Background
Monoamine dysfunction, particularly of the serotonin system, has been the dominant
hypothesis guiding research and treatment development in affective disorders. The
majority of research has been performed in midlife depressed adults. The importance
of understanding the neurobiology of depression in older adults is underscored by
increased rates of mortality and completed suicide and an increased risk of Alzheimer's
dementia. To evaluate the dynamic response of the serotonin system, the acute effects
of citalopram infusion on cerebral glucose metabolism was measured in depressed older
adults and control subjects. The hypothesis was tested that smaller decreases in metabolism
would be observed in cortical and limbic regions in depressed older adults relative
to control subjects.
Methods
Sixteen depressed older adults and 13 control subjects underwent two resting positron
emission tomography (PET) studies with the radiotracer [18F]-2-deoxy-2-fluoro-D-glucose
after placebo and citalopram infusions.
Results
In control subjects compared with depressed older adults, greater citalopram-induced
decreases in cerebral metabolism were observed in the right anterior cingulate, middle
temporal (bilaterally), left precuneus, and left parahippocampal gyri. Greater decreases
in the depressed older adults than control subjects were observed in left superior
and left middle frontal gyri and increases in left inferior parietal lobule, left
cuneus, left thalamus, and right putamen.
Conclusions
In depressed older adults relative to control subjects, the cerebral metabolic response
to citalopram is blunted in cortico-cortical and cortico-limbic pathways and increased
in the left hemisphere (greater decrease interiorly and increases posteriorly). These
findings suggest both blunted and compensatory cerebral metabolic responses to citalopram
in depressed older adults.
Key Words
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Article info
Publication history
Published online: April 16, 2009
Accepted:
February 22,
2009
Received in revised form:
February 19,
2009
Received:
August 29,
2008
Identification
Copyright
© 2009 Society of Biological Psychiatry. Published by Elsevier Inc. All rights reserved.
