Single photon emission computed tomography (SPECT) of anxiety disorders before and after treatment with citalopram

Abstract

Background: Several studies have now examined the effects of selective serotonin reuptake inhibitor (SSRI) treatment on brain function in a variety of anxiety disorders including obsessive-compulsive disorder (OCD), posttraumatic stress disorder (PTSD), and social anxiety disorder (social phobia) (SAD). Regional changes in cerebral perfusion following SSRI treatment have been shown for all three disorders. The orbitofrontal cortex (OFC) (OCD), caudate (OCD), medial pre-frontal/cingulate (OCD, SAD, PTSD), temporal (OCD, SAD, PTSD) and, thalamic regions (OCD, SAD) are some of those implicated. Some data also suggests that higher perfusion pre-treatment in the anterior cingulate (PTSD), OFC, caudate (OCD) and antero-lateral temporal region (SAD) predicts subsequent treatment response. This paper further examines the notion of overlap in the neurocircuitry of treatment and indeed treatment response across anxiety disorders with SSRI treatment.

The impacts of cognitive-behavioral therapy on the treatment of phobic disorders measured by functional neuroimaging techniques: a systematic review

“…As these regions have been associated with the pathophysiology of either SP or SAD, deactivations of such areas after CBT would be a possible marker of improvement. 14,19,20 Such findings, which are similar to those observed in functional neuroimaging studies of phobic patients treated with antidepressants, 22,23 could support the efficacy of CBT in the treatment of phobias. 6,[12][13][14][15][16][17][18][19][20][21] Moreover, recent studies have observed that functional brain imaging may detect biomarkers that substantially improve predictions for the success of cognitive-behavioral interventions, suggesting that such biomarkers could offer personalized approaches for optimally selecting among treatment options for a patient.…”

Depressive behavior and selective downregulation of serotonin receptor expression after early-life seizures: Reversal by environmental enrichment

“…While the comorbidity of epilepsy and depression has been documented empirically over the past several decades, a comprehensive understanding of a causal relationship has only recently emerged due, at least in part, to advances in neuroimaging tools [14,28]. PET measurement of 5-HT 1A receptor binding in patients with mesial temporal lobe epilepsy has shown a significant reduction in the epileptogenic hippocampus and its limbic connections [12,29].…”

“…Mutual features of both epilepsy and depression include the link to serotonergic pathways and the involvement of hippocampal and limbic circuitry. In patients with temporal lobe epilepsy, serotonergic receptor binding in the limbic area is decreased [12], while in patients with affective disorder, the efficacy of selective serotonergic reuptake inhibitors (SSRIs) is associated with the activation of regional metabolic rate in the limbic area [13,14]. Increased risk of depression is highly correlated with the cerebral structural and metabolic abnormalities in epilepsy [15,16], while significant reduction in hippocampal volume is observed in major depression [11,17].…”

Serotonin Transporter Imaging with [¹²³I]β-CIT SPECT before and after One Year of Citalopram Treatment of Obsessive-Compulsive Disorder

“…Plasma levels of citalopram were related to the clinical response in responders, but did not account for the lack of clinical effi cacy in nonresponders [5] . Hyperactivity in the caudate nucleus and orbitofrontal cortex was normalized both after treatment with SSRIs [6][7][8][9] and CBT [10] ; clinical improvement correlated with abnormalities in neuronal activity and perfusion within orbitofrontal circuits before treatment [11,12] and improvement of comorbid depressive symptoms was associated with abnormalities and changes in other brain areas [8] . The link between abnormalities in orbitofrontal circuits and response to serotonergic treatment in OCD is unclear at the moment.…”