title: Dopamine transporter binding in social anxiety disorder: the effect of treatment with escitalopram.
abstract: Social anxiety disorder (SAD) is characterised by fear of social or performance situations where the individual is exposed to unfamiliar people or to possible scrutiny by others. The literature on dopamine ligands and dopamine genotypes in SAD is however inconsistent. In this study we measured the effects of SSRI pharmacotherapy on dopamine transporter (DAT) binding in patients with SAD, also addressing variability in DAT genotype. Adult subjects meeting DSM-IV criteria for generalised SAD were studied before and after 12 weeks of pharmacotherapy with the selective serotonin reuptake inhibitor (SSRI) escitalopram. DAT single photon emission computed tomography (SPECT) using (123)I-FP-CIT was performed at baseline, and repeated at 12 weeks. Striatal DAT binding was analysed for changes following therapy, and for correlations with clinical efficacy, in the whole group as well as for a subgroup with the A10/A10 DAT genotype. The study included 14 subjects (9 male, 5 female) with a mean (SD) age of 41 (±13) years. The subjects' Liebowitz Social Anxiety Scale (LSAS) score was significantly decreased following pharmacotherapy. In the combined group the left caudate and left putamen showed clusters of increased DAT binding after therapy. The left caudate changes were also observed in the subgroup of 9 A10/A10 homozygotes. However no correlation was found between improved symptoms and DAT binding. The changes found in DAT binding in the caudate and putamen may be due to serotonergic activation of dopamine function by SSRI therapy. This is consistent with previous work indicating decreased DAT binding in SAD, and increased DAT binding after SSRI administration.
authors.affiliation: Nuclear Medicine, Faculty of Health Sciences, Stellenbosch University, Tygerberg, Cape Town, South Africa. jw@sun.ac.za
authors.forename: J M
authors.initials: JM
authors.lastname: Warwick
authors.forename: P D
authors.initials: PD
authors.lastname: Carey
authors.forename: N
authors.initials: N
authors.lastname: Cassimjee
authors.forename: C
authors.initials: C
authors.lastname: Lochner
authors.forename: S
authors.initials: S
authors.lastname: Hemmings
authors.forename: H
authors.initials: H
authors.lastname: Moolman-Smook
authors.forename: E
authors.initials: E
authors.lastname: Beetge
authors.forename: P
authors.initials: P
authors.lastname: Dupont
authors.forename: D J
authors.initials: DJ
authors.lastname: Stein
mesh_terms: D000328:Adult; D018687:Antidepressive Agents, Second-Generation / Q000627:therapeutic use*; D001921:Brain / Q000000981:diagnostic imaging; D015283:Citalopram / Q000627:therapeutic use*; D039721:Diagnostic and Statistical Manual of Mental Disorders; D050483:Dopamine Plasma Membrane Transport Proteins / Q000235:genetics / Q000378:metabolism*; D005260:Female; D005838:Genotype; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D010698:Phobic Disorders / Q000188:drug therapy* / Q000235:genetics / Q000378:metabolism*; D019275:Radiopharmaceuticals; D015899:Tomography, Emission-Computed, Single-Photon; D014326:Tropanes
chemical_list: D018687:Antidepressive Agents, Second-Generation; D050483:Dopamine Plasma Membrane Transport Proteins; D019275:Radiopharmaceuticals; D014326:Tropanes; D015283:Citalopram; C087552:2-carbomethoxy-8-(3-fluoropropyl)-3-(4-iodophenyl)tropane