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Neuroimaging of Obsessive-Compulsive Disorder: Insights into Serotonergic Mechanisms

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PET and SPECT in Psychiatry

Abstract

The neurobiology of obsessive-compulsive disorder (OCD) is not well understood. The clinical benefits of selective serotonin-reuptake inhibitors (SSRIs) have implicated serotonin, but a clear understanding of its role in symptom onset, aggravation, and resolution remains elusive. Some progress has come from studies using positron emission tomography (PET). PET studies with α-[11C]methyl-l-tryptophan suggest that OCD patients, relative to healthy controls, have elevated brain serotonin synthesis capacity. This increase becomes greater following treatment with either cognitive behavior therapy or an SSRI. A similar phenomenon has been observed in most PET studies targeting the serotonin transporter. Compared to healthy controls, OCD patients commonly exhibit decreased serotonin reuptake potential, a group difference that can also enlarge following treatment. Some of these serotonergic alterations might be unique to OCD. Finally, contrasting with what is seen in those with OCD, brain serotonin synthesis capacity is decreased in people who have difficulty regulating impulsive behaviors, such as those with borderline personality disorder and a history of suicide attempts. Together, these observations raise the possibility that elevated serotonergic tone may be an attempt to inhibit OCD symptoms, a mechanism of “braking” or “resistance” that becomes more effective with treatment.

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Acknowledgements

Alexandre Berney MD, Igor Sibon MD, PhD, Amir Barsoum MD, Gilbert Pinard MD, Akio Nakai MD, PhD, Mirko Diksic PhD.

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Authors and Affiliations

  1. Department of Psychiatry, McGill University, Montreal, QC, Canada

    Jennifer I. Lissemore, Linda Booij, Marco Leyton, Paul Gravel, Debbie Sookman & Chawki Benkelfat

  2. Department of Psychology, Concordia University & CHU Sainte-Justine Research Centre, Montreal, QC, Canada

    Linda Booij

  3. Department of Neurology and Neurosurgery, McConnell Brain Imaging Center, Montreal Neurological Institute, McGill University, Montreal, QC, Canada

    Marco Leyton, Paul Gravel & Chawki Benkelfat

  4. Department of Psychology, McGill University Health Center, Montreal, QC, Canada

    Debbie Sookman

  5. Department of Psychiatry and Behavioral Science, UC Davis Medical Center, Sacramento, CA, USA

    Thomas E. Nordahl

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Correspondence to Marco Leyton .

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Editors and Affiliations

  1. Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, Groningen, The Netherlands

    Rudi A.J.O. Dierckx

  2. Faculty of Electrical Engineering, Medical Engineering and Computer Science, Offenburg University, Offenburg, Germany

    Andreas Otte

  3. Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, Groningen, The Netherlands

    Erik F. J. de Vries

  4. Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, Groningen, The Netherlands

    Aren van Waarde

  5. Biomedical Sciences of Cells and Systems, University Medical Center Groningen, Groningen, The Netherlands

    Iris E. Sommer

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Lissemore, J.I. et al. (2021). Neuroimaging of Obsessive-Compulsive Disorder: Insights into Serotonergic Mechanisms. In: Dierckx, R.A., Otte, A., de Vries, E.F.J., van Waarde, A., Sommer, I.E. (eds) PET and SPECT in Psychiatry. Springer, Cham. https://doi.org/10.1007/978-3-030-57231-0_13

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