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):172-6. doi: 10.1007/s00406-002-0378-1.
Electroconvulsive therapy (ECT) is an effective treatment for major depressive illness, even for patients who do not respond to antidepressant drugs. According to the prevailing neurophysiological hypotheses for depression, it can be expected that an ECT therapeutic course modulates the responsivity of central neurotransmitter systems, but the results up to now have been inconclusive. To test such hypotheses, we studied possible changes in the serotonergic and in dopaminergic systems' responsivity in 11 male patients with major depression by performing neuroendocrine challenge tests before and after a therapeutic ECT course.
Serotonergic responsivity was assessed by measuring the prolactin and cortisol responses to i. v. administration of the serotonin uptake inhibitor clomipramine (CMI test), and dopaminergic responsivity by measuring the prolactin responses to the dopamine receptor blocker haloperidol (HAL test), administered intramuscularly. The prolactin and cortisol responses during the first and the last ECT of the course (8 to 13 sessions) were also assessed. The CMI and HAL tests were also performed in 13 male healthy subjects.
The prolactin responses to CMI were significantly blunted in the patient group compared to the control group, and remained unaltered at the end of the ECT course, although the depressive symptomatology was substantially reduced from 27.8 +/- 7.1 to 4.8 +/- 2.3 points in the Hamilton Depression Rating Scale. The cortisol responses to CMI were blunted before the ECT course compared to controls, but not after the course: there was a moderate increase of cortisol at + 30 min in the CMI test after the ECT course compared to that before ECT (p = 0.05). The prolactin and cortisol responses to the electrical stimulus during the first and the last ECT were identical.
The strong therapeutic effect of ECT in depression, observed already at the end of the course, is not a result of considerable modifications in central serotonergic or dopaminergic responsivity, as revealed by the neuroendocrine challenge tests and the hormone responses to the electrical stimulus. The enhancement of the cortisol responses to CMI after the course may indicate a moderate increase in 5-HT1A receptor responsivity.
电休克疗法（ECT）是治疗重度抑郁症的一种有效方法，即使对于对抗抑郁药物无反应的患者也是如此。根据目前关于抑郁症的神经生理学假说，可以预期一个ECT疗程会调节中枢神经递质系统的反应性，但到目前为止结果尚无定论。为了验证这些假说，我们通过在一个治疗性ECT疗程前后进行神经内分泌激发试验，研究了11例重度抑郁症男性患者血清素能和多巴胺能系统反应性的可能变化。
通过测量静脉注射血清素摄取抑制剂氯米帕明后的催乳素和皮质醇反应来评估血清素能反应性（CMI试验），通过测量肌肉注射多巴胺受体阻滞剂氟哌啶醇后的催乳素反应来评估多巴胺能反应性（HAL试验）。还评估了疗程中第一次和最后一次ECT（8至13次治疗）期间的催乳素和皮质醇反应。13名男性健康受试者也进行了CMI和HAL试验。
与对照组相比，患者组对CMI的催乳素反应明显减弱，并且在ECT疗程结束时保持不变，尽管汉密尔顿抑郁量表中的抑郁症状从27.8±7.1分大幅降至4.8±2.3分。与对照组相比，ECT疗程前对CMI的皮质醇反应减弱，但疗程后未减弱：ECT疗程后CMI试验中+30分钟时的皮质醇有适度增加，与ECT前相比（p = 0.05）。第一次和最后一次ECT期间对电刺激的催乳素和皮质醇反应相同。
如神经内分泌激发试验和对电刺激的激素反应所示，在疗程结束时已观察到的ECT对抑郁症的强大治疗效果，并非中枢血清素能或多巴胺能反应性发生显著改变的结果。疗程后对CMI的皮质醇反应增强可能表明5-HT1A受体反应性有适度增加。
