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

BMC Psychiatry. 2004 Oct 14;4:30. doi: 10.1186/1471-244X-4-30.

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.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Anxiety Disorders / diagnostic imaging*
  • Anxiety Disorders / drug therapy*
  • Brain / blood supply
  • Brain / diagnostic imaging*
  • Brain / drug effects*
  • Citalopram / pharmacology
  • Citalopram / therapeutic use*
  • Female
  • Humans
  • Limbic System / blood supply
  • Limbic System / diagnostic imaging
  • Limbic System / drug effects
  • Male
  • Obsessive-Compulsive Disorder / diagnostic imaging
  • Obsessive-Compulsive Disorder / drug therapy
  • Prefrontal Cortex / blood supply
  • Prefrontal Cortex / diagnostic imaging
  • Prefrontal Cortex / drug effects
  • Regional Blood Flow / drug effects
  • Seasonal Affective Disorder / diagnostic imaging
  • Seasonal Affective Disorder / drug therapy
  • Serotonin Uptake Inhibitors / pharmacology
  • Serotonin Uptake Inhibitors / therapeutic use*
  • Stress Disorders, Post-Traumatic / diagnostic imaging
  • Stress Disorders, Post-Traumatic / drug therapy
  • Technetium Tc 99m Exametazime
  • Tomography, Emission-Computed, Single-Photon / statistics & numerical data
  • Treatment Outcome

Substances

  • Serotonin Uptake Inhibitors
  • Citalopram
  • Technetium Tc 99m Exametazime