SPECT and neuropsychological performance in severe depression treated with ECT.
BACKGROUND
In severe depression, studies of regional cerebral blood flow (rCBF) by SPECT have not produced uniform results. The association between changes in SPECT and electroconvulsive therapy (ECT) has shown somewhat conflicting data. No data are available on benzodiazepine receptor function SPECT studies in ECT.


METHODS
Twenty drug-resistant adult inpatients fulfilling the DSM-IIIR criteria for major depression were studied by SPECT (rCBF by relative ECD uptake in all, and benzodiazepine receptor function by iomazenil uptake in five subjects) before and 1 week after clinically successful bitemporal ECT. Clinical and neuropsychological test scores were used as references for the possible changes in SPECT.


RESULTS
An increased perfusion after ECT was observed in right temporal and bilateral parietal cortices, whereas no reductions in relative ECD uptake were seen after ECT. Iomazenil-SPECT revealed a highly significant increase in the benzodiazepine receptor uptake in all studied cortical regions except temporal cortices.


CONCLUSIONS
Clinically successful ECT was associated with changes in vascular perfusion and GABAergic neurotransmission, providing new evidence for the mechanism of action of ECT and for the neurobiology of severe drug-resistant depression.
Mervaala
E
E
Department of Clinical Neurophysiology, University Hospital of Kuopio, 70210 Kuopio, Finland. esa.mervaala@kuh.fi
Könönen
M
M
Föhr
J
J
Husso-Saastamoinen
M
M
Valkonen-Korhonen
M
M
Kuikka
J T
JT
Viinamäki
H
H
Tammi
A K
AK
Tiihonen
J
J
Partanen
J
J
Lehtonen
J
J
D000328:Adult; D001921:Brain / Q000098:blood supply* / Q000503:physiopathology; D002540:Cerebral Cortex / Q000098:blood supply / Q000503:physiopathology; D003865:Major Depressive Disorder / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D004292:Dominance, Cerebral / Q000502:physiology; D004565:Electroconvulsive Therapy; D005260:Female; D005442:Flumazenil / Q000031:analogs & derivatives* / Q000493:pharmacokinetics; D006801:Humans; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D011869:Radioligand Assay; D011963:Receptors, GABA-A / Q000502:physiology*; D012039:Regional Blood Flow / Q000502:physiology; D009435:Synaptic Transmission / Q000502:physiology; D013702:Temporal Lobe / Q000098:blood supply / Q000503:physiopathology; D015899:Tomography, Emission-Computed, Single-Photon; D016896:Treatment Outcome; D005680:gamma-Aminobutyric Acid / Q000502:physiology
D011963:Receptors, GABA-A; D005442:Flumazenil; D005680:gamma-Aminobutyric Acid; C063038:iomazenil