Variation of plasma cortisol levels in patients with depression after treatment with bilateral electroconvulsive therapy

Abstract

Introduction: More than 60 years after the introduction of modern psychopharmacology, electroconvulsive therapy (ECT) continues to be an essential therapeutic modality in the treatment of mental disorders, but its mechanism of action remains unclear. Hormones play an essential role in the development and expression of a series of behavioral changes. One aspect of the influence of hormones on behavior is their potential contribution to the pathophysiology of psychiatric disorders and the mechanism of action of psychotropic drugs and ECT. Objective: We measured blood levels of the hormone cortisol in patients with unipolar depression according to the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) and compared results with levels found in healthy adults. Method: Blood cortisol levels were measured before the beginning of treatment with ECT, at the seventh session, and at the last session, at treatment completion. Depression symptoms were assessed using the Beck Depression Inventory (BDI). Results: Cortisol levels remained stable in both men and women between the seventh and the last sessions of ECT; values ranged from 0.686±9.6330 g/dL for women, and there was a mean decrease of 5.825±6.0780 g/dL (p = 0.024). Mean number of ECT sessions was 12. After the seventh and the last ECT sessions, patients with depression and individuals in the control group had similar cortisol levels, whereas BDI scores remained different. Conclusion: Cortisol levels decreased during ECT treatment. ECT seems to act as a regulator of the hypothalamic-pituitaryadrenal axis.

Gradient of electro-convulsive therapy’s antidepressant effects along the longitudinal hippocampal axis

“…There are several lines of neurobiological interpretation that converge on the pivotal role of hippocampus in controlling stress responses via inhibition of the hypothalamic-pituitary-adrenal axis 42,43 . Depression is characterized by stress dysregulation and hippocampal atrophy 44 and ECT thought to normalize the hyperactivity of the stress axis via seizure-induced decrease of stress hormones [45][46][47] . Following a reductionist view on the bipartite specialization along the hippocampus longitudinal axis, the differential structural and functional connectivity of its anterior and posterior portions support the idea of stronger involvement of the anterior hippocampus in regulating emotion and motivation [48][49][50][51][52] in contrast to mnemonic processes 48,[50][51][52][53] .…”

Ugo Cerletti (1877–1963): An Early Italian Father of Electroshock and a Pioneer in Many Other Ways

“…In this new clinic, and in collaboration with the Italian physiologist Gaetano Viale, who in 1934 published a study about the biological outcomes of radiation (Mora 1963), Cerletti decided to apply electroshock seizures in human beings (Mora 1963). One year after the beginning of the project (Burgese and Bassitt 2015), the neuropsychiatrist and neuropathologist of Budapest’s Royal State Mental Hospital Ladislav Joseph von Meduna (1896–1964) (Soreff and Bazemore 2006) presented the cardiazol shock therapy (Bentivoglio and Mazzarello 2010). It was a convulsive therapy caused by the intravenous injection of pentylenetetrazol (Green and others 2016).…”

“…The attribution of the title of the founder of electroshock to Cerletti reflects the fact that Cerletti defined the basic standards for the right application of ECT, provided early suggestions of how ECT works, noted its side effects; and after its discovery by Cerletti, ECT provided impetus for further study for many scientists all over the world (Bentivoglio and Mazzarello 2010; Faedda and others 2010; Gahr and others 2013; Lewis and others 2016; Morus 2004). It might be argued that the first application of electroshock is connected with the birth of modern biological psychiatry (Burgese and Bassitt 2015).…”

Is Electroconvulsive Therapy for Depression More Effective Than Placebo? A Systematic Review of Studies Since 2009

“…Forty seven of the 89 were observational studies (Azuma et al, 2011;Bär et al, 2010;Bayless et al, 2010;Beall et al, 2012;Bersani et al, 2014;Bilgen et al, 2014;Burgese & Bassitt, 2015;Casarotto et al, 2013;Chiaie et al, 2013;Dannlowski et al, 2013;Dukart et al, 2014;Ebert et al, 2010;Galletly, Paterson, & Burton, 2012;Goto et al, 2012;Guloksuz et al, 2015;Hu et al, 2010;Johansson, Ehnvall, Friberg, & Myredal, 2010;Joshi et al, 2015;Kalogerakou et al, 2015;Kautto et al, 2015;Lin et al, 2013;Loo, Mahon, Katalinic, Lyndon, & Hadzi-Pavlovic, 2011;Lucca et al, 2010;Lyden et al, 2014;McCall et al, 2013;Medda et al, 2014;Meeter, Murre, Janssen, Birkenhager, & van den Broek, 2011;Minelli et al, 2014;Nickl-Jockschat et al, 2015;Nordanskog, Larsson, Larsson, & Johanson, 2014;Ota et al, 2015;Oudega et al, 2011;Perrin et al, 2012;Piccinni et al, 2013;Rapinesi et al, 2015;Rapinesi et al, 2013;Royster et al, 2012;Saijo et al, 2010;Samuelsson, Gerdin, Öllinger, & Vrethem, 2012;Tendolkar et al, ...…”