Open Door Review III

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i)0*6BB!@_!A0#()!Q_!")<9B*0*!"_!Q22%$*0*!/_!V2!.EH""A/5!1)<49)%1#$69!2*&!60%)()*$*!(%2*61)%(0%!3$*&$*D!$*!&%BDE*2íY0!12($0*(6!Z$(#! 92j)%!&01%066$)*>!/647#$2(%4!2*&!8<$*$72! A0#()*0*!i_!"$$#)*0*!i_!i)0*6BB!@_!A0#()!Q@_!=#)<2!/_!Q22%$*0*!/;_!V2!")Z2%&!9)<07B<2%!1647#)(#0%214!):!O01%066$)*n!/1>!+-\E+P+>!;*?!A0Y4_!5>_!=3<)*_!Q>_!IJ7#0<0_!H>!['&6>^! '(A?-"*A+@$)?&&'(A?-",-%#@:A&3%(%@#?-C'#@?,)?%V`@(%*&2<)*%+?%&@+*&2<)*%+?%V`@(%*&'#@?,)?% ![11>!+-\E+P+^>!! HB92*2!/%066_!a0Z!e)%M_!+,-+>! A0#()*0*!i>!=(!(#0!7%)66%)2&6!):!1647#)2*2<46$6!2*&!*0B%)67$0*70>! 6?@+*)+@<)@+&'(A?-"@+@BA,)?&3%<)%= _!P._!\E +,_!+,-+2>! W(*&,!2-001(3! We found in two case-reports (Viinamäki et al. 1998, Saarinen et al. 2005) that lowered SERT in patients with major depression was normalised during dynamic psychotherapy, and we also found that SERT densities were elevated in mixed mania (Tolmunen et al. 2004). We then collected a naturalistic sample of patients with major depression and followed their Hamilton scores and SERT densities for psychotherapy of six months. It was found that the relationship between Hamilton score decrease and SERT increase during psychotherapy followed an inverted U-curve, thus suggesting two different types of responses (Laasonen-Balk et al. 2004). We thereafter collected a sample of drug-naïve first-episode patients with major depression (intention to treat analysis n=33) and randomised them to two groups, one being treated immediately after baseline measurements and the other after waiting six months for dynamic psychotherapy. The baseline findings revealed significant SERT reduction at the level of midbrain (MB) (Joensuu et al. 2007), and moreover an association was discovered between the SERT SS-allele genotype and SERT reduction in medial prefrontal cortex (MPC)(Joensuu et al. 2010). The patients in both groups received a one-year treatment twice a week with dynamic psychotherapy. The SERT changes did not differ between the groups which were consequently pooled together. It was found that in patients with atypical symptoms SERT densities changed towards normal, but not in patients with Hamilton scores typical for major depression (Lehto et al. 2008a). In the same sample dopamine transporter (DAT) densities showed an association with the length of depression (Lehto et al. 2008b). When the whole sample, with a significant baseline SERT reduction, was not selected according to the type of symptoms, it was found that after one-year of treatment patients with high severity of symptoms (above median) at the baseline showed significant SERT normalisation during the one-year therapy whereas patients with low severity (under median symptom burden) did not show changes in SERT densities. However, both groups showed equal reduction in Hamilton scores. (Joensuu et al. 2014, submitted). We conclude that SERT normalisation during dynamic psychotherapy is likely to be related to the reduction of symptom severity and that patients with less symptom burden do not respond to psychotherapy with a change in their lowered SERT levels.

Moreover, our findings on the SERT genotype at baseline is suggestive that different SERT genotypes may have a differential effect on the behaviour of SERT densities in depression.

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