Lower choline-containing metabolites/creatine (Cr) rise and failure to sustain NAA/Cr levels in the dorsolateral prefrontal cortex are associated with depressive episode recurrence under maintenance therapy: a proton magnetic resonance spectroscopy retrospective cohort study

Henigsberg, Neven and Šarac, Helena and Radoš, Marko and Radoš, Milan and Ozretić, David and Foro, Tamara and Erdeljić Turk, Viktorija and Hrabač, Pero and Bajs Janović, Maja and Rak, Benedict and Kalember, Petra (2017) Lower choline-containing metabolites/creatine (Cr) rise and failure to sustain NAA/Cr levels in the dorsolateral prefrontal cortex are associated with depressive episode recurrence under maintenance therapy: a proton magnetic resonance spectroscopy retrospective cohort study. Frontiers in Psychiatry, 8. p. 277. ISSN 1664-0640

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Abstract

Background: The aim of this study was to evaluate the relationship between changes in proton magnetic resonance spectroscopy (1H-MRS) parameters at the start of the index episode recovery phase and at recurrence in patients with recurrent depression who were treated with prolonged maintenance therapy. ----- Methods: 1H-MRS parameters were analyzed in 48 patients with recurrent depression who required maintenance therapy with antidepressant medication prescribed by a psychiatrist and who continued with the same antidepressant during the maintenance phase, either to recurrence of depression, completion of the 10-year observation period, or the start of the withdrawal phase (tapering-off antidepressant). N-acetylaspartate (NAA), choline-containing metabolites (Cho), creatine (Cr), and glutamine/glutamate were measured at the start of the recovery phase and 6 months later. ----- Results: Recurrent depressive episodes occurred in 20 patients. These individuals had a smaller increase in Cho/Cr after the beginning of the recovery phase compared to the non-recurrent patient group and also exhibited a decreased NAA/Cr ratio. ----- Conclusion: Sustainable NAA and increased Cho levels at the onset of the recovery phase of the index episode are early markers of antidepressant effectiveness associated with a lower risk of major depressive disorder recurrence. The NAA and Cho changes in the non-recurrent group may be attributable to increased brain resilience, contrary to the transient temporal effect observed in subjects who experienced a depressive episode.

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