Metabolic correlates of antidepressant and antipsychotic response in patients with psychotic depression undergoing electroconvulsive therapy.
OBJECTIVE
Although electroconvulsive therapy (ECT) is a very effective treatment of depression and psychosis, the mechanisms by which this occurs are not fully delineated. The objective of this study was to investigate the functional alterations in brain metabolism in response to ECT through the use of positron emission tomography assessment of cerebral glucose metabolism before and after a course of ECT.


METHODS
Ten subjects with psychotic depression were studied with positron emission tomography using [F]fluorodeoxyglucose before and between 2 and 3 weeks after a course of ECT. Statistical parametric mapping and region of interest analyses of the anterior cingulate cortex (ACC) subregions (dorsal, rostral, subcallosal, and subgenual) and hippocampus were used to determine glucose metabolic changes from ECT. The Hamilton Depression Rating Scale and the Scale for Assessing Positive Symptoms were the primary measures used for assessing clinical changes from ECT.


RESULTS
Electroconvulsive therapy led to significant increases in the left subgenual ACC and hippocampal metabolism, which were directly correlated with each other and to a reduction in depression as measured by total Hamilton Depression Rating Scale scores. Better antidepressant responders had increased, whereas poorer responders had a decreased left subgenual ACC and hippocampal metabolism. The decrease in positive symptoms was also correlated with increased left hippocampal metabolism.


CONCLUSIONS
The antidepressant effect of ECT was correlated with increased metabolism in the left subgenual ACC and hippocampus, whereas the antipsychotic effect of ECT was only correlated with increased left hippocampal metabolism. This finding has implications to better understand the mechanism of antidepressant and antipsychotic effects of ECT.
McCormick
Laurie M
LM
Department of Psychiatry, Carver College of Medicine, University of Iowa, Psychiatric Iowa Neuroimaging Center, Iowa City, IA 52242, USA. laurie-mccormich@uiowa.edu
Boles Ponto
Laura L
LL
Pierson
Ron K
RK
Johnson
Hans J
HJ
Magnotta
Vincent
V
Brumm
Michael C
MC
D000328:Adult; D000339:Affect / Q000187:drug effects / Q000502:physiology; D000928:Antidepressive Agents / Q000008:administration & dosage; D014150:Antipsychotic Agents / Q000008:administration & dosage; D001921:Brain / Q000000981:diagnostic imaging / Q000187:drug effects / Q000503:physiopathology*; D001931:Brain Mapping; D003131:Combined Modality Therapy; D003337:Corpus Callosum / Q000000981:diagnostic imaging / Q000187:drug effects / Q000503:physiopathology; D003865:Major Depressive Disorder / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D004292:Dominance, Cerebral / Q000502:physiology; D004565:Electroconvulsive Therapy; D004734:Energy Metabolism / Q000187:drug effects / Q000502:physiology*; D005260:Female; D019788:Fluorodeoxyglucose F18; D006179:Gyrus Cinguli / Q000000981:diagnostic imaging / Q000187:drug effects / Q000503:physiopathology; D006624:Hippocampus / Q000000981:diagnostic imaging / Q000187:drug effects / Q000503:physiopathology; D006801:Humans; D007091:Image Processing, Computer-Assisted; D021621:Imaging, Three-Dimensional; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D010555:Personality Inventory; D049268:Positron-Emission Tomography; D011569:Psychiatric Status Rating Scales; D016896:Treatment Outcome
D000928:Antidepressive Agents; D014150:Antipsychotic Agents; D019788:Fluorodeoxyglucose F18