Donald F. Smith

Major depressive disorder continues to challenge medical and psychological resources worldwide. A marked surge has occurred recently in China in neuroimaging studies of major depressive disorder. Those studies represent an emerging trend in neuropsychiatry in that such research has previously been extremely rare in China. The present article provides a systematic review of reports published in English by research institutes in China on resting-state functional connectivity studied by MRI in depressed subjects and healthy control subjects. Particular attention is given to whether the information may advance effective diagnosis and treatment options for patients with major depressive disorder.

Objective: Deep brain stimulation is currently an experimental treatment for major depressive disorder. Information is lacking, however, on how sham responding may affect efficacy. This article applies exploratory meta-analysis to address that topic.Methods: Data on benefits of deep brain electrical stimulation come from a recent review. Stimulated brain regions included subgenual cingulate, capsular interna, nucleus accumbens, and medial forebrain bundle. Expert opinion plus random number software was used to generate hypothetical values for sham responding.Results: An effect size of 1.71 (95% CI: 1.47–1.96) was obtained for deep brain stimulation versus sham treatment in patients suffering from long-term treatment-resistant depression.Conclusion: Preliminary findings on deep brain electrical stimulation suggest that the procedure may be 71% more effective than sham treatment. Expressing these findings as patients-needed-to-treat, deep brain electrical stimulation is required by 2.9 patients with long-term treatment-resistant depression in order for one of them to benefit.

Molecular mechanisms in the brain are assumed to cause the symptoms and severity of neuropsychiatric disorders. This review concerns the elusive nature of relationships between the severity of depressive disorders and neuromolecular processes studied by positron emission tomography (PET). Recent PET studies of human depression have focused on serotonergic, dopaminergic, muscarinic, nicotinic, and GABAergic receptors, as well as central processes dependent on monoamine oxidase, phosphodiesterase type 4, amyloid plaques, neurofibrillar tangles, and P-glycoprotein. We find that reliable causal links between neuromolecular mechanisms and relief from depressive disorders have yet to be convincingly demonstrated. This situation may contribute to the currently limited use of PET for exploring the neuropathways that are currently viewed as being responsible for beneficial effects of antidepressant treatment regimes.

The search for potential biomarkers of psychiatric disorders is a central topic in biological psychiatry. This review concerns published studies on potential biomarkers of treatment-resistant depression (TRD). The search for biomarkers of TRD in the bloodstream has focused on cytokines and steroids as well as brain-derived neurotropic factor. Additional approaches to identifying biomarkers of TRD have dealt with cerebrospinal fluid analysis, magnetic resonance imaging, and positron emission tomography. Some studies have also investigated potential genetic and epigenetic factors in TRD. Most studies have, however, used a post hoc experimental design that failed to determine the association between biomarkers and the initial risk of TRD. Particular attention in future studies should be on shifting the experimental paradigm toward procedures that can determine the risk for developing treatment resistance in untreated depressed individuals.

Smith DF, Gerdes LU. Meta‐analysis on anxiety and depression in adult celiac disease.Objective:  We used meta‐analysis to test hypotheses concerning whether adult celiac disease is reliably linked with anxiety and/or depression.Method:  We examined published reports on anxiety and depression in adult celiac disease.Results:  Eighteen studies on depression and eleven studies on anxiety in adult celiac disease met selection criteria. They show that depression is reliably more common and/or more severe in adults with celiac disease than in healthy adults (overall meta‐analysis effect size: 0.97). The fail‐safe margin of unpublished reports that would be required to negate the finding exceeds 8000. Adults with celiac disease do not, however, differ reliably in terms of depression from adults with other physical illnesses, nor do they differ reliably from healthy adults or adults with other physical illnesses in terms of anxiety.Conclusion:  Depression is common in adult celiac disease and resembles the condition in other physical illnesses. We view the findings as support for the notion that non‐specific mechanisms mediate emotional disorders in adult celiac disease.

We compared six kinetic models with and without the requirement of arterial cannulation for estimating the binding potential of [N-methyl-11C]mirtazapine in the living human brain. Distribution volumes of [N-methyl-11C]mirtazapine in brain regions were estimated using single- and two-tissue compartment models as well as a graphical plasma input model. The two-tissue compartment model provided a direct estimate of the binding potentials of [N-methyl-11C]mirtazapine in brain regions, while binding potentials of the single-tissue compartment model and the graphical plasma input model were estimated indirectly from ratios of distribution volumes in brain regions. We obtained also direct estimates of binding potentials using a graphical reference tissue model and two nonlinear reference tissue models. The two-tissue compartment model required several fits with different initial guesses for avoiding negative values of parameters. Despite the extra fits, estimates of distribution volumes and binding potentials of [N-methyl-11C]mirtazapine obtained by the two-tissue compartment model were far more variable than those produced by the other methods. The graphical plasma input method and the graphical reference tissue method provided estimates of the binding potential that correlated closely, but differed in magnitude. The single-tissue compartment model provided relatively low estimates of binding potentials with curves that failed to fit the data as well as the three other methods that used the entire series of positron emission tomography data. The reference tissue method and the simplified reference tissue method provided similar, consistent estimates of binding potentials. However, certain assumptions of the simplified reference tissue method may not be fulfilled by the radioligand. The reference tissue method is appropriate for estimating the binding potential of [N-methyl-11C]mirtazapine in regions of the human brain so that the binding potential of [N-methyl-11C]mirtazapine can be estimated without arterial cannulation.

Rationale Lack of benefit from antidepressant drug therapy is a major source of human suffering, affecting at least 25% of people with major depressive disorder. We want to know whether nonresponse to antidepressants can be linked to aberrant neuroreceptor binding. Objective This study aims to assess the antidepressant binding in brain regions of depressed nonresponders compared with healthy controls. Materials and methods Healthy volunteers and depressed subjects who had failed to benefit from at least 2 antidepressant treatments were recruited by newspaper advertisements. All subjects had received no antidepressant medication for at least 2 months before positron emission tomography (PET) that was carried out with [¹¹C]mirtazapine. Kinetic parameters of [¹¹C]mirtazapine were determined from PET data in selected brain regions by the simplified reference tissue model. Results Binding potentials of [¹¹C]mirtazapine in cerebral cortical regions were lower in depressed nonresponders than in healthy controls. Removal rates of [¹¹C]mirtazapine were higher in diencephalic regions of depressed nonresponders than in healthy controls. Conclusions PET neuroimaging with [¹¹C]mirtazapine showed aberrant neuroreceptor binding in brain regions of depressed subjects who had failed to benefit from treatment with antidepressant drugs.

There have been few radiotracers for imaging adrenergic receptors in brain by PET, but none has advanced for use in human studies. We developed a radiosynthesis for the alpha(2)-adrenergic antagonist (11)C-yohimbine and characterized its binding in living pigs. As a prelude to human studies with (11)C-yohimbine, we determined the whole-body distribution of (11)C-yohimbine and calculated its dosimetry. Yorkshire x Landrace pigs weighing 35-40 kg were used in the study. Baseline and postchallenge PET recordings of (11)C-yohimbine in pig brain were conducted for 90 min, concurrent with arterial blood sampling, and with yohimbine and RX821002 as pharmacologic interventions. (15)O-Water scans were performed to detect changes in cerebral perfusion. The PET images were manually coregistered to an MR atlas of the pig brain. Maps of the (11)C-yohimbine distribution volume ([V(d)] mL g(-1)) in brain were calculated relative to the arterial input function. Whole-body scans with (11)C-yohimbine revealed high accumulation of radioactivity in kidney, intestine, liver, and bone. The estimated human dose was 5.6 mSv/GBq, a level commonly accepted in human PET studies. Brain imaging showed baseline values of V(d) ranging from 1.9 in medulla, 3.0 in cerebellum, and to 4.0 in frontal cortex. Coinjection with nonradioactive yohimbine (0.07 mg/kg) reduced V(d) globally to approximately 1.5-2 mL g(-1). A higher yohimbine dose (1.6 mg/kg) was without further effect on self-displacement. Very similar results were obtained by displacement with the more selective alpha(2)-adrenergic antagonist RX821002 at doses of 0.15 and 0.7 mg/kg. Cerebral blood flow was globally increased 43% after administration of RX821002. Notable features of (11)C-yohimbine are a lack of plasma metabolism over 90 min and a rapid approach to equilibrium binding in brain. The new radiotracer (11)C-yohimbine seems well suited for PET investigations of alpha(2)-adrenergic receptors in brain and peripheral structures, with the caveat that displaceable binding was present in cerebellum and throughout the brain.