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Cingulate function in depression: a potential predictor of treatment response

Mayberg, Helen S.1,2,3,4,5; Brannan, Stephen K.2; Mahurin, Roderick K.2; Jerabek, Paul A.1,4; Brickman, Jerold S.1; Tekell, Janet L.2; Silva, J Arturo2; McGinnis, Sacott1; Glass, Thomas G.1,4; Martin, Charles C.1,4; Fox, Peter T.1,2,3,4

Clinical Neuroscience and Neuropathology

THE relationship between pretreatment regional cerebral glucose metabolism and eventual antidepressant drug response was measured using positron emission tomography (PET) in hospitalized patients with unipolar depression. Rostral anterior cingulate metabolism uniquely differentiated eventual treatment responders from non-responders. Hypometabolism characterized non-responders when compared with controls, in contrast to responders who were hypermetabolic. Metabolism in no other region discriminated the two groups, nor did associated demographic, clinical or behavioral measures, including motor speed, cognitive performance, depression severity or illness chronicity. Cingulate hypermetabolism may represent an important adaptive response to depression and failure of this response may underlie poor outcome. A critical role for rostral cingulate area 24a/b in the limbic-cortical network involved in abnormal mood states is proposed.

1Research Imaging Center, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78284-6240, USA

2Department of Psychiatry, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78284-6240, USA

3Department of Neurology, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78284-6240, USA

4Department of Radiology, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78284-6240, USA.

5Corresponding Author: Helen S. Mayberg

ACKNOWLEDGMENTS: The authors thank Betty Heyl and Ralph Evans for their expert technical assistance. This research is supported by The National Alliance for Research in Schizophrenia and Depression (NARSAD), Eli Lilly and Company, and NIMH grant MH49553.

Received 7 October 1996; accepted 17 December 1996

© Lippincott-Raven Publishers.