-Parc de Recerca Biomèdica de Barcelona, Centre Radiològic Computeritzat Hospital del Mar, Barcelona, Spain. csoriano@crccorp.es
authors.forename: Carles
authors.initials: C
authors.lastname: Soriano-Mas
authors.forename: Rosa
authors.initials: R
authors.lastname: Hernández-Ribas
authors.forename: Jesús
authors.initials: J
authors.lastname: Pujol
authors.forename: Mikel
authors.initials: M
authors.lastname: Urretavizcaya
authors.forename: Joan
authors.initials: J
authors.lastname: Deus
authors.forename: Ben J
authors.initials: BJ
authors.lastname: Harrison
authors.forename: Hector
authors.initials: H
authors.lastname: Ortiz
authors.forename: Marina
authors.initials: M
authors.lastname: López-Solà
authors.forename: Josep M
authors.initials: JM
authors.lastname: Menchón
authors.forename: Narcís
authors.initials: N
authors.lastname: Cardoner
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001921:Brain / Q000473:pathology*; D001931:Brain Mapping; D003866:Depressive Disorder / Q000473:pathology*; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008137:Longitudinal Studies; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009413:Nerve Fibers, Myelinated / Q000473:pathology*; D036421:Nerve Fibers, Unmyelinated / Q000473:pathology*; D012737:Sex Factors