Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
BMC Psychiatry
Published in: BMC Psychiatry 1/2004

Open Access 01-12-2004 | Research article

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

Authors: Paul D Carey, James Warwick, Dana JH Niehaus, Geoffrey van der Linden, Barend B van Heerden, Brian H Harvey, Soraya Seedat, Dan J Stein

Published in: BMC Psychiatry | Issue 1/2004

Login to get access

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.

Methods

Single photon emission computed tomography (SPECT) using Tc-99 m HMPAO to assess brain perfusion was performed on subjects with OCD, PTSD, and SAD before and after 8 weeks (SAD) and 12 weeks (OCD and PTSD) treatment with the SSRI citalopram. Statistical parametric mapping (SPM) was used to compare scans (pre- vs post-medication, and responders vs non-responders) in the combined group of subjects.

Results

Citalopram treatment resulted in significant deactivation (p = 0.001) for the entire group in the superior (t = 4.78) and anterior (t = 4.04) cingulate, right thalamus (t = 4.66) and left hippocampus (t = 3.96). Deactivation (p = 0.001) within the left precentral (t = 4.26), right mid-frontal (t = 4.03), right inferior frontal (t = 3.99), left prefrontal (3.81) and right precuneus (t= 3.85) was more marked in treatment responders. No pattern of baseline activation distinguished responders from non-responders to subsequent pharmacotherapy.

Conclusions

Although each of the anxiety disorders may be mediated by different neurocircuits, there is some overlap in the functional neuro-anatomy of their response to SSRI treatment. The current data are consistent with previous work demonstrating the importance of limbic circuits in this spectrum of disorders. These play a crucial role in cognitive-affective processing, are innervated by serotonergic neurons, and changes in their activity during serotonergic pharmacotherapy seem crucial.
Appendix
Available only for authorised users
Literature
1.
Lucey JV, Costa DC, Busatto G, Pilowsky LS, Marks IM, Ell PJ, Kerwin RW: Caudate regional cerebral blood flow in obsessive-compulsive disorder, panic disorder and healthy controls on single photon emission computerised tomography. Psychiatry Res. 1997, 74: 25-33.CrossRefPubMed
2.
Rauch SL, Savage CR, Alpert NM, Fischman AJ, Jenike MA: The functional neuroanatomy of anxiety: a study of three disorders using positron emission tomography and symptom provocation. Biol Psychiatry. 1997, 42: 446-452. 10.1016/S0006-3223(97)00145-5.CrossRefPubMed
3.
Kaplan A, Hollander E: A review of pharmacologic treatments for obsessive-compulsive disorder. Psychiatr Serv. 2003, 54: 1111-1118. 10.1176/appi.ps.54.8.1111.CrossRefPubMed
4.
Stein DJ, Seedat S, van der Linden GJ, Zungu-Dirwayi N: Selective serotonin reuptake inhibitors in the treatment of post-traumatic stress disorder: a meta-analysis of randomized controlled trials. Int Clin Psychopharmacol. 2000, 15 Suppl 2: S31-S39.CrossRefPubMed
5.
van der Linden GJ, Stein DJ, van Balkom AJ: The efficacy of the selective serotonin reuptake inhibitors for social anxiety disorder (social phobia): a meta-analysis of randomized controlled trials. Int Clin Psychopharmacol. 2000, 15 Suppl 2: S15-S23.CrossRefPubMed
6.
Hendler T, Goshen E, Tzila Zwas S., Sasson Y, Gal G, Zohar J: Brain reactivity to specific symptom provocation indicates prospective therapeutic outcome in OCD. Psychiatry Res. 2003, 124: 87-103.CrossRefPubMed
7.
Molina V, Montz R, Martin-Loeches M, Jimenez-Vicioso A, Carreras JL, Rubia FJ: Drug therapy and cerebral perfusion in obsessive-compulsive disorder. J Nucl Med. 1995, 36: 2234-2238.PubMed
8.
Saxena S, Brody AL, Maidment KM, Dunkin JJ, Colgan M, Alborzian S, Phelps ME, Baxter L.R.,Jr.: Localized orbitofrontal and subcortical metabolic changes and predictors of response to paroxetine treatment in obsessive-compulsive disorder. Neuropsychopharmacology. 1999, 21: 683-693. 10.1016/S0893-133X(99)00082-2.CrossRefPubMed
9.
Brody AL, Saxena S, Schwartz JM, Stoessel PW, Maidment K, Phelps ME, Baxter L.R.,Jr.: FDG-PET predictors of response to behavioral therapy and pharmacotherapy in obsessive compulsive disorder. Psychiatry Res. 1998, 84: 1-6.CrossRefPubMed
10.
Baxter L.R.,Jr., Schwartz JM, Bergman KS, Szuba MP, Guze BH, Mazziotta JC, Alazraki A, Selin CE, Ferng HK, Munford P, .: Caudate glucose metabolic rate changes with both drug and behavior therapy for obsessive-compulsive disorder. Arch Gen Psychiatry. 1992, 49: 681-689.CrossRefPubMed
11.
Benkelfat C, Nordahl TE, Semple WE, King AC, Murphy DL, Cohen RM: Local cerebral glucose metabolic rates in obsessive-compulsive disorder. Patients treated with clomipramine. Arch Gen Psychiatry. 1990, 47: 840-848.CrossRefPubMed
12.
Rauch SL, Shin LM, Dougherty DD, Alpert NM, Fischman AJ, Jenike MA: Predictors of fluvoxamine response in contamination-related obsessive compulsive disorder: a PET symptom provocation study. Neuropsychopharmacology. 2002, 27: 782-791. 10.1016/S0893-133X(02)00351-2.CrossRefPubMed
13.
Hoehn-Saric R, Schlaepfer TE, Greenberg BD, McLeod DR, Pearlson GD, Wong SH: Cerebral blood flow in obsessive-compulsive patients with major depression: effect of treatment with sertraline or desipramine on treatment responders and non-responders. Psychiatry Res. 2001, 108: 89-100.CrossRefPubMed
14.
Swedo SE, Schapiro MB, Grady CL, Cheslow DL, Leonard HL, Kumar A, Friedland R, Rapoport SI, Rapoport JL: Cerebral glucose metabolism in childhood-onset obsessive-compulsive disorder. Arch Gen Psychiatry. 1989, 46: 518-523.CrossRefPubMed
15.
Saxena S, Brody AL, Ho ML, Zohrabi N, Maidment KM, Baxter L.R.,Jr.: Differential brain metabolic predictors of response to paroxetine in obsessive-compulsive disorder versus major depression. Am J Psychiatry. 2003, 160: 522-532. 10.1176/appi.ajp.160.3.522.CrossRefPubMed
16.
Saxena S, Brody AL, Ho ML, Alborzian S, Maidment KM, Zohrabi N, Ho MK, Huang SC, Wu HM, Baxter L.R.,Jr.: Differential cerebral metabolic changes with paroxetine treatment of obsessive-compulsive disorder vs major depression. Arch Gen Psychiatry. 2002, 59: 250-261. 10.1001/archpsyc.59.3.250.CrossRefPubMed
17.
Van der Linden G., van Heerden B, Warwick J, Wessels C, van Kradenburg J, Zungu-Dirwayi N, Stein DJ: Functional brain imaging and pharmacotherapy in social phobia: single photon emission computed tomography before and after treatment with the selective serotonin reuptake inhibitor citalopram. Prog Neuropsychopharmacol Biol Psychiatry. 2000, 24: 419-438. 10.1016/S0278-5846(99)00109-8.CrossRef
18.
Furmark T, Tillfors M, Marteinsdottir I, Fischer H, Pissiota A, Langstrom B, Fredrikson M: Common changes in cerebral blood flow in patients with social phobia treated with citalopram or cognitive-behavioral therapy. Arch Gen Psychiatry. 2002, 59: 425-433. 10.1001/archpsyc.59.5.425.CrossRefPubMed
19.
Seedat S, Warwick J, van Heerden B, Hugo C, Zungu-Dirwayi N, van Kradenburg J, Stein DJ: Single photon emission computed tomography in posttraumatic stress disorder before and after treatment with a selective serotonin reuptake inhibitor. J Affect Disord. 2004, 80: 45-53. 10.1016/S0165-0327(03)00047-8.CrossRefPubMed
20.
MB First, RL Spitzer, M Gibbon, Williams JBW: Structured Clinical Interview for DSM-IV Axis I Disorders - Clinician Edition. 1998, Biometrics Research Department, New York State Research Institute, NY
21.
Guy W: ECDU Assessment Manual for Psychopharmacology. 1976, National Institute of Mental Health, Research Branch, 313-331.
22.
23.
Goodman WK, Price LH, Rasmussen SA, Mazure C, Fleischmann RL, Hill CL, Heninger GR, Charney DS: The Yale-Brown Obsessive Compulsive Scale. I. Development, use, and reliability. Arch Gen Psychiatry. 1989, 46: 1006-1011.CrossRefPubMed
24.
Blake DD, Weathers FW, Nagy LM, Kaloupek DG, Gusman FD, Charney DS, Keane TM: The development of a Clinician-Administered PTSD Scale. J Trauma Stress. 1995, 8: 75-90.CrossRefPubMed
25.
Montgomery SA, Asberg M: A new depression scale designed to be sensitive to change. Br J Psychiatry. 1979, 134: 382-389.CrossRefPubMed
26.
Friston KJ, Frith CD, Liddle PF, Frackowiak RS: Comparing functional (PET) images: the assessment of significant change. J Cereb Blood Flow Metab. 1991, 11: 690-699.CrossRefPubMed
27.
Devinsky O, Morrell MJ, Vogt BA: Contributions of anterior cingulate cortex to behaviour. Brain. 1995, 118 (Pt 1): 279-306.CrossRef
28.
McDonald AW, Cohen JD, Stenger VA: Dissociating the role of the dorsolateral prefrontal and anterior cingulate cortex in cognitive control. Science. 2000, 288: 1835-1838. 10.1126/science.288.5472.1835.CrossRef
29.
Bechara A, Tranel D, Damasio H: Double dissociation of conditioning and declarative knowledge relative to the amygdala and hippocampus in humans. Science. 1995, 269: 1115-1118.CrossRefPubMed
30.
Le Doux J: Fear and the brain: Where have we been, and where are we going?. Biol Psychiatry. 1998, 44: 1229-1238. 10.1016/S0006-3223(98)00282-0.CrossRef
31.
Rauch SL, Baxter LR: Neuroimaging in obsessive-compulsive disorder and related disorders. Obsessive-compulsive Disorders: Practical Management. Edited by: JenikeMA, BaerL and MinichielloWE. 1998, St Louis, MI, Mosby, 3rd
32.
Hamner MB, Lorberbaum JP, George MS: Potential role of the anterior cingulate cortex in PTSD: Review and hypothesis. Depress Anxiety. 1999, 9: 1-14. 10.1002/(SICI)1520-6394(1999)9:1<1::AID-DA1>3.3.CO;2-W.CrossRefPubMed
33.
Rauch SL, Whalen PJ, Shin LM, McInerney SC, Macklin ML, Lasko NB, Orr SP, Pitman RK: Exaggerated amygdala response to masked facial stimuli in posttraumatic stress disorder: a functional MRI study. Biol Psychiatry. 2000, 47: 769-776. 10.1016/S0006-3223(00)00828-3.CrossRefPubMed
34.
Bremner JD: Does stress damage the brain?. Biol Psychiatry. 1999, 45: 797-805. 10.1016/S0006-3223(99)00009-8.CrossRefPubMed
35.
Bremner JD, Narayan M, Staib LH, Southwick SM, McGlashan T, Charney DS: Neural correlates of memories of childhood sexual abuse in women with and without posttraumatic stress disorder. Am J Psychiatry. 1999, 156: 1787-1795.PubMedPubMedCentral
36.
Pizzagalli D, Pascual-Marqui RD, Nitschke JB, Oakes TR, Larson CL, Abercrombie HC, Schaefer SM, Koger JV, Benca RM, Davidson RJ: Anterior cingulate activity as a predictor of degree of treatment response in major depression: evidence from brain electrical tomography analysis. Am J Psychiatry. 2001, 158: 405-415. 10.1176/appi.ajp.158.3.405.CrossRefPubMed
37.
Carey PD, Warwick J, Harvey BH, Stein DJ, Seedat S: Single photon emission computed tomography (SPECT) in obsessvie-compulsive disorder before andafter treatment with inositol. Metabolic Brain Disease. 2004, 19: 135-144. 10.1023/B:MEBR.0000027423.34733.12.CrossRef
38.
Saxena S, Brody AL, Schwartz JM, Baxter LR: Neuroimaging and frontal-subcortical circuitry in obsessive-compulsive disorder. Br J Psychiatry Suppl. 1998, 26-37.
Metadata
Title
Single photon emission computed tomography (SPECT) of anxiety disorders before and after treatment with citalopram
Authors
Paul D Carey
James Warwick
Dana JH Niehaus
Geoffrey van der Linden
Barend B van Heerden
Brian H Harvey
Soraya Seedat
Dan J Stein
Publication date
01-12-2004
Publisher
BioMed Central
Published in
BMC Psychiatry / Issue 1/2004
Electronic ISSN: 1471-244X
DOI
https://doi.org/10.1186/1471-244X-4-30

Other articles of this Issue 1/2004

BMC Psychiatry 1/2004 Go to the issue

Research article

Family-based clusters of cognitive test performance in familial schizophrenia

Research article

The Depression Network (DeNT) Study: methodology and sociodemographic characteristics of the first 470 affected sibling pairs from a large multi-site linkage genetic study

Research article

Level of suicidal intent predicts overall mortality and suicide after attempted suicide: a 12-year follow-up study

Case report

Toxoplasma seropositivity and depression: a case report

Research article

Negative and positive childhood experiences across developmental periods in psychiatric patients with different diagnoses – an explorative study

Research article

Subjective and objective evaluation of alertness and sleep quality in depressed patients