Regional Cerebral Blood Flow in Mood Disorders, III: Treatment and Clinical Response

doi:10.1001/archpsyc.1994.03950110044007

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Vol. 51 No. 11, November 1994

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Regional Cerebral Blood Flow in Mood Disorders, III

Treatment and Clinical Response

Mitchell S. Nobler, MD; Harold A. Sackeim, PhD; Isak Prohovnik, PhD; James R. Moeller, PhD; Sukdeb Mukherjee, MD; David B. Schnur, MD; Joan Prudic, MD; D. P. Devanand, MD

Arch Gen Psychiatry. 1994;51(11):884-897.

Abstract

Background
Global and regional deficits in cerebral blood flow and glucosemetabolism have been reported in major depression, but thereis limited information on the effects of somatic treatment andclinical recovery on these abnormalities.

Methods
We assessed cortical blood flow with the xenon 133 techniquein depressed patients prior to a course of electroconvulsivetherapy (ECT), 30 minutes before and 50 minutes after a singletreatment, and during the week following ECT. Acute (preictaland postictal) effects of a single treatment also were studiedin manic patients.

Results
In the depressed and manic groups, larger blood flow reductionsin the acute period, both globally and in particular patternsof brain regions, were associated with a superior clinical outcomefollowing the treatment course. In depressed patients, similarpatterns were observed for the blood flow changes over a fulltreatment course. Blood flow reductions in anterior corticalregions were strongly associated with a positive clinical responsein both depression and mania.

Conclusions
The findings indicated that cerebral blood flow abnormalitiesin major depression were not reversed by successful treatmentwith ECT. Rather, particularly in responders, ECT resulted inadditional perfusion reductions. The therapeutic propertiesof ECT are related to reduced functional brain activity in specificneural regions.

Author Affiliations

From the Departments of Biological Psychiatry (Drs Nobler, Sackeim, Moeller, Prudic, and Devanand) and Brain Imaging (Dr Prohovnik), the New York State Psychiatric Institute; the Departments of Psychiatry (Drs Nobler, Sackeim, Prohovnik, Moeller, Prudic, Devanand), Neurology (Dr Prohovnik), and Radiology (Dr prohovnik), the College of Physicians and Surgeons, Columbia University; and the Department of Psychiatry, Mount Sinai School of Medicine (Dr Schnur), New York, NY; and the Departments of Psychiatry and Neurology, Medical College of Georgia, Augusta (Dr Mukherjee).

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