title: HPA axis normalization, estimated by DEX/CRH test, but less alteration on cerebral glucose metabolism in depressed patients receiving ECT after medication treatment failures.
abstract: OBJECTIVE
  To examine the clinical effects of electroconvulsive therapy (ECT) on depressed patients with medication treatment failures, we investigated the alterations in hypothalamic-pituitary-adrenocortical (HPA) function and regional cerebral metabolism rate of glucose (rCMRGlu) after ECT in these patients.
  
  
  METHODS
  Before and after ECT, the combined dexamethasone/corticotrophin-releasing hormone (DEX/CRH) test was administered to seven patients who were referred for ECT. In the same patients, (18)F-fluorodeoxyglucose positron emission tomography ((18)F-FDG PET) was also assessed.
  
  
  RESULTS
  Cortisol response in the DEX/CRH test significantly decreased after a successful ECT. A significant hypometabolism in various frontal regions and hypermetabolism in the parietal regions of these patients when compared with controls remained after ECT.
  
  
  CONCLUSIONS
  Depressed patients who failed trials of antidepressant medication showed a remission with ECT that was accompanied by resolution of HPA dysregulation. However, measures of cerebral brain metabolism did not resolve.
authors.affiliation: Department of Psychiatry and Human Behavior, Gunma University Graduate School of Medicine, Gunma, Japan.
authors.forename: N
authors.initials: N
authors.lastname: Yuuki
authors.forename: I
authors.initials: I
authors.lastname: Ida
authors.forename: A
authors.initials: A
authors.lastname: Oshima
authors.forename: H
authors.initials: H
authors.lastname: Kumano
authors.forename: K
authors.initials: K
authors.lastname: Takahashi
authors.forename: M
authors.initials: M
authors.lastname: Fukuda
authors.forename: N
authors.initials: N
authors.lastname: Oriuchi
authors.forename: K
authors.initials: K
authors.lastname: Endo
authors.forename: H
authors.initials: H
authors.lastname: Matsuda
authors.forename: M
authors.initials: M
authors.lastname: Mikuni
mesh_terms: D000893:Anti-Inflammatory Agents; D000928:Antidepressive Agents / Q000627:therapeutic use; D003346:Corticotropin-Releasing Hormone / Q000378:metabolism; D003866:Depressive Disorder / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000628:therapy*; D003907:Dexamethasone; D004351:Drug Resistance; D004565:Electroconvulsive Therapy; D005260:Female; D019788:Fluorodeoxyglucose F18; D005947:Glucose / Q000378:metabolism; D006801:Humans; D007030:Hypothalamo-Hypophyseal System / Q000502:physiology; D008297:Male; D008875:Middle Aged; D010913:Pituitary-Adrenal System / Q000502:physiology; D049268:Positron-Emission Tomography; D016896:Treatment Outcome
chemical_list: D000893:Anti-Inflammatory Agents; D000928:Antidepressive Agents; D019788:Fluorodeoxyglucose F18; D003907:Dexamethasone; D003346:Corticotropin-Releasing Hormone; D005947:Glucose