McCormick Laurie M, Boles Ponto Laura L, Pierson Ron K, Johnson Hans J, Magnotta Vincent, Brumm Michael C
Department of Psychiatry, Carver College of Medicine, University of Iowa, Psychiatric Iowa Neuroimaging Center, Iowa City, IA 52242, USA.
J ECT. 2007 Dec;23(4):265-73. doi: 10.1097/yct.0b013e318150d56d.
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.
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.
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.
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.
尽管电休克疗法（ECT）是治疗抑郁症和精神病的一种非常有效的方法，但其作用机制尚未完全阐明。本研究的目的是通过在一个ECT疗程前后使用正电子发射断层扫描评估脑葡萄糖代谢，来研究ECT引起的脑代谢功能改变。
对10名患有精神病性抑郁症的受试者在一个ECT疗程之前以及疗程后2至3周之间使用[F]氟脱氧葡萄糖进行正电子发射断层扫描研究。使用统计参数映射以及对前扣带回皮质（ACC）亚区域（背侧、喙部、胼胝体下和膝下）和海马体进行感兴趣区域分析，以确定ECT引起的葡萄糖代谢变化。汉密尔顿抑郁量表和阳性症状评估量表是用于评估ECT临床变化的主要测量工具。
电休克疗法导致左膝下ACC和海马体代谢显著增加，二者相互直接相关，并且与汉密尔顿抑郁量表总分所测量的抑郁程度降低相关。抗抑郁反应较好者左膝下ACC和海马体代谢增加，而反应较差者则降低。阳性症状的减少也与左海马体代谢增加相关。
ECT的抗抑郁作用与左膝下ACC和海马体代谢增加相关，而ECT的抗精神病作用仅与左海马体代谢增加相关。这一发现有助于更好地理解ECT的抗抑郁和抗精神病作用机制。
