Hostname: page-component-78c5997874-fbnjt Total loading time: 0 Render date: 2024-11-13T01:04:08.828Z Has data issue: false hasContentIssue false
  • English
  • Français

Cortical grey matter reductions associated with treatment-resistant chronic unipolar depression

Controlled magnetic resonance imaging study

Published online by Cambridge University Press:  03 January 2018

Premal J. Shah ,
Klaus P. Ebmeier ,
Michael F. Glabus  and
Guy M. Goodwin
Premal J. Shah
Affiliation:
MRC Brain Metabolism Unit and Department of Psychiatry, Royal Edinburgh Hospital
Klaus P. Ebmeier*
Affiliation:
MRC Bram Metabolism Unit and Department of Psychiatry, Royal Edinburgh Hospital
Michael F. Glabus
Affiliation:
MRC Brain Metabolism Unit and Department of Medical Physics, Royal Infirmary of Edinburgh
Guy M. Goodwin
Affiliation:
Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford
*
Professor Klaus P. Ebmeier, Royal Edinburgh Hospital, Morningside Park, Edinburgh, EHI 5HF
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

The aetiology of treatment-resistant major depression is little understood; its apparent intractability may reflect brain abnormality.

Method

Magnetic resonance images of the brains of 20 subjects with major depression lasting for two years or more were compared with 20 healthy control subjects and 20 other subjects who had completely recovered from depression. Subjects were individually matched for age, gender, years of education and premorbid IQ. Grey matter was segmented from the images, and compared between groups on a voxel-by-voxel basis.

Results

Subjects with chronic depression showed reduced grey matter density in the left temporal cortex including the hippocampus. There was also a trend for reduction in the right hippocampus. Left hippocampal grey matter density was correlated with measures of verbal memory, supporting the functional significance of the observed magnetic resonance imaging changes.

Conclusions

Our results potentially challenge the accepted view of depression as a functional and fully reversible illness, implying instead that more permanent brain changes may be associated with chronicity. Confirmatory longitudinal and prospective studies are required to determine whether these differences pre-date the onset of depression or are the result of the chronic illness process or its treatment.

Type
Papers
Information
The British Journal of Psychiatry , Volume 172 , Issue 6 , June 1998 , pp. 527 - 532
Copyright
Copyright © 1998 The Royal College of Psychiatrists 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Altshuler, L. L. (1993) Bipolar disorder: Are repeated episodes associated with neuroanatornic and cognitive changes? Bipolar Psychiatry, 33, 563–565.Google Scholar
American Psychiatric Association (1994) Diagnostic and Statistical Manual of Mental Disorders (4th edn) (DSM–IV), Washington, DC: APA Google Scholar
Amsterdam, J. D. Winokur, A. Bryant, S. et al (1983) The dexamethasone suppression test as a predictor of antidepressant response. Psychopharmacology, 80, 43–45.CrossRefGoogle ScholarPubMed
Annett, M. (1970) A classification of hand preference by association analysis. British Journal of Psychology, 61, 303–321.CrossRefGoogle ScholarPubMed
Axelson, D. A. Doraiswamy, P. M. McDonald, W. M. et al (1993) Hypercortisolemia and hippocampal changes in depression. Psychiatry Research, 47, 163–173.CrossRefGoogle ScholarPubMed
Bremner, J. D. Randall, P. Scott, T. M. et al (1995) MRl-based measurement of hippocampal volume in patients with combat-related post traumatic stress disorder. American Journal of Psychiatry, 152, 973–981.Google Scholar
DeLisi, L. E. Hoff, A. L. Schwartz, J. E. et al (1991) Brain morphology in first-episode schizophrenic-like psychotic patients: A quantitative magnetic resonance imaging study. Biological Psychiatry, 29, 159–175.CrossRefGoogle ScholarPubMed
Ebmeier, K. P. Glabus, M. F. Prentice, N. et al (1998) A voxel-based analysis of cerebral perfusion in dementia and depression of old age. Neuroimage (in press).Google Scholar
Endicott, J. & Spitzer, R. L. (1978) A diagnostic interview – the schedule for affective disorders and schizophrenia. Archives of General Psychiatry, 35, 837–344.CrossRefGoogle ScholarPubMed
Friston, K. J. Ashburner, J. Frith, C. D. et al (1995b) Spatial registration and normalization of images. Human Brain Mapping, 2, 165–189.Google Scholar
Friston, K. J. Holmes, A. P. Worsley, K. J. et al (1995b) Statistical parametric maps in functional imaging: A general linear approach. Human Brain Mapping, 2, 189–210.Google Scholar
Goldberg, T. E. Torrey, E. F. Barman, K. F. et al (1994) Relations between neuropsychological performance, brain morphology and physiological measures in twins discordant for schizophrenia. Psychiatry Research: Neuroimaging, 55, 51–61.CrossRefGoogle ScholarPubMed
Girth, C. Jones, P. & Murray, R. (1993) Familial psychiatric illness and obstetric complications in early-onset effective disorder. A case-control study. British Journal of Psychiatry, 163, 492–498.Google Scholar
Hamilton, M. (1960) A rating scale for depression. Journal of Neurology, Neurosurgery and Psychiatry, 23, 56–62.CrossRefGoogle ScholarPubMed
Hartigan, J. A. (1975) Clustering Algorithms New York: John Wiley and Sons.Google Scholar
Harvey, P. D. Powchik, P. Parrella, M. et al (1997) Symptom severity and cognitive impairment in chronically hospitalised geriatric patients with affective disorders, British Journal of Psychiatry, 170, 369–374.Google ScholarPubMed
Kaller, M. B. Shapiro, R. W. Lavori, P. W. et al (1982) Recovery in major depressive disorder: analysis with the life table and regression models. Archives of General Psychiatry, 39, 905–910.CrossRefGoogle Scholar
Lezak, M. D. (1983) Neuropsychological Assessment (2nd edn) New York Oxford University Press Google Scholar
Mayes, A. R. & Downes, J. J. (1997) What do theories of the functional deficit(s) underlying amnesia have to explain? Memory, 5, 3–36.Google Scholar
McKay, A. P. Tarbuck, A. F. Spapleske, J. et al (1995) Neuropsychological functions in manic-depressive psychosis: Evidence of chronic persistent deficits in patients with chronic, severe illness. British Journal of Psychiatry, 167, 51–57.CrossRefGoogle ScholarPubMed
Morinobu, S. Sagawa, R. & Kawakatsu, S. (1991) Regional cerebral blood flow in refractory depression. In Advances in Neuropsychiatry and psychopharmacology. Vol. 2: Refractory Depression (ed Amsterdam, J. D.), pp. 65–70. New Haven: Raven Press.Google Scholar
Nelson, H. & Willison, J. (1991) National Adult Reading Test (2nd edn), Windsor: NFER-Nelson Google Scholar
Roy-Byrne, P. P. Post, R. M. Kellner, C. H. et al (1988) Ventricular-brain ratio and life course of liness in patients with affective disorder. Psychiatry Research, 23, 277–284.Google Scholar
Sapolsky, R. M. Krey, L. C. & McEwen, B. (1986) The neuroendocrinology of stress and ageing: The glucocorticoid cascade hypothesis. Endocrine Reviews, 7, 284–301.CrossRefGoogle ScholarPubMed
Scott, A. I. F. Devanand, D. P. & Sackeim, H. A. (1995) Does ECT alter brain structure? (letter). American Journal of Psychiatry, 152, 1403.Google Scholar
Sheline, Y. I. Wang, P. W. Gado, M. H. et al (1996) Hippocampal atrophy in recurrent major depression. Proceedings of the Natural Academy of Sciences, USA, 93, 3908–3913.Google Scholar
Spitzer, R. L. Endicott, J. & Robins, E. (1978) Research Diagnostic Criteria (RDC) for a Selected Group of Functional Disorders (3rd edn). New York: New York State Psychiatric Institute.Google Scholar
Stein, M. B. Koverola, C. Hanna, C. et al (1997) Hippocampal volume in women victimized by childhood sexual abuse. Psycholgical Medicine, 27, 951–959.Google Scholar
Swayze, V. W. II., Andersen, A. Arndt, S. et al (1996) Reversibility of brain tissue loss in anorexia nervosa assessed with a computerized Talairach 3-D proportional grid. Psychological Medicine, 26, 381–390.Google Scholar
J, Talairach & Tournoux, P. (1988) A Coplanar Stereotaxic Atlas of a Human Brain. Stuttgart: Thieme.Google Scholar
Wright, I. C. McGuire, P. K. Poline, J.-B. et al (1995) A voxel-based method for the statistical analysis of grey and white matter density applied to schizophrenia. Neuroimage, 2, 244–252.Google Scholar
Submit a response

eLetters

No eLetters have been published for this article.