Esketamine combined with sertraline for brain altered regional homogeneity in patients with major depressive disorder: A preliminary study.
Xiang Liu, Ziyi Hua, Yongqiang Shu, Lifeng Li, Shan Xia, Jiangping Li, Haijun Li, Ailan Wan, Dechang Peng, Guojiang Wu
Brain Research Bulletin November 13, 2025 DOI: 10.1016/j.brainresbull.2025.111637 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Observational cohort Peer reviewed |
|---|---|
| Sample size | 27 |
| Population | Patients with major depressive disorder and healthy individuals |
| Interventions | esketamine sertraline |
| Dose | 0.25 mg/kg |
| Duration | 2-week intervention |
| Topics | Depression Esketamine |
| Keywords | Antidepressants Reho Sertraline Clinical depression Mood disorder Mental health Antidepressant therapy Pharmacotherapy Drug treatment Medication Psychopharmacology Combination therapy Brain activity Neuroimaging Brain function Regional homogeneity |
| Citations | 1 |
| Key findings | After two weeks of esketamine combined with sertraline, the left middle temporal gyrus showed a reversal of abnormal regional homogeneity toward normal levels, and these changes correlated with anxiety scores. |
Abstract
This study aims to explore the relationship between the antidepressant effects of drugs (esketamine combined with sertraline) and brain function changes in patients with major depressive disorder. A total of 27 patients with major depressive disorder (MDD) and 27 healthy individuals were included in the study. All MDD patients received a 2-week course of intravenous esketamine infusion (0.25 mg/kg) combined with sertraline. We assessed patients' post-treatment emotional and cognitive recovery using the Hamilton Anxiety Scale, Hamilton Depression Scale, Beck Suicide Ideation Scale, and Montreal Cognitive Assessment Scale. Additionally, all participants underwent magnetic resonance imaging (MRI) scans, with local consistency techniques employed to evaluate changes in brain spontaneous activity before and after treatment. Finally, correlation analysis was used to assess the relationship between the characteristics of spontaneous brain activity in MDD patients and clinical scales. We found that the Reho values of certain brain regions in MDD patients differed from those in the healthy group, primarily manifested as increased regional homogeneity (Reho) values in the right superior frontal gyrus, right precentral gyrus, right middle occipital gyrus, and left middle temporal gyrus; and decreased Reho values in the right middle temporal gyrus, bilateral temporal lobes, and right posterior cerebellar lobe. After two weeks of drug treatment, we observed a reversal in the local consistency of the left middle temporal gyrus (L-MTG), which tended toward normal levels. Additionally, we observed significant improvements in anxiety, depression symptoms, suicidal ideation, and MoCA scores in MDD patients post-treatment. Furthermore, changes in Reho values in the left middle temporal gyrus (L-MTG) were significantly correlated with scores on clinical assessment scales (HAMA). Patients with MDD exhibit imbalances in spontaneous brain activity. The L-MTG, as a key hub of the default mode network and salience network, is associated with the severity of depression and recovery after treatment.