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Publication: Single photon emission computed tomography (SPECT) of anxiety disorders before and after treatment with citalopram.
Carey, P.D. Warwick, J. Niehaus, D.J.H. van der Linden, G. van Heerden, B.B. Harvey, B.H. Seedat, S. Stein, D.J.
Carey, P.D.
Warwick, J.
Niehaus, D.J.H.
van der Linden, G.
van Heerden, B.B.
Harvey, B.H.
Seedat, S.
Stein, D.J.
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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.
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Date
2004
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Keywords
Anxiety disorders -- Treatment,Obsessive-compulsive disorder -- Treatment,Social anxiety disorder --Treatment.
Citation
Carey PD, Warwick J, Niehaus DJH, van der Linden G, van Heerden BB, Harvey BH, et al. Single photon emission computed tomography (SPECT) of anxiety disorders before and after treatment with citalopram. BMC Psychiatry