title: The Normalization of Brain ¹⁸F-fluorodeoxy-D-glucose Positron Emission Tomography Hypometabolism following Electroconvulsive Therapy in a 55-year-old Woman with Treatment-resistant Late Onset Depression: A Case Report.
abstract: Major depressive disorder, especially in later life, has heterogeneous clinical characteristics and treatment responses. Symptomatically, psychomotor retardation, lack of energy, and apathy tends to be more common in people with late-onset depression (LOD). Despite recent advances in psychopharmacologic treatments, 20% to 30% of patients with mood disorders experience inadequate responses to medication, often resulting in a trial of electroconvulsive therapy (ECT). However, the therapeutic mechanism of ECT is still unclear. By using ¹⁸F-fluorodeoxy-D-glucose positron emission tomography-computed tomography (¹⁸F-FDG PET/CT), we can obtain the status of brain metabolism in patients with neuropsychiatric disorders and changes during psychiatric treatment course. The object of this case report is evaluating the effect of ECT on brain metabolism in treatment-refractory LOD by PET/CT and understanding the mode of action of ECT. In this case report, we presented a 55-year-old female patient who suffered psychotic depression that was resistant to pharmacological treatment. Several antidepressants and atypical antipsychotics were applied but there was no improvement in her symptoms. The patient presented not only depressed mood and behaviors but also deficit in cognitive functions. We found decreased diffuse cerebral metabolism in her brain ¹⁸F-FDG PET/CT image. ECT resulted in amelioration of the patients' symptoms and another brain PET imaging 7 weeks after the last ECT course showed that her brain metabolism was normalized.
authors.affiliation: Department of Psychiatry, Soonchunhyang University College of Medicine, Cheonan, Korea.
authors.forename: Jeongjae
authors.initials: J
authors.lastname: Bak
authors.affiliation: Department of Nuclearmedicine, Soonchunhyang University College of Medicine, Cheonan, Korea.
authors.forename: Sang Mi
authors.initials: SM
authors.lastname: Lee
authors.affiliation: Department of Psychiatry, Soonchunhyang University College of Medicine, Cheonan, Korea.
authors.forename: Young-Joon
authors.initials: YJ
authors.lastname: Kwon
authors.affiliation: Department of Psychiatry, Soonchunhyang University College of Medicine, Cheonan, Korea.
authors.forename: Se-Hoon
authors.initials: SH
authors.lastname: Shim
authors.affiliation: Institute for Integrative Medicine, Catholic Kwandong University College of Medicine, Incheon, Korea.|Department of Radiology, International St. Mary's Hospital, Incheon, Korea.
authors.forename: Joong Il
authors.initials: JI
authors.lastname: Kim
keywords: Depression; Electroconvulsive therapy; Fluorodeoxyglucose F18; Positron emission tomography