Regional cerebral glucose metabolism and anxiety symptoms in bipolar depression: Effects of levothyroxine

Bauer, Michael; Berman, Steven M.; Schlagenhauf, Florian; Voytek, Bradley; Rasgon, Natalie; Mandelkern, Mark A.; Whybrow, Peter C.; London, Edythe D.

doi:10.1016/j.pscychresns.2009.07.001

« Previous Next »Psychiatry Research: Neuroimaging
Volume 181, Issue 1 , Pages 71-76, 30 January 2010

Regional cerebral glucose metabolism and anxiety symptoms in bipolar depression: Effects of levothyroxine

Michael Bauer
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
- Corresponding author. Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstr. 74, 01307 Dresden, Germany. Tel.: +49 351 458 2772; fax: +49 351 458 4324.
Steven M. Berman
- Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
Florian Schlagenhauf
- Department of Psychiatry and Psychotherapy, Charité — Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany
Bradley Voytek
- Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
Natalie Rasgon
- Department of Psychiatry and Behavioral Sciences, Stanford School of Medicine, Palo Alto, CA, USA
Mark A. Mandelkern
- Department of Physics, University of California Irvine, Irvine, CA, USA
Peter C. Whybrow
- Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
Edythe D. London
- Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA

Received 28 April 2008; received in revised form 8 April 2009; accepted 5 July 2009.

Abstract

We examined the relationships between regional brain activity and anxiety in bipolar depressed patients receiving adjunctive treatment with levothyroxine. Regional brain activity was assessed with positron emission tomography and [¹⁸F]fluorodeoxyglucose in 10 euthyroid, depressed bipolar women before and after 7 weeks of adjunctive therapy with levothyroxine. The primary biological measures were relative (to global) regional radioactivity as a surrogate index of glucose metabolism in pre-selected brain regions. Relationships were assessed between regional brain activity and anxiety symptoms while controlling for depression severity. At baseline, Trait Anxiety Inventory measures covaried positively with relative brain activity bilaterally in the dorsal anterior cingulate, superior temporal gyri, parahippocampal gyri, amygdala, hippocampus, ventral striatum, and right insula; state anxiety showed a similar pattern. After treatment anxiety was improved significantly. Change in trait anxiety covaried positively with changes in relative activity in right amygdala and hippocampus. Change in state anxiety covaried positively with changes in relative activity in the hippocampus bilaterally and left thalamus, and negatively with changes in left middle frontal gyrus and right dorsal anterior cingulate. Results indicate that comorbid anxiety symptoms have specific regional cerebral metabolic correlates in bipolar depression and cannot only be explained exclusively by the depressive state of the patients.

Keywords: Thyroid hormone, Levothyroxine, Bipolar disorder, Anxiety, Positron emission tomography, Depression