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Letter to the Editor   |    
Amygdala Morphometry in Affective Disorders
L. TEBARTZ van ELST, M.D.
Am J Psychiatry 2005;162:629-629. doi:10.1176/appi.ajp.162.3.629

To the Editor: In their interesting review article on hippocampal and amygdala volumetry, Stephanie Campbell, Ph.D., and coworkers (1) reported that inclusion of the amygdala with the hippocampus obscures volumetric findings. However, besides the technical argument, there are other strong points why the amygdala and hippocampus should not be measured as a single structure. Besides the studies mentioned in the review, there are even more reports of increased amygdala volumes in depressive (2, 3) and other (4) affective disorders. Thus, including possibly increased amygdala and decreased hippocampal volumes within one measurement obviously decreases the sensitivity of a method. Besides, the basolateral amygdala is a functionally and anatomically distinct structure (5) that is assessable in a reliable way with modern magnetic resonance imaging technology (6) and should therefore not be mixed up with the hippocampus.

Furthermore, the authors point out that clinical variables, such as duration of illness or presence of abuse, may account for much of the variance of the volumetric findings, whereas factors such as slice thickness or other scan parameters were not so important. However, another confounding clinical factor that might be even more important is medication. There is evidence that psychotropic medication might affect the volume not only of the amygdala (7) but also of the hippocampus (8). Thus, medication should be controlled when we measure amygdala or hippocampal volumes in affective and other neuropsychiatric disorders.

Campbell S, Marriott M, Nahmias C, MacQueen GM: Lower hippocampal volume in patients suffering from depression: a meta-analysis. Am J Psychiatry  2004; 161:598–607
[PubMed]
[CrossRef]
 
Altshuler LL, Bartzokis G, Grieder T, Curran J, Mintz J: Amygdala enlargement in bipolar disorder and hippocampal reduction in schizophrenia: an MRI study demonstrating neuroanatomic specificity (letter). Arch Gen Psychiatry  1998; 55:663–664
[PubMed]
[CrossRef]
 
Strakowski SM, DelBello MP, Sax KW, Zimmermann ME, Shear PK, Hawkins JM, Larson ER: Brain magnetic resonance imaging of structural abnormalities in bipolar disorder. Arch Gen Psychiatry  1999; 56:254–260
[PubMed]
[CrossRef]
 
De Bellis MD, Casey BJ, Dahl RE, Birmaher B, Williamson DE, Thomas KM, Axelson DA, Frustaci K, Boring AM, Hall J, Ryan ND: A pilot study of amygdala volumes in pediatric generalized anxiety disorder. Biol Psychiatry  2001; 48:51–57
 
McDonald AJ: Is there an amygdala and how far does it extend? an anatomical perspective. Ann NY Acad Sci  2003; 985:1–21
[PubMed]
 
Tebartz van Elst L, Hesslinger B, Thiel T, Geiger E, Haegele K, Lemieux L, Lieb K, Bohus M, Hennig J, Ebert D: Frontolimbic brain abnormalities in patients with borderline personality disorder: a volumetric magnetic resonance imaging study. Biol Psychiatry  2003; 54:163–171
[PubMed]
[CrossRef]
 
Tebartz van Elst L, Hesslinger B, Ebert D, Trimble MR: Chronic antidopaminergic medication might affect amygdala structure in patients with schizophrenia. Pharmacopsychiatry  2004; 37:217–220
[PubMed]
[CrossRef]
 
Schmitt A, Weber S, Jatzko A, Braus DF, Henn FA: Hippocampal volume and cell proliferation after acute and chronic clozapine or haloperidol treatment. J Neural Transm  2004; 111:91–100
[PubMed]
[CrossRef]
 
+

References

Campbell S, Marriott M, Nahmias C, MacQueen GM: Lower hippocampal volume in patients suffering from depression: a meta-analysis. Am J Psychiatry  2004; 161:598–607
[PubMed]
[CrossRef]
 
Altshuler LL, Bartzokis G, Grieder T, Curran J, Mintz J: Amygdala enlargement in bipolar disorder and hippocampal reduction in schizophrenia: an MRI study demonstrating neuroanatomic specificity (letter). Arch Gen Psychiatry  1998; 55:663–664
[PubMed]
[CrossRef]
 
Strakowski SM, DelBello MP, Sax KW, Zimmermann ME, Shear PK, Hawkins JM, Larson ER: Brain magnetic resonance imaging of structural abnormalities in bipolar disorder. Arch Gen Psychiatry  1999; 56:254–260
[PubMed]
[CrossRef]
 
De Bellis MD, Casey BJ, Dahl RE, Birmaher B, Williamson DE, Thomas KM, Axelson DA, Frustaci K, Boring AM, Hall J, Ryan ND: A pilot study of amygdala volumes in pediatric generalized anxiety disorder. Biol Psychiatry  2001; 48:51–57
 
McDonald AJ: Is there an amygdala and how far does it extend? an anatomical perspective. Ann NY Acad Sci  2003; 985:1–21
[PubMed]
 
Tebartz van Elst L, Hesslinger B, Thiel T, Geiger E, Haegele K, Lemieux L, Lieb K, Bohus M, Hennig J, Ebert D: Frontolimbic brain abnormalities in patients with borderline personality disorder: a volumetric magnetic resonance imaging study. Biol Psychiatry  2003; 54:163–171
[PubMed]
[CrossRef]
 
Tebartz van Elst L, Hesslinger B, Ebert D, Trimble MR: Chronic antidopaminergic medication might affect amygdala structure in patients with schizophrenia. Pharmacopsychiatry  2004; 37:217–220
[PubMed]
[CrossRef]
 
Schmitt A, Weber S, Jatzko A, Braus DF, Henn FA: Hippocampal volume and cell proliferation after acute and chronic clozapine or haloperidol treatment. J Neural Transm  2004; 111:91–100
[PubMed]
[CrossRef]
 
+
+

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