Markianos Manolis, Hatzimanolis John, Lykouras Lefteris
Athens University Medical School, Psychiatric Clinic, Eginition Hospital, Vas Sophias 74, Athens 11528, Greece.
Eur Arch Psychiatry Clin Neurosci. 2002 Aug;252(4):166-71. doi: 10.1007/s00406-002-0377-2.
The prolactin (PRL) increases in plasma, induced by the electrical stimulus during electroconvulsive therapy (ECT), is a consistent finding that can be studied in order to obtain information about its actions on the brain neurotransmitter systems, the most probable candidates being the serotonergic and the dopaminergic system. Central serotonergic and dopaminergic responsivity may also be assessed using neuroendocrine challenge tests. In this study, we measured the PRL responses during the first ECT of a therapeutic course in 15 male depressive patients, of mean age 49.2 +/- 14.5 (range 22 to 68 years), and score in the HDRS of 29 +/- 8 (range 18 to 43 points). Before the ECT course, we assessed the central serotonergic and dopaminergic responsivities, by measuring the PRL responses to the administration of the serotonin uptake inhibitor clomipramine (CMI) intravenously, and, two days later, the PRL responses dopamine receptor blocker haloperidol (HAL), administered intramuscularly. The CMI and HAL tests were also performed in 15 healthy male subjects. The PRL responses to CMI of the patients were blunted compared to healthy controls, while the PRL responses to HAL were not significantly different from controls. Searching for correlations among the maximal PRL responses to the three stimuli in the patient's group, we found that the PRL responses to ECT were significantly correlated to the PRL responses to i. m. HAL (r = 0.8205, N = 15, p < 0.001) and not to the PRL responses to i. v. CMI (r = 0.1713, n. s.). It is suggested that the rises in PRL during ECT reflect the responsivity of the hypothalamus-pituitary dopaminergic system, and seem to be the result of a transient decrease in the inhibitory dopaminergic input of the hypothalamus to the pituitary lactotrophs, caused by the electrical stimulus and the subsequent seizure.
在电休克治疗（ECT）期间，电刺激会使血浆中的催乳素（PRL）升高，这是一个持续存在的现象，可以对其进行研究以获取有关其对脑内神经递质系统作用的信息，最有可能的候选系统是血清素能系统和多巴胺能系统。中枢血清素能和多巴胺能反应性也可以使用神经内分泌激发试验进行评估。在本研究中，我们测量了15名男性抑郁症患者在一个治疗疗程的首次ECT期间的PRL反应，这些患者的平均年龄为49.2±14.5岁（范围为22至68岁），汉密尔顿抑郁量表（HDRS）评分为29±8（范围为18至43分）。在ECT疗程之前，我们通过测量静脉注射血清素摄取抑制剂氯米帕明（CMI）后的PRL反应，以及两天后肌肉注射多巴胺受体阻滞剂氟哌啶醇（HAL）后的PRL反应，来评估中枢血清素能和多巴胺能反应性。15名健康男性受试者也进行了CMI和HAL试验。与健康对照组相比，患者对CMI的PRL反应减弱，而对HAL的PRL反应与对照组无显著差异。在患者组中寻找对三种刺激的最大PRL反应之间的相关性时，我们发现对ECT的PRL反应与对肌肉注射HAL的PRL反应显著相关（r = 0.8205，N = 15，p < 0.001），而与对静脉注射CMI的PRL反应无关（r = 0.1713，无统计学意义）。提示ECT期间PRL的升高反映了下丘脑 - 垂体多巴胺能系统的反应性，似乎是电刺激和随后的癫痫发作导致下丘脑对垂体催乳细胞的抑制性多巴胺能输入短暂减少的结果。
