Department of Basic and Clinical Pharmacology, Anhui Institute of Innovative Drugs, School of Pharmacy, Anhui Medical University, Hefei, China.
Affiliated Psychological Hospital of Anhui Medical University, Hefei, China.
Front Endocrinol (Lausanne). 2022 Jun 16;13:904005. doi: 10.3389/fendo.2022.904005. eCollection 2022.
Modified electroconvulsive therapy (MECT) is an effective strategy for treatment-resistant depression (TRD); however, the mechanism underlying effects of MECT remains unclear. Accumulating evidence suggests that TRD is closely associated with dysfunction of the hypothalamic-pituitary-adrenal (HPA) axis, anorexigenic peptides, and pro-inflammatory cytokines. However, MECT effects on the HPA axis, anorexigenic peptides, and pro-inflammatory cytokines in elderly patients with TRD remain unclear. In this study, we investigated whether the HPA axis (cortisol), anorexigenic peptides (nesfatin-1), and pro-inflammatory cytokines (C-reactive protein, tumor necrosis factor-α, and interleukin-6, and interleukin-1β) are involved in the mechanism underlying MECT effects in elderly patients with TRD.
Elderly patients with TRD were enrolled in this study between December 2019 and October 2021; all patients underwent MECT after physical examination. Serum cortisol, nesfatin-1, and pro-inflammatory cytokine levels were measured before and after the first, third, and sixth MECT sessions. The Hamilton Depression Rating Scale-24 (HAMD-24) and the Mini-Mental State Examination (MMSE) were used to evaluate depression and cognitive impairment, respectively. We compared pre- and post-MECT serum cortisol, nesfatin-1, and pro-inflammatory cytokine levels to confirm the short-term effects of MECT on these serum indices. We compared these serum indices across three time points (before the first, third, and sixth MECT sessions) to determine the long-term effects of MECT on serum cortisol, nesfatin-1, and pro-inflammatory cytokine levels.
We observed no statistically significant changes in the pre- and post-MECT serum cortisol, nesfatin-1, or pro-inflammatory cytokine levels. No significant changes in serum cortisol, nesfatin-1, and pro-inflammatory cytokine levels were observed across the aforementioned time points. Moreover, there were no statistically significant sex-based differences in the aforementioned serum indices. Furthermore, the serum cortisol level was negatively correlated with the serum IL-6 level before and after the first MECT session in patients with high cortisol levels (> the 50 percentile value of all samples). Additionally, the post-MECT HAMD-24 and MMSE scores were significantly lower.
MECT reduced depressive symptoms despite an adverse effect on cognition and had no significant effect on the serum cortisol, nesfatin-1, and pro-inflammatory cytokine levels in elderly patients with TRD.
改良电抽搐治疗（MECT）是治疗抵抗性抑郁症（TRD）的有效策略；然而，MECT 效果的机制仍不清楚。越来越多的证据表明，TRD 与下丘脑-垂体-肾上腺（HPA）轴、厌食肽和促炎细胞因子的功能障碍密切相关。然而，MECT 对老年 TRD 患者 HPA 轴、厌食肽和促炎细胞因子的影响尚不清楚。在这项研究中，我们调查了 HPA 轴（皮质醇）、厌食肽（nesfatin-1）和促炎细胞因子（C 反应蛋白、肿瘤坏死因子-α、白细胞介素-6 和白细胞介素-1β）是否参与老年 TRD 患者 MECT 效果的机制。
本研究纳入了 2019 年 12 月至 2021 年 10 月期间接受检查的老年 TRD 患者；所有患者在体检后均接受 MECT 治疗。在第一次、第三次和第六次 MECT 治疗前后测量血清皮质醇、nesfatin-1 和促炎细胞因子水平。采用汉密尔顿抑郁量表-24 项（HAMD-24）和简易精神状态检查（MMSE）分别评估抑郁和认知障碍。我们比较了 MECT 前后的血清皮质醇、nesfatin-1 和促炎细胞因子水平，以证实 MECT 对这些血清指标的短期影响。我们比较了这三个时间点（第一次、第三次和第六次 MECT 治疗前）的这些血清指标，以确定 MECT 对血清皮质醇、nesfatin-1 和促炎细胞因子水平的长期影响。
我们没有观察到 MECT 前后血清皮质醇、nesfatin-1 或促炎细胞因子水平的统计学显著变化。在上述时间点，血清皮质醇、nesfatin-1 和促炎细胞因子水平均无显著变化。此外，在上述血清指标方面，性别之间无统计学显著差异。此外，在皮质醇水平较高（>所有样本 50%分位值）的患者中，第一次 MECT 前后血清 IL-6 水平与皮质醇水平呈负相关。此外，MECT 后汉密尔顿抑郁量表-24 项和简易精神状态检查评分显著降低。
MECT 降低了抑郁症状，尽管对认知有不良影响，但对老年 TRD 患者的血清皮质醇、nesfatin-1 和促炎细胞因子水平没有显著影响。
