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.
Key Words
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Article info
Publication history
Published online: September 28, 2010
Accepted:
July 29,
2010
Received in revised form:
July 28,
2010
Received:
January 14,
2010
Identification
Copyright
© 2011 Society of Biological Psychiatry. Published by Elsevier Inc. All rights reserved.
