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Serotonin and dopamine transporter availability in social anxiety disorder after combined treatment with escitalopram and cognitive-behavioral therapy
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2022 (English)In: Translational Psychiatry, E-ISSN 2158-3188, Vol. 12, no 1, article id 436Article in journal (Refereed) Published
Abstract [en]

Selective serotonin reuptake inhibitors (SSRIs) and internet-based cognitive behavioral therapy (ICBT) are recommended treatments of social anxiety disorder (SAD), and often combined, but their effects on monoaminergic signaling are not well understood. In this multi-tracer positron emission tomography (PET) study, 24 patients with SAD were randomized to treatment with escitalopram+ICBT or placebo+ICBT under double-blind conditions. Before and after 9 weeks of treatment, patients were examined with positron emission tomography and the radioligands [11C]DASB and [11C]PE2I, probing the serotonin (SERT) and dopamine (DAT) transporter proteins respectively. Both treatment combinations resulted in significant improvement as measured by the Liebowitz Social Anxiety Scale (LSAS). At baseline, SERT-DAT co-expression was high and, in the putamen and thalamus, co-expression showed positive associations with symptom severity. SERT-DAT co-expression was also predictive of treatment success, but predictor-outcome associations differed in direction between the treatments. After treatment, average SERT occupancy in the SSRI + ICBT group was >80%, with positive associations between symptom improvement and occupancy in the nucleus accumbens, putamen and anterior cingulate cortex. Following placebo+ICBT, SERT binding increased in the raphe nuclei. DAT binding increased in both groups in limbic and striatal areas, but relations with symptom improvement differed, being negative for SSRI + ICBT and positive for placebo + ICBT. Thus, serotonin-dopamine transporter co-expression exerts influence on symptom severity and remission rate in the treatment of social anxiety disorder. However, the monoamine transporters are modulated in dissimilar ways when cognitive-behavioral treatment is given concomitantly with either SSRI-medication or pill placebo.

Place, publisher, year, edition, pages
2022. Vol. 12, no 1, article id 436
Keywords [en]
social anxiety disorder, SAD, serotonin, dopamine, escitalopram, cognitive-behavioral therapy, CBT
National Category
Psychology
Research subject
Psychology
Identifiers
URN: urn:nbn:se:su:diva-210721DOI: 10.1038/s41398-022-02187-3ISI: 000864640500001PubMedID: 36202797Scopus ID: 2-s2.0-85139325414OAI: oai:DiVA.org:su-210721DiVA, id: diva2:1706301
Funder
Swedish Research CouncilThe Swedish Brain FoundationRiksbankens JubileumsfondAvailable from: 2022-10-25 Created: 2022-10-25 Last updated: 2024-01-17Bibliographically approved

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