The relationship between the acute cerebral metabolic response to citalopram and chronic citalopram treatment outcome.

OBJECTIVES: Given the challenges in the clinical management of geriatric depression, research over the past decade has focused on developing early neurobiological markers of antidepressant treatment response. This study tested the hypothesis that lower baseline glucose metabolism and greater acute cerebral metabolic responses to a single, intravenous (IV) dose of the selective serotonin reuptake inhibitor (SSRI) citalopram would be associated with greater improvement of depressive symptoms after 12 weeks of citalopram treatment in geriatric depression. METHODS: sixteen geriatric depressed patients underwent two scans to measure cerebral glucose metabolism after administration of either a saline placebo or citalopram infusion (40 mg, IV). Then, the patients were treated with the oral citalopram medication for 12 weeks. RESULTS: greater improvement of depressive symptoms was associated with lower baseline metabolism in anterior cingulate, superior, middle, and inferior frontal gyri (bilaterally), inferior parietal lobule (bilaterally), precuneus (right), insula (left), parahippocampal gyrus (right), caudate (bilaterally), and putamen (left) regions. Greater improvement of depressive symptoms was associated with greater reductions in metabolism after acute citalopram administration in similar brain regions, including additional posterior cortical regions. CONCLUSIONS: lower baseline cerebral metabolism and greater decreases with acute citalopram administration are associated with better antidepressant response to chronic citalopram treatment. These data are consistent with previous studies of total sleep deprivation and suggest that dynamic, early adaptive changes or normalization of cerebral metabolism may represent early neurobiological markers of chronic SSRI treatment response in geriatric depression.

Eco-effective design and evidence-based design: perceived synergy and conflict.

Eco-effective design (EED) and evidence-based design (EBD) are two powerful trends currently shaping healthcare architecture. EED addresses whether/how the design and operation of buildings improve ecological value and enhance human health. EBD addresses whether/how the design and operation of buildings support positive health outcomes in the built environment through a growing collection of solutions informed by research and practical knowledge. The primary hypothesis of this study was that EBD and EED are compatible approaches to health facility design, especially when addressing the impact of the environment on human health. To explore this hypothesis, healthcare facility administrators were surveyed regarding their perceptions of the relationship between EED and EBD. Input from focus groups and EED and EBD experts was used to formulate the administrator questionnaire. The study concluded that the relationship between EED and EBD typically was synergistic.