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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 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.

Methods
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.

Results
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.

Conclusions
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.

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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