Abstract
A tonically high level of brain arousal and its hyperstable regulation is supposed to be a pathogenic factor in major depression. Preclinical studies indicate that most antidepressants may counteract this dysregulation. Therefore, it was hypothesized that responders to antidepressants show a) a high level of EEG-vigilance (an indicator of brain arousal) and b) a more stable EEG-vigilance regulation than non-responders. In 65 unmedicated depressed patients 15-min resting-state EEGs were recorded off medication (baseline). In 57 patients an additional EEG was recorded 14 ± 1 days following onset of antidepressant treatment (T1). Response was defined as a ≥50% HAMD-17-improvement after 28 ± 1 days of treatment (T2), resulting in 29 responders and 36 non-responders. Brain arousal was assessed using the Vigilance Algorithm Leipzig (VIGALL 2.1). At baseline responders and non-responders differed in distribution of overall EEG-vigilance stages (F2,133 = 4.780, p = 0.009), with responders showing significantly more high vigilance stage A and less low vigilance stage B. The 15-minutes Time-course of EEG-vigilance did not differ significantly between groups. Exploratory analyses revealed that responders showed a stronger decline in EEG-vigilance levels from baseline to T1 than non-responders (F2,130 = 4.978, p = 0.005). Higher brain arousal level in responders to antidepressants supports the concept that dysregulation of brain arousal is a possible predictor of treatment response in affective disorders.
Highlights
Klinik und Poliklinik für Psychiatrie und Psychotherapie Zentrum für psychische Gesundheit Universitätsklinikum Leipzig AöR Direktor: Prof
During the 15 min EEG recording at baseline, the Vigilance Algorithm Leipzig (VIGALL) algorithm revealed a more frequent occurrence of the high EEG-vigilance stage A as well as less low vigilance stages B in responders compared to non-responders
Though not interpreted within the framework of arousal regulation by the authors, these findings portend a relationship between the proportion of high vigilance stages and clinical response to antidepressant treatment
Summary
Klinik und Poliklinik für Psychiatrie und Psychotherapie Zentrum für psychische Gesundheit Universitätsklinikum Leipzig AöR Direktor: Prof. Die vorgelegte Arbeit stellt die Ergebnisse der Studie „Arousalregulation als Responseprädiktor der antidepressiven Psychopharmakotherapie“ (VIRAP) vor, in welcher untersucht wurde, ob ein Zusammenhang zwischen der Arousalregulation bei Patienten mit einer depressiven Störung und dem Therapieansprechen einer antidepressiven Medikation besteht. Und damit das Therapieansprechen, wurde dabei als eine Reduktion des Hamilton Rating Scale for Depression (HAMD)-17-Scores von der Baseline-Untersuchung (BL) zu T2 ≥50% definiert. Zudem zeigte eine explorative Analyse, dass Responder gegenüber Non-Respondern eine signifikante Zunahme des Abfalls des Arousallevels von der BL zu T1 aufzeigten. Die Ergebnisse lassen Rückschlüsse zu, dass die Messung des Arousallevels vor und in der initialen Phase der Therapie als Prädiktor für den Verlauf der antidepressiven Behandlung verwendet werden könnte. ICA ICD-10 IDS-C iSPOT kOhm LORETA MAGE-D1 MAO-Hemmer min mV NARI (N)LC NPV NREM PET PFC PPV PSYA PSYE PSS qEEG rACC REM ROC ROI SF-A/R SIGH-D unabhängige Komponentenanalyse International Classification of Diseases – 10 Inventar Depressiver Symptome - Fremdbeurteilung International Study to Predict Treatment Response in Depression Kiloohm Low Resolution Brain Electromagnetic Tomography melanoma associated antigen D1 Monoaminooxidase-Hemmer Minute Millivolt Selektive Noradrenalin-Reuptake-Inhibitoren (Noradrenerger) Locus coeruleus Negativer Prädiktiver Wert Non-rapid-eye-movement Positronen-Emissions-Tomographie Präfrontale Kordanz Positiver Prädiktiver Wert Skala Psychische Ausgeglichenheit am Abend Skala Psychische Erschöpfung am Abend Skala Psychosomatische Symptome während der Schlafphase quantitatives Elektroencephalogramm rostraler anteriorer cingulärer Kortex rapid-eye-movement Receiver Operating Characteristic Regions of Interest Schlaffragebogen A/R Strukturierte Interview-Richtlinien für die Hamilton Depression Rating Scale
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