Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Health Care Services, Region Stockholm, Sweden.; Department of Neuropsychiatry, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan.
Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Health Care Services, Region Stockholm, Sweden.
J Affect Disord. 2021 Nov 1;294:645-651. doi: 10.1016/j.jad.2021.07.060. Epub 2021 Jul 17.
Electroconvulsive therapy (ECT) is an effective treatment for depressive disorders, although its molecular mechanism of action is unknown. The serotonin 1B (5-HT) receptor is a potential target for treatment of depression and low 5-HT receptor binding in limbic regions has been reported in previous positron emission tomography (PET) studies of depression.
The objective of this longitudinal PET study was to examine the effect of ECT for depression on 5-HT receptor binding. Fifteen hospitalized patients with major depressive episodes were examined with PET and the 5-HT receptor selective radioligand [C]AZ10419369, before and after ECT. Fifteen controls matched for age and sex were examined. Limbic regions with previously reported low 5-HT receptor binding in depression and a dorsal brain stem region were selected.
Thirteen patients completed the study according to protocol. Eleven out of thirteen patients responded to ECT. 5-HT receptor binding in hippocampus increased with 30 % after ECT (p=0.021). Using linear mixed effects modelling, we observed increases in 5-HT receptor binding following ECT with a moderate to large effect size, which did not differ significantly between regions. In an exploratory analysis, strong correlations between changes in 5-HT receptor binding and agitation scores on the Hamilton Depression Rating Scale after ECT were observed.
Albeit representative of a PET study, the sample size is still small and there are potential confounding effects of medication.
Increased 5-HT receptor binding was observed following ECT for depression, corresponding to previous findings of increased 5-HT receptor binding in hippocampus after rapid acting ketamine for treatment resistant depression.
电痉挛疗法（ECT）是治疗抑郁症的有效方法，尽管其作用机制尚不清楚。5-羟色胺 1B（5-HT）受体是治疗抑郁症的潜在靶点，先前的抑郁症正电子发射断层扫描（PET）研究报道了边缘区域 5-HT 受体结合减少。
本纵向 PET 研究的目的是研究 ECT 对抑郁症 5-HT 受体结合的影响。15 名住院的重性抑郁发作患者在 ECT 前后接受了 PET 和 5-HT 受体选择性放射性配体 [C]AZ10419369 检查。15 名年龄和性别匹配的对照组接受了检查。选择了先前报道的抑郁症中 5-HT 受体结合减少的边缘区域和背侧脑干区域。
13 名患者按方案完成了研究。13 名患者中的 11 名对 ECT 有反应。ECT 后海马体 5-HT 受体结合增加了 30%（p=0.021）。使用线性混合效应模型，我们观察到 ECT 后 5-HT 受体结合增加，效应大小为中到大，区域间无显著差异。在探索性分析中，观察到 ECT 后 5-HT 受体结合的变化与汉密尔顿抑郁量表的激动评分之间存在强烈的相关性。
尽管是 PET 研究的代表，但样本量仍然较小，并且存在药物潜在混杂效应。
抑郁症患者接受 ECT 后 5-HT 受体结合增加，与先前快速作用的氯胺酮治疗难治性抑郁症后海马体 5-HT 受体结合增加的发现一致。
