Different Effects of Mirtazapine and Venlafaxine on Brain Activation: An Open Randomized Controlled fMRI Study
J Clin Psychiatry 2011;72(4):448-457
© Copyright 2017 Physicians Postgraduate Press, Inc.
Purchase This PDF for $40.00
If you are not a paid subscriber, you may purchase the PDF.
(You'll need the free Adobe Acrobat Reader.)
Receive immediate full-text access to JCP. You can subscribe to JCP online-only ($86) or print + online ($156 individual).
With your subscription, receive a free PDF collection of the NCDEU Festschrift articles. Hurry! This offer ends December 31, 2011.
If you are a paid subscriber to JCP and do not yet have a username and password, activate your subscription now.
As a paid subscriber who has activated your subscription, you have access to the HTML and PDF versions of this item.
Click here to login.
Did you forget your password?
Still can't log in? Contact the Circulation Department at 1-800-489-1001 x4 or send email
Objective: Antidepressants with different mechanisms of action might have different effects on brain functions. The aim of the study was therefore to investigate effects of 2 antidepressants on brain activation and to identify predictors for therapy response.
Method: Twenty-four untreated patients with major depressive disorder (according to Structured Clinical Interview for DSM-IV) were enrolled in a prospective, randomized, 4-week trial with mirtazapine and venlafaxine. Functional magnetic resonance imaging (fMRI) was performed at baseline and after 4 weeks in the patients and in 15 healthy controls. The primary outcome measure was fMRI blood-oxygen-level dependence (BOLD) activation. The patients were recruited in 2007 and 2008.
Results: Comparison between patients and controls revealed that emotional face matching elicited enhanced activation in the anterior cingulate cortex (ACC), dorsomedial prefrontal cortex, dorsolateral prefrontal cortex, and basal ganglia in patients. During treatment, a significant decrease of BOLD responses was seen in the hippocampus, basal ganglia, thalamus, and cerebellum of venlafaxine-treated patients, and a significant increase in BOLD responses was seen in the middle cingulate gyrus and supplementary motor area of mirtazapine-treated patients (P < .05, family wise error [FWE] cluster-level corrected). Larger BOLD responses in the left fusiform gyrus at baseline predicted a better response to venlafaxine, and smaller BOLD responses in the right rolandic operculum at baseline predicted a better response to mirtazapine (P < .05, FWE cluster-level corrected).
Conclusions: These fMRI results indicate that antidepressants with different mechanisms of action have different effects on brain function. It therefore seems that fMRI can be used for therapy evaluation and response prediction and can facilitate the development of new pharmaceuticals.
J Clin Psychiatry
Submitted: May 27, 2009; accepted September 30, 2009.
Online ahead of print: September 21, 2010 (doi:10.4088/JCP.09m05393blu).
Corresponding author: Thomas Frodl, MD, Integrated Neuroimaging, Department of Psychiatry, Trinity College Dublin, Ireland (Thomas.firstname.lastname@example.org).