Five patients (three women, two men; 26.6 [SD: 4.56] years old) were enrolled. Their baseline rating data were as follows: Hamilton Rating Scale for Depression (Ham-D): 28.8 (4.6) and Panic Disorder Severity Scale (PDSS): 19.8 (4.32). No specific physical illness, psychotic features, past manic episodes, nonpsychiatric medication use, or substance abuse were mentioned. The treatment of duloxetine 30 mg/day was initiated, with titration to 60 mg within 2 weeks without any significant side effects except mild nausea and sedation. After a 6-week therapy, their MDD and PD symptoms responded to duloxetine (Ham-D: 8.2 [3.83]; PDSS: 3.4 [1.67]).
RFMRI scans were obtained with a 3T GE Version scanner housed at Buddhist Tzu Chi Hospital, Taipei Branch. Echo planar imaging (EPI) sequences were acquired in 20 axial slices (TR: 2,000 msec., TE: 40 msec., flip angle: 90°, FOV: 24 cm.; 5-mm. thickness, and 1-mm gap; 400 sec. for each subject) at baseline and 6th-week visit. The preprocessed RFMRI data were processed by REST (Resting State FMRI Data Analysis Toolkit, Version 1.4) to produce ReHo map image files by using default mask with cluster greater than 27 voxels. Each ReHo map was divided by its own mean ReHo within the mask for standardization purposes. The modulated ReHo map image files were then smoothed by FWHM 4 × 4 × 4 Gaussian kernel to reduce noise and residual differences in the gyral anatomy. The subsequent group-comparison analysis between baseline and 6th week was performed (second-level random effects model, paired t-test). There were modest increases of ReHo in the ACC region of these remitted patients after duloxetine treatment (uncorrected p<0.00005; cluster voxel threshold >10; volume >270 mm3; rmm: 6, with corner-connected hypothesis; Figure 1).
FIGURE 1.ACC (MNI coordinates [−6, 35, −4]) Increased Regional Homogeneity After 6 Weeks of Duloxetine Therapy in Five Patients With MDD Comorbid With PD