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Cerebral blood flow in depressed patients with systemic lupus erythematosus at baseline and after acetazolamide

¹ Department of Nuclear Medicine; ² Department of Rheumatology, University of Pisa, Pisa, Italy

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Objectives: The neural circuitry involved in depression associated to systemic lupus erythematosus (SLE) is under-investigated. We used SPECT to study CBF deficits in depressed SLE patients.

Methods: SPECT with 99mTc-ECD was performed in 24 SLE female patients (43±13 yr) with diagnosis of Depression according to the DSM-IV criteria and 25 age-matched (42±12 yr) healthy women. Patients also underwent SPECT with 99mTc-ECD after administration of acetazolamide (ACZ) within a week from the baseline study. T2-weighted magnetic resonance was acquired in all patients.

Results: White matter hyperintensities were present in 58% of patients, most frequently in the frontal lobe. At baseline, significant (P<0.0001) reduced CBF in SLE patients was detected bilaterally in the rectal and superior frontal gyrus, right inferior frontal gyrus, left precentral gyrus, left middle and superior temporal gyrus, right postcentral gyrus and right putamen. After ACZ, significant (P<0.0001) lower CBF in SLE patients was found in some brain areas with normal CBF at baseline, such as the anterior cingulate, right precuneus, left caudate, thalamus and brainstem; in regions with baseline CBF reductions, perfusion deficits were greater. A significant (P<0.001) negative correlation between CBF and duration of depression was detected in the left middle frontal gyrus.

Conclusions: Depressed SLE patients have CBF reductions in cerebral areas involved in Major Depression supporting the existence of a neural circuitry for depressive symptoms common to both SLE and Major Depression. Chronic ischemia due to subclinical cerebrovascular disease in the anterior circulation may contribute to the pathogenesis of depression in SLE patients.

This Article Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Google Scholar Articles by Giovacchini, G. Articles by Volterrani, D. PubMed Articles by Giovacchini, G. Articles by Volterrani, D.