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. Duloxetine 30 mg/day was initiated and then titrated to 60 mg within 2 weeks without any significant side effects except mild nausea and sedation. After a 6-week course of therapy, their FEMDDPD 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. ALFF was calculated by REST software (Resting State FMRI Data Analysis Toolkit, Version 1.4), using the preprocessed RFMRI data with default mask. The ALFF of each voxel was calculated within the brain and divided by global ALFF value. The standardized ALFF should have a value of approximately 1, and then be modulated for the following group comparison. The baseline and posttreatment-modulated ALFF maps were processed by the paired t-test function of REST software with production of T-statistic image (statistic threshold: p<0.00005; cluster size >270 mm3, rmm: 4; surface-connected hypothesis). Increased ALFF was observed in left fronto-parietal regions (left middle frontal gyrus [MFG]: −48, 12, 38 and inferior parietal lobe [IPL]: −48, −50, 43]), and decreased ALFF was found in left thalamus and left lingual gyrus (LG) after duloxetine therapy.