Prefrontal cortex neurochemical metabolite levels in major depression and the effects of treatment: an HMRS study]

Neuronal degeneration in the prefrontal cortex during depression results in altered production of neurochemical metabolites. The aim of the present study is to examine changes in neurochemical metabolites in the prefrontal cortex and evaluate the effects of psychodrama group therapy and pharmacotherapy on neurochemical metabolism in the first episode depression using 1HMRS methodology.Eighteen drug-free female patients with diagnosed first-episode major depression according to DSM-IV criteria and 10 healthy female subjects were enrolled in the study. The Hamilton Rating of Depression Scale (HAM-D) was used to asses the severity of depression in each of the study participants. Proton magnetic resonance spectroscopy (1HMRS) was applied to the right prefrontal cortex both before and after treatment and the concentration of N-Asetil Aspartate (NAA), choline (Cho), and creatine (Cr) were measured. All patients were prescribed ant-depressant medication at the time of the evaluation (essitalopram 10-20 mg/g). In addition, a psychodrama group therapy session was conducted in which 10 patients participated in one 3-hour session each week. HAM-D and 1HMRS were repeated after 16 weeks.Prior to treatment, the HAM-D score in the patient group was 14.55±4.55 while the HAM-D score was 3.88±2.47 after 16 weeks of treatment. The severity of symptoms among the patient group was determined to be mild/moderate. No neurochemical abnormalities were identified in the right prefrontal cortex of depressed patients compared to the healthy subjects in the baseline measurements and no significant change was observed in neurochemical metabolites following treatment with pharmacotherapy or pharmacotherapy with group psychotherapy.Our results identified no neurodegeneration, cell membrane dysfunction, alterations in energy metabolism, or altered neurochemical metabolite levels in patients undergoing a first episode of mild/moderate depression. Further studies will be needed to evaluate the effects of alternate treatments and the presence or absence of neuronal damage during follow-up of patients with depression.