Brain blood flow changes in depressed patients treated with interpersonal psychotherapy or venlafaxine hydrochloride - Preliminary findings

Background: Functional brain imaging studies in major depression have sugge sted abnormalities of areas, including the frontal cortex, cingulate gyrus, basal ganglia, and temporal cortex. We hypothesized that venlafaxine hydro chloride and interpersonal psychotherapy (IPT) might each alter brain blood flow in some or all of these areas on sequential single photon emission co mputed tomography (SPECT) scans. Methods: Twenty-eight men and women aged 30 to 53 years with a DSM-IV major depressive episode, a 17-item Hamilton Rating Scale for Depression (HAM-D) rating of 18 or higher, and antidepressant-naive for at least 6 months wer e studied. After baseline (99m)Technetium-hexa-methyl-propylene-amine-oxime scan, 1-T magnetic resonance imaging, and psychometric ratings, patients w ere assigned to different treatments. Thirteen patients had 1-hour weekly s essions of IPT from the same supervised therapist (E.M.). Fifteen patients took 37.5 mg twice-daily of venlafaxine hydrochloride. Single-photon emissi on computed tomography scans and ratings were repeated at 6 weeks. Results: Both treatment groups improved substantially, more so with venlafa xine (mean [SD] HAM-D scores at pretreatment: IPT, 22.7 [2.7], and venlafax ine, 22.4 [3.1]; and posttreatment; IPT, 16.2 [7.1], and venlafaxine, 10.9 [8.6]). No patients had structural brain abnormalities. On analysis with st atistical parametric mapping 96, the venlafaxine group showed right posteri or temporal and right basal ganglia activation (P=.01), while the IPT group had limbic right posterior cingulate and right basal ganglia activation (P =.01). Conclusions: This preliminary investigation has shown limbic blood flow inc rease with IPT yet not velafaxine, while both treatments demonstrated incre ased basal ganglia blood flow. This was, however, a short trial with a smal l sample, no control group, and different symptom reduction in the 2 groups .