The Change Of ReHo And ALFF After 12 Weeks Treatment Of Duloxetine In Treatment-naive Major Depressive Disorder

Objective:Depressive patients have changed in their brain functions.On clinical treatment,antidepressants can ameliorate the symptoms in depression.However,it is still unclear about the mechanism that the drug play its role to change the brain function.The aim of our study is to investigate the effect of duloxetine' on brain function to understand the treatment effect by examining alterations of regional homogeneity(ReHo)and the amplitude of low Irequency fluctuation(ALFF)of brain resting state functional magnetic resonance imaging in treatment-naive depression patients before and after treatment with duloxetine,comparing with healthy controls and exploring the mechanism of duloxetine in brain functional level.Methods:20 depression patients diagnosed with DSM-IV(Diagnostic and Statistical Manual of Mental Disorder,forth edition)and 20gender-and age-matched healthy controls were included in this study.All participants were arranged to undergo magnetic resonance imaging(MRI)scan session(patients with depression were scanned twice at baseline and the end of the twelfth week respectively,healthy controls were scanned once),and HAMD-17?MADRS were collected from all patients at baseline and the end of the twelfth week.All resting state functional magnetic resonance imaging(rs-fMRI)data of 20 patients and 20 healthy controls were processed automatically by using the software DPARSF running on MATLAB 2012a.Regional homogeneity(ReHo)images and amplitude of low Irequency fluctuation(ALFF)of resting state functional magnetic resonance imaging were obtained after the normalization,segmentation,detrend,filter and smoothing steps.Compared the two sets images of patients group,which were collected at baseline and the end of the twelfth week by pair-samples t-test,and compared the images of healthy control group and patients group by two-sample t-test respectively to detect regions where group differences exit pertaining to the images.Considering currently researchs on multy-angle data analysis are few,we use regional homogeneity and amplitude of low Irequency fluctuation comprehensively to explore depressive patients' brain function.Results:1.Compared with the scales score of patients at the end of the twelfth week and baseline,there were statistically significant differences in the HAMD-17 score,MADRS score and HAMA score(P<0.05),among them,12 patients achieved clinic cure,11 patients were clinically effective,13 cases were ineffective,63.89%patients' reduction rate of HAMD-17 was>50%.2.The incidence of adverse reaction was 55.56%,of which the incidence of xerostomia was 44.44%,the incidence of somnolence was 19.44%,the incidence of blurred vision was 16.67%,the incidence of constipation was 36.11%,the incidence of dysuria was 8.33%,the incidence of nausea and vomiting was 27.78%,the incidence of loss of appetite was 38.89%,the incidence of diarrhea was 16.67%,the incidence of weight loss was 22.22%,except two patient can not tolerate side effects,the rest of adverse reactions can be tolerated.3.Compared with the healthy control group,the ReHo images of the patients at baseline,ReHo increased in the following brain regions:Left middle temporal gyrus,left fusiform gyrus,right calcarine fissure cortex,right supplementary motor area and decreased in these regions:Right inferior temporal gyrus,right orbital superior frontal gyrus,right orbital inferior frontal gyrus,right middle temporal gyrus,left middle frontal gyrus,left inferior parietal gyrus;the ReHo images of the patients at the end of the twelfth week,ReHo increased in the following brain regions:Left superior temporal gyrus,left cerebellum area 6 and decreased in these regions:Right inferior temporal gyrus,left cerebellar peduncle area 1,left 'precuneus,the triangular part of right inferior frontal gyrus,right middle occipital gyrus,right angular gyrus.4.Compared with patients' ReHo images at the end of the twelfth week and baseline,ReHo of left middle temporal gyrus and left middle frontal gyrus increaseed;ReHo of right middle temporal gyrus,right middle frontal gyrus,right lingual gyrus,right superior occipital gyrus and right precentral gyrus decreased.5.Compared with the healthy control group,the ALFF images of the patients at baseline,ALFF increased in the following brain regions:left cerebellum area 7b,left caudate nucleus,left precentral gyrus,right thalamus,right supplementary motor area and decreased in these regions:left cerebellar peduncle area 1,right orbital inferior frontal gyrus,right temporal pole:superior temporal gyrus,right middle temporal gyrus;the ALFF images of the patients at the end of the twelfth week,ALFF increased in the following brain regions:right cerebellum area 3,left precentral gyrus and decreased in these regions:bilateral angular gyrus,left cerebellar peduncle area 1,left precuneus,the triangular part of right inferior frontal gyrus,right middle occipital gyrus,right superior temporal gyrus,right middle temporal gyrus.6.Compared with patients' ALFF images at the end of the twelfth week andbaseline,ALFF of left orbital inferior frontal gyrus and left middle temporal gyrus increaseed;No obvious decreased region.Conclusion:1.Duloxetine for depression is efficacious,it is able to improve depressive symptoms.Improve depressive symptoms in patients with depression and its treatment has certain safety and tolerability.2.Compared with ReHo and ALFF images of the healthy control group and the patients group at baseline and the end of the twelfth week,there were many brain regions with abnormal activities in frontal gyrus,temporal gyrus,cerebellum and midbrain,which suggest that the abnormity of brain function in patients with depression is extensive.3.Compared with patients' ReHo and ALFF images at the end of the twelfth week and baseline,frontal lobe and temporal lobe change have be found;Indicate that the frontal and temporal cortex function change may be the duloxetine-treated brain mechanisms underlying depression.