Increased Brain Lactate During Depressive Episodes and Reversal Effects by Lithium Monotherapy in Drug-Naive Bipolar Disorder

内科学 双相情感障碍 锂(药物) 扣带回前部 心情 抗抑郁药 医学 情绪稳定器 重性抑郁障碍 萧条(经济学) 情绪障碍 毒品天真 心理学 内分泌学 胃肠病学 精神科 海马体 焦虑 药品 认知 经济 宏观经济学
作者
Rodrigo Machado‐Vieira,Marcus V. Zanetti,Maria Concepción García Otaduy,Rafael T. de Sousa,Marcio G. Soeiro-de-Souza,Alana C. Costa,André F. Carvalho,Cláudia C. Leite,Geraldo F. Busatto,Carlos A. Zarate,Wagner F. Gattaz
出处
期刊:Journal of Clinical Psychopharmacology [Lippincott Williams & Wilkins]
卷期号:37 (1): 40-45 被引量:58
标识
DOI:10.1097/jcp.0000000000000616
摘要

Abstract Objective Mitochondrial dysfunction and energy metabolism impairment are key components in the pathophysiology of bipolar disorder (BD) and may involve a shift from aerobic to anaerobic metabolism. Measurement of brain lactate in vivo using proton magnetic resonance spectroscopy ( 1 H-MRS) represents an important tool to evaluate mitochondrial and metabolic dysfunction during mood episodes, as well as to monitor treatment response. To date, very few studies have quantified brain lactate in BD. In addition, no study has longitudinally evaluated lactate using 1 H-MRS during depressive episodes or its association with mood stabilizer therapy. This study aimed to evaluate cingulate cortex (CC) lactate using 3-T 1 H-MRS during acute depressive episodes in BD and the possible effects induced by lithium monotherapy. Methods Twenty medication-free outpatients with short length of BD (80% drug-naive) in a current major depressive episode were matched with control subjects. Patients were treated for 6 weeks with lithium monotherapy at therapeutic doses in an open-label trial (blood level, 0.48 ± 0.19 mmol/L). Cingulate cortex lactate was measured before (week 0) and after lithium therapy (week 6) using 1 H-MRS. Antidepressant efficacy was assessed with the 21-item Hamilton Depression Rating Scale as the primary outcome. Results Subjects with BD depression showed a significantly higher CC lactate in comparison to control subjects. Furthermore, a significant decrease in CC lactate was observed after 6 weeks of lithium treatment compared with baseline ( P = 0.002). CC Lactate levels was associated with family history of mood disorders and plasma lithium levels. Conclusions This is the first report of increased CC lactate in patients with bipolar depression and lower levels after lithium monotherapy for 6 weeks. These findings indicate a shift to anaerobic metabolism and a role for lactate as a state marker during mood episodes. Energy and redox dysfunction may represent key targets for lithium’s therapeutic actions.
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