Nobler M S, Sackeim H A, Prohovnik I, Moeller J R, Mukherjee S, Schnur D B, Prudic J, Devanand D P
Department of Biological Psychiatry, New York State Psychiatric Institute.
Arch Gen Psychiatry. 1994 Nov;51(11):884-97. doi: 10.1001/archpsyc.1994.03950110044007.
Global and regional deficits in cerebral blood flow and glucose metabolism have been reported in major depression, but there is limited information on the effects of somatic treatment and clinical recovery on these abnormalities.
We assessed cortical blood flow with the xenon 133 technique in depressed patients prior to a course of electroconvulsive therapy (ECT), 30 minutes before and 50 minutes after a single treatment, and during the week following ECT. Acute (preictal and postictal) effects of a single treatment also were studied in manic patients.
In the depressed and manic groups, larger blood flow reductions in the acute period, both globally and in particular patterns of brain regions, were associated with a superior clinical outcome following the treatment course. In depressed patients, similar patterns were observed for the blood flow changes over a full treatment course. Blood flow reductions in anterior cortical regions were strongly associated with a positive clinical response in both depression and mania.
The findings indicated that cerebral blood flow abnormalities in major depression were not reversed by successful treatment with ECT. Rather, particularly in responders, ECT resulted in additional perfusion reductions. The therapeutic properties of ECT are related to reduced functional brain activity in specific neural regions.
据报道，重度抑郁症患者存在全脑和局部脑血流及葡萄糖代谢不足的情况，但关于躯体治疗及临床康复对这些异常情况的影响，相关信息有限。
我们采用氙133技术评估了抑郁症患者在接受电休克治疗（ECT）疗程前、单次治疗前30分钟和治疗后50分钟以及ECT治疗后一周的皮质血流情况。还研究了单次治疗对躁狂症患者的急性（发作前和发作后）影响。
在抑郁症和躁狂症组中，急性期全脑尤其是特定脑区血流减少幅度更大，与治疗疗程后的更好临床结局相关。在抑郁症患者中，整个治疗过程中的血流变化也呈现出类似模式。前额叶皮质区域的血流减少与抑郁症和躁狂症的积极临床反应密切相关。
研究结果表明，ECT成功治疗并未逆转重度抑郁症患者的脑血流异常。相反，尤其是在有反应的患者中，ECT导致了额外的灌注减少。ECT的治疗特性与特定神经区域的脑功能活动降低有关。
