Abstract
Melancholic depression is a biologically homogeneous clinical entity in which structural brain alterations have been described. Interestingly, reports of structural alterations in melancholia include volume increases in Cerebro-Spinal Fluid (CSF) spaces. However, there are no previous reports of CSF volume alterations using automated whole-brain voxel-wise approaches, as tissue classification algorithms have been traditionally regarded as less reliable for CSF segmentation. Here we aimed to assess CSF volumetric alterations in melancholic depression and their clinical correlates by means of a novel segmentation algorithm (‘new segment’, as implemented in the software Statistical Parametric Mapping-SPM8), incorporating specific features that may improve CSF segmentation. A three-dimensional Magnetic Resonance Image (MRI) was obtained from seventy patients with melancholic depression and forty healthy control subjects. Although imaging data were pre-processed with the ‘new segment’ algorithm, in order to obtain a comparison with previous segmentation approaches, tissue segmentation was also performed with the ‘unified segmentation’ approach. Melancholic patients showed a CSF volume increase in the region of the left Sylvian fissure, and a CSF volume decrease in the subarachnoid spaces surrounding medial and lateral parietal cortices. Furthermore, CSF increases in the left Sylvian fissure were negatively correlated with the reduction percentage of depressive symptoms at discharge. None of these results were replicated with the ‘unified segmentation’ approach. By contrast, between-group differences in the left Sylvian fissure were replicated with a non-automated quantification of the CSF content of this region. Left Sylvian fissure alterations reported here are in agreement with previous findings from non-automated CSF assessments, and also with other reports of gray and white matter insular alterations in depressive samples using automated approaches. The reliable characterization of CSF alterations may help in the comprehensive characterization of brain structural abnormalities in psychiatric samples and in the development of etiopathogenic hypotheses relating to the disorders.
Highlights
Melancholic depression is a subtype of major depressive disorder (MDD) that encompasses a constellation of distinctive clinical features such as anhedonia, distinct quality of mood and mood non-reactivity, psychomotor disturbances, feelings of guilt, early awakening, diurnal variation and anorexia [1,2,3,4]
Specific neurobiological correlates such as cortisol dysregulation and altered sleep patterns have been appreciated in melancholia [5,6,7]
Ethics Statement The study protocol was approved by the ethical committee of clinical research (CEIC) of the Bellvitge University Hospital, and was in compliance with the national legislation and the principles expressed in the Declaration of Helsinki
Summary
Melancholic depression is a subtype of major depressive disorder (MDD) that encompasses a constellation of distinctive clinical features such as anhedonia, distinct quality of mood and mood non-reactivity, psychomotor disturbances, feelings of guilt, early awakening, diurnal variation and anorexia [1,2,3,4] Specific neurobiological correlates such as cortisol dysregulation and altered sleep patterns have been appreciated in melancholia [5,6,7]. Since all these symptoms are regularly present in most melancholic patients, melancholia may be considered as a biologically homogeneous clinical entity, especially when compared with other depression subtypes [2,8]. In one of the studies [10], CSF increases in the left Sylvian fissure were related to the time to remission of the depressive episode, giving clinical relevance to the findings
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