Bimodal effect of lithium plasma levels on hippocampal glutamate concentrations in bipolar II depression: a pilot study

Marcus V Zanetti, Maria C Otaduy, Rafael T de Sousa, Wagner F Gattaz, Geraldo F Busatto, Claudia C Leite, Rodrigo Machado-Vieira, Marcus V Zanetti, Maria C Otaduy, Rafael T de Sousa, Wagner F Gattaz, Geraldo F Busatto, Claudia C Leite, Rodrigo Machado-Vieira

Abstract

Background: The hippocampus has been highly implicated in the pathophysiology of bipolar disorder (BD). Nevertheless, no study has longitudinally evaluated hippocampal metabolite levels in bipolar depression under treatment with lithium.

Methods: Nineteen medication-free BD patients (78.9% treatment-naïve and 73.7% with BD type II) presenting an acute depressive episode and 17 healthy controls were studied. Patients were treated for 6 weeks with lithium in an open-label trial. N-acetyl aspartate (NAA), creatine, choline, myo-Inositol, and glutamate levels were assessed in the left hippocampus before (week 0) and after (week 6) lithium treatment using 3T proton magnetic resonance spectroscopy (1H-MRS). The metabolite concentrations were estimated using internal water as reference and voxel segmentation for partial volume correction.

Results: At baseline, acutely depressed BD patients and healthy controls exhibited similar hippocampal metabolites concentrations, with no changes after 6 weeks of lithium monotherapy. A significant correlation between antidepressant efficacy and increases in NAA concentration over time was observed. Also, there was a significant positive correlation between the changes in glutamate concentrations over follow-up and plasma lithium levels at endpoint. Mixed effects model analysis revealed a bimodal effect of lithium plasma levels in hippocampal glutamate concentrations: levels of 0.2 to 0.49 mmol/L (n=9) were associated with a decrease in glutamate concentrations, whereas the subgroup of BD subjects with "standard" lithium levels (≥ 0.50 mmol/L; n = 10) showed an overall increase in glutamate concentrations over time.

Conclusions: These preliminary results suggest that lithium has a bimodal action in hippocampal glutamate concentration depending on the plasma levels.

Trial registration: ClinicalTrials.gov NCT01919892.

Keywords: bipolar disorder; depression; glutamate; hippocampus; lithium; magnetic resonance spectroscopy.

© The Author 2015. Published by Oxford University Press on behalf of CINP.

Figures

Figure 1.
Figure 1.
Axial (A), coronal (B), and sagittal (C) planes demonstrating the positioning of the VOI in the left hippocampus. Images are displayed in radiological convention (the left side of the brain corresponds to the right side of the figure).
Figure 2.
Figure 2.
Example of spectra showing the glutamate peak. Cho, choline; Cr, creatine; Glu, glutamate; mI, myo-inositol; NAA, n-acetyl-aspartate.
Figure 3.
Figure 3.
Scatterplot showing an inverse correlation between reductions in the 21-item Hamilton Depression Rating Scale (HDRS) scores in patients with bipolar disorder (BD) and the rate of change in hippocampal N-acetyl aspartate (NAA) concentrations over the 6 weeks of follow-up.
Figure 4.
Figure 4.
Scatterplot depicting a positive correlation between plasma levels of lithium at endpoint and the rate of change in glutamate (Glu) concentrations over the 6 weeks of follow-up in patients with bipolar disorder (BD).

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Source: PubMed

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