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).