Effect of electroconvulsive therapy on brain 5-HT(2) receptors in major depression.

Abstract

BACKGROUND:

Brain serotonin(2) (5-hydroxytryptamine(2); 5-HT(2)) receptors were considered potential targets for therapeutic efficacy of electroconvulsive therapy (ECT), but pre-clinical studies showed that electroconvulsive shock up-regulates 5-HT(2) receptors in contrast to antidepressant medications, which down-regulate brain 5-HT(2) receptors. Positron emission tomography (PET) studies in individuals with depression confirmed that antidepressant medications reduce brain 5-HT(2) receptors, but the effects of ECT on these receptors in individuals with depression are unknown.

AIMS:

To determine if a course of ECT alters brain 5-HT(2) receptors in individuals with depression and whether such changes correlate with improvement in symptoms.

METHOD:

Fifteen people with major depression, refractory to antidepressant therapy and referred for a course of ECT, had an [18F]setoperone scan during baseline drug-free washout period and another after a course of ECT. We assessed changes in brain 5-HT(2) receptors with ECT and their relationship to therapeutic outcome.

RESULTS:

Widespread reduction in brain 5-HT(2) receptors was observed in all cortical areas with changes slightly more prominent in the right hemisphere. There was a trend for correlation between reduction in brain 5-HT(2) receptors in right parahippocampal gyrus, right lingual gyrus and right medial frontal gyrus, and improvement in depressive symptoms.

CONCLUSIONS:

Unlike in rodents, and similar to antidepressants, ECT reduces brain 5-HT(2) receptors in individuals with depression. The ability of ECT to further down-regulate brain 5-HT(2) receptors in antidepressant non-responsive individuals may explain its efficacy in those people with antidepressant refractory depression.

• Authors: Lakshmi N Yatham, Peter F Liddle, Raymond W Lam, Athanasios P Zis, A Jon Stoessl, Vesna Sossi, Michael J Adam, Thomas J Ruth
• Journal: The British journal of psychiatry : the journal of mental science (Br J Psychiatry) Vol. 196 Issue 6 Pg. 474-9 (Jun 2010) ISSN: 1472-1465 [Electronic] England
• PMID: 20513859 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Contrast Media
• Pyrimidinones
• Receptors, Serotonin, 5-HT2
• setoperone

Topics

• Adolescent
• Adult
• Aged
• Brain Mapping
• Contrast Media
• Depressive Disorder, Major (therapy)
• Down-Regulation
• Electroconvulsive Therapy
• Female
• Humans
• Male
• Middle Aged
• Pyrimidinones
• Receptors, Serotonin, 5-HT2 (metabolism)
• Treatment Outcome
• Young Adult