Right temporal activation differs between melancholia and nonmelancholic depression: A multichannel near-infrared spectroscopy study Noa Tsujii a, * , Wakako Mikawa a , Hiroyuki Akashi a , Emi Tsujimoto a, b , Toru Adachi a , Eiji Kirime a , Masahiko Takaya a , Masaya Yanagi a , Osamu Shirakawa a a Department of Neuropsychiatry, Kinki University Faculty of Medicine, Osaka, Japan b Department of Psychological Science, Graduate School of Humanities, Kwansei Gakuin University, Hyogo, Japan article info Article history: Received 4 January 2014 Received in revised form 17 March 2014 Accepted 1 April 2014 Keywords: Major depressive disorder Melancholic feature Near-infrared spectroscopy Verbal fluency task abstract The aim of this study was to determine whether melancholia differs from nonmelancholic depression in frontotemporal functioning by means of multichannel near-infrared spectroscopy. We recruited 32 major depressive disorder (MDD) patients with melancholic features (MDD-MF), 28 MDD patients with non- melancholic features (MDD-NMF), and 24 healthy controls. Regional hemodynamic changes induced by a verbal fluency task (VFT) were monitored, and their correlations with depressive symptoms were examined. In comparison with the controls, significant differences were observed in mean oxygenated hemoglobin (oxy-Hb) changes induced by VFT in patients with MDD-MF in 25 channels (p ¼ 0.000 e0.047) and in those with MDD-NMF in 12 channels (p ¼ 0.000e0.023). Moreover, patients with MDD- MF had significantly smaller mean oxy-Hb changes than those with MDD-NMF in 8 channels of the right temporal region (p ¼ 0.001e0.048). No significant correlations were observed between mean oxy-Hb changes and the Hamilton rating scale for depression (HAMD) 17 total score in both groups of pa- tients with MDD. On examining each item of HAMD17, psychomotor retardation in patients with MDD- MF showed a significant positive correlation with mean oxy-Hb changes in the right temporal region (ch43; r ¼ 0.55; p ¼ 0.001), whereas that in patients with MDD-NMF showed a significant negative correlation with mean oxy-Hb changes in the frontal and left temporal regions in 3 channels (r ¼À0.60 to À0.53; p ¼ 0.000e0.004). In conclusion, our results indicate that melancholia is qualitatively distinct from nonmelancholic depression both clinically and biologically. Ó 2014 Elsevier Ltd. All rights reserved. 1. Objectives of the study and background Melancholia is defined as episodes of depression with affective disturbances, psychomotor retardation, and cognitive impairment (Parker et al., 2010a; Rush and Weissenburger, 1994), and it is observed in 20%e30% of individuals meeting the diagnostic criteria for major depressive disorder (MDD) (Day and Williams, 2012). Melancholia is believed to be a valid depression subtype with worse outcomes, treatment response, suicidal risk, and biological func- tioning. Furthermore, it is believed to be qualitatively distinct from nonmelancholic MDD both clinically and biologically (Rush and Weissenburger, 1994; Pizzagalli et al., 2003; Leventhal and Rehm, 2005; McGrath et al., 2008). Neuroimaging studies of MDD have provided evidence of spe- cific functional abnormalities mainly in the prefrontal cortex. Structural magnetic resonance imaging studies have reported that individuals with MDD exhibit a reduction in white matter in the dorsolateral frontal cortex and areas associated with the limbic system, thalamic projection fibers, and corpus callosum (Korgaonkar et al., 2010; Kupfer et al., 2012). Functional neuro- imaging studies have indicated that patients with MDD with melancholic features (MDD-MF) show decreased regional cerebral blood flow in the right hemisphere (Lesser et al., 1994) and right anterior frontal cortex (Murata et al., 2000). In addition, individuals with MDD-MF show decreased activity of the subgenual prefrontal cortex (Pizzagalli et al., 2003). Furthermore, in comparison with nonmelancholic MDD, melancholia is more likely to be associated * Corresponding author. Department of Neuropsychiatry, Kinki University Faculty of Medicine, 377-2 Ohnohigashi, Osakasayama, Osaka 589-8511, Japan. Tel.: þ81 72 366 0221; fax: þ81 72 367 6950. E-mail address: tujiinoa@med.kindai.ac.jp (N. Tsujii). Contents lists available at ScienceDirect Journal of Psychiatric Research journal homepage: www.elsevier.com/locate/psychires http://dx.doi.org/10.1016/j.jpsychires.2014.04.003 0022-3956/Ó 2014 Elsevier Ltd. All rights reserved. Journal of Psychiatric Research xxx (2014) 1e7 Please cite this article in press as: Tsujii N, et al., Right temporal activation differs between melancholia and nonmelancholic depression: A multichannel near-infrared spectroscopy study, Journal of Psychiatric Research (2014), http://dx.doi.org/10.1016/j.jpsychires.2014.04.003