Use of proton magnetic resonance spectroscopy in the treatment of psychiatric disorders: a critical update

Abstract

Because of the wide availability of hardware as well as of standardized analytic quantification tools, proton magnetic resonance spectroscopy ((1)H-MRS) has become widely used to study psychiatric disorders. (1)H-MRS allows measurement of brain concentrations of more traditional singlet neurometabolites like N-acetylaspartate, choline, and creatine. More recently, quantification of the more complex multiplet spectra for glutamate, glutamine, inositol, and γ-aminobutyric acid have also been implemented. Here we review applications of (1)H-MRS in terms of informing treatment options in schizophrenia, bipolar disorder, and major depressive disorders. We first discuss recent meta-analytic studies reporting the most reliable findings. Then we evaluate the more sparse literature focused on 1H-MRS-detected neurometabolic effects of various treatment approaches in psychiatric populations. Finally we speculate on future developments that may result in translation of these tools to improve the treatment of psychiatric disorders.

Keywords: NAA; glutamate; glutamine; schizophrenia; spectroscopy.

Figure 1.. Single voxel location (2 x 2 x 3 cm) in the anterior dorsal cingulate cortex, shown in sagittal, coronal, and axial planes from MRI (top panel). A spectra, averaged from 196 acquisitions, collected from the above location at 3 Tesla, with a standard point resolved spectroscopic sequence (time to echo = 40 msec, time to repetition = 1500 msec), in about 5 mins. The fitted spectra (red line) has peak areas for glutamine (Gln), glutamate (Glu), N-acetyl-aspartate compounds (NAAc), total-creatine (Cre), myo-inositol (Ins) and choline (Cho) are labeled. Top irregular line represents the residual signal after fitting. Lower continuous line represents the baseline used for fitting with linear combination (LC) model (bottom panel).