0
Get Alert
Please Wait... Processing your request... Please Wait.
You must sign in to sign-up for alerts.

Please confirm that your email address is correct, so you can successfully receive this alert.

1
Letters   |    
Aripiprazole Monotherapy-Related Gray-Matter Growth in a Patient With First-Episode Drug-Naïve Non-Psychotic Major Depressive Disorder
Chien-Han Lai, M.D.
The Journal of Neuropsychiatry and Clinical Neurosciences 2012;24:E49-E50. doi:10.1176/appi.neuropsych.11080198
View Author and Article Information

This case study was approved by the institute of review board of Buddhist Tzu Chi Hospital, Taipei Branch. The author thanks Miss Wang (MR Center, National Yang Ming University) for MRI acquisition help and technique assistance and also acknowledges MR support from National Yang-Ming University, Taiwan, which is in part supported by the MOE plan for the top university.

Department of Psychiatry, Buddhist Tzu-Chi General Hospital, Taipei Branch, Taipei, Taiwan

To the Editor: Aripiprazole, a kind of D2 partial agonist antipsychotic, is approved for major depressive disorder (MDD) add-on therapy. It is believed to be related to its 5-HT1A partial agonist, 5-HT2C antagonist and 5-HT2A antagonist property. Here I want to present a case of first-episode drug-naïve nonpsychotic MDD with improvements of symptoms after 6-week treatment. Magnetic resonance imaging (MRI) structural analysis also revealed gray matter (GM) growth and brain volume (BV) increase within 6 weeks.

Miss L is a 47-year-old female patient with first-episode drug-naïve MDD for 1-2 months. No specific physical illness, psychotic features, past manic episodes, nonpsychiatric medication use and substance abuse were mentioned. The symptoms of typical depression were mentioned, such as distinct depressed mood, suicide ideation, lack of interest, lack of energy, psychomotor agitation and sleep disturbances [Hamilton Rating Scale for Depression (HRSD): 32]. After visiting my clinic, she started to receive aripiprazole monotherapy as 2.5 mg/day and then the dose was titrated to 5 mg within 1 week without any significant side effects except mild headache and dizziness. No significant extrapyramidal side effects were mentioned. After 6 weeks of therapy, her MDD symptoms improved (HRSD: 13).

Structural brain magnetic resonance imaging (MRI) scans were obtained with 3T Siemens version scanner housed at MR Center, National Yang Ming University. Scans with three-dimensional fast spoiled gradient-echo recovery (3D-FSPGR) T1W1 (TR 2530ms; TE 3.03ms; slice thickness=1mm (no gap);192slices; matrix = 224×256; field of view: 256mm; number of excitation=1) were performed at first visit and 6th week visit. Her body weight was 71.2 kg at baseline and 71.7 kg at 6th week. Structural MRI was preprocessed with Structural Image Evaluation, using Normalization, of Atrophy (SIENAX) function of FSL (FMRIB Software Library) to calculate single time point GM, WM, and BV after registering and normalizing to template. The brain morphology change was estimated by SIENA function to calculate percentage BV change (PBVC). After analyzing brain MRI structure by SIENAX, GM increased from 750145.59 to 790751.54 within 6 weeks and PBVC is 0.0352900, which suggested BV increase after aripiprazole treatment (Figure 1).

 
Anchor for JumpAnchor for Jump
FIGURE 1.BV Increased After Aripiprazole (5 mg/day) 6-week Therapy

Blue color represented atrophy and red color represented growth of BV. A positive estimated PBVC value represented BV increase.

According to study of Frodl et al., MDD is associated with GM deficits over amygdala, hippocampus, prefrontal cortex, and anterior cingulate cortex.1 These regional GM deficits are related to their symptoms severity and even represent a kind of “trait marker” for MDD.2 GM growth effects might be related to the following reasons, such as synaptic remodeling and neurogenesis3 from the stimulation of neutrophic factors by antipsychotics,4 prevention of oxidative stress or 6-OH-dopamine lesioning and with subsequent increased glial cell proliferation in frontal cortex.5

Frodl  TS;  Koutsouleris  N;  Bottlender  R  et al:  Depression-related variation in brain morphology over 3 years: effects of stress? Arch Gen Psychiatry 2008; 65:1156–1165
[CrossRef] | [PubMed]
 
Lai  CH;  Hsu  YY;  Wu  YT:  First episode drug-naïve major depressive disorder with panic disorder: gray matter deficits in limbic and default network structures.  Eur Neuropsychopharmacol 2010; 20:676–682
[CrossRef] | [PubMed]
 
Konradi  C;  Heckers  S:  Antipsychotic drugs and neuroplasticity: insights into the treatment and neurobiology of schizophrenia.  Biol Psychiatry 2001; 50:729–742
[CrossRef] | [PubMed]
 
Parikh  V;  Khan  MM;  Mahadik  SP:  Olanzapine counteracts reduction of brain-derived neurotrophic factor and TrkB receptors in rat hippocampus produced by haloperidol.  Neurosci Lett 2004; 356:135–139
[CrossRef] | [PubMed]
 
Wang  HD;  Dunnavant  FD;  Jarman  T  et al:  Effects of antipsychotic drugs on neurogenesis in the forebrain of the adult rat.  Neuropsychopharmacology 2004; 29:1230–1238
[CrossRef] | [PubMed]
 
References Container

FIGURE 1. BV Increased After Aripiprazole (5 mg/day) 6-week Therapy

Blue color represented atrophy and red color represented growth of BV. A positive estimated PBVC value represented BV increase.

+

References

Frodl  TS;  Koutsouleris  N;  Bottlender  R  et al:  Depression-related variation in brain morphology over 3 years: effects of stress? Arch Gen Psychiatry 2008; 65:1156–1165
[CrossRef] | [PubMed]
 
Lai  CH;  Hsu  YY;  Wu  YT:  First episode drug-naïve major depressive disorder with panic disorder: gray matter deficits in limbic and default network structures.  Eur Neuropsychopharmacol 2010; 20:676–682
[CrossRef] | [PubMed]
 
Konradi  C;  Heckers  S:  Antipsychotic drugs and neuroplasticity: insights into the treatment and neurobiology of schizophrenia.  Biol Psychiatry 2001; 50:729–742
[CrossRef] | [PubMed]
 
Parikh  V;  Khan  MM;  Mahadik  SP:  Olanzapine counteracts reduction of brain-derived neurotrophic factor and TrkB receptors in rat hippocampus produced by haloperidol.  Neurosci Lett 2004; 356:135–139
[CrossRef] | [PubMed]
 
Wang  HD;  Dunnavant  FD;  Jarman  T  et al:  Effects of antipsychotic drugs on neurogenesis in the forebrain of the adult rat.  Neuropsychopharmacology 2004; 29:1230–1238
[CrossRef] | [PubMed]
 
References Container
+
+

CME Activity

There is currently no quiz available for this resource. Please click here to go to the CME page to find another.
Submit a Comments
Please read the other comments before you post yours. Contributors must reveal any conflict of interest.
Comments are moderated and will appear on the site at the discertion of APA editorial staff.

* = Required Field
(if multiple authors, separate names by comma)
Example: John Doe



Related Content
Books
The American Psychiatric Publishing Textbook of Psychopharmacology, 4th Edition > Chapter 61.  >
The American Psychiatric Publishing Textbook of Psychopharmacology, 4th Edition > Chapter 52.  >
The American Psychiatric Publishing Textbook of Psychopharmacology, 4th Edition > Chapter 61.  >
The American Psychiatric Publishing Textbook of Psychopharmacology, 4th Edition > Chapter 31.  >
The American Psychiatric Publishing Textbook of Psychopharmacology, 4th Edition > Chapter 52.  >
Topic Collections
Psychiatric News
Read more at Psychiatric News >>
APA Guidelines