Mr. H is a 38-year-old male patient with a single MDD-with-PD episode for 1 year (Hamilton Rating Scale for Depression [Ham-D]): 43; Panic Disorder Severity Scale [PDSS]: 27). He received the following antidepressant therapy: fluoxetine, venlafaxine, escitalopram, and mirtazapine each for 3–4 months without much improvement (Ham-D lowest score: 35; PDSS lowest score: 23). Because of nonresponse to previous antidepressants, he started to receive duloxetine 30 mg initially with abrupt switching from mirtazapine 60 mg/day (Ham-D: 41; PDSS: 25), and was titrated to 60 mg within 2 weeks without any significant side effects except mild nausea and sedation. After 6 weeks of therapy, his MDD and PD symptoms improved (Ham-D: 20; PDSS: 11). Structural brain MRI scans were obtained with a 3T GE version scanner. Scans with three-dimensional fast spoiled gradient-echo recovery (3D-FSPGR) T1W1 (TR=11.2 msec, TE=5.2 msec, matrix=256 x 256, field of view=260 mm, number of excitation=1, slice thickness=1 mm, 180 slices; no gap) were performed at first visit and 6th-week visit. Structural MRI was processed with FMRIB's Integrated Registration and Segmentation Tool function (FIRST Version 1.2) of FSL (FMRIB Software Library; Version 4.1.1; Oxford, England) to perform subcortical brain segmentation using a shape and appearance model. The volume changes are listed as follows (Table 1).
TABLE 1.Subcortical Volume Increase After 6 Weeks of Antidepressant Therapy