Altered fractional amplitude of low-frequency fluctuation after cognitive behavioral therapy combined with fluoxetine in young depressed patients with suicide attempts
10.3760/cma.j.cn113661-20200619-00285
- VernacularTitle:认知行为治疗联合氟西汀治疗对自杀未遂青年抑郁症患者脑区比率低频振幅的影响
- Author:
Yanping SHU
1
;
Li KUANG
;
Qiankun HUANG
;
Lihui HE
Author Information
1. 贵州省第二人民医院心身科，贵阳 550004
- Publication Type:Journal Article
- Keywords:
Depressive disorder;
Suicide, attempted;
Cognitive therapy;
Magnetic resonance imaging;
Fractional amplitude of low-frequency fluctuation
- From:
Chinese Journal of Psychiatry
2020;53(5):392-399
- CountryChina
- Language:Chinese
-
Abstract:
Objective:This study aimed to evaluate the changes of fractional amplitude of low frequency fluctuation (fALFF) in young depressed patients with suicide attempts after cognitive behavior therapy (CBT) combined with fluoxetine by using the resting-state functional magnetic resonance imaging (rs-fMRI).Method:From March 2017 to December 2019, 45 young depressed patients with suicide attempts were recruited from the Second People′s Hospital of Guizhou Province. The patients were randomly allocated into CBT combined with antidepressant treatment (combination group) and antidepressant treatment alone (antidepressant group). Individuals in combination group were treated with 8-time CBT combined with fluoxetine, patients in antidepressant group were treated with fluoxetine alone. Healthy volunteers matched with the age, gender and education level of the patients were recruited as the control group. The rs-fMRI data were collected before and after the treatment.The clinical symptoms and the suicidal ideation were evaluated by HAMD 24 scale and the Scale for Suicidal Ideation (SSI). The brain function in response to the treatment was analyzed by fALFF, change after the treatment. And the correlation analysis was explored between the brain function and the clinical symptoms. Result:At the baseline, compared with the control group, the fALFF values of combination group were significantly increased in the left posterior lobe ( t=4.312), right anterior cingulate cortex ( t=4.079), left inferior parietal lobe ( t=3.983), left superior temporal cortex ( t=3.983), left caudate nucleus ( t=4.109), left superior frontal cortex ( t=5.191) and left middle frontal cortex ( t=5.191), while significantly decreased in left angular gyrus ( t=-4.607). After 8 weeks of treatment, the depressive symptoms and the suicidal ideation in combination group were significantly improved compared to those in antidepressant group. Compared to antidepressant group, higher fALFF values were found in combination group in right middle frontal cortex ( t=3.456), right inferior frontal cortex ( t=3.456), left posterior cerebellar lobe ( t=5.120), and left anterior cerebellar lobe ( t=5.120); lower values were found in left medial frontal cortex ( t=-4.045), and left anterior cingulate cortex ( t=-4.045; P<0.05, AlphaSim correction). In combination group, the value of fALFF in left superior frontal cortex was negatively correlated with the score of HAMD 24( r=-0.600, P=0.002), and that of right anterior cingulate cortex was positively correlated with SSI score ( r=0.428, P=0.037); after treatment, the value of fALFF in right medial prefrontal lobe was positively correlated with the SSI improvement (ΔSSI) ( r=0.518, P=0.010). Conclusion:After 8 weeks of CBT combined with fluoxetine treatment, depressive symptoms may get more improved with less suicidal ideation than the fluoxetine treatment alone in young depressed patients who have suicide attempts before, and the local spontaneous brain activities change accordingly, especially in the frontal limbic system and cerebellum. It may suggest that CBT combined with fluoxetine may effectively regulate the spontaneous activities of these brain regions and possibly reshape the emotional processing as well as the cognitive circuit which contribute the symptoms improvement.
