Decreased Brain Ventricular Volume in Psychiatric Inpatients with Serotonin Reuptake Inhibitor Treatment

Abstract

Background Brain ventricles have been reported to be enlarged in several neuropsychiatric disorders and in aging. Whether human cerebral ventricular volume can decrease over time with psychiatric treatment is not well-studied. The aim of this study was to examine whether inpatients taking serotonin reuptake inhibitors (SRI) exhibited reductions in cerebral ventricular volume. Methods Psychiatric inpatients, diagnosed mainly with depression, substance use, anxiety, and personality disorders, underwent two imaging sessions (Time 1 and Time 2, approximately 4 weeks apart). FreeSurfer was used to quantify volumetric features of the brain, and ANOVA was used to analyze ventricular volume differences between Time 1 and Time 2. Inpatients’ brain ventricle volumes were normalized by dividing by estimated total intracranial volume (eTIV). Clinical features such as depression and anxiety levels were collected at Time 1, Time 1.5 (approximately 2 weeks apart), and Time 2. Results Inpatients consistently taking SRIs (SRI + , n = 44) showed statistically significant reductions of brain ventricular volumes particularly for their left and right lateral ventricular volumes. Reductions in their third ventricular volume were close to significance ( p = .068). The inpatients that did not take SRIs (SRI-, n = 25) showed no statistically significant changes in brain ventricular volumes. The SRI + group also exhibited similar brain structural features to the healthy control group based on the 90% confidence interval comparsions on brain ventricular volume parameters, whereas the SRI- group still exhibited relatively enlarged brain ventricular volumes after treatment. Conclusions SRI treatment was associated with decreased brain ventricle volume over treatment.

A viewpoint on aldosterone andBMIrelated brain morphology in relation to treatment outcome in patients with major depression

“…The association between increased ventricles and reduced corpus callosum volume on the one hand and worse treatment outcome on the other hand has recently been confirmed in a larger study 122 . From a therapeutic aspect, it may be considered that a reduction in the release of aldosterone could thus also be associated with a reduction in ventricle size, which recently was reported with the use of selective serotonin reuptake inhibitors, and an improved treatment outcome 123 . Further precedence is provided by rapid acting antidepressant manipulations: Sleep deprivation has a fast, but only temporary antidepressant effect 124,125 .…”

“…122 From a therapeutic aspect, it may be considered that a reduction in the release of aldosterone could thus also be associated with a reduction in ventricle size, which recently was reported with the use of selective serotonin reuptake inhibitors, and an improved treatment outcome. 123 Further precedence is provided by rapid acting antidepressant manipulations: Sleep deprivation has a fast, but only temporary antidepressant effect. 124,125 During the recovery night after sleep deprivation, an increase in nocturnal renin but not aldosterone release occurs.…”

The Anatomic Variability of the Lateral Ventricles of the Human Brain Depending on Age and Sex

“…The monitoring of the cerebrospinal fluid pressure and the ventricular parameters may be a helpful tool in adjusting the treatment choices for different conditions. Specifically, controlling the dose of the serotonin reuptake inhibitors in psychiatric patients was studied, and volume reduction was reported after the treatment course [11]. This signifies the importance of understanding the normal anatomic parameters of the ventricular system in order to timely diagnose any pathologic changes in the size, volume, or symmetry of the system [12].…”

“…The monitoring of the cerebrospinal fluid pressure and the ventricular parameters may be a helpful tool in adjusting the treatment choices for different conditions. Specifically, controlling the dose of the serotonin reuptake inhibitors in psychiatric patients was studied, and volume reduction was reported after the treatment course [ 11 ].…”