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Paradoxical effects of short-term antidepressant treatment in fMRI emotional processing models in volunteers with high neuroticism

Published online by Cambridge University Press:  19 April 2013

M. Di Simplicio ,
R. Norbury ,
A. Reinecke  and
C. J. Harmer
M. Di Simplicio*
Affiliation:
MRC Brain and Cognition Sciences Unit, Cambridge, UK University Department of Psychiatry, Warneford Hospital, Oxford, UK
R. Norbury
Affiliation:
University Department of Psychiatry, Warneford Hospital, Oxford, UK Oxford Centre for Clinical Magnetic Resonance Research (OCMR), John Radcliffe Hospital, Oxford, UK
A. Reinecke
Affiliation:
University Department of Psychiatry, Warneford Hospital, Oxford, UK
C. J. Harmer
Affiliation:
University Department of Psychiatry, Warneford Hospital, Oxford, UK
*
*Address for correspondence: Dr M. Di Simplicio, MRC Brain and Cognition Sciences Unit, 15 Chaucer Road, Cambridge CB2 7EF, UK. (Email: [email protected])
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Abstract

Background

Short-term antidepressant administration has been reported to decrease amygdala response to threat in healthy volunteers and depressed patients. Neuroticism (N) is a risk factor for depression but has also been associated with slow or incomplete remission with antidepressant drug treatment. Our aim was to investigate early selective serotonin reuptake inhibitor (SSRI) administration neural effects on implicit processing of fearful facial expressions in volunteers with high levels of N.

Method

Highly neurotic subjects received 20 mg/day citalopram versus placebo for 7 days in a double-blind, between-groups design. On the last day haemoperfusion and functional magnetic resonance imaging (fMRI) data during a gender discrimination task with fearful and happy faces were acquired. A control group of non-neurotic volunteers was also tested.

Results

High-N volunteers had reduced responses to threatening facial expressions across key neural circuits compared to low-N volunteers. SSRI treatment was found to elevate resting perfusion in the right amygdala, increase bilateral amygdalae activation to positive and negative facial expressions and increase activation to fearful versus happy facial expressions in occipital, parietal, temporal and prefrontal cortical areas.

Conclusions

These results suggest that 7 days of SSRI administration can increase neural markers of fear reactivity in subjects at the high end of the N dimension and may be related to early increases in anxiety and agitation seen early in treatment. Such processes may be involved in the later therapeutic effects through decreased avoidance and increased learning about social ‘threat’ cues.

Keywords

AntidepressantsanxiogenicemotionfMRIneuroticism
Type
Original Articles
Information
Psychological Medicine , Volume 44 , Issue 2 , January 2014 , pp. 241 - 252
Copyright
Copyright © Cambridge University Press 2013 

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